The Wall Street Journal (WSJ, 9/07/09) has a cautionary article worth-reading regarding the potential dangers of using dietary supplements specifically to enhance physical strength or promote weight loss (http://online.wsj.com/article/SB10001424052970204731804574390840811949538.html). Although relatively rare, liver failure is a real and dreaded complication of using such dietary supplements. The anxiety healthcare providers have about supplement use has to do with a variety of factors:
- These supplements are not regulated by the US FDA, and it is nearly impossible to verify that supplements available on the market actually contain what they say on the label and that they do not contain other additives or contaminants.
- Many individuals do not disclose they are using such supplements to their healthcare providers.
As healthcare providers, we need to encourage an open dialogue about supplement use with our patients. This means doing what we do with pharmaceutical agents: we need to be familiar with what is available to consumers, understand why patients choose to use these supplements, review the medical literature about what is known and not known about their effects, and study their effects in clinical research trials. It is only in this way we can best advise our patients.
The WSJ article refers to a study summarizing the causes, clinical features, and outcomes from the first 300 patients enrolled in a national registry of drug-induced liver injury patients. It was published in the journal, Gastroenterology, in 2008. Dietary supplements accounted for 9% of mild to severe liver injury cases, but what the WSJ article neglects to say is that antimicrobials (45.5%) and central nervous system agents (15%) accounted for most of the cases. So what does this tell us? We need to be vigilant not just about supplements, but about all medications and prescribe only when there are clear indications to do so and when we believe the potential benefits outweigh the risks.