Hazards of food supplements

Last week, one of my “regulars” came in for his Class I flight physical. I was glad to see him, as I knew him to be young and healthy. It was a busy Friday and I was already a bit behind. I was looking forward to an “easy” case to catch up. However, this was not to be. To both our surprise, his blood pressure was very high! I was surprised because his past pressures, as recently as 6 months ago, had always been nice and low. He was surprised because he couldn’t think of anything that had happened to cause this, and besides, he felt perfectly fine. I questioned him about the usual: family history, severe stress, new medications, espresso coffee ingestion, over-the-counter cold medications, diet pills, and the like. He denied everything. His pressure was so high that I was considering sending him to the emergency room.

Finally he told me that the only thing different since his last flight physical was a new vitamin product which he had been taking for the last couple months. Because it was “just vitamins” he didn’t think to mention it. Further questioning revealed that these were not “just vitamins,” as there were additional ingredients to “enhance male energy.” He had no idea what all was in this product, but because it was “organic and natural” and from a reputable company, he assumed it was perfectly safe.

I asked him to stop taking this product and that he continue to measure his blood pressure over the weekend. He was to recheck with me on Monday, and bring the container so that I could read the ingredients. Although still not down to normal, his pressure was much improved from a couple days later. Of great relief to him, it was now at least low enough to pass FAA standards.

So, what was in this seemingly harmless concoction from a very reputable and nationally known company? Other than the standard vitamins (which one can purchase for pennies a day) this expensive product contained the following ingredients, among others:

Damiana (for sexual enhancement)

Gingko Biloba (for mental enhancement)

DHEA, or dehydroepiandrosterone (for muscle building)

Ginseng (for general energy)

Ephedra, also known as Huang Ma (for energy and heightened metabolism)

I am not sure if Damiana and Gingko Biloba have effects on blood pressure, but certainly DHEA, Ginseng and ephedra can. DHEA, which is a type of anabolic steroid, can also be dangerous to the kidneys. This is an ingredient found in many body-building products. Gingko Biloba and Ginseng, although quite popular within the natural supplement community, have not been found to be effective (more than placebo) in controlled scientific studies. Ephedra (Huang Ma) on the other hand, is a form of “speed” and is related to substances such as pseudoephedrine, which is found in over-the-counter decongestants and is a main ingredient for making methamphetamine and diet pills. These chemicals can have profoundly deleterious effects on the cardiovascular system by provoking hypertension, rapid heart rates, and narrowing of important small blood vessels….such as in the heart and brain. Additionally they can produce adverse psychological symptoms such as anxiety and even panic attacks. In healthy younger people these effects might be well tolerated, but in older individuals with underlying circulatory disease these products can precipitate heart attacks and strokes.

Plants produce thousands, perhaps millions of different chemicals that are used a variety of purposes. Biologists have only scratched the surface in learning about these compounds, but many have been known to mankind for thousands of years for their medicinal purposes. Some medications in use today are direct derivatives of these substances, and are indispensable in treating acute and chronic diseases. These drugs are purified versions of plant extracts, and are prepared under carefully controlled conditions ensuring accurate concentrations and purity. Some can be purchased over-the-counter (such as aspirin) but most require a doctor’s prescription. That is not the case in the health food industry. In the USA, powerful interest groups have prevented these “food supplements” from being regulated by the Food and Drug Administration. This has created a totally unregulated industry, meaning that there is no governmental agency ensuring that these products are actually what they are labeled to be. The purity and dosage of the products are not assured.

The purpose of this column is not to describe in detail all the possible side-effects of various health food substances on the market, but rather to alert the reader to the potential health hazards in this unregulated industry. The science behind the claims these companies make is usually very weak, and relies on testimonials rather than on properly conducted double-blind studies. The buyer must be aware, as there is no regulatory agency overseeing quality inspections or monitoring.

The FAA requires pilots to disclose the prescription and non-prescription medications they take on the medical certificate application 8500-8. However, because the FDA classifies these substances as food supplements and not as medications, the pilot is not required to disclose these products to the FAA. This further strengthens the fallacy in many minds that these products are safe.

So if you are taking more than just appropriate vitamins, please make sure that you follow the primary rule of healers, which is TO DO NO HARM. Make sure you really need this stuff, that you are not just succumbing to media hype feeding on your fears of aging. Even if the evidence for its benefit is weak, make sure that at least it is not going to hurt you……or your medical!