In a world that so frequently values the importance of "natural" products, I think we sometimes forget that natural does not necessarily mean that it is good for us. Enter the world of dietary supplements. Crash course here: dietary supplements can be vitamins/minerals, herbals, or other products that are in food.
Sometimes the line between "a substance naturally derived from food" and "a specific chemical or compound in food concentrated to a degree that it borders on excessive levels and seems more similar to a pharmaceutical than a 'dietary supplement' is a fine line, but a large portion of the substances out there either herbals or vitamins/minerals.
Here's the thing: There's a difference between coating a burn with aloe vera and coating a burn with poison ivy. The same holds true inside the body. There's a difference between eating a big bowl of strawberries and a big bowl of nightshade berries.
Now that I've gone to an extreme example to show that not all items from nature are the same, I would like to argue that there are effects that "natural" products can have, even products touted for health, that pose risks not as bad as death but still worth noting (especially if your goal is health in the first place).
My point here is that you need to really DO YOUR RESEARCH before just taking any old supplement. Not "superhealthnews.com" research. I mean actual research studies that have been published by scientific journals, the National Library of Medicine, and the like.
Let's be honest, we don't conduct a research study for every single ingredient we put in our mouths. That's because we can generally trust that the FDA isn't going to allow blatantly harmful foods on the market. Yes, we have to be responsible for not eating in excess or for avoiding foods we know we are allergic to, but the FDA, grocery stores, etc. are all the time releasing recalls and monitoring food and food products for safety. As for pharmaceuticals, they have to go through clinical trials before they are approved.
Side note before I begin one of my main points of this article. Hairdryers have labels warning not to use your hairdryer in the bathtub. You could get electrocuted. Self-evident, yes, but it's on there in case there was any uncertainty there. Midol? You know, the over-the-counter cocktail women use to treat PMS symptoms? It says to ask your doctor before use if you have trouble urinating due to enlarged prostate.
WOMEN DON'T HAVE PROSTATES. But it's on there - just in case. That's the kind of responsibility we find in other aspects of our lives. If there's any slight risk, our litigious society requires that we have some type of label on there.
Why wouldn't we expect the same principles to apply to dietary supplements, the cross between food and medicine we put in our bodies for purported health benefits? After all, foods and medicines always have warnings on them.
Back to dietary supplement labels (and the law) - they are required to list the ingredients in the supplement, and any claims on the bottle have to follow guidelines (a.k.a. they can make unsubstantiated claims and put a standard little disclaimer in tiny font on the back of the bottle -
"This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.")
While certain aspects of the supplement are required on the label, side effects are not, likely because these supplements are not required to go through any kind of clinical trial that might solidify any probable side effects. Does this mean that people don't usually have side effects, or that they aren't too risky?
No.
Some are generally safe, but most have some kind of side effect that has been reported, and most become dangerous at some dosage as well. (However, most people want results, and supplement stores seem to have no shortage of products that offer extra strength or high content versions.)
There are literally SO MANY different supplements out there that it is near impossible to stay up to date on what the most recent research says about every single supplement out there. In fact, they hit shelves before all the answers are out there. The FDA has the right to issue warnings and even recalls of dietary supplements, but they basically have to wait for health problems to arise first before taking action.
The FDA has to gather evidence proving that the substance is hazardous to health before they can just come out and really start affecting the product's sales. Also, even when new warnings are issued, most people may not hear anything about it unless they regularly check online because these warnings are not necessarily expressed on the supplement labels.
While there are bounds of supplements out there, in this article I would like to share some recent cases where I personally have felt betrayed by a lack of warnings from dietary supplements.
The first instance is actually from a year or so ago, because the company has recently changed the product composition. For several years now I have enjoyed the taste of Sobe LifeWater beverages and would consume one every now and again.
Flavors included Fuji Apple Pear, Yumberry Pomegranate, Black And Blue Berry, and so on. The label touts that it is fortified with "Vitamins B and C," "0 Cal per bottle," and that it is a "nutrient enhanced hydration beverage." If you look on the back of the back of the bottle of the "Fuji Apple Pear" for example, there are several possibly unfamiliar terms: "erythritol," "xanthan gum," "ascorbic acid," "garcinia cambogia rind extract," "niacinamide," "calcium pantothenate," "pyridoxine hydrochloride," "L-carnitine," "beta carotene," "Panax ginseng root extract," and "cyanocobalamin."
Let's go ahead and get the vitamins out of the way. (It puts which vitamin it is in parentheses on the label). Ascorbic acid is vitamin C, niacinamide is vitamin B3, calcium panthothenate is a form of vitamin B5, pyridoxine hydrochloride is vitamin B6, and cyanocobalamin is B12. Now let's look at the other ingredients.
Erythritol - Erythritol is an artificial sweetener. It is a sugar alcohol that some might argue as "natural" rather than "artificial" due to its natural presence in some organisms such as algae.
Xanthan gum - This is a stabilizer or emulsifier generally regarded as safe for use in foods and beverages. It's used for texture basically.
I'm going to come back to garcinia cambogia.
L-Carnitine is where we start getting into the stuff you'll find in a bottle at GNC. It is a nonessential amino acid (meaning the body can make it on its own from other amino acids you eat). Some athletes use it to improve performance, but in the 20 years that it has been researched, no studies provide any clear benefits.
Beta-carotene is an orange-ish pigment used for color, an antioxidant, and can be converted to vitamin A in the body.
Garcinia cambogia (rind extract) is a supplement some use for the purpose of weight loss, as well as for other purposes, even though the evidence is inconsistent. This would explain why prior packaging referred to this drink flavor as "lean machine," based on the possible weight loss implications.
While most think it may be safe, it may cause nausea, headache, or other mild symptoms, and its safety in the long-term is uncertain. Either way, most people grabbing this "drink" likely didn't know there was a supplement used for weight loss inside. Parents would have no idea this was anything more than a sugar-free drink fortified with vitamins.
Lastly, Panax ginseng is a supplement made from a root that is used for energy or mental function. It is often used in energy drinks. (We've never heard anything bad or dangerous about energy drinks, now have we?) There are actually several other proposed benefits, ranging from respiratory problems to anxiety, but like many supplements, there's not a lot of research backing these claims.
As far as side effects, it is not recommended for use in children, those using certain medications like warfarin, if you have diabetes, high blood pressure, or some other conditions. In fact, some believe this supplement is "likely unsafe" for children, and has been related to fatal poisoning. There have also been contraindications for those with heart conditions, autoimmune diseases like lupus, insomnia, hormonal conditions, and for those pregnant and breastfeeding. Guess how many of these warnings were on the label?
None.
If you didn't read the ingredients list and research every ingredient on there you didn't know, you wouldn't be able to tell this drink from another drink that just had artificial sweeteners and vitamins. Even this "food analysis" site that lists the old ingredients seems more concerned with how processed it is rather than the presence of potentially dangerous dietary supplements snuck into the drink - 3 to be in fact. This really could be considered more of a "nutraceutical" than an actual food or beverage, and there's no obvious way to tell. Children could totally pick this up and drink it, no questions asked.
Fortunately, PepsiCo (who owns SoBe and their products now) has recently reformulated their "SobeWater" beverages, kicking the erythritol and the supplements. In the words of the PepsiCo rep that I verified these changes with, they got rid of the "artificial sweeteners" and the ingredients that had no real health benefit (a.k.a. the garcinia cambogia, Panax ginseng, etc.) The representative surmised that the product may not technically have been considered a "nutraceutical" since no specific health claim was asserted on the label regarding the additives.
This would explain why even that FDA disclaimer was not there. However, just a short time ago, individuals could drink these beverages, blissfully unaware of the potential hazards or side effects from the quietly unannounced ingredients.
Bringing this up to issues still applicable today, a few weeks ago at our university library, I was looking for some tea to drink. I was primarily looking at flavors, and decided on a apple-vanilla flavored "hibiscus tea." I assumed hibiscus might just be a flavor, like something similar to green tea.
As I was brewing my tea, I noticed that the back of the tea bag said, "Supplement Facts," where it listed hibiscus, rosehips, apple, and stevia (exact amounts of each were not specified, as it is a "proprietary blend.") What I did not see at the time was a small phrase at the bottom of the packaging that says, "CAUTION: Do not use during pregnancy or lactation without the advice of a healthcare practitioner."
Luckily neither of those apply to me at present, but had I not read the entirety of the packaging and looked up information about the ingredients, I would have had no idea. In fact, before I drank the tea, I specifically looked to see if there was any kind of warning or indications as to what the "supplements" did, and didn't see anything.
Let's start with the rosehips. They recommend not consuming if pregnant or nursing simply because they are not sure about all the side effects, and want individuals to be safe. In addition, it can increase risks of blood clots.
It can affect diabetes. It can increase risk of kidney stones, worsen anemia, cause acidic internal crisis in those specifically with sickle cell anemia, and could cause excess bleeding in those undergoing surgery in the near future. I didn't find those warnings anywhere on the package. I just thought it was tea.
Rosehips are often considered "likely safe," but these are still possibilities, and probably something anyone with any of these conditions would like to have in mind before unknowingly consuming.
Next, let's go to the hibiscus, a.k.a. the big reason that itty bitty warning I completely overlooked is on the package. Hibiscus is an emmenagogue. This means it stimulates menstrual flow. WHICH CAN CAUSE MISCARRIAGE.
Without going into too much detail, let's just say that if I had been pregnant at the time and went to go sip my cup of tea, I very well might have lost an unborn child. That one small cup was enough. BECAUSE I COULDN'T FIND A WARNING ON WHAT I THOUGHT WAS JUST TEA. Hibiscus can also affect blood sugar in individuals with diabetes, and can lower blood pressure.
All this to say, I almost feel like dietary supplements are a wolf in sheep's clothing. We see a tea bag, and we think it's no less safe than the tea bags we use to make our sweet tea. We see a bottle of pills, and we assume it has gone through the same clinical trials as any other pills you'll find either over the counter or as a prescription.
However, it is almost pathetic how little information is easily accessible compared to what we're used to with food or drugs, or how a little piece of legislation called DSHEA (look it up for more info) cripples the FDA from being able to do more to protect the public until unknowing individuals may have already sustained harm.
Supplement companies slap on any wild, unsubstantiated health claims they want, cover their backs with a handy-dandy disclaimer, and don't have to provide any information about the actual possible side effects, or even whether research reliably supports the claims they're making.
Check out the NIH Office of Dietary Supplements, the NIH National Center for Complementary and Integrative Health, or even just WebMD before you use these supplements. WebMD is pretty user-friendly, has a large database of dietary supplements, and checks a massive amount of literature to provide readers with what the research actually shows and what the side effects might actually be.