Medicines & health claims
Supplement & medicine safety
Are your supplements on the same list as your prescriptions?
Most people do not think of supplements as medicines, so they leave them off the list. Yet some weaken or strengthen prescriptions, and none are checked by the FDA before sale. One complete list fixes most of it.
In 30 seconds
The short answer
Supplements can be beneficial, but they can also involve health risks.38 Some interact with medicines, interfere with lab tests or cause problems during surgery,3 and the FDA does not approve them for safety and effectiveness before they are sold.4 The fix is simple: keep one written list of everything you take, including supplements, and bring it to every visit.2426
- "Natural" doesn't always mean safe. Comfrey and kava, for example, can harm the liver.8
- St. John's wort is the big one. It can weaken birth control pills, transplant medicines, some HIV drugs and warfarin.15
- The label may not match the bottle. The FDA has found prescription drugs in products sold as supplements.9
- Before surgery, speak up early. Tell your providers about every supplement as far ahead as possible.22
Why supplements belong on your medicine list
Who checks what before it reaches the shelf
Medicines and supplements follow different rules.
Prescription and OTC medicines
One list, every visit
An illustration of the habit NIH recommends. It costs nothing and needs no new products.
What the research says
- What's on the label may not be what's in the product. The FDA has found warfarin, phenytoin and other prescription drugs in products sold as supplements.9
- Products promoted for weight loss, sexual enhancement and bodybuilding are the most likely to contain hidden drugs or unlisted ingredients.10
- St. John's wort weakens drugs by speeding up the body's processes that turn them into inactive substances.14
- In healthy adults given goldenseal with metformin, metformin levels fell about 25%.18
- Antioxidant supplements such as vitamins C and E might reduce the effectiveness of some cancer chemotherapy.36
- Problems are most likely when you combine supplements, mix them with medicines, take too much, or take them instead of medicines.7
Combinations worth asking about
| If you take | Ask about | What the source says |
|---|---|---|
| Warfarin (blood thinner) | Vitamin K; St. John's wort | Keep vitamin K about the same daily: sudden changes can cause bleeding or clots.29 St. John's wort can weaken warfarin.15 |
| Birth control pills | St. John's wort | Can weaken their effect.15 |
| Transplant or HIV medicines | St. John's wort; any supplement | Can weaken cyclosporine and some HIV drugs.15 Discuss every supplement.27 |
| Antidepressants | St. John's wort | Serotonin-related side effects can be serious.16 |
| Levothyroxine (thyroid) | Calcium; iron | Calcium carbonate within 4 hours cuts absorption; iron can reduce its effect.3031 |
| Metformin | Goldenseal | Metformin levels fell about 25% in healthy adults also given goldenseal.18 |
Examples from NIH sources, not a complete list. Ask a pharmacist about your own combination.
Before surgery
- Some supplements may affect anesthesia, increase bleeding, or change heart rate and blood pressure.21
- Tell your providers about every supplement as far in advance as possible.22
- Some providers ask patients to stop all herbal supplements several weeks before planned surgery.22
- In an emergency, you or a loved one should still tell the surgeon and anesthesia provider.23
How big is the problem?
Many adults and children in the United States take vitamins or other supplements.1 These published figures show why that matters.
Supplement problems are common, not rare
- 52% of American adults took at least one supplement in 2011–2012.2
- An estimated 23,000 emergency visits a year — many young adults with heart problems from weight-loss or energy products, and older adults choking on large pills.11
- In a 2012 government study, 20% of 127 weight-loss or immune supplements made illegal claims.12
The clinic's approach
The clinic whose documents inform this site, the Pakistan Institute of Medical Advancement in Karachi, recommends several products that are used outside standard medicine. Each proposal below is described as the clinic's documents state it, followed by what independent evidence shows.
The clinic's approach, and what the evidence shows
Four products the clinic's documents recommend; DMSO has two cards. Each card gives the clinic's own words first, then independent evidence.
Drinking MMS (sodium chlorite activated into chlorine dioxide) for cancer, autism, infections and HIV/AIDS
Proposed instead of standard careRegulator safety warning- Where the clinic says this
- Brochure set, pages 2–3: an "Amazing MMS Facts Sheet" printed under the clinic's name.3940 The sheet says it was written by private citizens.42
- The clinic's stated rationale
- Chlorine dioxide is said to destroy disease-causing microbes by oxidation and then break down into table salt and oxygen.41
- Evidence and limitations
- Chlorine dioxide is a genuine disinfectant for water and surfaces. Swallowed, MMS becomes chlorine dioxide, a powerful bleach.50 The FDA urges people not to use it for any reason, warning of severe vomiting, diarrhea and life-threatening low blood pressure,51 and it has reports of hospitalizations and deaths.52 The sheet itself notes the FDA's opposition.43
- What this means for you
- Do not drink or inject it, and never give it to a child. If someone has swallowed it, get emergency care or call a poison center, and tell the clinician exactly what was taken.
A calcium hypochlorite and chlorine dioxide capsule for hepatitis C, and a chlorine-based "Unibiotic" mix
Proposed instead of standard careRegulator safety warning- Where the clinic says this
- Brochure set, page 6 (hepatitis C);44 handwritten formulary, page 1 ("Unibiotic").45
- The clinic's stated rationale
- The brochure describes the injection course as expensive and unsuccessful and presents a chlorine-compound capsule as the alternative.44
- Evidence and limitations
- Hypochlorites are bleach chemicals. MedlinePlus describes sodium hypochlorite, a close relative of the compound named, as caustic and poisonous to swallow.53 A chlorine dioxide label kept in the clinic's website files reads "Non medicinal" and "Clean the Probe of Endoscopy".46 Hepatitis C itself is now curable: antiviral medicines cure more than 95% of people with chronic hepatitis C in 8 to 12 weeks.54
- What this means for you
- If you have hepatitis C, ask about antiviral treatment; it is short and usually curative. Do not swallow products made as disinfectants.
DMSO presented as an FDA-approved "wonder drug" for pain, wounds and degenerative disease, and as a killer of microbes said to cause cancer
Proposed instead of standard careNot proven- Where the clinic says this
- Brochure set, pages 4–5;47 clinic DMSO booklet, cover and page 3.48
- The clinic's stated rationale
- DMSO is said to attack "the disease itself rather than just the symptoms"47 and to kill microbes behind cancer and autoimmune disease.48
- Evidence and limitations
- DMSO is a real medicine with one approved use: a solution placed in the bladder to relieve symptoms of interstitial cystitis. Its label says it is not approved as safe and effective for any other use.55 "FDA approved" therefore applies to that bladder use only, not to the other uses the sheets list.
- What this means for you
- On the skin, DMSO is absorbed into the body's tissues and fluids,56 so treat it as a medicine: check with a pharmacist first, especially if you take other medicines.
EDTA presented as the "drug of choice" for blocked arteries, kidney and gallstones, blood pressure, osteoporosis, stroke prevention and all bacterial infections
Proposed instead of standard careRegulator safety warning- Where the clinic says this
- Brochure set, page 4;49 handwritten formulary, page 1.45
- The clinic's stated rationale
- The sheet presents EDTA as opening blocked vessels, removing stones and raising antibiotic success "up to 100%".49
- Evidence and limitations
- Chelation drugs are real prescription medicines, used under a clinician's supervision.57 The FDA has never approved a chelation product for over-the-counter use, and it warns of dehydration, kidney failure and death, and of proven care being delayed.5758
- What this means for you
- Chelation belongs under specialist supervision for a diagnosed problem. Do not stop heart, blood pressure, bone or infection medicines in favor of it.
DMSO at home during a stroke or heart attack, and DMSO packs over tumours
Proposed instead of standard careEvidence points the other way- Where the clinic says this
- Clinic DMSO booklet, pages 7–8;59 Urdu DMSO sheet, "tips".62
- The clinic's stated rationale
- The booklet says DMSO given soon after a stroke "has been shown to dissolve the stroke-causing clot", tells of a man who would not go to hospital, and suggests DMSO packs over tumours near the skin.59 An Urdu sheet gives "tips" for DMSO during a stroke and by mouth during a heart attack.62
- Evidence and limitations
- Stroke and heart attack are emergencies: call 911 right away, because immediate treatment may save a life.6063 The clot-dissolving medicine used in hospital for stroke can only be given within 4 hours of symptoms starting.61 DMSO is approved only as a bladder treatment.55
- What this means for you
- At any sign of a stroke or heart attack, call 911 at once; do not wait or treat at home. Do not use DMSO on a tumour in place of cancer care.
From the Dr. Majid Ali archive
A historical perspective
“In acute medical situations, blood thinners (Coumadin, Pradaxa, Xarelto, and Eliquis) can be life-saving.”— Dr. Majid Ali, 2014-10-17Dr. Ali's archive says very little about drug interactions; it was an alternative-medicine library, not a pharmacy one. One habit from it is worth keeping: ask what assumption sits underneath a dosing recommendation.
The same archive also holds the clearest example of why this page exists. A 2014 article agreed that blood thinners can be life-saving in acute situations, then argued that in chronic illness spices were preferable. That is exactly the kind of swap that current guidance warns against.734
Where ProperHealth stops. We reject the idea of spices in place of a blood thinner completely. Never use a supplement instead of a prescribed medicine without your provider's approval,34 and remember that changing what you take can tip warfarin into bleeding or clots.29
What to do next
Write one list with everything on it
Prescription and over-the-counter medicines, including supplements.24
Add the dose, how often and why
For each product: name, dose, how often, and the reason for use.28
Bring it, or the bottles, every time
Update it at each visit; bottles help your provider check ingredients.2526
Speak up early before surgery
Tell your providers as far in advance as possible.22
Ask before adding or swapping anything
Get your provider's approval before using a supplement with, or instead of, a prescribed medicine.34
Medicines, supplements and safety
A pharmacist can run a full interaction check, plan the timing of doses, and prepare a clean list for a surgeon or specialist. A pharmacist does not diagnose deficiencies, prescribe, or tell you to stop a prescribed medicine, and will not endorse a supplement as a substitute for one.
- St. John's wort interacts in dangerous, sometimes life-threatening ways with many medicines,13 so telling your providers is especially crucial.17
- Warfarin and vitamin K. Keep vitamin K from food and supplements about the same every day; a sudden change can cause bleeding or clots.29
- Thyroid medicine. Levothyroxine is not absorbed well within 4 hours of calcium carbonate,30 and iron can reduce its effect.31
- Narrow-range medicines such as carbamazepine, phenytoin, cyclosporine, digoxin and warfarin need special care, because small changes matter.1920
- Children. Accidental iron overdose is a leading cause of fatal poisoning in children under 6.32 Pregnancy: be cautious beyond a standard prenatal supplement.33
Compared
Conventional and integrative care, compared
How medicines and supplements are regulated differently, the interactions that matter most, why labels mislead, and the clinic's MMS, DMSO and EDTA sheets against the regulators' record.
How medicines are held to account
- Medicines must be shown to be safe and effective before they are sold; the FDA can act against a bad supplement only after it is on the market.6 The FDA does not have the authority to approve supplements or their labels before sale,4 and companies are responsible for the evidence that their products are safe and their labels truthful.5
- Approved chelation drugs need a prescription because they are only safe under a clinician's supervision; the FDA has never approved a chelation product for over-the-counter use.57 The FDA-approved DMSO product is a bladder solution for interstitial cystitis, not approved as safe and effective for any other use.55
Where supplements and medicines collide
- Problems are most likely when you combine supplements, mix them with medicines, take too much, or take them instead of medicines.7 St. John's wort interacts in dangerous, sometimes life-threatening ways with a variety of medicines13 — birth control pills, cyclosporine, some HIV drugs, warfarin, some antidepressants and some heart medicines.15 For narrow-therapeutic-range drugs even a little too much or too little causes serious reactions;19 examples are carbamazepine, phenytoin, cyclosporine, digoxin and warfarin.20 Around surgery, supplements may affect anesthesia, increase bleeding, or cause serious changes in heart rate or blood pressure.21
- A 2015 study estimated 23,000 U.S. emergency room visits a year from supplements.11 On warfarin, keep vitamin K steady;29 levothyroxine is poorly absorbed within 4 hours of calcium carbonate, quinolones within 2 hours of calcium;30 iron with levothyroxine reduces its effectiveness.31
Why the label is not enough
- What is on the label may not be what is in the product: the FDA has found prescription drugs, including warfarin and phenytoin, in products sold as supplements,9 and products for weight loss, sexual enhancement and bodybuilding may contain prescription drugs or unlisted ingredients.10 "Natural" does not always mean safe — comfrey and kava can harm the liver.8 Quality-testing seals do not guarantee that a product is safe or effective.37
Integrative and naturopathic approaches, by evidence
Evidence levels: EstablishedEmergingHypothesisNot supported
- Established
Bring a written list of every prescription and over-the-counter medicine and supplement, with doses and how often,24 or bring the bottles,25 and update it each visit.26 Get your provider's approval before taking a supplement in place of, or together with, a prescribed medicine.34 Before surgery, tell your providers about every supplement as far in advance as possible.22
- Not supported
A sheet printed under the clinic's name describes MMS as chlorine dioxide and says case histories show improvements and "even cures" in cancer, autism, infections and HIV/AIDS,39 suggests it for anyone willing to take responsibility for their own health,40 and itself acknowledges the FDA is firmly against medical use.43 The FDA: drinking MMS is the same as drinking bleach, causing severe vomiting, diarrhea and life-threatening low blood pressure,51 with reports of hospitalizations, life-threatening conditions and deaths.52
- Not supported
Clinic sheets call DMSO "a FDA approved drug" that "attacks the disease itself",47 a booklet calls it "The Wonder Drug" that kills the microbes behind cancer and autoimmune disease,48 says DMSO given soon after a stroke dissolves the clot and tells of a man who did not go to hospital,59 and an Urdu sheet gives tips for using it during a stroke or heart attack.62 If you think someone is having a stroke, call 911 right away;60 the clot-dissolving medicine tPA can only be given within 4 hours;61 with heart attack symptoms call 911 even if you are not sure.63 A clinic sheet presents EDTA as the "drug of choice" for osteoporosis, circulation, stroke prevention and "all kind of bacterial infection";49 the FDA warns that chelation can cause dehydration, kidney failure and death, and that relying on unproven chelation products delays proven care.58
Anyone telling you to replace a prescribed medicine with a supplement — do not stop your medicine; talk to your prescriber first.64
When to get help now
Each warning sign cites the official guidance behind it. The wording still needs pharmacist sign-off.
- Anyone telling you to replace a prescribed medicine with a supplement — do not stop your medicine; talk to your prescriber first.6465
- Unusual bruising, bleeding gums, blood in urine or stool, or a nosebleed that won't stop — especially on a blood thinner. Call your doctor right away.66
- Yellow eyes or skin, dark urine, or pain under the right ribs — stop the supplement and get seen promptly.676869
- Agitation, fever, a racing heart, shaking or confusion after adding a supplement to an antidepressant — contact your provider right away. This can be life-threatening.7071
- Chest pain, or a racing heart with dizziness or shortness of breath, after a weight-loss or energy product — call 911.7273
- A child swallowed iron or adult supplements — call Poison Control at 1-800-222-1222, or 911 if the child is unwell.7475
- Swelling of the lips or face, or difficulty breathing, with or without a rash, after a supplement — call 911.7677