Last updated: Nov 09, 2010
In Part 1 of this series, Health outlined some of the hidden dangers of dietary supplements, including the shocking fact that they may not be as safe or as regulated as you assume. Part 2 of this special report investigates how we use natural cures—and why our habits may be jeopardizing our health.



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Every morning Angie Gilstrap-Ross gulps down an herbal multivitamin; a capsule of black currant oil; a 1,000 IU vitamin D tablet; a capsule of licorice root and a capsule of Chinese herbs to tame her rosacea; and (two weeks out of every month) an echinacea–vitamin C tincture to boost her immune system.

But although Gilstrap-Ross, 45, takes these six supplements routinely, she balked last year when a doctor suggested that she go on a prescription heartburn medication to treat symptoms resulting from a hiatal hernia. "I'm antimedicine as a first line of defense—the strongest over-the-counter medicine I've taken in over a year is baby aspirin for headaches and body aches," says Gilstrap-Ross, a continuing-education program assistant in Greenville, South Carolina. "There's no way I'd take any other medications unless absolutely nothing else worked. The supplements I take now are herbal and all-natural. For me, they're much healthier than any medicine out there."

Like Gilstrap-Ross, many health-conscious women assume that natural remedies are safer, healthier, and just plain better than conventional medicine. In fact, according to a Health.com poll, 83% of you take some type of supplement at least occasionally, and 56% of you said you believe these products are safer for you than prescription or OTC drugs. "Since the 1990s, studies have shown that people clearly believe that the more natural a treatment is, the more desirable it is," says Tanya Edwards, MD, director of the Center for Integrative Medicine at the Cleveland Clinic. Patients are also increasingly interested in finding holistic solutions to their health problems, she adds: "We've seen a shift in the last 10 to 15 years where people have said, 'Whoa, we don't want to just use drugs to mask symptoms. We want to figure out underlying problems such as nutritional deficiencies, which are making the conditions worse.'"

But our belief that natural is always good—and more natural is even better—can lead us to take alarming risks, treating these supplements like food without considering the potential side effects many have. "Ninety percent of my patients, the first time they see me, come in with an entire bag of supplements, and quite often they have no idea what they're taking," says Alexander Kulick, MD, an integrative-medicine specialist and internist in New York City. "They assume that because these products are labeled as dietary supplements, they can take as much as they want without worrying about side effects, drug or supplement interactions, or overdoses. But the reality is, some of these natural remedies are pretty powerful stuff." Here's what every smart woman must know about going natural safely.



Keeping your doctor out of the loop is a risky move
Quick question: When was the last time you checked with your doctor before trying a new vitamin or all-natural cold cure? If you can't recall ever doing so, you're not alone. Only 31% of respondents in our Health.com poll say they always discuss their supplement use with their doctors. It may not even occur to us that we should. "Women want to take care of themselves—after reading so many scary reports about drug recalls, they want to feel like they are in control of their own health care," Dr. Kulick says. And because we get supplements not only from the drugstore or health-food store but also from nutritionists, spas, or even salons, they seem harmless and out of the realm of our medical doctor. But not discussing them with your doc is risky. "Most supplements on the market have potential adverse effects, just like a prescription or OTC medication," says Evangelia Davanos, PharmD, pharmacotherapy specialist at the Brooklyn Hospital Center in Brooklyn, New York.

One reason we don't broach this subject with our MDs is we suspect they're not very up on herbal cures—or will scoff at us for being interested in them. And we may not be wrong about that. While more and more consumers are embracing supplements (to the tune of more than 25 billion dollars in sales per year)—and more physicians are learning about them, Dr. Kulick says—some doctors are still skeptical about them. And that can make us less willing to talk. "Patients are pretty sophisticated at picking up negative vibes from their doctors, and it creates a communication barrier between patients and physicians," says pharmacologist Joe Graedon, MS, creator of peoplespharmacy.com.

And in this age of HMOs—when doctors are squeezed for every precious minute—you may get more individualized attention at a health-food store. "Research shows that the average time a doctor spends with a patient is about seven-and-a-half minutes," says Mark Moyad, MD, MPH, Jenkins/Pokempner Director of Preventive and Alternative Medicine at the University of Michigan Medical Center. "But patients tell me they go to the health-food store, and the guy behind the counter spends 15 minutes with them discussing a product. Is it any wonder why they follow his recommendations? He's giving them twice the time." Unfortunately, attention doesn't equal expertise: An investigation from the U.S. Government Accountability Office published this past May found that sales staff at herbal-supplement retailers often gave incorrect or even potentially harmful advice, such as saying it was safe to take an herb-and-drug combination that could increase one's risk of bleeding or telling a customer they could take a supplement instead of a doctor-prescribed medication.

When Luann Smith, 45, started feeling stressed and anxious, her doctor prescribed Xanax, but advised her not to take it long-term. She found another option at her local health-food store in Chesapeake, Virginia, where one of the clerks suggested that she take St. John's wort to boost her mood, as well as melatonin to help her sleep at night. Both have potential side effects, ranging from dizziness and rashes to stomach cramps and diarrhea, that she wasn't warned about. They can also interact with other medications. Melatonin, for example, may slow blood clotting, increasing the risk of bleeding when taken with medications that also slow clotting, such as naproxen—which Smith takes occasionally for neck pain.



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Natural cures can interact with your meds—or with each other
Dangerous interactions are, in fact, a risk with many supplements, especially if your doctor doesn't know everything you're taking. Last spring, Davanos saw a 40-something woman who had been complaining of severe muscle aches. "I asked her if she was taking any medications, and she said she was on one of the cholesterol-lowering statins," Davanos recalls. "But when I asked her if she was taking any vitamins or natural remedies, she revealed that she was also taking a high dose of red yeast rice supplement. I said to her, 'You realize the red yeast rice can have the same effect as the statin, right? So it's like doubling your medication dose.' She was totally shocked—she hadn't even bothered to tell her doctor, because she assumed that since it was 'natural,' it was completely safe."

Yet even some of the most innocuous-seeming of these products can lead to problems when combined with medications. Fish oil, for example, can cause problems if used before surgery or at the same time as anticoagulant drugs, because high doses of fish oil may slow blood clotting. Supplements can interact with each other, too; for example, taking both ginkgo and folic acid could increase the risk of seizure, to name one potentially dangerous combo.

"When I see patients, I actually use a computer program that tells me immediately whether the supplements they are on can interact with any drugs they are taking, to prevent problems down the road," says Marcelle Pick, a nurse practitioner and co-founder of the Women to Women clinic in Yarmouth, Maine.



Supplements aren't a substitute for medicine
Some women may be hesitant to go on prescription drugs because of their cost, potential side effects, or the idea that it seems to label them as having an illness. So instead of taking the antidepressant or cholesterol-lowering medication that their doctor recommends (and that clinical trials, U.S. Food and Drug Administration (FDA) review, and real-world experience have shown to be safe and effective), they might decide to try something that seems a little less extreme, a supplement that appears to be a more "natural" option. (More than half of you have done this, according to our poll.) "I have had patients who took it upon themselves to come off medications for blood pressure or cholesterol and only took supplements," Dr. Edwards says. Luckily, her patients suffered no immediate ill effects beyond their blood pressure and cholesterol levels rising, and their levels went back down when they were placed back on medication. But untreated high blood pressure, for example, can damage the heart and blood vessels, and in extreme cases can damage the eyes, brain, and kidneys, too.

Supplements aren't intended to treat diseases—in fact, FDA regulations prohibit manufacturers from labeling them as treating, preventing, or curing a disease or condition. What's more, by turning to supplements instead of medications when you really need the latter, you're putting your health at risk—not only because you're not treating the underlying disease, but also because you can end up with new problems you'd never even thought of, from side effects to allergic reactions, says Ann Kulze, MD, a family physician in Charleston, South Carolina. "I can't tell you how many patients I've had come in with severe rashes, and upon questioning I've found out that they haven't been taking the medications I prescribed and instead were relying on expensive boutique-brand supplements that triggered the problem," she says.



The Internet doesn't have a medical degree
Adding to our misuse of natural remedies is the fact that many of us are getting our info primarily from the Internet. According to our poll, 83% of you go online for information on what supplements to take, and 53% say the web is the number-one place you turn to learn about natural cures. Unfortunately, experts say, people finding misinformation online is all too common. "A lot of my patients decide which supplements to take based on what they read on the Internet," Pick says. "The problem is, there's some crazy stuff on message boards out there. I've seen women on 50,000 IU of vitamin D—a potentially toxic dose—based on the recommendation of someone they met in a chat room."

Online sleuthing is how 23-year-old Melissa McMillan decided that vitamin A might be the miracle cure for her acne. "I'd been on and off Accutane since I was 16, but you're not supposed to be on the drug for more than a few months at a time, and every time I'd go off of it, my acne would flare up again," the Lubbock, Texas, college student recalls. Determined to find a solution, McMillan started researching and found that some web sites were recommending megadoses of vitamin A. "For the past year, I've been taking five to ten 8,000 IU pills per day, and I've found that it keeps my skin clear and beautiful," she says.

McMillan is taking between 40,000 and 80,000 IU of vitamin A a day—but the National Institutes of Health (NIH) Office of Dietary Supplements doesn't recommend taking more than 10,000 IU daily. "You can start seeing adverse effects with chronic use at high doses," says Stephen Stone, MD, a professor of dermatology at the Southern Illinois University School of Medicine in Springfield, Illinois. McMillan says she's on the lookout for potential side effects, such as chapped lips and dry, flaky skin, but "you don't always get those warning signs before running into real problems like severe headaches, bone and joint pain, or liver damage," Dr. Stone says. (If you're pregnant, high doses of A can also cause birth defects.) He adds, "It worries me to hear that some women are possibly risking their lives based on information they found on the Internet."



There's such a thing as too much natural
Even some physicians make the mistake of thinking you can't possibly overdo all-natural remedies. "A decade ago, I was taking 12 different supplements a day, including a multivitamin, calcium, vitamin D, and fish oil," Dr. Kulze says. "Then I developed a severe case of dry eye, so my doctor ran tests to figure out what was going on. We thought it might be an autoimmune disease like lupus, until I did some research and realized it could be an early sign of vitamin A toxicity. When I looked at all my supplements I realized I was getting a little more vitamin A than is now recommended. And we know that the fat-soluble form of vitamin A can build up in the body over time to the point of toxicity. I stopped all the supplements cold turkey, and sure enough, after a couple months, the dry eye resolved. But it had never even initially occurred to me that I was at risk for an overdose."

In fact, many vitamins may turn dangerous in large amounts. "The dose makes the poison," says David Katz, MD, director of the Yale Prevention Research Center. "Something that is essential for life can turn on you if the dose is wrong."

Adding to the problem: When you layer fortified foods and beverages on top of supplements, you may be getting too much without even realizing it, causing potentially harmful imbalances in nutrients, Dr. Katz says.

And it's not just vitamins that are the problem, either. "When a patient asks if they should take zinc to ward off a cold, I say no," Dr. Moyad says. "It's very easy to pop large amounts of these lozenges like candy, which can lead to zinc toxicity, which not only suppresses your immune system, so you'll actually get sicker, but also damages taste and nerve receptors. There's also some evidence that very high levels of zinc may actually be detrimental to your heart health."



You can take them safely
There's no need to swear off supplements entirely—in fact, experts stress that both conventional and alternative medicine can be part of a healthy life, provided you take a few precautions. First, check with your physician or a pharmacist before taking any supplement, even if it's just a multivitamin or fish oil, Dr. Moyad says. You should also present a list of supplements you're taking to your primary care physician at each annual checkup, and to any physician you see if they prescribe you something new or ask what drugs you're currently taking.

When going online to research supplements, look to impartial, research-backed sites such as those sponsored by the NIH, including the Office of Dietary Supplements (ods.od.nih.gov) and the National Center for Complementary and Alternative Medicine (nccam.nih.gov). Avoid getting advice from message boards or manufacturer web sites; look for sites that end in .gov or .edu, or that are from a major medical institution like the Mayo Clinic or other national organizations like the American Medical Association. Don't chase the latest studies—if headlines proclaim that B vitamins boost your memory or vitamin D prevents breast cancer, discuss it with your doctor. The best advice is based on years of research, not a single news-making study, says Pieter Cohen, MD, assistant professor of medicine at Harvard Medical School. Never replace a medication you've been prescribed with a supplement unless your doctor expressly says it's OK to do so, and always let your MD know if you have any unusual symptoms after starting a supplement, such as headaches or rashes.

Finally, it's important to keep some perspective, Dr. Katz says. "The grass is always greener on the other side of the fence. When we lived in a world where nature was in charge, we did everything we could to get away from it," he says. "When we first realized infections were caused by microbes, and that we could control that with sanitation and drugs, that was considered a great thing. Now that our world is dominated by medicine, we want to get back to natural healing. It's true that there is healing power in nature, but nature also gave us botulism and smallpox. You can go too far in either direction. Remedies and harms can come from both test tubes and tree leaves."