As a general cardiology fellow I discuss the risks and benefits of medications, diagnostic tests, and procedures with my patients everyday. Often I’m asked about unproven herbal remedies or over the counter (OTC) supplements. So let’s use a popular supplement used for cardiovascular disease to talk about supplements.
Supplements and the Food and Drug Administration (FDA)
The issue with these over the counter supplements is that they are not regulated by the FDA. When a drug is FDA approved it means it has generally gone through extensive testing to understand its safety and efficacy for specific indications. Drugs that are not proven to be efficacious or safe are not approved. FDA regulated medications also have quality control measures. It means that drug companies are required to prove that the drug you are taking is in fact of high quality and purity- that what you are prescribed is what you are actually taking. Conversely, non-FDA regulated supplements are not held to the same rigorous standards.
Here’s an example- red rice yeast
One example from the field of cardiology is the supplement known as red rice yeast. It is sold as a cholesterol lowering medication and as an alternative to prescription cholesterol lowering drugs. Red rice yeast contains monacolin K and is the active ingredient found in lovastatin that helps lower cholesterol levels. So it can in fact actually lower your cholesterol levels. However the quality and purity of the supplement is not nearly the same as that found in its prescription counterpart.
In 2017 a study from the European Journal of Preventative Cardiology researchers analyzed 28 brands of red yeast rice supplements to quantify their monacolin K content, the active cholesterol lower ingredient. To no surprise the authors found that ‘the strength and composition of red years rice supplements sold at mainstream retail stores in the United States remains unpredictable’ (1). In 2 brands no monacolin K was detected at all! In the 26 other brands the quantity of the active ingredient ranged from 0.09 to 5.48mg per 1200mg of red yeast rice. That’s a 60-fold range in quantity. Imagine being prescribed a medication and not knowing if you were getting 0.5mg or 5mg. Additionally if patients followed the manufacturers’ daily serving recommendations they could consume a range of monacolin K from 0.09 to 10.94mg- more than a 120-fold range in dosage (1). In summary, you don’t know how much of the medication you would actually be taking. Not only does this raise the question of the efficacy of the supplement but also its safety.
So should you be taking supplements at all?
Generally, if you are eating a well balanced diet you should not need to be taking supplements. A colorful diet rich in fruits and vegetables is the best natural supplement that you can take. For more information on healthy dietary choices and plant based diets check out two great handouts below created by cardiology fellow Dr. Danielle Belardo who hosts a nutrition podcast, blog, and cardiology clinic on plant based diets.
Okay but is it unsafe or unhealthy to use supplements?
At the end of the day the first thing you should do before you take any supplement is talk to your doctor. From a doctor’s perspective, we want to make sure that any supplement you take does not interact with medications you are currently taking and ensure that any supplement in question does not have serious side effects.
Conclusion
There are no magic pills. I’m always amazed that we know the most about the human body today than we ever did in human history but there still are no magic pills. As far as the medical field has come we still can’t cure every disease, ache, or ailment. Be extremely cautious about anyone selling a product with claims that sound too good to be true because they often are just that- not true. Supplements are a multibillion dollar industry and the last thing I would want to happen is for a patient not to be able to afford proven life prolonging medications because they were buying unproven and potentially dangerous or impure supplements.
Works Cited
- Cohen, P. A., Avula, B., & Khan, I. A. (2017). Variability in strength of red yeast rice supplements purchased from mainstream retailers. European Journal of Preventive Cardiology, 24(13), 1431–1434. https://doi.org/10.1177/2047487317715714