2000-09 Dietary Supplements and Alternative Medicines
By Fred Bove, M.D., Ph.D.
In the past several years, a variety of medications have become available without prescription in the form of dietary supplements. As their use increases, we find that some of the supplements can cause health problems that outweigh any benefit they may provide.
Sports Illustrated (January 17, 2000) featured an article on a severe reaction that occurred in a professional basketball player, Tony Guggliotta, who used an alternative medicine that was supposed to aid in sleep and help muscle growth. Guggliotta lapsed into a coma, required artificial respiratory support and had a seizure after ingesting the medication. Fortunately, quick work by the team trainer, paramedics and team physician avoided any further problems. The use of a dangerous alternative medicine by a well-informed professional is an indication of the problem we all have using these medications.
When I prescribe a medication for one of my patients, I go through a complex process that allows me to understand the expected effect of the medication and the potential side effects that might occur. Decisions on use of a medication balance the value of the medication with the potential side effects. All physicians look for data from which to make informed decisions about medications.
To provide proper advice to my patients, I usually look to the published medical literature. Most prescription drugs are tested in several phases before they are available for prescription. The typical study may involve thousands of people. After a period of time, the data are examined by a group of researchers and statisticians to determine if the drug had the effect claimed by the manufacturer and what the side effects were. This information is then published in a medical journal after being reviewed by several experts for accuracy. When your physician recommends an FDA (United States Food and Drug Administration) approved medication for treatment of an illness, the medication has undergone intense scrutiny over several years. We understand what the benefit should be and what the side effects are. Your physician should provide this information to you whenever a new medication is prescribed.
The problem with the alternative medications is that there is no requirement for any testing for efficacy or for side effects because these are considered to be natural foods. However, most of the alternative medications are indeed medications. All of the alternative medications contain chemicals that are expected to have a beneficial effect on some body function, yet there is no requirement to show that these medications actually have the claimed effect, nor is there any obligation to provide information on detrimental effects or side effects.
It is safe to say that most of the alternative medicines have not been tested in clinical trials to determine if they actually do what they claim to do. In many cases, when a trial of these medications is done the claims are not proven. There are a few exceptions: St. John's Wort is useful in treating mild depression; ginseng augments insulin effects and may be useful as an adjunct in treating diabetes; and creatine may help in muscle building.
However, the biggest concern is the use of performance enhancing mixtures, as they can have serious detrimental effects. The medication that caused the problem in Mr. Guggliota is known as GHB (Gama-hydroxybutyrate). This compound suppresses brain function and results in coma. When mixed with alcohol, it can cause a lethal respiratory arrest. The FDA has warned consumers and manufacturers about this danger, but there are several compounds still available that will result in this serious effect. Although GHB is banned, its precursor GBL (Gamma-butyrolactone) can still be found outside of the United States, sold as Furanone di-hydro. The body converts the GBL to GHB, and the effect is the same. A report published in 1999 (Morbidity and Mortality Weekly Report, Volume 48) indicated that there were 55 reported cases of adverse reactions to GBL. There has been one death recorded. Yet the chemical is available as a health food and performance enhancer.
Other Problem Supplements: A college football player visited my office last year with complaints of shortness of breath. An echocardiogram showed that his heart was failing, and there seemed to be no explanation for the weakened heart. When asked if he was taking any supplements, he showed me several bottles filled with performance supplements. The labels revealed that the active ingredients in these medications were caffeine and ephedrine.
Ephedrine is a close relation to adrenalin and causes elevated blood pressure, stimulating the heart and increasing its pumping action. Knowing that adrenalin will enhance performance, and that ephedrine (called Ma Huang) is one of the naturally occurring relatives of adrenalin, it seems logical to use ephedrine to improve athletic performance.
This medication is often teamed with caffeine. The combination of ephedrine and caffeine is commonly found in performance enhancing supplements.
The negative effects of ephedrine are well-described. They include abnormal heartbeats, hypertension, stroke and heart attack due to constriction of coronary arteries. Ephedrine has been associated with heart muscle damage in several medical case reports. This is likely due to overstimulation of the heart muscle cells, a phenomenon that was discovered with adrenalin years ago. Heart attacks, strokes and sudden death have been found in people taking ephedrine.
When taking alternative medications, it is wise to read the labels on the bottles, and be certain that you do not have a medical problem that would be aggravated by using the medication. Your physician may be able to provide advice about these medications.
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