It seems only natural to think that natural must mean healthy. If something comes from nature with minimal processing and human intervention it must be better for you and have no risks, right?
A recent report on the use of complementary approaches to health showed 17.9% of adults in the United States used nonmineral, nonvitamin dietary supplements in 2012 (the greatest of all complementary approaches).1 So almost 1 in 5 adults were turning to herbal pills or tonics for what ailed them.
Some believe something “natural” is safer, while others want to avoid side effects of conventional medicine approaches. The booming supplement industry, whose revenue in 2011 was over $30 billion and continues to grow, is a testament to this trend (this figure also contains sales for vitamins and minerals).3
But consumers need to take an educated approach to herbal (and any other) supplement use, and here is why:
1) Regulations differ for food, medications, and supplements. What does that mean for you? Supplements have no required 3rd party (or governmental) pre-market approval process. Based on current regulations, a product can be placed directly on the market purely on the company’s assertion that it is safe. But “safe” can be put to the test in several different scenarios:
A product contains an ingredient not listed on the label. Product adulterations with steroids, active ingredients from prescription medications, or “fillers” are examples of companies looking to boost product effectiveness or reduce costs. A study of 12 North American companies and 44 herbal products in 2013 revealed 59% contained ingredients not listed on the labels.4 The concern regarding unlabeled steroid and medication is fairly obvious, but some may not consider the risk of filler ingredients like wheat for those with food allergies or Celiac disease.
A product does NOT contain an ingredient on the list. If you purchase a product for medicinal purposes, and supposing the product was effective, not containing the active ingredient would be a real concern. Not to mention a big waste of money.
A product contains less or more of an ingredient than is listed on the label. Dosage is just as important when taking a supplement as it is when taking a medication. Too little and it’s not effective; too much and there is a risk of adverse events or toxicity. There are many examples of supplement labels claiming a certain active ingredient amount only for a 3rd party test to find it was inaccurate. One recent example is Garcinia cambogia – a ConsumerLab.com report of 13 different brands found that only 6 contained the labeled amount of the supposed active compound, hydroxycitric acid.5 One product contained only 14% of the labeled amount.5 On the other end of the spectrum, some supplement products contain more than double the labeled amount which can pose serious health risks.
A product has contaminants. Beyond simply more or less of a labeled ingredient, there is also a risk of products containing contaminants such as mercury or heavy metals. This typically stems from poor manufacturing processes or raw materials purchased from outside the United States.
2) They can have side effects or interact with medications or foods. Make no mistake, herbal supplements can have side effects, many of which are just as strong as those seen in conventional medicines. Take red yeast rice for example, a popular supplement taken for its alleged cholesterol-lowering abilities. The effective versions of red yeast rice typically contain monacolin K, a byproduct of the rice culturing process. Monacolin K is chemically identical to the active ingredient in the commonly used Lovastatin medication, and it also has the same possible side effects (muscle pain and liver toxicity). Interestingly, the versions without monacolin K don’t seem to be effective.
Supplements can also interact with food or other medication. One such example is ginkgo – some data suggest its blood-thinning abilities should be a concern for individuals with bleeding disorders or on blood thinners.
3) They often lack research or evidence supporting effectiveness. At the end of the day, the number of herbal supplements lacking scientific evidence for efficacy far outnumbers the ones with research-based proof. Many are supported by anecdotal stories or poorly designed studies which supplement companies have exploited and manipulated with advertising.
There are new supplements introduced to the market every day. Keeping track of what works or is safe can be a difficult task. Follow these recommendations if you are considering using herbal supplements (or any dietary supplement):
1) Do your research. These volunteer, 3rd party testing companies and online resources can provide you valuable information on the safety and effectiveness of supplements. Although none can provide you an absolute 100% guarantee, it’s better than no testing at all.
NSF International – Search for specific products to see if they have an NSF label which can indicate various levels of ingredient and facility testing.
USP – Search for products with the USP label, a similar program to NSF but not quite as extensive.
National Center for Complementary and Alternative Medicine (NCCAM) – Review user-friendly fact sheets on research-based evidence and side effects of hundreds of supplements.
Food and Drug Administration (FDA) Safety Alerts – The FDA is responsible for intervening once a product is suspected of causing adverse events or containing non-disclosed ingredients. This site can give you the latest alerts to supplement companies (as well as food recalls).
2) Tell your doctor. Your physician should always know if you are taking any supplements, including seemingly benign multivitamins.
3) Talk to a dietitian. A registered dietitian can help you determine if a supplement is necessary, and if so, an appropriate brand and dosage.
Above all, don’t assume that because something is “natural” it is safe for you to consume. Supplements can have a place in your diet but it is essential to be an educated user.
The Harvard School of Public Health website. Shining the Spotlight on Trans Fats. http://www.hsph.harvard.edu/nutritionsource/transfats/. Accessed on April 18, 2014.
Peregoy JA, Clarke TC, Jones LI, Stussman BJ, Nahin RL. Regional Variation in Use of Complementary Health Approaches by U.S. Adults. National Center for Health Statistics. No. 146; 2014.
The National Institutes of Health Office of Dietary Supplements website. Multivitamin/Mineral Supplement Fact Sheet for Health Professionals. http://ods.od.nih.gov/factsheets/MVMS-HealthProfessional/. Last updated January 7, 2013. Accessed April 18, 2014.
Newmaster SG, Grguric M, Shanmughanandhan D, Ramalingam S, Ragupathy S. DNA barcoding detects contamination and substitution in North American herbal products. BMC Medicine. 11:22; 2013.
ConsumerLab.com website. Product Review: Garcina Cambogia Supplements. https://www.consumerlab.com/reviews/garcinia_hydroxycitric-acid_HCA-weight-loss/garcinia/. Last updated April 15, 2014. Accessed April 20, 2014.