Gluten Exposed: The Science Behind the Hype and How to Navigate to a Healthy, Symptom-free Life. Rory Jones
label on the [drug] my doctor prescribed—it was longer than my college thesis. Looked as if it would probably cure me if it didn’t kill me first. The labels on my supplements have no [listed] side effects of note.
(SHARON, 65)
They’ve been using these as medical cures in China for centuries.
(ANGELA, 33)
The fact that they have been used for thousands of years in the East may be the only justifiable claim many supplements can make. Although there is little scientific evidence to support the medical claims made in the popular media about the effectiveness of supplements, most people consider them “natural” and basically safe. But several recent and scientifically rigorous studies have proved that there are some very dangerous trends in this unregulated industry, and some supplements may have life-threatening consequences. A recent study in the New England Journal of Medicine showed that approximately 23,000 emergency room visits each year—between the years 2004 and 2013—were due to “adverse events related to dietary supplements.”
Laxatives in Your St. John’s Wort?
A 2015 Canadian study tested popular herbal supplements and found that many of the bottles contained pills that were diluted or contained none of the product listed on the label. Others consisted entirely of fillers such as soybeans, wheat, and rice—ingredients that were not necessarily on the label. These were the only “plants” in the pill. One bottle of St. John’s wort, the New York Times reported, “contained only Alexandrian senna, an Egyptian yellow shrub that is a powerful laxative.” Other supplements contained walnuts, potentially deadly for people with nut allergies. This study suggests that the problem may be widespread. It is especially troubling for those with a severe food allergy or requiring a strict gluten-free diet.
This study and others prompted the New York State attorney general in 2015 to issue a cease-and-desist order to several large chains selling supplements, requiring them to withdraw the products. He was joined by other state agencies. The aim of the initiative is to require manufacturers to address their own product issues so that supplements are not pulled from store shelves after they have done harm.
If you are currently gluten-free and suddenly have a return of symptoms, you may need to look at the supplements you take instead of what you had for dinner the night before. Unfortunately, inspecting the label may not help—the “FACTS” section of a supplement label may show the product contains very little or none of this important “ingredient.”
Another study published in the Journal of the American Medical Association found that half of the FDA Class I recalls between 2008 and 2012—where there is a “reasonable probability that [their use] will cause serious adverse health consequences or death”—were supplements. And about two-thirds of the recalled dietary supplements that were analyzed still contained banned drugs at least six months after being recalled. These banned and/or prescription-only drugs found in supplements included:
Sibutramine—a weight-loss drug that was withdrawn from the U.S. market in October 2010 since it is known to substantially increase blood pressure and/or pulse rate and may present a significant risk of heart attack and stroke in some people.
Sildenafil—used for erectile dysfunction, it can cause hearing loss and low blood pressure and reacts with a number of other prescription drugs.
Fluoxetine—trade name Prozac, this drug is sold only by prescription.
Phenolphthalein—formerly the main component in laxatives, such as Ex-Lax, banned by the FDA in 1999 for sale in the U.S. due to the risk of causing cancer with long-term use.
Aromatase inhibitor—used by prescription only in breast cancer treatments to lower estrogen levels.
Various anabolic steroids.
A September 2015 recall by the FDA is particularly sobering. Two weight loss supplements were found to contain both sibutramine and phenolphthalein—neither of which were listed on the label. They were marketed under the names Pink Bikini and Shorts on the Beach and sold online. The FDA also noted that “these products may also interact in life-threatening ways with other medications a consumer may be taking.”
Most of the FDA-recalled supplements were for bodybuilding, weight loss, and sexual enhancement. If you use these products, you may be getting an enhancement in the form of side effects you did not bargain for. Supplement labels may hide more than that pink bikini can.
When Your Doctor Advises Vitamin or Mineral Supplements
Vitamin deficiencies are often found in people with newly diagnosed celiac disease and require supplementation until the gut has healed and can absorb nutrients properly, and the deficiency is resolved. Anyone on a restricted diet or with another GI condition that involves malabsorption is also a candidate for supplementation.
We recommend choosing a gluten-free vitamin that has only the regulated amounts of vitamins. Try to avoid multivitamins that have megadoses of anything.
People who eat processed food are most likely getting their vitamins synthetically to begin with. Milk, fortified with vitamin D, is the primary source of D for most people who avoid the sun. Ironically, cereals, breads, flours, and canned foods all are fortified to replace the vitamins and minerals removed by processing. But manufacturers have just begun to fortify gluten-free foods, and this can pose problems for someone who has grown accustomed to obtaining their vitamins synthetically from processed food and is now on a gluten-free diet.
The pendulum can easily swing in the other direction. Many people still take megadoses of vitamins, assuming that if some is good, more must be better. We see more people with vitamin B6 toxicity than deficiency, due to excess supplementation.
Vitamin B6 (pyridoxine) is involved in many metabolic functions throughout the body. It is needed for brain development and function and involved in the process of making serotonin and norepinephrine, chemical transmitters in the brain. Although vitamin B6 is often promoted for “nervous system health,” its toxicity is usually focused on the nervous system. A vitamin B6 deficiency is rare in the general population since it is found in many foods.
Test First
It is not surprising that many people, anxious about the amount of different vitamins they are getting in their diet, rely so heavily on vitamin and mineral supplements. What is surprising is that they read the pros and ignore the cons—the toxicities, interactions with other vitamins and drugs, contamination, and mislabeling.
A vitamin or mineral deficiency can be ascertained by blood tests and addressed by some simple dietary changes.
A Word on Fatigue and L-Carnitine
L-carnitine is an amino acid that is produced by the body and a natural component of the diet. It helps the body produce energy and is used in Europe to treat fatigue and as a replacement supplement for people on a very strict vegetarian/vegan diet.
It is found in high levels in red meat and in lower levels in dairy products as well as pork, seafood, and chicken. High levels of carnitine are found in those who consume excess amounts of red meat. A natural compound, it is available by prescription as well as over the counter.
L-carnitine excess can cause a number of side effects including diarrhea, nausea, and cramps. It can interact with prescription drugs and is associated with increased risk of cardiovascular disease. You should take supplements only under a doctor’s instruction. (See chapter 17, “Celiac Disease.”)
Widely Used Supplements That Cause Drug Interactions
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