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Aeromedical Forum

Flying with Dietary Supplements: Am I Bigger Yet?

Stop by the pharmacy section at the grocery or drug store and you’ll find a dietary supplement for just about everything you want to be: strong, big, potent, smart, handsome. You name it and somebody will sell you an extract of herbs and vitamins to fit the bill. Now I know that there are folks that swear by whatever they’re taking to achieve whatever they want out of life and that’s fine, sort of. Indeed more than 50% of adults in the US consume dietary supplements to the tune of $35 billion per annum. Big business! These supplements usually include vitamins, minerals, botanicals, amino acids and/or enzymes that according to the US Food and Drug Administration (FDA) are not meant for the treatment or prevention of diseases. The loophole that allows them to be marketed is the 1994 Dietary Supplement Health and Education Act. In this piece of work dietary supplements were classified as a category of food rather than a drug. Therefore they are not subject to the premarket safety and effectiveness testing that the FDA requires if they were to be sold as a drug to cure or prevent something. In practice that means that the supplement you buy may or may not contain the ingredients they say they do in the potency they claim. Also they may contain other potentially harmful ingredients that are not listed. A study that came out of the California Department of Public Health last October found that from 2007 through 2016, 776 dietary supplements were adulterated with potentially harmful drugs. These products came from 146 different companies. The most common adulterants were sildenafil (Viagra) for sexual enhancement supplements, sibutramine (Meridia) for weight loss and synthetic steroids for muscle building.

Mind you, the FDA does have some control of this potential mayhem. They rely on post-market reporting of adverse events (AKA a trip to the ER), consumer complaints and occasional inspection of the firms that make the stuff. The latter is happening less frequently as the FDA budget has been cut. Therefore, you are the test pilot for any new supplement the makers come up with. So what is the risk? One study found that dietary supplement use was associated with 23,000 emergency department visits and 2,000 hospitalizations in the United States each year. Illnesses associated with their use included stroke, liver failure, kidney failure, blood clots to the lung and death. Have I got your attention?

It’s pretty obvious that if you are a pilot, you have a substantial responsibility before you start belting down Essence of Deadly Nightshade to improve your whatever. For example, the Viagra that might be slipped into your sexual enhancement supplement can cause a dangerous drop in blood pressure and sudden vision loss, especially if you’re taking heart medications. Think you’ll be able to grease a landing with that going on? The sibutramine in your weight loss supplement has so many side effects such as stroke and heart attack it was banned in the US in 2010. The muscle building steroids can destroy your liver but a least you’ll look good when they roll you into the OR for the liver transplant.

So what’s a pilot to do? First of all ask yourself, “Do I really need this stuff?” The effectiveness of most supplements is debatable. A few such as St. John’s Wort can help in mild depression. (Oh, a side note: if you have chronic depression you need to ground yourself and talk with your AME). If you are unsure about your needs, a chat with your personal physician could help a lot. Second, “If I really need this stuff how can I be sure I’m getting what I need?” That’s a tough one. If the supplement you are seeking is manufactured in Germany go for that. The Germans regulate their supplement manufacturing tightly in contrast to the US, so your chances of getting a potent, unadulterated product are much greater. Also, you might check out the FDA’s Center for Drug Evaluation and Research Tainted Supplements database It won’t tell you what’s OK but it will steer you away from some of the bad actors.

So the bottom line is, if you want to take a supplement it is incumbent on you as a pilot to make sure that it is free of adulterants and is not causing any immediate or long term side effects that would impair the safety of flight. If you can’t do that, don’t take it!

Fly wisely. See you next month.


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