Supplements side effects

Tests showed that although side effects of red rice products are not more common or more severe than those of competitor medications, safety issnes must be considered very carefully. Red rice has been tested under controlled conditions on fewer people that the pure active substances in medicines. Another cause for caution is that the known side effects of drags have to be registered by authorities, whereas no similar obligation exists for dietary supplements. Side effects may very easily remain hidden or totally unrecognized, especially if they only develop in the long term, which makes establishing causahty difficult. 

Stevioside and rebaudioside A are diterpene glycosides. The sweetness is tainted with a bitter and undesirable aftertaste. The time—intensity profile is characteristic of naturally occurring sweeteners slow onset but lingering. The aglycone moiety, steviol [471 -80-7] (10), which is the principal metaboHte, has been reported to be mutagenic (79). Wide use of stevia ia Japan for over 20 years did not produce any known deleterious side effects. However, because no food additive petition has been presented to the FDA, stevioside and related materials caimot be used ia the United States. An import alert against stevia was issued by the FDA ia 1991. In 1995, however, the FDA revised this import alert to allow the importation and use of stevia as a diet supplement (80), but not as a sweetener or an ingredient for foods. Several comprehensive reviews of stevia are available (81,82). 

Several different niacin formulations are available niacin immediate-release (IR), niacin sustained-release (SR), and niacin extended-release (ER).28,29 These formulations differ in terms of dissolution and absorption rates, metabolism, efficacy, and side effects. Limitations of niacin IR and SR are flushing and hepatotoxicity, respectively. These differences appear related to the dissolution and absorption rates of niacin formulations and its subsequent metabolism. Niacin IR is available by prescription (Niacor ) as well as a dietary supplement which is not regulated by the FDA.28 Currently, there are no FDA-approved niacin SR products, thus, all SR products are available only as dietary supplements. 

Non-enteric-coated pancreatic enzyme supplements can be used for initial therapy. The relative dose of amylase, lipase, and protease may be increased until control of pain and fatty diarrhea is achieved or the patient experiences intolerable side effects. If pain and diarrhea control are achieved, the patient can be transitioned to an enteric-coated supplement to maximize compliance. A reasonable example starting regimen is Viokase-8, six tablets with each meal and at bedtime, given with famotidine 20 mg at bedtime. 

Obtain a thorough medication use history, including present and past drugs prescription and nonprescription drugs the patient s self-assessment of response and side-effect problems use of alcohol, tobacco, caffeine, and illicit substances and use of herbal products and dietary supplements, as well as any allergies and adherence difficulties. 

Some precautions are based on the dietary supplement s side effect profile. St. John s wort may induce photosensitivity therefore, fair-skinned persons should be cautioned about exposure to bright sunlight while taking the herb. 

A dietary supplement may be safe when taken in the recommended doses but may become dangerous in higher doses. However, patients may develop side effects even when ingesting recommended doses. Adverse reactions may be due to allergic reactions, dietary supplements containing toxic substances, mis-identification of plant, mislabeling of plant, natural toxic substances such as pyrrolizidine alkaloids in comfrey, unnatural toxic substances such as heavy metals, or pesticides. 

Side effects may be as mild and rare as headache, nausea, and stomach upset for saw palmetto [23,24], However, some supplements may have serious side effects. Hypertension, euphoria, restlessness, nervousness, insomnia, skin eruptions, edema, and diarrhea were reported in 22 patients following long-term ginseng use at an average dose of 3 g of ginseng root daily [38]. Side effects reported with valerian use include headaches, hangover, excitability, insomnia, uneasiness, and cardiac disturbances. Valerian toxicity including ataxia, decreased sensibility, hypothermia, hallucinations, and increased muscle relaxation have been reported [39]. 

Siems, W, Wiswedel, I, Salerno, C, Crifo, C, Augustin, W, Schild, L, Langhans, CD, and Sommerburg, O, 2005. Beta-carotene breakdown products may impair mitochondrial functions—Potential side effects of high-dose beta-carotene supplementation. J Nutr Biochem 16, 385-397. 

Figure 4.2 Steve Bechler, a former pitcher for the Baltimore Orioles, died after taking a weight loss supplement containing ephedra. Here he is being taken off the playing field during training camp, when he began to suffer from heat exhaustion, a side effect of ephedra-based drugs.

Figure 6.1 Anna Nicole Smith, a famous actress and model, reports that she used the dietary supplement TrimSpa to achieve her recent weight loss. Advertisements like these encourage consumers to believe they will achieve miraculous weight loss results, i.e., look like a runway model, if they use this product. These advertisements never even hint at the potential side effects associated with this diet pill.

Unlike with drugs, manufacturers of dietary supplements do not have to disclose potential side effects of their products to consumers. The label of the supplement may contain a cautionary statement, but the lack of such a statement does not mean that no adverse effects are associated with the product. Dietary supplements may also interfere with the activity of other medicines (drugs or other supplements) an individual is taking. Also unlike with drugs, the manufacturer is not required to disclose these interactions to the consumer. 

In February 2004, the FDA withdrew ephedra, one of the most popular dietary supplements, from the market because it finally had enough information to prove that ephedra presented an unreasonable risk of illness or injury under the conditions of use recommended on the product labeling. This withdrawal did not happen until many people suffered from the terrible potential side effects of this supplement (see Chapter 4). 

G, Gasbarrini A Effect of Lactobacillus GG supplementation on antibiotic-associated gastrointestinal side effects during Helicobacter pylori eradication therapy A pilot study. Digestion 2001 63 1-7. 

There is some evidence that long-term cyclic administration of rifaximin combined with fiber supplementation is effective for inducing symptomatic relief in patients with uncomplicated diverticular disease of the colon. A therapeutic gain of approximately 30% compared to fiber supplementation only can be expected. The drug is well tolerated and no relevant side effects have been reported. Symptoms attributed to diverticula (abdominal pain or discomfort, bloating, disturbance of bowel habits) are nonspecific symptoms and are also features of irritable bowel syndrome. It has been suggested that irritable bowel syndrome and diverticular disease of the colon may coexist in many people and when bowel symptoms occur with diverticulosis coli, they may be due to a coexistent irritable bowel rather to the diverticula themselves [47, 48]. This hypothesis is supported by the fact that many patients with symptomatic diverticular disease show co-... 

A newer therapeutic approach is the administration of betaine (6-12 g daily), which lowers homocysteine levels by favoring remethylation [33], A theoretical hazard of betaine treatment is increasing the blood methionine, sometimes to an extravagant degree ( 1 mmol/1). Experience to date indicates that betaine administration is safe, with no major side effects except for a fishy odor to the urine. Other therapeutic approaches have included the administration of salicylate to ameliorate the thromboembolic diathesis. Patients also have been treated with dietary supplements of L-cystine, since the block of the transsulfura-tion pathway in theory could diminish the synthesis of this amino acid. 

Oral pancreatic enzyme supplements are available as powders, uncoated or coated tablets, capsules, enteric-coated spheres and microspheres, or enteric-coated microtablets encased in a cellulose or gelatin capsule (Table 28-2). Microencapsulated enteric-coated products are not superior to recommended doses of conventional non-enteric-coated enzyme preparations. The quantity of active lipase delivered to the duodenum appears to be a more important determinant in pancreatic enzyme replacement therapy than the dosage form. GI side effects appear to be dose related but occur less frequently with enteric-coated products. 

Hardman, W. E., Moyer, M. P., and Cameron, I. L., 1999, Fish oil supplementation enhanced CPT-11 (irinotecan) efficacy against MCF7 breast carcinoma xenografts and amehorated intestinal side-effects, Br. J. Cancer SI 440-448. 

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