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How many supplements does Linda need? - (5/1/2018)

By Dr. Ron Gasbarro

Linda was busy in the vitamin aisle, tossing supplements and herbs into her basket. She pulled a list from her purse and asked the pharmacist “Do you have any dong quai, ashwagandha, or ginger root?” The pharmacist did not stock those items, although he offered to order them for Linda. As he always does. Because Linda consumes many dozens of supplements, herbs, botanicals, vitamins, and minerals. 

Linda is also on a number of prescription medications for her heart as well as for other conditions that this 50-year old woman has. The pharmacist has spoken to her about the possibility of herb-drug interactions – that is, when an herb either increases or decreases the potency of a prescribed drug. For example, Linda is taking a medication for high blood pressure. If one of the many supplements she is also taking cancels out her hypertension drug, then she is at risk for uncontrolled high blood pressure and its complications. Conversely, if one of her supplements blocks the breakdown of her medication, then the amount of the hypertension drug in her blood skyrockets and she is in danger of the side effects of that drug, such as extreme dizziness and falling. 

Another issue to consider regarding herbal supplements: the therapeutic dose is often unknown. Many have been used for generations – a chunk of root here, a bit of leaf there. What is an acceptable dose of botanicals such as licorice root, olive leaf extract, or pine bark? It is somewhere between “it does not work” and “it kills you.” 

Many botanical preparations are marketed in the US as “dietary supplements.” The dietary ingredients in these products may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes and organ tissues. In whatever their form, the Dietary Supplement Health and Education Act of 1994 places dietary supplements in a category under the general umbrella of foods – not drugs – and requires that every product is labeled as a dietary supplement, not as a drug. The labeling on a dietary supplement cannot claim to diagnose, cure, mitigate, treat, or prevent disease. Hence, the manufacturers of these products are counting on consumers to do their own research and to purchase the product based on the hope that their horny goat weed, mistletoe, or thunder god vine will do the trick. By law, they cannot tell you what the product does, only what it costs. 

Not all of us are supplement connoisseurs like Linda – because only she would buy bladderwrack and butcher’s broom. But there are some plant-based supplements that are familiar to most. Echinacea, for instance, is used for preventing and treating the common cold. An analysis of 24 clinical studies showed that this flower is not effective for this indication. St. John’s Wort is a popular herbal supplement widely used to help with symptoms of depression. However, it interacts with many medications, such as those used for migraines, birth control pills, and prescription antidepressants. Ginkgo biloba has been used for memory support. A 2018 study showed that ginkgo did not reduce the risk of cognitive decline. But it does interact with a long list of medications. 

Linda needs to analyze why she takes so many supplements. She may be jeopardizing her health, and many of the products she buys are probably a waste of money. Always check with your pharmacist before you buy a dietary supplement. Also, visit the National Institutes of Health Office of Dietary Supplements at ods.od.nih.gov where you will find a treasure trove of helpful information.  

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com 


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