What's in your supplement? - (1/29/2019)

By Dr. Ron Gasbarro

Joanie came into the pharmacy and showed the pharmacist a bottle of pills. “My daughter got these for me at the Vitamin Bizarre Shop. She says they will make my heart stronger!” The pharmacist read the label: “Kind-Hearted Chewables. The all-natural, heart-happy way to go!” Joanie has a history of heart failure and A-fib (irregular heartbeat). Hence, she is on 5 medications for her heart. So, when the pharmacist read the ingredients on the back label, he was alarmed.

Colorful Kind-Hearted Chewables contain the following: Hawthorn berry, horny goat weed, pinecone elixir, snootberry leaves, licorice, Vietnamese thyme, goatweed, wood betony, shepherd’s purse, and sea grape. What are these substances? What, for instance, is sea grape? The pharmacist looked it up. Sea grape is another name for ephedra. Ephedra – or ephedrine – is a potent stimulant that has essentially been banned in the US and other countries because it can cause many types of heart problems from increased heart rate to a drastic elevation of blood pressure. Note that ephedra has other names such as ma huang and sida cordifolia, which may confuse the consumer. In Joanie’s case, this ingredient could place her heart in jeopardy. 

Things get worse. The licorice in the formulation interacts with Joanie’s beta-blocker, which is intended to slow down her heart rate, thereby reducing her blood pressure. However, licorice may elevate her blood pressure, negating the effects of her beta-blocker. Licorice may also increase the breakdown and decrease the effectiveness of warfarin (Coumadin®), used to thin her blood. Decreasing the efficacy of warfarin might increase the risk of clotting, escalating her chances of a stroke. She is on amiodarone to control the way her heart beats. Goatweed, also known as St. John’s wort, may accelerate the metabolism of the amiodarone, making that drug not as effective in keeping her out of A-fib. 

“Herbal supplements are all-natural, so they must be safe, right?” asked Joanie. Not necessarily, explained the pharmacist. “All-natural” has no defined meaning. The phrase often means that companies want to increase sales by making you think you are buying something infinitely healthier. Yes, the ingredients in the “Kind-Hearted” concoction do come from the plant world. However, scores of plants are pharmacoactive, meaning that they can affect the body’s organs. In fact, numerous drugs we use come from plants, such as aspirin (white willow bark) and morphine (opium poppy).  

Early on, when our ancestors discovered the potential for willow to decrease fever and for morphine to treat pain, countless people likely died from ingesting too much bark or poppy because the correct doses to treat these conditions were unknown. Today, the pharmaceutical industry establishes both the dose of the medication (the amount of the drug given; e.g. warfarin 4 mg) and the dosage (the frequency of the drug given; e.g., warfarin 4 mg once daily). The herbal supplement industry, which is not as tightly regulated as the pharmaceutical industry, simply adds up all the ingredients and declares, for example, that Kind-Hearted Chewables have a total of 930 mg per pill. Thus, one has no way of knowing how much goatweed or licorice is in each capsule. This is bad “medicine.” Joanie agreed, “I think, for the sake of my heart, that I better stay on the medications my prescriber has prescribed.” The pharmacist was relieved because Joanie may have saved her own life that day.   

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Read more at 


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