Many scientists and physicians are excited about the recent results from studies of vitamin E and heart disease and are taking E supplements themselves. However, given the contradictory nature of much of this data, especially the beta-carotene and cancer work, other experts are cautious in recommending antioxidant supplements for the prevention of chronic diseases. A better option, they say, is to get as many of these nutrients as possible from foods. Indeed, that is the official word from the NAS, the AHA, and the NCI.
What might be better about fruits and vegetables? The micronutrients identified so far may not actually be the protective ones or foods may contain other chemicals that magnify a nutrient's protective effect. In some cases, evidence indicates that the form of a nutrient in foods is better absorbed than the form that comes in pills or powders. Calcium in milk and other dairy products, for example, is known to be better absorbed by the body than in pill form.
Potential Dangers
Taking high doses of certain supplements can be dangerous. Although they are not called drugs, vitamins and minerals at high doses act like drugs and can have drug-like side effects. For example, it is known that doses of vitamin A above 25,000 IU can cause, among other things, severe liver damage, bone diseases, and, when taken by pregnant women, birth defects. Recent evidence has shown that doses even as low as 10,000 IU can cause some types of birth defects.
Other vitamins can also be toxic. Taking more than 100 mg per day of vitamin B6—a whopping 50 times the RDA—can harm the nervous system, causing problems with balance and altered sensations. Nevertheless, this vitamin often is sold in capsules containing 100 mg to 500 mg. And niacin, which comes in supplements of 250 mg, 400 mg, and 500 mg, can trigger vomiting, diarrhea, and even liver damage, among other maladies, in doses of 500 mg from slow-release formulations and 750 mg from immediate-release pills.
Toxicity also has been associated with high doses of iron, selenium, and even vitamin C. Folic acid doses above 1 mg can mask symptoms of vitamin B12 deficiency, a rare condition that is most often seen among the elderly and some strict vegetarians. If it goes undetected, vitamin B12 deficiency can lead to irreversible nerve damage. There may be unidentified dangers as well. While doses of vitamin E up to 800 IU appear to be safe for most healthy people, it will take long-term studies of the use of vitamin E, involving thousands of people, to know whether high doses are safe for everyone.
Doses of supplements go largely unregulated because of the 1976 Proxmire Amendment to the Federal Food, Drug, and Cosmetic Act. One provision of this amendment prohibits the FDA from establishing a maximum daily dose unless the agency can prove there is a health hazard.
Herbal Remedies
Unlike vitamins, which consumers use primarily for prevention, herbs are typically used as treatments, for everything from colds to cancer. Unrefined herbs—the leaves, bark, flowers, berries, or roots of plants—are not yet a part of mainstream U.S. medicine. But they are in other countries.
In China, herbal remedies—such as Yin Chiao, an herbal formulation used to treat colds, and stephania, a root used for weight loss—dominate medical practice. European doctors also readily incorporate herbs into their practices. In Germany, a concentrated extract made from the leaves of the ginkgo tree is used as a treatment for headaches and tinnitus (a ringing in the ears), among other maladies. In the South Sea Islands, tea-tree oil, pressed from the leaves of a tropical tree, has been used for centuries as a skin antiseptic.
In the United States, herbal remedies have caught on among the general public, if not physicians. Experts say that herbal remedies or “botanicals” are the fastest growing segment of the supplement market. Their appeal lies largely in the word “natural.” But natural is not a synonym for safe. It does not mean the stuff works, either.
Do Herbs Work?
Some herbs probably are effective. After all, about 25 percent of U.S. prescription drugs are derived from plants. For example, digitalis, the heart-muscle strengthener, is an herb derived from a plant called foxglove, and taxol, a cancer treatment, comes from the Pacific yew tree. To date, the FDA has judged at least 16 herbs as safe and effective, allowing them to be sold over the counter as drugs. These include elm bark, sold as Throat Coat Tea, and the laxatives senna, marketed under the brand name Senokot, and psyllium seeds, sold under the label Metamucil.
That still leaves hundreds of herbs sold in the United States whose effectiveness is unproven. For instance, there is little documentation for the purported ability of a Chinese root called ginseng to build up the body's resistance to stress and disease and to enhance sexual potency. Similarly, garlic's power to strengthen the immune system, prevent cancer, or unstuff sinuses remains highly controversial.
Still, that does not mean that these herbs and others do not do something to the body. In fact, ingredients in some products sold as herbs are similar to over-the-counter drugs. White willow bark, for instance, is a lot like aspirin. Both belong to a class of compounds called salicylates and so have similar effects on the body. And the Chinese herb Ma Huang, derived from an evergreen plant of the genus Ephedra, contains ephedrine, a stimulant used in many over-the-counter and prescription drugs.
Are They Safe?
Because herbs are not required to undergo safety tests, it is difficult to be sure any are completely safe. The safest herbs are those for which no one has reported toxic effects. Examples of such herbs include ginger, milk thistle, and garlic. The absence of negative reports about a substance is not, however, proof of safety, since people do not always associate their symptoms with herbs they are taking. Thus, many adverse effects probably go unnoticed and unreported.
Meanwhile, many herbs known to be toxic remain on the market. One such herb is a desert shrub called chaparral. In the February 8, 1995, Journal of the American Medical Association (JAMA), doctors reported severe liver damage in a 60-year-old woman who had taken capsules of a chaparral extract for 10 months for its supposed antioxidant properties. The woman experienced no symptoms before becoming seriously ill with liver failure; she eventually needed a liver transplant.
Ma Huang is perhaps the best known example of herbal toxicity of late.
Containing ephedrine, a stimulant that can harm the nervous system and heart, Ma Huang is a component in dietary supplements that manufacturers claim will promote weight loss and boost energy. In some cases, it is supposed to produce a natural “high” like that from illegal drugs such as “ecstasy.” Its harmful effects range from dizziness, headaches, and stomachaches to heart attacks, strokes, seizures, and death. So far, more than 600 reports of injuries and 17 deaths linked to ephedrine products have poured into the FDA.
The majority of injuries were reported by women taking weight-loss formulations containing the substance.
Herbs can also pose risks because they are unregulated and thus bear no warning labels mentioning side effects or safe dosages. For instance, consumers are not told on a package of white willow bark that this herb, like aspirin, can upset the stomach, cause bleeding during pregnancy, increase the risk of a stroke, or spawn Reye's syndrome, a serious illness appearing in some feverish children given aspirin.
In addition, herbal products are not subject to careful quality control; thus, undesirable substances can sneak in without anyone knowing. Ayurvedic herbs, made in India and used in traditional Hindu medicine, are boiled in clay or metal pots, which can leave behind traces of toxic substances such as lead, mercury, or arsenic. And sometimes products contain misidentified plant parts. In the early 1990s, 70 women at a clinic in Belgium took an herb for weight loss that clinic administrators thought was stephania. Instead, it was a toxic plant, called aristolochia, that poisoned their kidneys.
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