Once Again, They’re Coming After Your Supplements

On July 29th, Consumer Reports (CR) released a report identifying 15 supplements as "potentially" harmful with "insufficient health benefits to justify the risk."1 As they stated in the introduction to their report, "With the help of an expert panel of independent doctors and dietary-supplement researchers [more on this panel in a moment], Consumer Reports identified 15 supplement ingredients that are potentially harmful. The risks include organ damage, cancer, and cardiac arrest. The severity of these threats often depends on such factors as pre-existing medical conditions as well as the quantity of the ingredient taken and the length of time a person has been exposed to the substance.

"Many of the ingredients on this list also have the potential to interact with prescription and over-the-counter medications, such as cholesterol-lowering statins and blood-thinning drugs like aspirin and warfarin (Coumadin and generic).

"Moreover, our experts agree that none of these supplement ingredients provide sufficient health benefits to justify the risk. Even so, we found all 15 ingredients in products available online or in major stores such as GNC, Costco, CVS, Walmart, and Whole Foods."

The Panel

Before we look at the actual report, let's examine the reality behind it for a moment. The following information is included in the report's background briefing, "Methodology Behind "15 Ingredients to Always Avoid."2 First, let's look at the expert panel of independent doctors and dietary-supplement researchers. The one thing that stands out is that they all come from mainstream academia. There isn't one alternative health doctor or supplement formulator in the bunch.

• Pieter Cohen, M.D., FACP, assistant professor of medicine at Harvard Medical School and an internist with the Cambridge Health Alliance in Cambridge, Mass. Cohen is a noted expert on the safety and regulation of dietary supplements and the author of more than three dozen peer-reviewed and published studies on dietary supplements.
• Philip J. Gregory, Pharm.D., M.S., FACN, director of the Center for Drug Information & Evidence-Based Practice and associate professor of pharmacy practice at Creighton University in Omaha, Neb.; associate editor, Journal of Evidence-Based Complementary and Alternative Medicine; and editor-in-chief, natural medicines, Therapeutic Research Center, Stockton, Calif.
• Arthur P. Grollman, M.D., distinguished professor of pharmacological sciences and Glick Professor of Experimental Medicine at Stony Brook University in New York. Grollman is a recognized expert on the clinical pharmacology of herbal medicines and has testified on that subject before the White House Commission on Alternative and Complementary Health Policy; the Senate Subcommittee on Commerce, Science, and Transportation (Sen. John McCain, chairman); and the Governor of New York's Task Force on Life and Law. He has also published more than 200 papers in the fields of molecular biology and cancer research.
• Donald M. Marcus, M.D., professor of medicine and immunology emeritus at Baylor College of Medicine in Houston. Marcus has published numerous papers on the hazards of nonvitamin and nonmineral supplements, and has made presentations on this subject at medical schools and national professional meetings.
• Paul A. Offit, M.D., professor of pediatrics in the division of infectious diseases, director of the Vaccine Education Center at the Children's Hospital of Philadelphia, and author of "Do You Believe in Magic? Vitamins, Supplements, and All Things Natural: A Look Behind the Curtain" (Harper, 2014).
• Marvin M. Lipman, M.D., FACP, FACE, is the chief medical adviser for Consumer Reports. Lipman has represented the public as a member of the Board of Trustees of the U.S. Pharmacopeia and has served on several FDA advisory panels. He has authored articles on the dangers of dietary supplements. He is professor emeritus of clinical medicine at New York Medical College in Valhalla, N.Y.

I always find it fascinating when the mainstream feels they can evaluate some alternative treatment or supplement without having anyone who actually works in the field be part of their study. It always reminds of the medical doctor I met years ago at a seminar who told me that he had become an expert in alternative health--the entire field--in one weekend of reading about it. That's pretty amazing since after 45 years of working in the field, I only claim to have a good general understanding of it--with expertise in just a couple of specialized areas. All I can say, sarcastically speaking, is that he was certainly smarter than I am…as it appears is everyone else connected with mainstream medicine.

An MD once told me he had become an expert in alternative health--the entire field--in one weekend of reading about it.

Pre-existing Bias

That background briefing then went on to say that many people regard dietary supplements as a safe and "natural" component of a healthy lifestyle. But ingredients in "numerous" supplements pose significant health risks. The briefing then cites a 2013 report from the Government Accountability Office that showed that the Food and Drug Administration received 6,307 reports of health problems from supplements between 2008 and 2011, including more than 1,000 serious injuries or illnesses, hundreds of life-threatening conditions, and 92 deaths.

Despite those risks, according to the briefing, manufacturers of supplements are not required to prove to the FDA that their products are safe to take before they reach the market. That puts a heavy onus on consumers to arm themselves with accurate information. And I would agree with that. The question we're asking today is: does the Consumer Reports (CR) article constitute "accurate information...or bias?"

The Risks

The 15 ingredients listed in the CR article are contained in products found available for sale in the U.S. According to CR, the severity of the risks cited often depends on such factors as pre-existing medical conditions, the quantity of the ingredient consumed, and the length of time that a person has been exposed to the substance. But all of the ingredients meet one or more of the following criteria:

• 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.

Incidentally, how tenuous or marginal those associations may be is not an issue for CR. As long as someone, somewhere, at some time, has made that association, that qualifies the supplement for inclusion on their list. And that's a big deal as we will soon see.

To identify products that contained these 15 ingredients, CR searched the ingredients lists on the labels of products available on each retailer's website. For retailers that did not sell their products online, such as Whole Foods, they visited stores near their Yonkers office and examined product labels. In the case of stores such as Costco that carry a different selection of products online and in-store, they reviewed the ingredients lists of the products available online and also visited local stores to examine product labels.

The Report

Ingredient	Claimed Benefits	Risks
Aconite Also called: Aconiti tuber, aconitum, angustifolium, monkshood, radix aconti, wolfsbane	Reduces inflammation, joint pain, gout	Nausea, vomiting, weakness, paralysis, breathing and heart problems, possibly death
Caffeine Powder Also called: 1,3,7-trimethylxanthine	Improves attention, enhances athletic performance, weight loss	Seizures, heart arrhythmia, cardiac arrest, possibly death; particularly dangerous when combined with other stimulants
Chaparral Also called: Creosote bush, greasewood, larrea divaricata, larrea tridentata, larreastat	Weight loss; improves inflammation; treats colds, infections, skin rashes, cancer	Kidney problems, liver damage, possibly death
Coltsfoot Also called: Coughwort, farfarae folium leaf, foalswort, tussilago farfara	Relieves cough, sore throat, laryngitis, bronchitis, asthma	Liver damage, possible carcinogen
Comfrey Also called: Blackwort, bruisewort, slippery root, symphytum officinale	Relieves cough, heavy menstrual periods, stomach problems, chest pain; treats cancer	Liver damage, cancer, possibly death
Germander Also called: Teucrium chamaedrys, viscidum	Weight loss; alleviates fever, arthritis, gout, stomach problems	Liver damage, hepatitis, possibly death
Greater Celandine Also called: Celandine, chelidonium majus, chelidonii herba	Alleviates stomachache	Liver damage
Green Tea Extract Powder Also called: Camellia sinensis	Weight loss	Dizziness, ringing in the ears, reduced absorption of iron; exacerbates anemia and glaucoma; elevates blood pressure and heart rate; liver damage; possibly death
Kava Also called: Ava pepper, kava kava, piper methysticum	Reduces anxiety, improves insomnia	Liver damage,exacerbates Parkinson's and depression, impairs driving, possibly death
Lobelia Also called: Asthma weed, lobelia inflata, vomit wort, wild tobacco	Improves respiratory problems, aids smoking cessation	Nausea, vomiting, diarrhea, tremors, rapid heartbeat, confusion, seizures, hypothermia, coma, possibly death
Methylsynephrine Also called: Oxilofrine, p-hydroxyephedrine, oxyephedrine, 4-HMP	Weight loss, increases energy, improves athletic performance	Causes heart rate and rhythm abnormalities, cardiac arrest; particularly risky when taken with other stimulants
Pennyroyal Oil Also called: Hedeoma pulegioides, mentha pulegium	Improves breathing problems, digestive disorders	Liver and kidney failure, nerve damage, convulsions, possibly death
Red Yeast Rice Also called: Monascus purpureus	Lowers LDL ("bad") cholesterol, prevents heart disease	Kidney and muscle problems, liver problems, hair loss; can magnify effect of cholesterol-lowering statin drugs, increasing the risk of side effects
Usnic Acid Also called: Beard moss, tree moss, usnea	Weight loss, pain relief	Liver injury
Yohimbe Also called: Johimbi, pausinystalia yohimbe, yohimbine, corynanthe johimbi	Treats low libido and erectile dysfunction, depression, obesity	Raises blood pressure; causes rapid heart rate, headaches, seizures, liver and kidney problems, heart problems, panic attacks, possibly death

What is the Truth?

The above table is fascinating. The most notable thing about it is that it contains no references--either for the list of risks or the assertion that any benefits are merely "claimed." Remember, in their preface to the table, they stated, "Moreover, our experts agree that none of these supplement ingredients provide sufficient health benefits to justify the risk," thereby dismissing any claims to possible health benefits. But is that dismissal warranted--supported by fact? Let's look at some of the ingredients in detail to see how well they stand up the report's assertions.

Chaparral

I've talked about chaparral in detail in my report on blood cleansing, so I'm just going to save myself some work and grab from that report.

Native Americans have used chaparral for centuries as an anticancer remedy. In fact, it is the cornerstone of most anticancer herbal formulas. Exactly how it works is open to debate, but some of its main actions are:

• Chaparral is one of the most powerful anti-oxidants in nature. The primary biochemical responsible for this is NDGA (nordihydroguaiaretic acid). NDGA is so effective that it is often used as a food preservative. 
• It is anti-pathogenic. In other words, it kills viruses, bacteria, and parasites. 
• Chaparral has even shown much promise with herpes. 
• Chaparral cleanses the lymph system. 
• It cleanses the blood. 
• It cleanses the liver. 
• It cleanses the urinary tract. 
• It's a natural chelator that clears heavy metals from the blood. 
• Studies show that chaparral may also inhibit uncontrolled cell proliferation as well as damage to DNA. 
• And a number of university studies have indicated that chaparral can destroy and dissolve many types of tumors. 

We'll talk more about the science behind many of these benefits in a moment, but first we need to address the safety issue.

The obvious question is how could such a beneficial herb be on every government's blacklist? According to the FDA, citing a 1997 study published in the Archives of Internal Medicine, "Chaparral: sold as teas and pills to fight cancer and "purify blood," has been linked to serious liver damage. FDA has recorded two deaths and 10 cases of hepatitis or other liver abnormalities in users."3

The reality, though, is that the evidence for chaparral liver toxicity is anecdotal. It's not the result of any double blind studies or clinical trials. For example, one of the two cases the FDA likes to cite can be found in a 1995 issue of the Journal of the American Medical Association.4 The details of the case concern a 60-year-old woman who developed jaundice and liver failure while taking one to two capsules of chaparral each day with a pinch of garlic in a tea made from nettle and chickweed. The authors of the JAMA article concluded it must have been the chaparral that caused the liver problems. What is fascinating is that the patient in question was also consuming atenolol, aspirin, using a nitro patch, and occasional acetaminophen, as well as diltiazem hydrochloride--all drugs with profound hepatotoxic potential. Amazingly, none of these other substances were even considered as a possible cause of the liver problems by the authors...or the FDA. What a surprise!

Nevertheless (and despite the fact that Dr. Norman Farnsworth's extensive studies on chaparral in the 1970s and 1980s found no hepatotoxic effects for chaparral whatsoever), in December 1992, FDA Commissioner David Kessler announced, "The public should not purchase or consume chaparral."

After these allegations of liver toxicity by the FDA, manufacturers voluntarily restricted sales of chaparral for several years until the reports were investigated. Following a lengthy review, a panel of medical experts concluded "no clinical data was found... to indicate chaparral is inherently a hepatic toxin." In late 1994, this report was submitted to the FDA and chaparral was subsequently given a clean bill of health by the American Herbal Products Association (AHPA). After comparing the quantity of chaparral consumed each year (it is estimated that over 200 tons, 500 million capsules, were sold in the U.S. in the 1970's and 80's alone) to the number of product complaints, industry regulators concluded that chaparral did not pose a significant threat to consumer safety. Dr. Clark Watt and a group of scientists and doctors concluded that hepatotoxicity was most likely due to an allergic reaction rather than "inherent liver toxicity."5 And in 2001, a retrospective clinical study published in The Journal of Alternative and Complementary Medicine found no evidence of liver toxicity from the use of low dose chaparral.6

The bottom line is that despite the claims in the CR report, chaparral has been fully cleared in terms of liver damage. The only concern is possible allergic reactions. But let's think for a moment about how likely that is. Consider that even though chaparral has been in use as an herbal supplement for several centuries, and that millions and millions of doses have been consumed, only a tiny handful of "possible" complaints concerning allergic reactions have ever been reported. When you compare that to acetaminophen, which, according to a 2005 study published in Hepatology, is the leading cause of acute liver failure in the United States, by far,7 then Consumer Reports' complaints about chaparral appear to be extremely bad research at best, and disingenuous at worst.

But what about the dig from CR that chaparral does not have sufficient proven benefits to warrant what amounts to an almost non-existent risk? Setting aside the centuries of anecdotal evidence, are there any studies that demonstrate benefits?

Chaparral studies

According to a report in the May 2010 issue of the Medical Science Monitor, numerous studies have shown that the main metabolite of chaparral, NDGA, is likely effective in the treatment of multiple diseases, such as cardiovascular diseases, neurological disorders, cancers, and in the field of tissue engineering.8 The report went on to explain that several medicinal properties such as NDGA's antineoplastic, antiviral, and anti-inflammatory characteristics have been supported by in vitro and in vivo experimental studies, as well as historical reports. Studies have also confirmed that NDGA has extensive pharmacological effects and specific mechanisms of actions. It is a strong antioxidant; it can scavenge ROS (reactive oxygen species, AKA free radicals) or inhibit ROS production, stimulate nitrous oxide production, increase immune function, enhance central nervous system function, and prevent cardiovascular or other diseases. And tissue engineering studies demonstrate that NDGA-crosslinking is an effective way to improve the mechanical properties and biocompatibility of artificial tissues and organs.

And when it comes to cancer, there are a number of studies that show the benefits of chaparral and NDGA--and many of them recent. For example, a 2010 study published in Bioorganic & Medicinal Chemistry Letters found that several synthetic variations of NDGA act as inhibitors against human liver cancer.9 The results of this study were reinforced by a study published in 2014 inChemMedChem that found that eight methylated versions of NDGA were protective against liver cancer.10 Incidentally, I started with two studies on chaparral's ability to inhibit liver cancer specifically to counter any lingering concerns over its falsely rumored liver toxicity, but its anticancer benefits are by no means limited to liver cancer. As a 2012 study published in Breast Cancer Research and Treatment shows, it's equally protective against breast cancer.11 And a 2008 study published in the journal Prostate shows that it might be just as effective in dealing with prostate cancer.12 And then, of course, there are the numerous studies that show that NDGA is more effective than acyclovir when it comes to treating the viruses HIV, HSV,13 and HPV14--HPV being notable as a primary factor in the onset of cervical cancer. And for that matter, studies have shown that NDGA and its derivatives are directly effective against cervical cancer itself.15

At this point, I think it is safe to conclude that there is more than just bad scholarship involved in CR's report. The complaints about chaparral are clearly agenda driven. But that's just one of the 15 ingredients. Anybody can make a mistake--unless there's a pattern of misrepresentation in the report.

Red Yeast Rice

The first thing we notice is that the risks associated with red yeast rice in the CR report--kidney and muscle problems, liver problems, hair loss; can magnify effect of cholesterol-lowering statin drugs, increasing the risk of side effects--look surprisingly familiar. In fact, they are theexact same side effects associated with statin drugs, especially Mevacor. That's curious. How could that be? Well, as it turns out, one of the most important components in red yeast rice is monacolin K, also known as lovastatin, which just happens to be the active ingredient in the prescription drug Mevacor. Hmmm, if Mevacor and red yeast rice contain the same active ingredient, why would the claim that red yeast rice lowers LDL ("bad") cholesterol and prevents heart disease be considered questionable by the panel? Just saying.

And in fact, there is a pair of studies published in 2009, one in the Annals of Internal Medicine16and the other in the American Journal of Cardiology17showing that a red rice yeast supplement works as well to lower LDL ("bad") cholesterol as prescription statin drugs. The study included 62 patients, all of whom quit taking statins because of muscle pain, the most common side effect of these drugs. Half the 62 patients in the study received a red rice yeast supplement; the other half were given a placebo. After three months, average LDL levels among those taking the red rice yeast had dropped an average of 27 percent compared with six percent among the placebo group.

Even better, only seven percent of the patients taking the supplement with the natural lovastatin developed muscle pain, whereas among the pharmaceutical statin users, at least twenty percent (almost three times as many) experienced muscle pain, although, to be fair, many improved once their bodies got used to the drug. Which brings up the question: if they have the same active ingredient, why would red yeast rice perform better than the pharmaceutical drug? And the answer is that red rice yeast is a natural source of statins, which means that unlike pharmaceutical drugs, it provides a mix of beneficial compounds rather than just monacolin K. The complex mixture interacts with the body more smoothly and is less likely to cause toxicity. The lead researcher of theAnnals of Internal Medicine study, David Becker, M.D., of Chestnut Hill Cardiology in Pennsylvania, said that because the dose of monacolin K in the red rice yeast supplement used in the study was five times smaller than the amount in a typical Mevacor prescription, "something else is having a powerful lipid-lowering effect."

Bottom line: for the panel to say that any benefits associated with red rice yeast are questionable is simply disingenuous. They have the same active ingredient! Now to be fair, their argument might be that the greater number of side effects associated with the pharmaceutical drugs as well as its lower effectiveness are not concerning because the drugs are being prescribed by a doctor, whereas the people using the red rice yeast are self-medicating. But isn't that a circular argument, which ultimately translates as: don't use supplements because they might work? And really, isn't it more than a bit disingenuous to consider doctors responsible gatekeepers of medication when they now want to prescribe statin drugs for nearly 25 million adults, and at ever younger ages?18

Green Tea Extract Powder

The risks they're listing for this supplement are dizziness, ringing in the ears, reduced absorption of iron; exacerbates anemia and glaucoma; elevates blood pressure and heart rate; liver damage; possibly death.

That just seems plain silly. We're talking about green tea here.

In fact, it's probably based on recommendations for green tea extract published in The American Journal of Gastroenterology, saying it can be toxic and cause liver failure.19 According to those guidelines, the culprit is too many catechins, a key polyphenol antioxidant found in green tea. According to the journal, catechins target mitochondria--the powerhouses of your cells. The problem is that if you have too high a dose of catechins in your bloodstream (over 500 mg a day), they prevent the mitochondria from being able to help your body metabolize food and turn it into energy, which can lead to jaundice, hepatitis, or liver failure. The problem is that some outlying weight-loss supplements that use green tea extract as their primary ingredient contain up to 700mg in one capsule and come with instructions to take several capsules daily.

Let's be clear here, the problem isn't with green tea extract powder, but with stupid formulators and marketers who have no idea what they're doing and encourage people to vastly overdose on a beneficial ingredient. Given that situation, why would you throw the baby out with the bathwater? You don't dismiss the supplement, you control the irresponsible companies. (Incidentally, when I use green tea extract in my ultimate antioxidant formula, I only use 120 mg a day.)

Well, that covers the safety issue, but what about efficacy? Both the CR experts and the ACG Guidelines are dismissive of any benefits associated with green tea extract. How valid is that position?

When taken for weight-loss, there is certainly some validity to their concerns, but even then, there is no question that accelerating metabolism, which the caffeine in the green tea will do, helps you lose weight. The problem, of course, is that there are better ways to accelerate metabolism that don't carry the risks associated with massive overdoses of green tea. But again, we're talking about bad formulations and ignorant marketers. Setting weight-loss aside, though, and despite the claims to the contrary by the CR panel, there are numerous studies attesting to the benefits of green tea--either consumed as a beverage or taken as a supplement.

As a refresher on green tea extract, green tea antioxidants are of the same family as grape seed and pine bark extracts. They are polyphenols, chief of which are the flavonoids called proanthocyanidins. In green tea, the main proanthocyanidins are the catechins, and the most powerful of the catechins is epigallocatechin gallate (EGCG), found in the highest concentration in green tea. It works to prevent tumors from developing the blood vessels they need to survive (anti-angiogenesis),20 and it has been shown to inhibit metastasis.21 It is the first known natural telomerase inhibitor, eliminating the "immortality" of cancer cells, which is what makes them so deadly.22 Green tea is particularly effective in destroying the causes of leukemia, prostate cancer, and breast cancer. It has also been shown to be effective in regulating blood sugar, reducing triglycerides, and in reversing the ravages of heart disease.23 (Incidentally, the Japanese, who drink large amounts of green tea, have some of the lowest rates of cardiovascular disease in the world.) Green tea seems to almost totally prevent cancer from causing DNA damage in smokers--a possible explanation as to why the Japanese, who are among the world's heaviest smokers, have such a low incidence of lung cancer.24 And finally, green tea has great benefits for the brain as well, serving as an effective monoamine oxidase (MAO) inhibitor, protecting against brain-cell death. The net result is that there are strong indications that green tea extract may play a major role in protecting against both Parkinson's and Alzheimer's disease.25

More recently, there's the study published just last month in Nutrients that confirmed that tea catechins inhibit breast cancer.26 And more to point, there's the Acta Cardiologica Sinica study, also published just last month, which seems to run counter to The American Journal of Gastroenterologyrecommendations. This study found that green tea catechins produced a significant reduction in LDL cholesterol levels versus placebo--with greater benefits in patients not taking statin drugs.27The bottom line is that once again the implication that the supplements on the CR list provide no proven benefits seems more than a tad disingenuous.

Conclusion

That the Consumer Reports conclusions represent bad research, bad scholarship, and bad science would seem to go without saying. Unfortunately, I don't think that's the worst of it. Keep in mind, the panel that put them together is comprised of some very bright academics. There's no way they make that many mistakes accidentally. And let's be honest here, it's not only that they screwed up on just three of the 15 ingredients, or that they stretched the truth on a number of others such as kava kava, lobelia, and caffeine powder for that matter. No, the real statement of intent is that so many of the ingredients they list are outliers in the world of supplements.

Go to vitacost.com, which has one of the largest supplement inventories in the world. Search on Coltsfoot, Germander, Greater celandine, Methylsynephrine (which by the way is not a dietary supplement), and Usnic acid. None of them are available for sale. Can you find them elsewhere? Yes, vitaminsshoppe.com sells one celandine product and none of the others. But best of all is when you search vitacost.com for Aconite. Several products do indeed appear, but they're all homeopathic formulas. As it turns out, aconite is a homeopathic ingredient. And remember, one of the knocks against homeopathy in the scientific community is that homeopathic products may not have a single molecule of the original ingredient in the final formula. So Consumer Reports is warning you about an ingredient that may not even appear in the products that list them on the label. Why would they do that?

And the answer is simple. In fact, all one has to do is look at the title of their report to understand what's going on: "15 Supplement Ingredients to Always Avoid." The key word here is "supplements." This report is not about the 15 ingredients in the list. It's about all supplements. The purpose of this report is to undermine the credibility of all supplements. It's yet another attempt to promote the idea that supplements, in general, are dangerous--and pretty much always useless. It's an attempt to promote the ultimately ridiculous idea that no natural ingredient is ever useful or safe. That when it comes to health, the only thing that is safe and good for you is a pharmaceutical drugs. Trust me, I'm a doctor! If you think I'm exaggerating, then look how the media promoted the CR report.

• "Consumer Reports Highlights Dietary Supplement Dangers." ABC News28
• "New report exposes potential dangers of dietary supplements." WNCT TV29
• "Are Herbal Supplements Safe?" Medical Daily30

You get the idea.

If your name is John Wayne Bobbitt, you want a surgeon after your wife "adjusts" you, not an herbalist.

As I have stated on many occasions before, unlike many in the alternative health community, I'm actually a fan of doctors and like much of what the medical community does. And sometimes there is simply no natural alternative. If your name is John Wayne Bobbitt, you want a surgeon after your wife "adjusts" you, not an herbalist. But, and this is absolutely crucial to understand and acknowledge, medical doctors and their supporting academics have no monopoly on health and safety. And by no means should you ever trust them or the medications they prescribe for you blindly. If you think supplements account for death and destruction, then you need to check out the over 100,000 deaths a year caused by adverse reactions to properly prescribed, pharmaceutical drugs31 or the fact that we are now facing the largest drug addiction epidemic in the history of our country because people trusted their doctors when they prescribed opioid pain killers like candy. And if you think, "Well yes there might be risks, but at least pharmaceutical drugs always provide benefits, then you might want to reconsider. Even the medical community itself doesn't believe that. For instance, there's a huge debate in the medical community about the risks VS benefits of statin drugs, but you'd never know it. Like any good PR machine, the medical community makes sure you don't see that debate. As a result, people keep using vast quantities of questionable statin drugs. Sometimes doctors simply prescribe drugs because they're in the habit of prescribing them--not because they're safe or they work.

• 1."15 Supplement Ingredients to Always Avoid."  Consumer Reports July 27, 2016. http://www.consumerreports.org/vitamins-supplements/15-supplement-ingredients-to-always-avoid/
• 2."Methodology Behind "15 Ingredients to Always Avoid."" ConsumerReports. (Accessed 8 Aug 2016.) http://www.consumerreports.org/content/dam/cro/magazine-articles/2016/September/Consumer_Reports_Magazine_Methodology_Behind_15_Ingredients_to_Always_Avoid_9-16_Issue.pdf
• 3.Sheikh, N. M.; Philen, R. M.; Love, L. A. "Chaparral-associated hepatotoxicity." Arch Intern Med, 157(8), 913-919. http://www.accessdata.fda.gov/scripts/Plantox/Detail.CFM?ID=28
• 4.Dafna W. Gordon, Gayle Rosenthal, John Hart, et al. "Chaparral Ingestion, the Broadening Spectrum of Liver Injury Caused by Herbal Medications." JAMA. 1995;273(6):489-490. http://jama.jamanetwork.com/article.aspx?articleid=386895
• 5.Watts, C. "Final Report to the American Herbal Products Association." Special Counsel, Ford and Ferraro, LLP, Austin, TX. 6 Sept 1994. Unfortunately, there do not appear to be any internet accessible copies available at this time.
• 6.SILENA HERON, N.D., and ERIC YARNELL, N.D. "The Safety of Low-Dose Larrea tridentata (DC) Coville (Creosote Bush or Chaparral): A Retrospective Clinical Study. THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE. Volume 7, Number 2, 2001, pp. 175--185
• 7.Larson AM et al. "Acetaminophen-Induced Acute Liver Failure: Results a United States Multicenter, Prospective Study." HEPATOLOGY 2005;42:1364-1372. http://www.ncbi.nlm.nih.gov/pubmed/16317692
• 8.Lü JM, Nurko J, Weakley SM, Jiang J, et al. "Molecular mechanisms and clinical applications of nordihydroguaiaretic acid (NDGA) and its derivatives: an update." Med Sci Monit. 2010 May;16(5):RA93-100. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2927326/
• 9.Hwu JR1, Hsu CI, Hsu MH, Liang YC, Huang RC, Lee YC. "Glycosylated nordihydroguaiaretic acids as anti-cancer agents." Bioorg Med Chem Lett. 2011 Jan 1;21(1):380-2. http://www.ncbi.nlm.nih.gov/pubmed/21123067
• 10.Hsu MH1, Wu SC, Pao KC, Unlu I, et al. "Hepatocellular carcinoma targeting agents: conjugates of nitroimidazoles with trimethyl nordihydroguaiaretic Acid." ChemMedChem. 2014 May;9(5):1030-7. http://www.ncbi.nlm.nih.gov/pubmed/24648164
• 11.Zhang Y1, Xu S, Lin J, Yao G, Han Z, Liang B, et al. "mTORC1 is a target of nordihydroguaiaretic acid to prevent breast tumor growth in vitro and in vivo." Breast Cancer Res Treat. 2012 Nov;136(2):379-88. http://www.ncbi.nlm.nih.gov/pubmed/23053656
• 12.Ryan CJ1, Zavodovskaya M, Youngren JF, Campbell M, Diamond M, Jones J, Shiry L, et al. "Inhibitory effects of nordihydroguaiaretic acid (NDGA) on the IGF-1 receptor and androgen dependent growth of LAPC-4 prostate cancer cells." Prostate. 2008 Aug 1;68(11):1232-40. http://www.ncbi.nlm.nih.gov/pubmed/18491370
• 13.Chen H1, Teng L, Li JN, Park R, Mold DE, et al. "Antiviral activities of methylated nordihydroguaiaretic acids. 2. Targeting herpes simplex virus replication by the mutation insensitive transcription inhibitor tetra-O-methyl-NDGA." J Med Chem. 1998 Jul 30;41(16):3001-7. http://www.ncbi.nlm.nih.gov/pubmed/9685239
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