Today during our “morbidity and mortality” lecture, we discussed a case of a woman who suffered a devastating stroke because she was taking naturopathic dietary supplements. She had a list of 70 different homeopathic supplements that she was taking, one of which contained thyroid hormone from animal organs. She presented to the hospital with a heart arrhythmia called atrial fibrillation as a result of the off the charts thyroid hormone levels in her body. Soon after arriving to the hospital she suffered a major stroke which left her permanently disabled (new-onset atrial fibrillation can put patients at risk of forming clots in the heart which can travel to the brain and cause ischemia, or inadequate blood supply, leading to cerebral infarction–commonly known as stroke).
Earlier this month I took care of a patient who died of metastatic breast cancer because she refused conventional treatment. She was diagnosed with breast cancer in her 40s, 7 years prior to her death. At that time, she had a very good chance of being cured with surgery and local radiation alone. However, she was a firm believer in naturopathic medicine, which essentially teaches that the body can heal itself, and she refused conventional or allopathic treatment. She was an educated person, and she had received a doctorate in a branch of alternative medicine. Eventually, her cancer became metastatic, infiltrating her liver, her bones, a diffusely throughout her tissues (known as “carcinomatosis”). She did agree to some chemotherapy towards the end of her life, but by that point it was too late. When I met her, she was bed bound, in severe pain all over her body, with chest tubes in place draining up to 2 liters per day of pleural fluid (fluid from around her lungs). The morning I met her I assisted her husband in draining her chest tubes, a task he meticulously completed every day. They were a very loving couple, speaking gently and kindly to each other in the most frustrating of circumstances, and she was a very sweet lady. After she died, after I left her room, I went somewhere private to cry. I had bonded with her. After some time passed, I also felt ashamed that she had died a preventable death. Somehow, we as allopathic doctors had failed her by not doing a good enough job of convincing her to allow us to treat her with evidence-based medicine. Maybe we hadn’t pushed hard enough, because we thought it was a losing battle.
Last week I met a patient with gastroesophageal reflux disease (GERD) who did not believe in taking medications and refused to take her Nexium (omeprazole, a proton pump inhibitor which decreases the acid content of the stomach). She experienced an uncomfortable feeling in the back of her throat after eating, and she was convinced that she had food allergies. A naturopathic doctor had diagnosed her with a whole slew of food allergies. In clinic, skin testing to the common food allergies, including the ones diagnosed by the naturopath, were all negative. The one treatment that would make her feel better was the proton pump inhibitor; however, due to misinformation and her mistrust of conventional or allopathic medicine, she would continue to feel lousy.
In medical school I took care of a patient who went into liver failure because she was taking Herbalife. Here, a local police officer lost his job because he was taking a weight loss supplement that contained amphetamines.
There are countless stories like this. In the US, about half of the adult population uses dietary supplements. The US Food and Drug Administration (FDA) defines dietary supplements as “vitamins, minerals, herbs or other botanicals… amino acids, enzymes, organ tissues, glandulars, and metabolites… extracts or concentrates” and may be found in many forms such as “tablets, capsules, softgels, gelcaps, liquids, or powders.” Dietary supplements are a $34 billion per year industry. These supplements are marketed as “natural” and they are sold at “health food stores,” GNC, Whole Foods, etc.
The reality is that dietary supplements are not categorized by the FDA in the same way that drugs made by pharmaceutical companies are, and thus they are not held to the same rigid standards and regulations. Dietary supplements do not even need approval from the FDA before they are marketed to consumers. Under current law, the responsibility of monitoring safety and effectiveness falls not on the government, but on the manufacturer. In other words, I can bottle a concoction of sugar and rosehips and write on the label that my product cures cancer, diabetes, and heart disease, and the government will not stop me.
Though regulations were created in 2007 to “ensure the identity, purity, quality, strength and composition” of supplement products (in other words, to make it more likely that the bottle labeled as Vitamin C actually contains Vitamin C), the government does NOT enforce these regulations. Straight from FDA.gov: “Unlike drug products that must be proven safe and effective for their intended use before marketing, there are no provisions in the law for FDA to ‘approve’ dietary supplements for safety or effectiveness before they reach the consumer.” Under the DSHEA law signed in 1994 by President Clinton, dietary supplements are regulated retroactively; manufacturers are supposed to report adverse effects of their products to the FDA. In other words, the onus of regulating supplements falls on the manufacturers of these products, who have a vested interest in selling them and making money.
Furthermore, the dosing is completely unregulated. As mentioned on FDA.gov’s Q&A section, “Other than the manufacturer’s responsibility to ensure safety, there are no rules that limit a serving size or the amount of a nutrient in any form of dietary supplements. This decision is made by the manufacturer and does not require FDA review or approval.” A supplement may contain very high levels of a compound, or they can contain such a minimal amount that a person would have to take thousands of pills to have any kind of effect.
Many supplements are manufactured abroad, and often contain dangerous contaminants, including lead.
There is one reason alone to take vitamins or supplements: when your allopathic healthcare provider (board-certified MD or DO, or ARNP/PA working under the supervision of one) prescribes it. Notable examples include
- When you have certain types of anemia that require supplementation with Vitamin B12, Folic acid, and/or iron.
- When you have been diagnosed with Vitamin D insufficiency or deficiency
- When you are trying to become pregnant, and prenatal vitamins are prescribed.
- Or when studies have otherwise shown that taking that supplement is 1) safe and 2) effective in treating your problem.
Why is there a demand for dietary supplements? Now, this is just my personal conjecture… But perhaps we buy supplements because, in spite of the best evidence-based conventional medicine, people still get sick and die every day. The big bad pharmaceutical companies have big bad reputations, and conventional doctors make mistakes every day that hurt and kill people (“iatrogenic” events). We place unreasonably high expectations on medicine, and by proxy on doctors, to be perfect and Godly, Almighty Fathers and Mothers who keep us safe and take away our ailments. And conventional medicine very often fails to accomplish either. So, in rebellion, or perhaps with our last ounce of hope, we buy magical potions sold with impossible promises. Because we need to believe that something will fix us. Because illness is scary. Because death is scary.
My suggestions to the reader are:
- Know what you are ingesting.
- Do not waste money on products that are at best ineffective, and at worst dangerous.
- Put your faith in scientific evidence, not in false promises.
[PS This post is in no way implying that all alternative and complementary practices are harmful. The stipulation is that they be evidence-based–meditation and other stress-relieving techniques, for example, have some proven benefits. Otherwise, that they be low-risk and have subjective benefits–for example, massage therapy makes me feel great. In any case, alternative and complementary practices are not adequate substitutes for conventional medical therapy. The purpose of this post is to make the point that certain active compounds found in dietary supplements can be very harmful.]