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Vitamin Packets: Take With Caution


They hang on racks beside key chains at gas stations and crowd the candy bars at convenience stores: little packets full of pills promising a day's dose of energy, stamina and good health.

"You're there with your coffee and Danish, maybe you had a bad night, and you say, 'I'll try one of these,'" said Patrick Rea, director of natural product research at Nutrition Business Journal in San Diego. "It's an impulse buy," he adds, and "you're not even thinking much about what's in it.''

Perhaps you should, doctors say. The contents of daily supplement packets vary widely: Some products, with names like Xtra-Energy and MINI Natural, contain ephedrine, the amphetamine-like stimulant in diet and sports products that some doctors have linked to heart palpitations, stroke, cardiac arrest and sudden death. Others contain mostly vitamins and minerals--sometimes in heavy dosages.

Many combine vitamins with a list of natural extracts that could be taken from a Harry Potter novel: hawthorn berry, bissy nut, yellow dock, dong quai, fo-ti root, ashwaganda, yerba mate--you get the idea.

"They come up with all these combinations for which there's no evidence whatsoever that they do much of anything," said Dr. Joyce Lashof, professor emeritus of public health at UC Berkeley. "Hawthorn berry--honestly, who really knows what that's doing in the body?"

A daily-packet dose certainly can wake you up, pharmacists say, even if there's no ephedrine in it. Dr. Michael Wincor, an associate professor at the USC School of Pharmacy, said several of the herbal extracts commonly found in packets contain caffeine. Depending on the preparation, he said, the packets may contain the equivalent of up to two cups of coffee. "There's your energy boost right there," he said.

Yet, because dietary supplements makers don't have to prove their products to be effective or safe, many doctors are skeptical of them. Even essential vitamins such as A and D can cause health problems over time if taken in large doses, Lashof said.

In studies among more than 25,000 people during the early 1990s, researchers found that high doses of beta carotene--the plant form of vitamin A--appeared to increase the risk of lung cancer in smokers. There's no good evidence that beta carotene supplements cause health problems in nonsmokers. Some companies that sell the daily packets insist that their products are safe and effective. Fresh Start Vitamin Co. of Carson claims to have sold some 700 million vitamin and herb packets without receiving a complaint more serious than a mild allergic reaction, said a company spokesman, who asked not to be named.

He said the company's products, which contain no ephedrine, are regularly tested for purity and dosage, offer a balance of vitamins and minerals, and are distributed at some military bases, fire and police departments.

The Fresh Start "Herbal Energy Tablets" contain such ingredients as wu chi root (thought to soothe menstrual cramps, among other things); fo-ti root (said to boost circulation); and mullein (anti-inflammatory properties).

Vivi Ann Keene, chief executive of Uptime Sports Nutrition in Santa Barbara, said she is unaware of any major customer complaints during some 20 years of selling supplement packets. Uptime makes a variety of preparations, none with ephedrine, which contain vitamins, minerals and herbs.

"We have many very loyal customers," she said, "and what we always say is, if someone is worried about a product, or they have an illness, they should take the product to their doctor first."

There are several extracts in the company's Uptime Herbal packet that Keene had to look up when asked about them, including dong quai (for menstrual problems, among other things) and ligustrum (thought to stimulate the immune system).

Doctors say it's not clear yet whether most of these substances reliably boost immune response, or circulation, or prevent disease, or whether the dosages in supplements are enough to induce those effects. But insofar as the herbs are active in the body, they can also have side effects.

Pharmacists say mullein may cause skin inflammation if used topically, and drowsiness; yellow dock can induce abdominal pain and diarrhea; dong quai may cause diarrhea, even fever.

Some herbs may also interact with common prescription or over-the-counter drugs. Doctors, for example, caution against taking doses of ginkgo biloba with blood thinners such as aspirin. Cholesterol-lowering drugs such as Lipitor and Mevacor interact with several herbs, including gotu kola, which is taken for fatigue and skin problems, among other things.

Steven Dentali, vice president of scientific affairs at the American Herbal Products Assn., a group in Silver Spring, Md., that represents the dietary supplement industry, said he often takes herbs.

"But I don't take them willy-nilly," he said. "I read labels, and if the label doesn't make sense to me, then I won't take it. If I was looking at the label to check for sources of caffeine, for instance, I would want to know exactly how much caffeine is there and where it's coming from."

But packet labels are as variable as the products: Some appear detailed and complete; others are confusing. "The bottom line is we really don't have any idea what's in these things, and we have no idea how they might interact with one another," Lasher said.

She offers a better option for getting your vitamins and minerals, along with an energy lift: a balanced meal and a cup of strong coffee or tea.

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