Herbal and Dietary Supplements: Hidden Dangers to Kidney Health

In an era in which wellness trends dominate social media and supermarket shelves, herbal and dietary supplements have exploded in popularity, promising a cornucopia of health benefits. However, beneath this facade of wellness lurks a potential threat, which poses hidden dangers to kidney health (Table).

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Kidney syndromes associated with the use of herbal and dietary supplements

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Widespread use

Unlike prescription medications, herbal and dietary supplements are often categorized as food products, leading to lax regulations. This means that the ingredients may not be fully disclosed, their quality can vary significantly, and potential side effects often go unreported. The kidneys are particularly vulnerable to toxic injury because of their high blood flow rate, large endothelial surface area, high metabolic activity, active uptake by tubular cells, medullary interstitial concentration, and low urine pH (1).

One of the primary contributors to kidney damage is the widespread use of herbal supplements. Herbal medicine can be a source of kidney injury through several mechanisms: the presence of known herbs with unknown or underestimated toxicity, toxic effects resulting from incorrect preparation or the use of substitutes, contamination or adulteration, indirect toxicity due to interactions between drugs and herbs or between different herbs, and the presence of active biological compounds. For instance, aristolochic acid, found in certain traditional Chinese herbs, has been linked to chronic kidney disease (CKD) and urinary tract cancers (2). Similarly, Cape aloe (Aloe capensis)—used extensively in Africa as a laxative, as an anti-inflammatory and antioxidant, and for treating skin conditions like eczema—has been implicated in cases of acute kidney injury due to acute interstitial nephritis and acute tubular necrosis as a result of dehydration (3).

Nearly half of Americans use dietary supplements (4), which may be mislabeled, interact with medications, or contain kidney-harming substances. People with CKD are particularly vulnerable, yet many supplements remain unstudied in this group, raising safety concerns (5). In the National Health and Nutrition Examination Survey cohort, 27.8% of patients with CKD reported supplement use, with flaxseed oil being common (4). A minority (2.6%), notably those with diabetes or hypertension, used high-risk supplements.

Adverse events from supplements are under-reported. In 63 US emergency departments, 23,005 annual visits and 2154 hospitalizations were supplement related, mostly among young adults using herbal or nutritional products. Weight loss and energy supplements caused 71% of adverse effects, including cardiac palpitations (6). Weak regulations worsen risks to kidney health. Manufacturers can easily sell products with undisclosed ingredients or false claims, endangering consumers.

Prevention strategies

Addressing the hidden dangers posed by herbal and dietary supplements requires a multifaceted approach. First, there is an urgent need for enhanced regulation and oversight of the supplement industry to ensure product safety and transparency. Regulatory bodies must enforce rigorous testing protocols and stringent labeling requirements to inform consumers accurately about potential risks to kidney health. Consumers should exercise caution and adopt a critical mindset (7).

Additionally, health care professionals play a crucial role in educating the public about the potential dangers of supplement use, particularly in vulnerable populations such as the elderly and individuals with pre-existing kidney conditions. Encouraging open dialogue between patients and health care professionals can facilitate informed decision-making regarding supplement use, minimizing the risk of adverse renal outcomes. Furthermore, promoting evidence-based practices and emphasizing the importance of a balanced diet and lifestyle interventions can help mitigate the reliance on supplements as quick-fix solutions.

The widespread availability and consumption of herbal and dietary supplements pose significant yet often overlooked risks to kidney health. By addressing regulatory gaps, enhancing consumer awareness, and promoting evidence-based approaches to wellness, we can safeguard against the hidden dangers lurking within the supplement aisle, ensuring that individuals can pursue health and vitality without compromising the well-being of their kidneys.