Dietary supplements and side effects

Supplements, which are not held to the same federal approval standards as over-the-counter and prescription drugs, despite their widespread use, contain active ingredients that can have

strong effects on the body, the National Institutes of Health’s (NIH) Office of Dietary Supplements explains. And in some products, these ingredients can be particularly potent. Cohen points

to red yeast rice as an example — it’s a traditional Chinese culinary and medicinal product that’s “been used for hundreds of years to treat a variety of problems.” In the U.S., supplements

containing red yeast rice are often marketed as effective at lowering cholesterol, and that’s because some red yeast rice products contain a substance produced by the yeast that is

“chemically identical to the active ingredient in the cholesterol-lowering drug lovastatin,” the NIH’s National Center for Complementary and Integrative Health says. Some supplements contain

no or low levels of this substance (known as monacolin K), but others are formulated “more like a prescription drug,” Cohen says. In turn, they can cause the same types of side effects and

drug interactions as lovastatin, like muscle pain and weakness and liver toxicity, according to the NIH. And often consumers have no way of knowing how much of this prescription-like

substance is present in a supplement.  Supplements can also interact with other drugs in dangerous ways. Vitamin K can hamper the effectiveness of blood thinners, while vitamin E can augment

their power, increasing the risk of bleeding. And Saint-John’s-wort can weaken the effects of some heart medications, antidepressants and statins. Older adults need to be especially careful

when it comes to possible interactions such as these, Cohen warns, since “many people who are over 65 are taking prescription medications.” In fact, more than 4 in 10 adults 65 and older

take at least five prescription drugs a day, and nearly 20 percent take 10 or more, according to a Lown Institute report. What’s more, older people don’t metabolize compounds found in drugs

and supplements as efficiently as their younger peers. “So taking excessive supplements can certainly lead to more problems in someone [who has a harder time] getting it out of their system,

because the kidneys are not functioning like they would in a 20- or 30-year-old,” he explains. MOST-USED NATURAL PRODUCTS BY U.S. ADULTS 1. Fish oil/omega 3/DHA, EPA fatty acids 2.

Glucosamine and/or chondroitin 3. Probiotics/prebiotics 4. Melatonin 5. Coenzyme Q10 6. Echinacea 7. Cranberry (pills or capsules) 8. Garlic supplements 9. Ginseng 10. Ginkgo biloba _Source:

National Center for Complementary and Integrative Health/NIH_ In some instances, the FDA has identified supplements containing prescription drugs and other active ingredients not listed on

the label, ratcheting up the risk for additional side effects and reactions. A study published in _JAMA Network_ found that pharmaceutical ingredients were identified in 776 dietary

supplements between 2007 and 2016. Most were marketed for sexual enhancement, weight loss or muscle building.