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Last month Consumer Reports magazine published its "dirty dozen" list of dangerous and potentially dangerous dietary supplements. As more people turn to supplements for therapeutic and performance enhancing purposes, the U.S. Food and Drug Administration is in a precarious position because the 1994 Dietary Supplement Health and Education Act limits the FDA's authority over supplements.

Supplement manufacturers are not required to test their products, provide warning labels, or report adverse reactions. The FDA is left to prove supplements unsafe after they are on the market, which can be difficult and take years to complete. For example, it took the FDA seven years to successfully build a case against ephedra, a weight-loss aid now banned in the U.S.

Ann Zerr, MD, talks with us about the dangers of dietary supplements. She is associate professor of clinical medicine at the Indiana University School of Medicine and director of the Medical Weight Management Program at Wishard Hospital.

The most popular supplements among Dr. Zerr's patients are a diet aid called bitter orange, yohimbe, used for sexual enhancement, and andro, used for building muscle mass. Not only are these and other products unproven in their claims, they often come in compounds. Zerr stresses that it's the mixture of multiple ingredients in supplements that should cause consumers concern.

Some supplements interfere with prescription medications, including the popular St. Johns Wort, an anticoagulant that can cause complications during surgery. Dr. Zerr notes that hypertension is the most common health effect resulting from supplement use.

For various reasons, patients often don't tell healthcare providers what supplements they are taking. Zerr says doctors can encourage disclosure just by asking patients if they are using herbal supplements.

Dr. Zerr urges consumers to be careful when choosing a supplement. In general, if a product makes dramatic health claims, it is probably too good to be true.

Additional Resources:

• The FDA web site posts warnings, general information and frequently-asked questions about the safety of supplements.
• Read Consumer Reports' investigation of dietary supplements, including the dirty dozen list.
• Get the facts on dietary supplements -- learn why people take these drugs, and how to use them safely.

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