C&EN: Supplementing Knowledge

Posted By elissa on Jul 23, 2010 | 2 comments

As I surf around the medical blogosphere, I can’t help but notice the hostility that various MD’s express towards supplements.  I understand where they’re coming from – there are a lot of sensational claims being made on very shaky evidence.  They’re concerned about safety – not to mention the prospect of seeing people with eminently treatable ailments and conditions abandon needed medical care in favor of “natural” miracle cures.  Nonetheless. I don’t agree with their solution – the repeal of DSHEA. As I’ve noted before, I treasure my right to choose, and feel better enforcement of the existing regs and GMPs is the answer – not insisting supps meet the same criteria as prescription drugs (as if that’s a solution… cases like Avandia and Vioxx argue otherwise).

Thus, I was encouraged to see a much more even-handed attitude expressed by a different set of docs (Ph.D.s) over at Chemical & Engineering News (published by the American Chemical Society).  Rather than seeing gaps in the data and shrieking DANGEROUS!!! the authors of this article take a much more cautious – and (I feel) responsible – approach:

“People take heavy metals out of context,” says Ikhlas A. Khan, a professor of pharmacognosy at the University of Mississippi who studies botanical dietary supplements. “The plants are grown outside. They’re going to contain trace amounts of heavy metals.”

…Researchers who study botanical supplements are less concerned about contamination than they are about the botanicals themselves and their intrinsic toxicity. Contamination, they believe, can be adequately addressed by the Good Manufacturing Practices that all supplement manufacturers must now follow. But “right now, we do not even understand the chemical composition” of botanicals, Khan says. “Inherent variability blurs the composition.”

An important step toward understanding possible toxicity, as well as efficacy and mechanism of action, is standardization of the contents of supplements. “All botanical dietary supplements should be standardized,” UIC’s van Breemen argues.

No flames or rocks being thrown here, which is refreshing.  And a very reasonable concern is raised:

At the forefront of botanical supplement research, he adds, is the potentially dangerous effect that botanical supplements might have on drug metabolism. Taking a botanical supplement every day could induce or inhibit the activity of liver enzymes that are involved in the metabolism of certain medications, van Breemen notes. “The half-life of a pharmaceutical might change,” he says.

This is a completely legit issue, and one that anyone taking prescription drugs should consider before taking an “all-natural” herbal concoction. Drug interactions are quite possible, and several have already been identified.

As the editorial portrays, information about the safety and efficacy of many herbal supps is incomplete.  Thus, it’s important not to be lulled into a false sense of security by the words “natural,” “herbal,” “ancient,” or similar terms – none of which provide any guarantees of wholesomeness. This doesn’t mean the opposite – that herbal supps are unsafe to take – but it does mean that users should do some research up front, and not rely on ad claims or soft-focus adjectives.