Important Information on Dietary Supplements

In 1994, the United States Congress classified dietary supplements as foods, which include vitamins, minerals, herbs or other botanicals, amin­o acids, and other dietary substances that increase total dietary intake. However, they are not regulated as stringently as medications, either prescription or over-the-counter, even though the US FDA is responsible for designating the safety of these supplements. “In fact, it is estimated more than 50% of the adult US population use dietary supplements,” stated Mary Alice Middlebrooks, RN, MSN, assistant professor in the Texas A&M Health Science Center College of Nursing. “Reasons for in­creased use in­clude preventing and treating chronic diseases, weight loss, and lack of effective conventional treatment for some illnesses.” For example, black cohosh is commonly used to treat menopausal symptoms such as hot flashes, anxiety, and depression. Remi­femin, an extract of black cohosh, is thought to work through a mechanism similar to some newer antidepressant medications. Controlled tests of Remifemin have not consistently shown a beneficial effect. It is considered generally safe, but it should not be used for more than 6 months, as a few cases of liver damage have been reported. 

Ginkgo comes from the leaf extract of the plant Ginkgo biloba. It is thought to slow the progression of brain-related diseases such as Alz­hei­mer’s. Other common uses have been tinnitus and after ischemic stroke. Studies of ginkgo in these indications have rarely shown improvement for ei-ther condition. Yet, one of the ingredients in ginkgo, terpene ginkgolide B, has the ability to increase the risk of bleeding if the person is also taking an an-ticoagulant, ie, warfarin (Coumadin), an antiplatelet drug, ie, clopidogrel (Plavix), or other herbal supplements that increase the risk of bleeding, ie, feverfew or ginseng. Intake of ginkgo should be stopped well before surgery. Be­cause of the potential side effects and lack of consistent data showing effectiveness, ginkgo cannot be recommended at this time. Ms. Middlebrooks advises, “Be sure to inform your health­care provider of any and all dietary supplements/herbal medications that you take to prevent interactions and un­wanted side effects between them and any prescription medications that may be prescribed.”