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Dietary supplements: are they worth it? - Airman's Consumer

Airman, August, 2002 by G.W. Pomeroy

Dietary supplements are the rage these days. People take them for a host of reasons, like to boost their energy or lose weight. Base exchanges and commissaries sell a host of them -- many with hard-to-pronounce names.

But Air Force surgeon general officials strongly advise airmen to contact their physicians or health care providers before taking dietary supplements that contain Ma Huang, ephedra or ephedra alkaloids.

"Consultation is especially necessary if individuals have pre-existing medical problems, are taking other medications or exercise vigorously as part of their occupation or fitness program," said Wing Commander (Dr.) Victor Wallace. Wallace, a Royal Air Force exchange officer, is chief of flight medicine at the Air Force Medical Operations Agency in Washington, D.C.

Such supplements, which include so-called energy boosters, over-the-counter diet pills and bodybuilding drinks or mixes, may pose health and occupational risks -- even for those not taking other prescribed drugs, Wallace said.

Today, at least 20 states and the National Football League are among those that have banned or restricted use of ephedrine products.

The Air Force surgeon general's office issued a policy letter in October 1999 cautioning military members, especially those on flying status and the personnel reliability program, to consider herbal and dietary supplements as "over the counter" medications.

The policy requires these members to discuss using supplements with their health care providers before taking them. There's good reason for that.

Ephedra and its alkaloids, derived from the plant Ma Huang, are central nervous system stimulants. They are chemically related to pseudoephedrine, the synthetic active ingredient in Sudafed, Wallace said.

"Some people have used it in an attempt to lose weight, although there remains considerable scientific debate as to its effectiveness in this regard," he said.

Ephedra content, which the product label should display, can range from 15 to 60 milligrams per serving. But there's evidence that some product labels haven't reflected actual content, Wallace said. Other products include as much as 900 milligrams of caffeine, an amount equal to six to eight cups of brewed coffee or eight to 22 cups of instant coffee.

Ephedra and ephedra alkaloids can produce a number of side effects "including increased blood pressure and heart rate, insomnia, anxiety, tremors, agitation, skipping heartbeats, vomiting and may exacerbate problems with body heat regulation if exercising in hot environments," Wallace said.

Between 1994 and 1997, the Food and Drug Administration received and investigated more than 800 reports of adverse events associated with using products containing ephedrine alkaloids. They ranged from episodes of high blood pressure, irregularities in heart rate, insomnia, nervousness, tremors, headaches, seizures, heart attacks, strokes and sudden death, according to an FDA statement.

Most events occurred in young to middle-aged otherwise healthy adults using the products for weight control, to increase energy or to enhance fitness.

In 2000, The New England Journal of Medicine published results of a study conducted by two California physicians who reviewed reports of 140 deaths or injuries from adverse events dealing with ephedra alkaloids reported to the FDA between June 1997 and April 1999.

The study concluded:

* 10 events resulted in death

* 13 produced permanent disability

* 31 percent of the cases were considered definitely or probably related to using supplements containing ephedra

* 31 percent were deemed possibly related to using supplements containing ephedra

* 47 percent involved cardiovascular symptoms and

* 18 percent involved the central nervous system.

The FDA doesn't regulate dietary supplements the same way it does prescription and other over-the-counter products. Under the Dietary Supplement Health and Education Act of 1994, it's up to the supplement's manufacturer to ensure its product is safe before marketing it, according to the FDA.

On the other hand, the FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market. Generally, manufacturers don't need to register with the FDA or get FDA approval before producing or selling dietary supplements.

That means it's up to the consumer to beware. Check with the manufacturer of the dietary supplement to find out about side effects.