Dietary Supplements

Herbs and other dietary supplements are the most commonly used complementary therapies for children and adolescents. The U.S. Food and Drug Administration (FDA) defines dietary supplements as oral preparations that may include vitamins, minerals, single or multiple herbal ingredients, amino acids, essential fatty acids, hormones (such as melatonin and DHEA), and probiotics. More than $4 billion are spent on these products each year in the USA. Some uses are common and recommended, such as vitamin D supplements for breast-fed infants, whereas other uses are more controversial, such as using echinacea to treat upper respiratory infections. Use of dietary supplements is most common among children whose families have higher income and education and whose parents use them, and among older children and those suffering from chronic, incurable, or recurrent conditions. Less than 50% of patients who use supplements talk with their physician about their use. Even when asked directly, some patients deny using herbs (such as coffee, cranberry, protein powders, probiotics, or fish oil) because they do not consider their use to be medicinal and they consider them to be safe because they are “natural.” To elicit a complete history, clinicians need to ask patients routinely about and provide examples of dietary supplements.

Although they are generally safe, natural products can cause serious toxicity (Tables 59-1 to 59-5). For example, acute hepatic toxicity and death can result from ingestion of even small amounts of Amanita mushrooms. Ephedra, also known as ma huang, is banned as a weight loss or sports supplement in the United States because of its toxicity. Even when a product is safe when used correctly, it can cause mild or severe toxicity when used incorrectly. For example, although peppermint is a commonly used and usually benign gastrointestinal spasmolytic included in after-dinner mints, it can exacerbate gastroesophageal reflux. Probiotics are generally safe when taken orally, but in an immune-compromised patient in an ICU setting, they can cause sepsis. Excessive vitamin C or magnesium can cause diarrhea.

Table 59-1 POSSIBLE HERBS FOR ASTHMA

Table 59-2 COMMONLY USED SEDATIVE HERBS

Table 59-3 HERBS FOR SKIN CONDITIONS

Table 59-4 POTENTIALLY TOXIC HERBS

Table 59-5 SPANISH-ENGLISH BOTANICAL NAME TRANSLATION CHART*

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