It’s be­come a part of ev­ery­day life for mil­lions of Aus­tralians but is the sup­ple­ment in­dus­try ac­tu­ally putting our health in dan­ger? JANE HANSEN re­ports.

The Sunday Telegraph (Sydney) - - THE SNITCH -

It’s a multi-bil­lion dol­lar busi­ness, and one in three Aus­tralians reg­u­larly take their prod­ucts, but health ex­perts are con­cerned the in­creas­ing pop­u­lar­ity of herbs and sup­ple­ments is con­tribut­ing to a spate of liver trans­plants. With more and more peo­ple turn­ing to sup­ple­ments for health rea­sons, gen­eral prac­ti­tioner Dr Sam Manger warned the in­dus­try had be­come like “big pharma’’, em­ploy­ing the same sales tac­tics as ma­jor phar­ma­ceu­ti­cal com­pa­nies and sell­ing hun­dreds of dol­lars worth of con­coc­tions to vul­ner­a­ble peo­ple who had lit­tle un­der­stand­ing of the ef­fects.

“It’s about money, it’s the new ‘big pharma’,” Dr Manger said. “It uses all the same dirty tricks but with far, far, less reg­u­la­tion and very low stan­dards. It’s the Wild West.”

Dr Manger re­cently y saw a pa­tient who had d spent more than $2000 0 on vi­ta­mins, min­er­als, ho­moeopathies and var­i­ous tests when sim­ple life­style changes would have fixed her ail­ments.

“She’d spent thou­sands s over a month, the sup­ple­ments caused a wide range of side-ef­fects and she had quite a se­vere re­ac­tive e de­pres­sion as a re­sult, along with who-knows-what other sup­ple­ment side-ef­fects that were in­ter­act­ing, and she had lost much of her sav­ings,” he said.

Dr Manger was so shocked he took a pho­to­graph of the pyra­mid of sup­ple­ments that had been pre­scribed by an al­ter­na­tive health prac­ti­tioner. He also re­cently saw a man who sought al­ter­na­tive ther­apy for a car­ci­noma. “He had been us­ing black salve for over a year at the rec­om­men­da­tion of his nat­u­ral ther­a­pist, it had grown to over 15cm long and a deep ul­cer, I sus­pect it would be metastatic now and will be too late for him,” he said.

Trans­plant physi­cian As­so­ciate Pro­fes­sor Si­mone Strasser (in­set above), from the Aus­tralian Na­tional Liver Trans­plan­ta­tion Unit in Syd­ney, said they saw six pa­tients last year who had taken too many sup­ple­ments, iron­i­cally in the pur­suit of health.

“We are see­ing more and more peo­ple de­vel­op­ing se­vere liver in­jury re­lated to herbal and di­etary sup­ple­ments, sup­ple­ments taken at the gym, for weight loss, for all sorts of things,” she said. “We are cer­tainly see­ing more and more peo­ple de­vel­op­ing se­vere liver in­jury re­quir­ing trans­plan­ta­tion or a month in hos­pi­tal to re­cover and some­times not re­cov­er­ing at all.

“A pa­tient re­cently had a trans­plant, she was in her 40s and took a herbal com­pound for weight loss and she re­quired a liver trans­plant. There is very lit­tle reg­u­la­tion in the in­dus­try. Peo­ple ex­pect they are safe be­cause they are so-called nat­u­ral and they are c clearly not.”

Stud­ies have shown that herbs such as garcinia cam­bo­gia, Jin bu huan, Ma huang, Pen­ny­royal and green tea ex­tract can all c cause liver fail­ure, while a 2014 Amer­i­can study found se­vere liver in­jury a at­trib­ut­able to health and di­etary sup­ple­ments had in­creased from 7 per cent t to 20 per cent over the p pre­vi­ous decade.

Syd­ney mum Ann G Gil­berthorpe knows the dan­gers all too well. She ended up on life sup­port af­ter tak­ing herbal teas and sup­ple­ments to fight a virus. Her liver was de­stroyed and she re­quired an ur­gent liver trans­plant to sur­vive.

“In in­ten­sive care the doc­tor said ev­ery­one thinks these things are nat­u­ral but so is fun­nel-web venom,” she said. In 2016, Ger­ald­ton man Matthew Whitby, then 27, also suf­fered liver fail­ure and needed a trans­plant af­ter buy­ing green tea ex­tract on­line. “I didn’t re­ally think green tea ex­tract could be harm­ful,” he said af­ter his life­sav­ing trans­plant.

Dr Rose­mary Smith, who wrote a re­search paper on Mr Whitby’s case, said the easy ac­cess to such prod­ucts was part of the rea­son physi­cians will start to see more cases.

“These prod­ucts were pre­vi­ously mostly found in spe­cial­ist stores or on­line but in­creas­ingly they are avail­able in main­stream su­per­mar­kets,” she said.

“This is surely sec­ondary to de­mand, and de­mand is not sur­pris­ing given that such prod­ucts are mar­keted as ben­e­fi­cial for health. In­deed, they are of­ten found in the su­per­mar­ket ‘health food’ sec­tion.”

While some sup­ple­ments like fo­late for preg­nancy are ev­i­denced­based and rec­om­mended by doc­tors, the sup­ple­ment in­dus­try has dou­bled in value in the past 10 years with an ex­plo­sion of prod­ucts with du­bi­ous claims, like pro­tect­ing eyes from smart phones and mak­ing kids smarter. Ac­cord­ing to the Com­ple­men­tary Medicines Aus­tralia re­port 2018, the “num­ber of Aus­tralian con-

sumers who used a com­ple­men­tary medicine on a reg­u­lar ba­sis in 2015 was 8.1 mil­lion, up 22.7 per cent from 6.6 mil­lion in 2011”. The same re­port showed most peo­ple (41 per cent) pur­chased their herbs and sup­ple­ments from phar­ma­cies who are in­creas­ingly hir­ing natur­opaths to “achieve sales tar­gets’’ as one re­cently posted job ad­ver­tise­ment for a natur­opath in a New­cas­tle phar­macy said.

In­deed, Ta­ree phar­ma­cist Ian Carr has voiced his con­cern about the blur­ring of lines be­tween ev­i­denced-based phar­ma­ceu­ti­cals be­ing sold along­side sup­ple­ments, with natur­opaths hired in­store to sell them.

“They are sub­sidised by the sup­ple­ment com­pa­nies and they have to meet sales tar­gets” he said. “A lot of the sup­ple­ment com­pa­nies are owned by ‘big pharma’ now any­way but the dif­fer­ence is they can make claims that are du­bi­ous at best.

“I had a pen­sioner with a heart con­di­tion who was spend­ing over $100 a month on sup­ple­ments and she could not af­ford them.”

Natur­opaths, un­like doc­tors, are un­reg­u­lated which means any­one can call them­selves one, even if they have no train­ing. “Peo­ple are un­der the mis­un­der­stand­ing that any rec­om­men­da­tion (from a nat­u­ral ther­a­pist) is ev­i­dence based, but more of­ten than not it is ide­o­log­i­cal based. It’s very dan­ger­ous and it is killing peo­ple,” Dr Manger said.

The Na­tional Health and Med­i­cal Re­search Coun­cil put out a po­si­tion paper in 2015 af­ter a re­view of ho­moeopa­thy which found zero ev­i­dence it worked. Dr Jon War­dle, sec­re­tarygen­eral of the World Natur­o­pathic Fed­er­a­tion, said “cor­po­rate phar­ma­cies” who hired natur­opaths were prob­lem­atic and called for reg­u­la­tion.

“These are not meant to be com­mer­cial prod­ucts, they’re ac­tu­ally medic­i­nal prod­ucts and need to be treated as such,” he said. “The whole rise of cor­po­rate phar­ma­cies that are push­ing prod­ucts is where we see the prob­lems hap­pen­ing. It’s all based on sales quo­tas, I think reg­u­la­tory at­ten­tion is needed.

“A lot of phar­ma­cies are plac­ing un­re­al­is­tic sales quo­tas on natur­opaths. Asso­ciations like the Natur­opaths and Her­bal­ists As­so­ci­a­tion have been call­ing for natur­opaths not to be used as sales as­sis­tants in phar­ma­cies.’’

Pro­fes­sor Ken Har­vey, from Monash Uni­ver­sity, said the Ther­a­peu­tic Goods Ad­min­is­tra­tion (TGA) had failed in its duty to pro­tect Aus­tralians from in­ef­fec­tive health prod­ucts and dan­ger­ous sup­ple­ments which made un­sub­stan­ti­ated claims.

“It’s a combo of pro­mo­tional hype, quest for prof­its and a lack of reg­u­la­tion by the TGA,” he said.

John O’Do­herty, from Black­mores, one of the na­tion’s largest sup­ple­ment man­u­fac­tur­ers, said the com­pany dis­con­tin­ued a trial of natur­opaths placed in phar­ma­cies in favour of ed­u­cat­ing phar­ma­cists and sales as­sis­tants about their prod­ucts.

“We pro­vide ex­ten­sive and on­go­ing train­ing to phar­ma­cists to help en­sure cus­tomers re­ceive the best ad­vice and prod­ucts for their health needs,” he said.

Dr Sam Manger is con­cerned the sup­ple­ments in­dus­try is be­com­ing like ‘big pharma’ by putting prof­its ahead of needs.

Ann Gil­berthorpe, pic­tured at home in Hornsby, needed a liver trans­plant af­ter tak­ing herbal sup­ple­ments. Pic­ture: Tim Hunter

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