Supplements in one form or another have been around for a long time, with the earliest written account of herbal remedies coming from China in 2800 BC. They can contain a variety of ingredients such as herbs, minerals, and vitamins and can be used for a variety of health reasons. However, sometimes people have blind faith about supplements, a belief that whatever is natural must be beneficial. This blind faith is unwise, as supplements are not closely regulated by the FDA, and false claims of their purported benefits can sometimes be harmful.
A recent article in the American Journal of Medicine suggested that physicians advise patients about the use of dietary supplements. Some of the reasons why supplements have become so popular, is the emphasis on "natural" substances such as herbs and vitamins, which are thought to be milder and safer than pharmaceuticals. People often believe them to be less expensive, quick, and a hassle-free cure (which is highly unlikely). The article also lays out a six-step approach for physicians, so they can advise patients who are considering use of dietary supplements.
Supplements can be loosely organized under three categories:
(1) no adverse effects observed, as is generally the case with vitamin and mineral supplements (so long as the quantity of vitamins and minerals does not greatly exceed the daily recommended intake)
(2) neutral effects, as with coenzyme Q10 and cranberry, supplements that have shown no adverse effects yet do not necessarily show any conclusive benefits
(3) potential adverse effects, from supplements themselves or from health-threatening interactions with necessary pharmaceuticals
The American Journal of Medicine recognizes the importance of patients and physicians comparing the risk/benefits of supplements to conventional therapies. Some patients may not even realize there is a potential drug-supplement interaction. If the physician is unable to provide adequate information about supplements, pharmacists can be a great resource, since they often have access to databases that can quickly cross-reference drugs and supplements to assess interactions. It is important to inform patients that supplements are not required to have Food and Drug Administration (FDA) approval before their production or distribution. Efficacy and safety studies are unnecessary before product marketing, which is not the case with pharmaceutical products. "Innocent until proven guilty" may work for our justice system, but can it be applied to the digestive system too?
In addition to the wait and see approach used by the FDA -- where they assume supplements are safe unless proven otherwise through postmarket surveillance -- consumers must deal with claims that are sometimes exaggerated, misleading, or blatantly incorrect. In the U.S., product ads must be truthful, not misleading, and must be clinically substantiated. The Federal Trade Commission (FTC) is in charge of enforcing the guidelines. However they do not "approve" individual ads, using advertisement surveillance instead (which has led to millions of dollars in fines being levied against companies making false claims). With new products coming on the market all the time, some false advertising slips through the cracks.
In some countries such as Iran and Gambia, the governments themselves are promoting unproven herbal remedies to cure AIDS, which can have huge consequences. The president of Gambia, Yahya Jammeh, recently was awarded an honorary degree in Herbal and Homeopathic Medicine by the Brussels-based Jean Monnet European University and has claimed to develop a herbal cure for HIV/AIDS, obesity, and impotence. As sketchy as an herbal cure for HIV/AIDS may sound, it's even more shocking to hear that the "herbal cure" is being promoted instead of antiretroviral therapies, which are scientifically proven to be life-saving for those who are battling AIDS.
Although we may believe that we are more savvy about supplements here in America and would never fall for false claims that herbs can cure AIDS, we still take our daily doses of ginseng or cranberry, with the thought that it can't hurt. Taking vitamins, minerals, or herb supplements may be beneficial for some people, it may have no effect at all, or it can do harm. The point is not to take anything blindly, as there is no such thing as absolute safety. Therefore, those interested in taking supplements should weigh the benefits versus the risk, doing so with the help of their physicians.
See also: ACSH's brochure What's the Story? Drug-Supplement Interactions.