Recently, a young cardiologist in California warned about a rise in heart rhythm issues in "twenty-somethings" due to herbal supplements. However, as a physician with 40 years of medical training and practice as a busy cardiologist, I disagree with the headlines and the hype. While there is some concern about the safety of herbal supplements, they can also benefit many patients. The case for alarm was made without statistics or case studies from her practice.
The four supplements of concern highlighted in the article include Ephedra, which was removed from the U.S. market in 2004 due to safety concerns. Her call for alarm rests on a single case study of someone sourcing black market Ephedra, which is hardly a crisis to be focused on. Bitter orange is another supplement of concern, although there are no case studies on actual heart rhythm issues. Additionally, none of my 20-something patients have chosen bitter orange for their health. A single case study of an herb called ashwagandha was hyperlinked in the news report, featuring 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 its safety and benefits in many conditions, including thyroid disease. I have seen many of my patients benefit from ashwagandha by reducing stress and anxiety and reporting fewer heart irregularities. Finally, the 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 healthcare practitioners and can also be purchased over the counter in many stores.
Prescription Omega-3 fatty acid preparations are given by healthcare 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. Therefore, prescriptions are the greater risk.
When it comes to the safety of dietary supplements, consumers should pick supplements that are GMP certified, which stands for Good Manufacturing Practices. The National Science Foundation and other organizations inspect dietary supplement manufacturers to ensure that they follow recommended practices and that the manufacturer has GMP training for all employees.
In my clinic, patients with simple palpitations and irregularities of the heart consistently respond 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 prescription or over the counter, have the potential to heal or do harm. Annually, over 1 million patients go to emergency rooms as a result of adverse reactions to prescription medications. Therefore, herbal preparations, like all dietary supplements and prescription drugs, should be considered in terms of quality, risks, and benefits. While there are concerns about the safety of some herbal supplements, bitter orange and fish oil are not worthy of the fear-factor article that made headlines this week.
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