An article appeared this week that attracted a lot of national media featuring a young cardiologist in California warning that, in her practice, she is observing a rise in heart rhythm issues in “twenty somethings” due to herbal supplements.
In my 40 years of medical training and practice as a busy cardiologist, including being the first cardiologist in the world certified in Metabolic Cardiology by the Metabolic Medicine Institute/George Washington University, I take exception to the headlines and the hype. Do herbal supplements cause significant harm? Are they unregulated? Can they also benefit many patients?
The case for alarm was made without statistics or case studies from her practice. However, 4 supplements of concern were highlighted. One of these, Ephedra, was removed from the US market in 2004 and her call for alarm rests on a single case study of someone sourcing black market Ephedra, hardly a crisis to be focused on. My patients use many supplements for heart issues but none have ever used Ephedra. Another herbal supplement of concern was bitter orange although there are no case studies on actual heart rhythm issues. My 20-somethings over the last decades of practice have never chosen bitter orange for their health, another rarity. In addition, there are safety and efficacy trials of orange preparations and weight loss performed as randomized clinic studies without any heart issues observed. A single case study of an herb called ashwagandha was hyperlinked in the news report. It featured a 73-year-old with thyroid disease, hardly a “20-something”. In contrast, the National Library of Medicine has over 1,000 articles about Ashwagandha and over 30 randomized human studies indicating the safety and benefit in many conditions including thyroid disease. I have seen many of my patients benefit from ashwagandha by reducing stress and anxiety and they report fewer heart irregularities. Finally, a warning about Omega-3 fatty acids, known as fish oil, and the risk of atrial fibrillation was highlighted. While not an herbal supplement, fish oil capsules are commonly prescribed by health care practitioners and can also be purchased over the counter in many stores. Omitted from this recent article is that prescription Omega-3 fatty acid preparations are given by health care practitioners to meet “guideline derived medical therapy” recommendations at much higher doses than patients generally buy over the counter and studies show that the risk of atrial fibrillation appears to be dose related so the prescriptions are the greater risk.
Should you be concerned about dietary supplement quality? Pick supplements that are manufactured by companies that are GMP Certified. There are organizations that inspect and certify Dietary Supplement manufacturers. GMP stands for Good Manufacturing Practices. Organizations like NSF inspect Dietary Supplement manufacturers to make sure that they follow Good Manufacturing Practices and to ensure that the manufacturer has GMP training in place for all of their employees.
How about herbal and dietary supplements benefiting patients with heart arrhythmias, including 20-somethings? After a thorough examination and testing, patients with simple palpitations and irregularities of the heart in my clinic respond consistently by adding magnesium and coenzyme Q10. Vitamin C has been studied many times and can reduce forms of heart rhythm issues. Taurine has been reported to suppress palpitations and I consistently observe this in my practice.
Overall, many treatments, whether prescriptions or over the counter, have the potential to heal or do harm. Annually, over 1 million patients present to emergency rooms from adverse reactions to prescription medications. Herbal preparations, like all dietary supplements and prescription drugs, should be considered in terms of quality, risks, and benefits. We have a lot of health issues in the US, like the opioid crisis, but bitter orange and fish oil are not worthy of the fear factor article that made headlines this week.