[Suzanne 3FC]

I ran across an interesting article on supplement side effects that may be helpful to some of us. I was surprised by many parts of it.

How safe is your weight-loss supplement? A user's reference.



Consumers' Research Magazine; 9/1/2002; Heinrich, Janet

Available research on weight-loss supplements, though limited, in general suggests that some supplements are associated with both minor and potentially serious adverse effects. Further, many supplements are contraindicated for individuals with some underlying health problems. That is, there are specific dangerous side effects for persons with certain health conditions. In addition, a variety of weight-loss supplements can have dangerous interactions with prescription and over-the-counter drugs that are being taken concurrently. However, few systematic studies exist on the negative health consequences of particular weight-loss supplements.

Adverse effects, contraindications, and interactions that have been associated with some of the more commonly used weight-loss supplements:

Bitter Orange (Citrus Aurantium). Adverse effects: Sensitivity to light and increased blood pressure.

Contraindications: Should be avoided by individuals with cardiovascular concerns such as hypertension.

Bladderwrack (Fucus Vesiculosus). Adverse effects: High doses and prolonged use associated with risk of iodine overdose and hyperthyroidism.

Contraindications: Should be avoided by individuals with hyperthyroidism. Long-term use is not recommended.

Interactions: May have additive effect with antihyperglycemic medications.

Brindle Berry (Garcinia Cambogia, Hydroxy Citric Acid). Adverse effects: High doses associated with gastrointestinal distress.

Contraindications: Should be avoided by individuals with diabetes and dementia syndromes.

Caffeine (Guarana, Cola Nut). Adverse effects: Gastrointestinal distress, nausea, dehydration, headaches, insomnia, nervousness, anxiety, muscle tension, heart palpitations, increased blood pressure, addiction, and possible genetic damage.

Contraindications: Should be avoided by individuals with gastric ulcers. High doses and long-term use are not recommended.

Interactions: May strengthen the action of central nervous system stimulants that reverse depression.

Chromium. Adverse effects: Mild gastrointestinal distress, anemia, blood abnormalities, liver dysfunction, renal failure, memory loss, rhabdomyolysis, tissue damage, genetic damage, genetic mutation, and cancer.

Contraindications: Should be used with caution by individuals with a history of hypoglycemia. Should be used only under medical supervision by individuals with a history of hyperglycemia or Type II diabetes. High doses of chromium picolinate are not recommended.

Interactions: May cause corticosteroid-induced diabetes when taken with corticosteroid medications.

Conjugated Linoleic Acid (CLA). Adverse effects: Gastrointestinal distress and nausea.

Interactions: Should not be used with medications, mineral oil, dietary supplements, or food additives that prevent absorption of fats.

Dehydroepiandrosterone (DHEA). Adverse effects: Altered hormone profiles, increased facial hair, acne, scalp hair loss, oily skin, mood swings, aggressiveness, irritability, virilization in women and gynecomastia in men, a deepening of the voice, and menstrual cycle irregularities. Also associated with insomnia; headaches; nervousness; fatigue; low energy; decreased high density lipoprotein (HDL) cholesterol ("good cholesterol"); cardiac arrhythmias; liver abnormalities; hepatitis; and increased risk of heart disease, diabetes, stroke, and some hormone,related cancers.

Contraindications: Should be used only under medical supervision by individuals at risk for hormone-related cancer such as prostate, ovarian, endometrial, and breast cancer. Long-term use may worsen prostate hyperplasia. High doses are not recommended.

Interactions: May alter the effects of antidepressants, estrogen and estrogen-like medications, anticoagulants, central nervous system stimulants, and diabetic/hypoglycemic medications.

Dieter's Teas (Containing Aloe, Buckthorn, Cascara, Castor Oil, Rhubarb Root, Senna, or Other Herbal Laxatives). Adverse effects: Gastrointestinal distress, stomach cramps, pain, constipation, nausea, vomiting, and diarrhea (sometimes chronic), fainting, dehydration, electrolyte disorders, potassium deficiency, nephropathies, edema, accelerated bone deterioration, and cardiac arrhythmias. Also, taken orally, may increase risk of cancer.

Contraindications: Should be avoided by individuals with abdominal pain of unknown origin, diarrhea, dehydration, intestinal obstruction, and any inflammatory condition of the intestines (appendicitis, colitis, Crohn's disease, irritable bowel syndrome, or ulcerative colitis). Aloe should be avoided by individuals with hemorrhoids or kidney dysfunction. Rhubarb should be used with caution by individuals with a history of kidney stones. Use for more than two weeks is not recommended.

Interactions: May alter the effects of antiarrhythmics, digoxin, digitalis, electrolytes, non-steroidal anti-inflammatory drugs, and decrease the absorption of other oral medications. Potassium deficiencies associated with use of stimulant laxatives can lead to disorders of heart function and muscle weakness, especially with concurrent use of cardiac glycosides, diuretics, and corticosteroids. Aloe may lower blood sugar levels and alter the effect of diabetic/hypoglycemic medications. Senna decreases the absorption of estrogens.

Ephedra (Ma Huang). Adverse effects: Loss of appetite, nausea, vomiting, disturbances of urination, sweating, pupil dilation, insomnia, irritability, nervousness, dizziness, shortness of breath, elevated body temperature, tremor, muscle injury, nerve damage, severe headaches, memory loss, psychosis, increased blood pressure, heart palpitations, seizures, stroke, heart attack, and death. High doses associated with dependency.

Contraindications: Should be avoided by individuals with glaucoma, thyroid disease, diabetes, high blood pressure, or heart disease. Should also be avoided by individuals with difficulty in urination due to prostate enlargement. Should be used only under medical supervision by individuals with a kidney disorder, psychiatric disorder, or seizure disorder. Should discontinue use at least 24 hours prior to surgery.

Interactions: May alter the effects of cardiac medications. Should not be used with other medications, including nonprescription allergy, asthma, cold/cough, weight-control products, and antidepressants. Use of ephedra with monoamine oxidase (MAO) inhibitors strengthens the stimulant action of ephedra and may result in life-threatening fever, hypertension, and coma.

Fiber (Chitosan, Psyllium, Methylcellulose, Glucomannan, Pectin, or Others). Adverse effects: Gastrointestinal distress including gas; bloating; intestinal cramps; abdominal distention; nausea; diarrhea; choking; and obstruction of the esophagus, throat, and intestines.

Contraindications: Should be avoided by individuals with a history of intestinal obstruction, fecal impaction, or narrowing of the gastrointestinal tract, and those who have difficulty controlling their diabetes. Should be used with caution by individuals with shellfish allergies and insulin-dependent diabetes (insulin and/or medication levels may need to be adjusted).

Interactions: May alter the effects and decrease the absorption of diabetic/hypoglycemic medications, cholesterol-lowering medications, anticoagulants, digoxin, and other medications. High intake may decrease absorption of fat-soluble vitamins (A, D, E, and K) and carotenoids (such as beta-carotene, lutein, and zeaxanthin).

Green Tea (Catechins). Adverse effects: Gastrointestinal distress, decreased appetite, insomnia, nervousness, hyperactivity, increased blood pressure, increased heart rate, and gastric irritation. High doses associated with headache, heart palpitations, and vertigo.

Contraindications: Should be used with caution by individuals with renal disease, hyperthyroidism, susceptibility to spasm, anxiety, and panic disorder. Should be used only under medical supervision by individuals with peptic ulcers, cardiovascular disease, and blood clotting abnormalities. High doses should be avoided by individuals with irregular heartbeat. Should discontinue use at least 24 hours prior to surgery.

Interactions: May alter the effects of anticoagulant medications and supplements (including vitamin E and ginko biloba), resulting in decreased platelet aggregation (blood clotting) and increased bleeding times.

Guggul (Myrrh). Adverse effects: Gastrointestinal distress, diarrhea, nausea, and skin rash.

Contraindications: Should be used only under medical supervision by individuals with hyperthyroidism.

Interactions: May alter the effects of thyroid medications, cholesterol-lowering medications, anticoagulants, antiplatelet medications, propranolol, and diltiazem.

Gymnema. Adverse effects: Gastrointestinal distress. Extremely high doses associated with hypoglycemia.

Contraindications: Should be used only under medical supervision by individuals with active diabetes.

Interactions: May alter the effects of oral hypoglycemics and insulin. Antidepressants, including St. John's wort and salicylates (white willow and aspirin), may enhance the effects of gymnema. Stimulants, including ephedra, may reduce its effectiveness.

5-Hydroxytryptophan (5-HTP). Adverse effects: Nausea, vomiting, diarrhea, loss of appetite, difficult breathing, pupil dilation, blurred vision, abnormally sensitive reflexes, loss of muscle coordination, and cardiac arrhythmias.

Contraindications: Should be avoided by individuals with any significant cardiovascular disease. Should be used only under medical supervision by individuals with cancerous tumors.

Interactions: Should not be used with MAO inhibitors, other antidepressants (including herbal remedies such as St. John's wort), or prescription weight-loss medications.

L-Carnitine. Adverse effects: Nausea, vomiting diarrhea, abdominal cramps, and seizures.

Contraindications: Should be used only under medical supervision by individuals with thyroid disease or seizure disorder.

Pyruvate. Adverse effects: Gastrointestinal distress including nausea, gas, bloating, and diarrhea.

Contraindications: Should be used only under medical supervision by individuals with blood-clotting abnormalities. Should discontinue use at least 14 days prior to surgery.

St John's Wort. Adverse effects: Gastrointestinal distress, nausea, loss of appetite, constipation, dry mouth, sensitivity to light, allergic reactions, skin rash, hives, tiredness, fatigue, insomnia, restlessness, dizziness, confusion, and fast or irregular breathing.

Contraindications: Should be avoided by individuals who are attempting to become pregnant (may be mutagenic and toxic to sperm), and individuals who have received organ transplants or are taking medications that decrease immune system activity. Should be used only under medical supervision by individuals with severe depression.

Interactions: May alter the effects of oral contraceptives, decrease the effectiveness of HIV medications, immunosuppressants, digoxin, anticoagulants, chemotherapy, and asthma medications. May alter the effects of other prescription or over-the-counter medications. Should be used only under medical supervision when taking MAO inhibitors or other prescription antidepressants. Should not be used with tyramine-containing foods (certain wines, liver, and cheeses).

Vanadium. Adverse effects: Gastrointestinal distress. High doses and long-term use associated with muscle cramps, depression, and damage to the nervous system and other organs.

Contraindications: Should be avoided by individuals with hyperglycemia, hypoglycemia, or diabetes.

Yohimbe. Adverse effects: Queasiness, vomiting, insomnia, headache, sweating, flushing, nervousness, tension, tremors, difficulty breathing, hallucinations, anxiety, psychotic episodes, increased blood pressure, increased heart rate, heart palpitations, and chest pain. High doses associated with decreased blood pressure, gastrointestinal distress, and unpleasant central nervous system symptoms.

Contraindications: Should be avoided by individuals with low blood pressure, diabetes, high blood pressure, kidney disease, liver disease, chronic inflammation of the sexual organs or prostate gland, cardiovascular disease, women who could become pregnant, and elderly persons. High doses and long-term use are not recommended.

Interactions: Should not be used with antidepressant medications or supplements, nasal decongestants, weight-loss supplements with ephedrine, or tyramine-containing foods (certain wines, liver, and cheeses). May increase the effect of MAO inhibitors and hypotensive drugs. May alter the effects of psychopharmacological herbs.

Since manufacturers of dietary supplements are not required to provide reports of adverse events to the FDA, the agency and others rely on voluntary post-marketing reporting of adverse events to understand better the safety of dietary supplements. In addition to these adverse event reports, the FDA uses data from poison control centers, reports and inquiries from consumers and health-care providers, and complaints from trade competitors to track potentially dangerous supplements. These reporting systems can then be used to signal safety concerns. There are numerous problems with this passive system of adverse-event reporting, and these have been noted extensively in our earlier work. For example, only a small proportion of adverse events are reported, and those reports often are incomplete or contain inconsistent information.

Ms. Heinrich is Director of Health Care and Public Health Issue for the U.S. General Accounting Office. This article is adapted from her testimony before the U.S. Senate Committee on Governmental Affairs, "Dietary Supplements for Weight Loss: Limited Federal Oversight Has Focused More on Marketing than on Safety," GAO-02-985T.

COPYRIGHT 2002 Consumers' Research, Inc.