Over the counter dietary supplements are the most popular form of self-medication in Australia. Often considered a way of increasing our vitamin & mineral intake, can also be a dangerous way of self-diagnosing and self-medicating.
Marketing usually doesn’t include any of the side effects or the possibility of:
Adverse reactions.
Interaction with prescription medicines.
Toxicity.
High cost.
It is in fact very easy to get vitamins and minerals from a balanced diet:
Vitamin A is found in tuna, cheese, eggs.
Vit. E: nuts, veggies.
Vit C: F&V
Milk is rich in vit. & minerals…
Our GP/Health provider should be the one to find out if we do need to take any vitamins or minerals and to prescribe the appropriate type and most importantly the ‘correct’ dosage.
There are too many disadvantages and risks in self-prescribing.
The following link is a very interesting and valid one:
Products may bear some waffly statement like “may help in the management of bodily condition X”. Products do not need to have been tested to a scientific standard of rigour for efficacy i.e. that they actually work(!).
Bear in mind though that some people may have underlying medical conditions, particularly in the digestive system, that interfere with effective absorption of nutrients.
As you say, your GP should be involved in
what pathology tests should be used to identify deficiencies
interpreting the results of those tests
indicating what supplement and dosage thereof is appropriate, if any, potentially looping around a few times to get the dosage correct (or whether in fact the deficiency points to some other more specific medical problem that needs to be treated directly! or whether simple dietary change will address the issue).
Self-medication with something that on the one hand might not even work and on the other hand might be toxic at high doses is a Bad Thing.™
In my opinion the government has been asleep at the wheel on this one for a long time.
On a related point, non-active ingredients don’t have to be listed on the label, nor even mentioned.
I needed some Vit C to take with Iron supplements (GP “prescribed) and wanted some with no sugars and no sugar alcohols, since I’m recovering from a CDiff infection and my gut reacts badly to sugar alcohols.
I found a Blackmores tablet, stated ingredients Vit C and bioflavinoids.
I took one, and my gut reacted very badly. I checked their website, found the product, no mention of other ingredients. Read a review on their site on the same topic, and Blackmores had replied that, non-active ingredients don’t have to be listed on the label if they won’t fit, but can be found by searching for the product on the FDA site. Sure enough, the Vit C contains sugar alcohols.
So their approach was within the law, but consumer-unfriendly. When shopping for a supplement, I’d like to be able to trust what’s listed on the label. At the very least, a note that there are other ingredients would be preferable, and a note about where to find out about them.
I’m disappointed by Blackmores’ approach of sticking to the letter of the law when this can easily 1. waste the consumer’s money 2. potentially make the consumer sick 3. take extra effort for the consumer to find out exactly what other ingredients are included.
I do take vitamin supplements, particularly Vit C. My choice is Melrose brand, powdered form, and its not sodium ascorbate entirely, but calcium ascorbate. Cannot recall if one type is solely calcium ascorbate. 1/3 teaspoon is adequate dose.
Also take garlic, vit E, and 1 multi - not in high doses - toxic doses would be if i took 5 or 6 daily for couple weeks - that would be stupid and dangerous!
Another issue - turmeric - its used in countries on daily basis in diet, its a cultural ingredient, so its used in cooking and eaten from young age and by most of the population. Doubt if taking supplements in western diets will have major benefits. Same with many foods - its part of normal diet not as “extra” vitamin/health benefit - examples, yoghurt (unsweetened)(not Greek as so many other cultures have made yoghurt for centuries) and fermented foods, a staple daily item also for centuries.
The vitamin shelves at chemists are mind boggling in their variety - and as written elsewhere, not all ingredients listed.
While AUST L medicines have not been pre-market evaluated by the TGA, there is another type of listed medicine, called listed assessed medicines, which are evaluated by the TGA for efficacy pre-market. These have an AUST L(A) number on the medicine label. Like other listed medicines they can only use pre-approved low risk ingredients.
I’ve tried to find an example of a vit C Aust L(A) but couldn’t find any to include as an example.
The only supplements I use are Ostelin (doc prescribed, my D levels are staying in the proper range with one a day) and Magnesium in the hope that it will prevent cramps. Sometimes it doesnt.
This herbal remedy contains a herb called Andrographis paniculata that can trigger serious, even life-threatening allergic reactions.
In short:
After taking ArmaForce, a complementary medicine that promotes boosted immunity and relief from cold and flu symptoms, Kerry Smith experienced a severe reaction within minutes.
Her symptoms included itching, stomach cramps, difficulty breathing and a swollen tongue, requiring emergency hospital treatment.
ArmaForce contains a herb called Andrographis paniculata, which has been linked to 1,365 adverse event reports to the Therapeutic Goods Administration.
She had previously taken Armaforce without any such reaction, so hadn’t paid much attention to the warning on the label.
Ms Smith said that while she read the label, she misunderstood it to mean that she should not use it if she had a history of severe allergic reaction to ArmaForce, which she had previously taken without incident.
In fact, it means that anyone with a history of severe allergic reactions to anything, including bee stings, should not take the supplement.
I’m wondering whether Andrographis paniculata has only recently been added to Armaforce?
What is concerning is one might not know if they have a reaction until they take the supplement, the first time or from later doses like in the ABC article (even though earlier doses didn’t trigger a reaction). Some reactions have had catastrophic consequences:
I am surprised the TGA hasn’t taken strong action as it could pose risks to any user.
A reminder when self-medicating: read all labels carefully and never exceed a specified maximum daily dose. Paracetamol / acetaminophen overdose is very dangerous, and not only is the drug the main ingredient in many popular analgesics, it’s often present in over-the-counter cold and flu medications.
With my emphasis,
Acetaminophen poisoning is one of the leading causes of hospitalization and deathrelated to non-prescription drugs in the United States, according to Kennon Heard, MD, PhD, a professor in the CU Anschutz Department of Emergency Medicine and the department’s section chief of medical toxicology.
… Acetaminophen is the main ingredient in Tylenol and many store-brand pain relievers used for mild to moderate pain and low-grade fever. It is also included in a wide range of over-the-counter products for colds, flu, sinus symptoms, and menstrual discomfort.
There are related topics about this in Australia. A reality is many supplements as well as prescription medicines affect different persons differently based on sex, weight, overall health, and other medications/supplements being taken. What is a safe daily dose for one could be too much for another, yet not nearly enough for another.
And a corollary to that … be very careful about mixing medications.
In this case, I am saying that because two medications might overlap in their active ingredients and hence the dose of an active ingredient combines together to reach an excessive amount. (But there are more general problems with polypharmacy.)
Acetaminophen, found in Tylenol
Fortunately most Aussie consumers won’t recognise either of those names and hopefully therefore won’t be misled by the latest dubious health advice from RFK.
Until fairly recently the focus has been on what the pregnant person has been taking / eating / drinking before or during pregnancy, but there’s a growing body of evidence that the sperm supplier’s eating / drinking / supplement taking up to the time of conception can also have a major effect on a developing fetus.
The TGA will “consult stakeholders on plans to remove the herb from a list of low-risk ingredients” given that “unpredictable” reactions have continued in spite of mitigations including stronger warning labels.
The TGA’s safety review has found that people taking supplements containing Andrographis have experienced “unpredictable” reactions to the herb, regardless of whether they have taken the product for the first time or have used it previously.
Since 2005, the regulator has received 1,368 reports of adverse reactions related to medicines containing Andrographis, including 287 incidents of anaphylaxis.
“The sustained high reporting pattern since 2019 indicates that Andrographis is associated with risk of life-threatening anaphylaxis which is inconsistent with the low-risk regulatory framework for listed medicines,” the TGA’s report stated.
“Current risk mitigation strategies, including stronger label warnings, have not reduced the risk of anaphylaxis from Andrographis for it to be suitable for use in listed medicines.”
Unfortunately, many people who’ve had a very serious reaction to it would have said the same.
In fact, it’s now known thatpeople who’ve previously taken Andrographis paniculata without any problems can still be at risk.
It’s not yet known why it can suddenly start causing severe allergic reactions in such cases.
So … people can dutifully read labels and be aware of its presence, but assume they’re safe because they’ve had it before. After all, the labels say something like “Do not use if you have a history of severe allergic reaction”, which doesn’t apply in their cases.
The above article tells of two cases where people had a life-threatening reaction after previously having taken Andrographis paniculata without any problems. Neither would have been alerted by the typical label, because they naturally assumed they weren’t allergic to it.
The TGA’s now considering removing it from the list of low-risk ingredients in listed medicines (ones that can be bought over-the-counter in shops and pharmacies).
Should it take more drastic action, recalling all Andrographis paniculata-containing supplements / medicines and publicly warning about its surprise-allergic reaction ability?
At least until/unless it’s known what triggers the sudden allergic reactions?
Needless to say, it also doesn’t apply to a first time user. I imagine that a first time user has no way of knowing whether s/he will experience a “severe allergic reaction”.
Presumably therefore, if it remains legal at all to include this ingredient, the real consideration is: how far from a hospital ED am I and is my stoopid 000 call going to work?
Some supplements are routinely delivered to us via additions to water supplies (eg, fluoride) and some foods (eg, folic acid in bread).
Last century, iodised salt became an important defence against iodine deficiency, but that’s no longer the case.
Iodine deficiency is often seen as a problem of the past, but this isn’t entirely true. During the 20th century, the iodisation of salt became one of the most effective public health interventions for preventing conditions caused by a lack of this mineral, including goiter (enlargement of the thyroid gland) and preventable damage to neurological development.
The World Health Organization (WHO) still views iodised salt as a safe and effective strategy, while UNICEF notes that it is the most widely used way of improving iodine intake worldwide.
However, the success of this simple measure means iodine has all but disappeared from public debate. And today, in several countries, signs of insufficient intake are once again being detected in certain groups, particularly in pregnant or breastfeeding women and people on restrictive or poorly planned diets.
What we are witnessing is not a dramatic resurgence of the most severe symptoms everywhere, but rather a silent risk of deficiency in contexts where vigilance has waned.
A major reason for this silent increase in iodine deficiency is NOT that people don’t eat enough salt, but that these days most salt added to commercial foodstuffs – the major source of dietary salt for many people – hasn’t had iodine added.
With my emphasis,
the WHO itself has emphasised that reducing salt intake and fortifying salt with iodine are compatible, provided the concentration of the mineral is properly adjusted and salt used by the food industry is also fortified.
Iodine is present naturally in a lot of foods other than the ones that have had iodine added, but these are mostly animal products of one form or another – eg, eggs and dairy milk. Dried deaweed is an exception.
