It’s a Natural Supplement, so It’s Safe…Right?
I appreciate the internet and all the access to information. So many questions can be answered with a simple search. However, there is one aspect of the internet that I find extremely frustrating and that is the amount of misinformation floating around, especially medical misinformation. One of the most prevalent misconceptions is that natural supplements and treatments are safe. I, a board-certified physician with years of intense training, who does not get any bonuses or kickbacks from any Big Pharma company (one did buy me lunch once in 2017 for $11.25) or government agencies, am here to tell you that natural supplements and treatments can be extremely dangerous, and you need to know about it.
The Supplement Industry: Big Business, Little Oversight
Before we dive into safety, it’s important to discuss the vitamin and supplement industry overall. It is 100% true that certain foods have favorable health properties. For example, legumes are very healthy. They provide an abundance of fiber and protein. Consumption of legumes is associated with lower risk of heart disease.1 The industry takes this data and markets a ground-up processed version of it in pill or powder form and makes over $100 billion annually through the sale of vitamins and supplements like ground-up legume concoctions.2
Not only are the supplement companies making a ton of money, but they are doing so with minimal regulation.3The US Food and Drug Administration (FDA) categorizes supplements as a product taken orally that contains a dietary ingredient intended to supplement the diet.2 While products are not permitted to make unsubstantiated claims to cure illness or benefit health, they can make those claims if there is some evidence to support the claim. However, the sources of some evidence aren’t scrutinized. Additionally, claims can be made if the manufacturer includes the statement, “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease” anywhere on the packaging.3 The lack of regulation has also led to variable amounts of active ingredients in supplements,2,4 so consumers may not even be getting what they think.
Natural Does Not Equal Safe
Some of you may say, “Ok. Fine. I don’t care about all of that. They are natural. It’s not like they are going to hurt me.” That is false. Natural does not equal safe. For example, amanita mushrooms are very natural and very detrimental to your liver. Eating them can kill you. Digoxin was derived from foxglove. Morphine was derived from poppy. Aspirin came from white willow bark.5 Eating foxglove, which is 100% natural, can kill you. An overdose of morphine or aspirin can also kill you. Apricot pits are natural and eating them can give you cyanide toxicity,6,7 so let’s put aside that things that are natural or come from natural components are safe. This is simply wrong.
Hidden Risks: Interactions and Contamination
Not every supplement is toxic. Some are pretty safe, but they may interact with medications you are taking. For example, there is evidence that garlic can reduce cholesterol but it can also thin an individual’s blood.5 Taking garlic while on a blood thinner can lead to significant bleeding. In fact, there are several herbals that increase bleeding risk when taken in addition to a blood thinner.8 Another concern is purity. As stated previously, supplements are not regulated so they may be mixed with agents such as heavy metals or other contaminants that can cause harm.2,5,9
How to Protect Yourself When Taking Supplements
Now that I have freaked you out, what do you need to do. First of all, let your doctor know if you are taking herbals or supplements. Only about 30% of individuals taking supplements share this with their doctor.10 Your doctor should know so they can help guide you through possible drug interactions. Next, purchase products from reputable companies. Forbes published an article that vetted out a few brands and made some recommendations. There are also third party testing companies that test these products. The most trusted is United States Pharmacopeia. Items with the USP verified mark (a circle with the letters USP inside) indicate that the product contains what is listed in verified amounts, does not contain harmful levels of contaminants, and is made at a facility that follows strict quality manufacturing practices. Lastly, remember my post Buyer Beware? Same rules apply here. These companies want to make money. Approach these products with some degree of skepticism knowing there is not a ton of evidence out there to support many claims. In being consistent with practicing what I preach, I’ve done all the above and supplement my breakfast with a protein powder I like. I invite you to do the same.
Disclaimer: Even though I’m a doctor, I’m not your doctor—and reading this blog does not establish a doctor–patient relationship. This information is intended for general educational purposes only and should not be taken as personalized medical advice. Always speak with your own healthcare provider before making decisions about your health.
References
1. Afshin A, Micha R, Khatibzadeh S, Mozaffarian D. Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. The American journal of clinical nutrition. 2014;100(1):278-288.
2. Binns CW, Lee MK, Lee AH. Problems and prospects: public health regulation of dietary supplements. Annual review of public health. 2018;39(1):403-420.
3. Swann JP. The history of efforts to regulate dietary supplements in the USA. Drug testing and analysis. 2016;8(3-4):271-282.
4. Andrews KW, Roseland JM, Gusev PA, et al. Analytical ingredient content and variability of adult multivitamin/mineral products: national estimates for the Dietary Supplement Ingredient Database. The American journal of clinical nutrition. 2017;105(2):526-539.
5. Brown AC. An overview of herb and dietary supplement efficacy, safety and government regulations in the United States with suggested improvements. Part 1 of 5 series. Food and Chemical Toxicology. 2017;107:449-471.
6. Kaya A, Okur M, Ustyol L, Temel H, Çaksen H. Acute cyanide poisoning after eating apricot pits: a case report. Turk Arch Ped. 2012;47:141-2.
7. Drankowska J, Kos M, Kościuk A, Tchórz M. Cyanide poisoning from an alternative medicine treatment with apricot kernels in a 80-year-old female. Journal of Education, Health and Sport. 2018;8(12):19-26.
8. Hatfield J, Saad S, Housewright C. Dietary supplements and bleeding. Taylor & Francis; 2022:802-807.
9. Charen E, Harbord N. Toxicity of herbs, vitamins, and supplements. Advances in chronic kidney disease. 2020;27(1):67-71.
10. Kennedy J, Wang C-C, Wu C-H. Patient disclosure about herb and supplement use among adults in the US. Evidence‐Based Complementary and Alternative Medicine. 2008;5(4):451-456.