In their April 2004 issue, Consumer Reports lists twelve supplements the magazine's researchers-and the FDA-consider to be too dangerous to be on the market. The list includes controversial hormone androstenedione, commonly called "andro", as well as kava, a popular stress-relief herb and bitter orange, commonly included in weight-loss formulas. It should be noted that the organization only researched the availability of these substances, but did not conduct their own research regarding their purported dangers. 

The article cites cases of liver and kidney damage, cancer, and even death supposedly resulting from the use of various dietary supplements. These products are often used to treat medical problems but are not regulated by the "drug" part of the US Food and Drug Administration, rather by the "food" part-thus the designation "dietary supplements". Since herbs and other supplements such as vitamins and amino acids are widely available and thus not eligible for patent protection, manufacturers usually will not perform the same kind of research on them as they do on pharmaceuticals, where the exclusivity of a patent allows them to recoup the money spent on research. Therefore, information on herbal and other so-called natural supplements is largely anecdotal and usually considered unreliable by mainstream medicine. 

While some of the claims of organ damage or death may have merit, many of the specific instances have not been conclusively linked to responsible use of the supplement despite CR's claims. So called "natural" supplements require the same caution as pharmaceuticals in considering pre-existing conditions, drug interaction, and side effects. Pharmaceuticals cause many more deaths per year than herbs do, yet few drugs are actually pulled from the market because of them. 

"If you can buy it at a clean, well-lighted store, if it's "all natural," it's not going to do you serious harm, right? That's what many Americans assume about dietary supplements." Consumer Reports, April 2004

Unfortunately, some people are under the assumption that, as the Consumer Reports article mentions, if a product is "natural" then it can't hurt you. Nothing could be farther from the truth. Cocaine and opium are perfect examples of natural substances that have legitimate uses, but can cause illness or death if used improperly. Oleanders make beautiful additions to a yard, but the leaves are highly poisonous. 

Not only are some people misguided as to the safety of natural products, but some people just shouldn't take certain substances that may be perfectly safe for general use. After all, even food allergies can be lethal. A person with high blood pressure should not take an herb such as yohimbe, which is known to raise blood pressure. For centuries pregnant women have benefited from black cohosh, but only in the last few weeks of pregnancy. The very therapeutic use of the herb, to help dilate the cervix and prepare the uterus for childbirth, shows how dangerous it would be to use earlier in the pregnancy. And while foxglove, from which digitalis derives, can save the life of someone with congestive heart failure or atrial fibrillation, it can cause heart palpitations, convulsions and even death if taken unnecessarily or in high doses. 

Andro and other similar supplements such as creatine and DHEA can be manufactured to specific standards, so strength and purity are generally not issues in pharmaceutical-grade products manufactured by reputable companies. 
Herbs, however, vary significantly in content of active constituents from crop to crop and even plant to plant. Often those compounds are "standardized", meaning the chemical is isolated from the plant so that each dose will contain the same amount of what is thought to be the substance that gives the desired result. 
Unfortunately, this process does not take into consideration the possibility that another chemical may actually be key, or that it's a synergistic combination where all elements must be present to achieve the desired result without causing unwanted side effects. Therefore data gathered from the use of standardized extracts may not accurately reflect the way the product performs in normal usage. 

Without standardization, though, it's difficult to determine potency. Manufacturers often add fillers, but even products without fillers may contain portions of the plant that contain few or no active ingredients, yet can still be labeled as the herb. Researchers at the University of Hawaii determined that the likely culprit in the allegations of liver damage among some kava users resulted from the inclusion of stem peelings and kava leaves in production of the herb for mass consumption by mainlanders. A particular compound found in the bark and leaves-but not in the root-showed potential for damage to liver cells. The islanders only use the root for their traditional kava drink, and in centuries of use have shown no ill-effects. Kava researchers noted a need to pay attention to local customs regarding the ingestion of unfamiliar herbs. 

Popular remedies such as kava and other herbs have the same potential for interaction as traditional medications do, not only with each other, but with prescription or over-the-counter drugs. While Chinese medicine often blends remedies with opposite properties to balance the formula, such choices should be made with caution, and overseen by an herbalist or a naturopath. When choosing an herbal remedy or supplement, consider how they may interact with any current therapeutic regimen. For instance, a patient taking prescription blood thinners should use ginkgo biloba with caution, since it also has anti-coagulant properties. The same patient should probably also avoid vitamin k supplements, as it facilitates blood clotting, thus neutralizing the effectiveness of both products. 

Finally, the characterization of almost any dietary supplement as being too dangerous to be sold smacks of protectionism and hypocrisy. The number of hospitalizations and deaths each year from mainstream drugs used as recommended-not even considering overdoses and abuse-outnumbers those from dietary supplements by such a margin as to be ridiculous. According to a 1998 article in the Journal of American Medicine, a conservative estimate had non-steroidal anti-inflammatory medications such as ibuprophen and naproxen responsible for over 100,000 hospitalizations and 16,500 deaths among arthritis patients alone! At one point Prozac was the most-prescribed drug in the country, yet it had 27 deaths linked to it before it was even released! 

So while herbs and other dietary supplements have their risks, so do pharmaceutical medications. Common sense is key in deciding what is "too dangerous". The simple truth is that anyone can have a reaction to anything, whether it be mainstream medication, dietary supplements, personal grooming products or food. Natural isn't necessarily safe, but then neither is synthetic. Overall, consumers should take care in the products they choose ask questions of their health care professionals, and most of all, take responsibility for their own health. 

Read the Consumer Reports article at: 
http://www.consumerreports.org/main/content/display_report.jsp?FOLDER%3C%3Efolder_id=419337&bmUID=1082088232831 or at www.consumerreports.org . 

See the list of supplements