COMMENTARY

Time to Re-evaluate Herbal Supplements?

Caroline Apovian, MD

Disclosures

September 02, 2022

Caroline Apovian, MD

The unfortunate death of Lori McClintock, wife of Northern California congressman Tom McClintock, shortly after consuming the herbal remedy white mulberry leaf on December 15, 2021, gives us the opportunity to discuss how to better protect the American public from nutritional supplements with claims to aid health. Mulberry leaf has been purported to lower blood glucose levels, cholesterol, and inflammation as well as promote weight loss.

Many people desire to improve their health with concoctions purported to be "natural" or "from nature" instead of seeing a doctor and taking a medication or other therapy that is evidenced-based and backed by approval from the US Food and Drug Administration (FDA). With the burgeoning prevalence of obesity and type 2 diabetes in this country (and worldwide) and the lack of a magic bullet that can stop the progression of these life-threatening diseases, many Americans turn to herbal and nutritional supplements that claim to promote weight loss and improve health.

Passed in 1994, the Dietary Supplement Health and Education Act (DSHEA) has allowed manufacturers of herbal and nutritional supplements to be "off the radar" of government regulators, unless their products have been shown to do harm — which is the government's burden to prove.

A dietary supplement is defined as a product containing one or more vitamin, mineral, herb, or other botanical, amino acid, or other substance that would increase the total dietary intake of that product.

DSHEA exempted dietary supplements from the rigorous safety and efficacy testing that medications must undergo for various disease states, which is regulated by the FDA.

People With Obesity May Fall Prey to Dietary Supplements' Claims

Persons suffering from obesity and its metabolic sequelae may be susceptible to the claims of dietary supplements because:

  • The stigma associated with obesity, including the lack of understanding that obesity is a disease not under a person's control, may make those with the disease wish to remedy it on their own out of shame and peer pressure.

  • Clinicians and doctors traditionally have not been trained in obesity medicine so they aren't comfortable treating obesity.

  • It's only fairly recently that obesity was recognized as a disease, so many insurance companies still don't reimburse for obesity treatments, including the agents that can suppress appetite and result in weight loss.

For all of these reasons and more, only 2% or less of the millions of Americans suffering from obesity are treated with an antiobesity agent each year.

This has paved the way for the dietary supplement industry to prey on a desperate population, in much the same way that fad diets continue to attract multitudes of Americans. These supplements, however, carry much more risk than fad diets.

The solution, of course, is better regulation of the supplement industry, but it's also improvement of how obesity is treated by the medical community.

How Can Clinicians and the Community Help?

Government, academic, community, clinical, and lay persons are more frequently recognizing obesity as a disease. Stigma will slowly come to a halt, as it has for other diseases such as depression and addiction to alcohol and drugs. Medications that have undergone rigorous testing for safety and efficacy eventually will be prescribed more and covered by healthcare insurance. Clinicians, and specifically physicians, are the most trusted persons in terms of giving medical advice. We need to ask patients whether they are taking supplements and be vocal about their lack of protection against harm, as allowed by DSHEA.

It would not be overkill to add prompts to the medical record to ask patients not only about smoking, alcohol, and drug use but also about supplements of all kinds. Some medical records do use these prompts but they are not as ubiquitous as those for smoking, alcohol, and drug use.

The supplement industry is powerful, but so is the medical industry when it comes to lobbying for change. It is ironic that Lori McClintock was the wife of a congressman. Perhaps the silver lining is future work toward legislation advocating for an end to these tragic deaths from poorly regulated supplements. Alignment with government in pushing for stricter regulations could save lives in the future.

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