A cardiologist in Pasadena, California, Dr. Danielle Belardo, has been vocal about the risks associated with supplement use after a troubling case earlier this year. A 49-year-old man visited her due to persistent chest pain. Instead of adhering to his doctor’s recommendation of statins to manage his high cholesterol, he opted for berberine and red yeast rice supplements, believing them to be more natural options.
Unfortunately, these supplements did not help his condition. Upon examination, Dr. Belardo found that not only did he still have high cholesterol, but he also exhibited elevated liver enzymes and had severe coronary artery disease, necessitating open-heart surgery. Following the procedure, she prescribed statins and discontinued his supplement use, leading to the resolution of his liver issues.
This case highlights a growing trend in the United States, where over half of adults now take dietary supplements, prompting healthcare professionals to urge patients to reconsider their usage. Dr. Belardo frequently advises against excessive supplement consumption in her practice, often “de-prescribing” them. In one instance, she convinced a patient to stop taking an astonishing 132 supplements, including those marketed for “detoxing” the kidneys and liver.
Marily Oppezzo, an instructor of medicine at the Stanford Prevention Research Center, advocates for a more thoughtful approach to supplements. Inspired by decluttering expert Marie Kondo, she encourages patients to evaluate which supplements truly provide “real, evidence-backed joy.”
Supplements encompass an extensive array of products, including vitamins, minerals, herbal compounds like ashwagandha and kava, and performance enhancers like creatine. While some supplements have established benefits—such as folic acid for women trying to conceive—many are not as beneficial as marketed and can have unintended side effects.
Dr. Mitra Rezvani, a hospitalist at Westchester Medical Center in New York, notes that many patients are often surprised to learn about the side effects associated with supplements. Some side effects may be minor, like gastrointestinal discomfort, but others can be far more serious. A study published in The New England Journal of Medicine estimates that dietary supplements are responsible for approximately 23,000 emergency room visits annually.
Physicians employ diverse strategies to address supplement use with their patients. Dr. Rezvani has had success by asking patients to list all their supplements along with their reasons for taking them, allowing for an open discussion on what might be reconsidered. Dr. Jen Gunter, an OB-GYN in San Francisco, prefers a gentler approach, emphasizing the importance of maintaining an open dialogue with her patients. However, she often finds it hard to understand patients who come in regularly seeking help despite taking probiotic supplements, questioning their effectiveness.
One significant concern regarding supplements lies in their regulation, or lack thereof, by the Food and Drug Administration (FDA). Supplements are subjected to minimal oversight compared to prescription drugs, which allows them to bypass rigorous testing for safety and effectiveness before hitting the market. Mislabeling has been an issue, with discrepancies in ingredients and concentrations. Moreover, some supplements can interact negatively with prescribed medications or with each other.
Dr. Pieter Cohen, an associate professor at Harvard Medical School who studies supplements, recounts a case where a 45-year-old patient developed rashes after taking an anti-migraine supplement. Upon his recommendation to discontinue use, her skin condition improved.
Dr. Gunter raises alarms about certain Ayurvedic supplements, which have been found to contain harmful levels of lead, arsenic, and mercury. Meanwhile, Dr. Rezvani remains vigilant for signs of liver damage from supplements. A study from the University of Michigan reported that around 15 million American adults take supplements linked to liver toxicity, like turmeric and red yeast rice.
In one instance, Dr. Rezvani treated a 70-year-old woman who presented symptoms of nausea, jaundice, and dark urine after starting a turmeric supplement, in addition to the diabetes medication semaglutide, marketed as Ozempic. After stopping the supplement, the woman’s liver function notably improved.
The appeal of supplements can often stem from a mistrust in traditional healthcare. Dr. Belardo acknowledges that many patients turn to supplements when they feel dismissed or disillusioned by the healthcare system. Some rely on supplements to alleviate symptoms without seeking proper medical evaluations that could identify underlying health issues.
Dr. Belardo recounted a troubling case from 2021 when a 44-year-old woman consulted her after taking an iron supplement for anemia, which was prescribed by a naturopath. Despite her efforts, the patient still felt fatigued. While the iron supplement was not the issue, Dr. Belardo was concerned that the naturopath had not explored the underlying cause. A referral to a gastroenterologist led to a colonoscopy, revealing stage IV colon cancer.
Reflecting on this case, Dr. Belardo expressed her frustration: “Months, if not years, of opportunity for earlier detection and treatment had been lost because her care was reduced to supplement prescriptions.” Such cases highlight the importance of seeking comprehensive medical advice rather than relying solely on supplements for health management.
