By David Kiefer, MD, Editor

Clinical Assistant Professor, Department of Family Medicine, University of Wisconsin; Clinical Assistant Professor of Medicine, Arizona Center for Integrative Medicine, University of Arizona, Tucson

Dr. Kiefer reports no financial relationships relevant to this field of study.

SOURCES: Mohney G. Consumer Reports highlights dietary supplement dangers. ABC News. Available at: Accessed Aug. 10, 2016.

Consumer Reports. 15 supplement ingredients to always avoid. July 27, 2016. Available at: Accessed Aug. 10, 2016.

Occasionally, there is current, hot-off-the-press information that is relevant to the readers of Integrative Medicine Alert but nonetheless doesn’t fit the traditional genres of Review Article, Abstract & Commentary, nor Short Report. We feel that it is important to share these pearls, and use the “Editor’s Note” as such a medium. As the above links detail, an ABC article on a Consumer Reports publication reviewed concerns surrounding dietary supplement safety. Consumer Reports melded its own research of “medical studies” (clinical trials, adverse event reports, government warnings, and “other literature” not specified) with recommendations by a six-person expert panel. Panelists’ biographies were provided in an attached file, as were the criteria (see Table 1) that the experts used to create a list of 15 ingredients to “always avoid.”

Table 2 lists the 15 dietary supplement ingredients that are the focus of this article. All of the experts have experience and documented knowledge on the topic, although three, as written, seem to have a focus in their background on the hazards and dangers of dietary supplement use, which could indicate some bias in the methodology behind this treatise. At the end of the article, there is a sentence and link imploring anyone who suspects that an adverse effect from a dietary supplement has happened to report it to the FDA; this is an important and useful alert.

Table 1: Criteria Used to Create the List of 15 “no-use” Dietary Supplement Ingredients

  • It has been associated with kidney or liver problems.
  • It has been associated with cardiac arrest or heart attack.
  • It has been linked to cases of organ failure.
  • It has carcinogenic properties.
  • It has been associated with a possible risk of death.
  • It has been found to contain pharmaceutical drugs at prescription doses.
  • The FDA has advised manufacturers to remove products containing it from the market.

SOURCE: Consumer Reports. Methodology Behind “15 Ingredients to Always Avoid." Available at: Accessed Aug. 10, 2016.

Table 2: 15 Supplement Ingredients to be Avoided, according to Consumer Reports

  • Aconite
  • Caffeine powder
  • Chaparral
  • Coltsfoot
  • Comfrey
  • Germander
  • Greater celandine
  • Green tea extract powder
  • Kava
  • Lobelia
  • Methylsynephrine
  • Pennyroyal oil
  • Red yeast rice
  • Usnic acid
  • Yohimbe

SOURCE: Consumer Reports. 15 supplement ingredients to always avoid. July 27, 2016. Available at: Accessed Aug. 10, 2016.

None of the information presented in the Consumer Reports article is new; concerns about label claims, regulation, adulteration, and supplement-pharmaceutical interactions have been on clinicians’ radar for years. These are important factors to consider when prescribing or counseling about dietary supplement use. In many cases, knowledge about the correct form, dose, and duration of use of a dietary supplement can keep such use aligned with evidence-based proof of efficacy and avoid most safety concerns. Accurate knowledge about the science of dietary supplements is a key component to help clinicians best guide (or avoid) the use of integrative therapies for their patients. In this vein, the Consumer Reports article misses the mark by merely listing 15 supplement ingredients “to always avoid” because of the possibility of “organ damage, cardiac arrest, and cancer.” The article itself softens this wording slightly by noting “potential” harms that are dependent on a variety of factors, such as supplement quality, duration of use, and a person’s past medical history, a more accurate representation of the multitude of factors to consider in dietary supplement counseling. For example, one ingredient listed is red yeast rice, a natural product that contains naturally produced statin compounds, which can cause the same liver toxicity as pharmaceutical statins; such an adverse effect is not a sure bet, and certainly not a reason to carte blanche remove red yeast rice from an integrative provider’s tool box. The article is correct in listing other ingredients, such as green tea extract powder (concerns about liver toxicity; little reason to use this product rather than green tea infusion) and chaparral (also known as creosote bush; concerns for liver toxicity with oral use; may still be some safe, indicated topical uses).

It is important for dietary supplement consumers and healthcare providers to always be aware of the risks of any treatment, and for this the Consumer Reports article serves an important purpose. Missing were some of the important details that those of us who work with dietary supplements regularly would really need to take this information and apply it to patient care.