Some 58% of Americans report taking dietary supplements, often motivated by a desire to “improve” or “maintain” their health. But the death of Lori McClintock, wife of U.S. Representative Tom McClintock of California, is a tragic reminder that dietary supplements aren’t always good for you.
A report recently obtained by Kaiser Health News revealed that McClintock died of dehydration ultimately caused by ingesting white mulberry leaves, commonly advertised as a weight loss aid and available in forms like pills and tea. Deaths from white mulberry leaves appear to be rare, and we do not know in what form McClintock consumed the leaves or if they were sold to him as a supplement. But they commonly are, and if that were the case here, it would be far from the first death caused by dietary supplements.
Many dietary supplements are not what they claim to be or contain harmful ingredients.
Basic regulations are needed to ensure that these types of supplements, which include herbs, probiotics, and vitamins, are safe and effective. Unlike prescription or over-the-counter drugs, supplements are treated more like food, which means regulators only step in after a problem has been reported, which creates a lot of room in which things can go wrong. Many dietary supplements are not what they claim to be or contain harmful ingredients.
The Dietary Supplements Health and Education Act of 1994 states that dietary supplements are not required to undergo testing to ensure they are safe before being sold. Instead of the Food and Drug Administration testing substances for safety in advance, supplements are assumed to be safe until proven otherwise. If your doctor has written a prescription for a drug that may or may not have been tested for human safety, you’ll probably think twice before heading to the pharmacy. But that’s the very real position people find themselves in when they walk into an aisle full of vitamin extracts and diet pills.
Unfortunately, while white mulberry leaf is generally safe, other supplements are not. A 2015 study found that approximately 23,000 emergency room visits each year are caused by dietary supplements. In the case of the OxyELITE Pro bodybuilding supplement, dozens of people have suffered from severe hepatitis and liver failure, and several people have died after taking it.
And a 2002 congressional report found that supplement producer Metabolife hid nearly 2,000 reports of adverse side effects from the FDA and consumers, including strokes, seizures and heart attacks. (Metabolife claimed that it has not received any reports of adverse reactions related to its products, although the FDA has banned ephedra, an active ingredient in the popular Metabolife supplement, and several court decisions have found the product dangerous.)
Often supplements are not even what they claim to be. Imagine ordering a BLT sandwich and getting something that looks like a BLT but has no bacon, lettuce or tomatoes in it. This is unlikely to happen as we are familiar with bacon, lettuce, and tomatoes, but people are generally unaware of the specific ingredients allegedly contained in supplements. Do you know what a pill containing white mulberry leaf extract looks like? I do not know.
A study of ginseng supplements found that 12% of ginseng products purchased in the United States, for example, were not made from the type of ginseng claimed on the label. Another study found that a quarter of black cohosh supplements did not contain black cohosh. Even supplement promoters themselves admit that mislabeling is a problem.
Sometimes supplements also come with nasty surprises, such as hidden prescription drugs. After athletes started unexpectedly failing drug tests and blaming their workout supplements, scientists looked at the chemical makeup of one called Craze. The name was fitting given that it contained a new methamphetamine analogue. People who take workout supplements generally want to become stronger athletes, not paranoid meth addicts. (Driven Sports, the company that produced Craze, claimed it didn’t contain a meth analogue and was “safe and effective,” though it’s still being pulled from the market.)
Earlier this year, the FDA alerted consumers to honey-based sexual enhancement pills that secretly contained sildenafil and tadalafil, the active ingredients in Viagra and Cialis. Such “special ingredients” are not uncommon. The FDA’s Fraudulent Health Products Database lists hundreds of supplements that secretly contain tadalafil and sildenafil.
It doesn’t sound as bad as Craze (after all, these pills might actually do what they’re advertised to do), but unlabeled prescription drugs can still have life-threatening side effects if taken alongside other medications; sildenafil can cause problems if taken with anything from alpha-blockers to vericiguat, for example. A competent doctor prescribing sildenafil would ensure that it does not interact with other drugs, but doctors and patients cannot check for dangerous drug interactions if they do not know what they are taking.
Voices as varied as the Hoover Institution and comedian John Oliver called for the FDA to have the power to regulate dietary supplements, but a major reason that didn’t happen was opposition from former Senator Orrin. Hatch, R-Utah, who championed legislation that deregulated supplements and for decades fought back against efforts for sensible rules. Although he passed away earlier this year, lobbying money from the supplement industry remains a powerful obstacle to stricter regulation.
The Senate is currently considering the Dietary Supplements Listing Act of 2022, which would require supplements to be registered with the FDA and list their ingredients. That would be an improvement, but we would still need another bill that would require supplements to be tested for safety and effectiveness before they hit the market, similar to the prescription drug approval process.
The FDA has to wait until the next time people report a dodgy supplement to take action, but we don’t have to wait to show our support for laws that would regulate supplements to ensure they’re safe and effective before people never get sick again.