Dietary Supplements Can Land You in the ER

For a long time, we’ve been critical of Americans’ love of dietary supplements, and often write about the dangers they pose, and that they’re a waste of money. Now, the Centers for Disease Control and Prevention (CDC) has measured this harm in real terms.

Last week CDC researchers published a study in the New England Journal of Medicine pegging the number of U.S. emergency department visits related to dietary supplements at 23,000 every year.

Even though that doesn’t begin to approach the number of emergencies related to the consumption of most pharmaceutical drugs, the real danger for most people is that these products are perceived to be safe. As one of the researchers wrote, “dietary supplements are regulated and marketed under the presumption of safety.”

Last week’s sad story of basketball/reality TV star Lamar Odom’s admission to a hospital renewed focus on the dangers of supplements. Odom was in critical condition after reportedly ingesting several substances, including an over-the-counter supplement to enhance sexual performance.

One emergency caused by supplements marketed for weight loss and to boost energy — symptoms of cardiac distress — actually accounted for more ER visits than prescription stimulants. But by law, prescription meds must bear warnings about side effects, “while supplements are not required to identify adverse effects,” the authors pointed out.

Critics have been exercised for a long time about lax regulation of supplements, as reported by MedPageToday.com. They note that although the 1994 Dietary Supplement and Health Education Act (DSHEA) forbids companies from marketing supplements as products that cure a disorder, it still leaves a lot of room to sell stuff that actually could cause one, because the industry lacks sufficient oversight.

Because supplements aren’t considered medicine, they don’t require FDA approval before being offered for sale. Their manufacturers are required only to report serious adverse events to that agency.

Between the passage of the DSHEA and 2012, the supplement industry boomed. The number of products rose from 4,000 to more than 55,000, according to the CDC research. That pencils out to about $15 billion that people spend annually on herbal or complementary nutritional products.

If such products contain ingredients not listed on the label, the FDA does have authority to recall them, which it did more than 200 times from 2004 to 2012. But that’s a pretty paltry number compared with how many products have been sold.

Even unadulterated supplements can cause problems, the researchers said. Because reliable data isn’t widely available the researchers used data from 63 EDs that contributed information to the National Electronic Injury Surveillance System — Cooperative Adverse Drug Event Surveillance (NEISS-CADES) system to estimate the number of ED visits tied to supplements from 2004 to 2013.

They estimated that 23,005 ED visits every year involve adverse events from dietary supplements, and that there were 2,154 hospitalizations every year. Most involved either young adults 20 to 34 (28%), or unsupervised children (21%).

Kid cases often involved multivitamins, iron, weight-loss supplements and products to enable sleep, sedation, or to treat anxiety. The authors mentioned the need for better child-proof packaging of supplements.

Older adults showed up at the ED mostly with swallowing problems, which the researchers said indicated a need to limit tablet shape and size.

Those recommendations seem more like rearranging Titanic deck chairs than a real remedy.

When the researchers excluded children who accidentally ingested a supplement, 2 in 3 ED visits involved a single supplement. Most often, it was a product for weight loss (26%) or increased energy (10%).

Those two types of products represented more than 7 in 10 cases of cardiac issues, including palpitations, chest pain or tachycardia (rapid heart rate); nearly 6 in 10 cardiac symptom visits involved patients 20 to 34 years old.

According to MedPage Today, “the study probably underestimated the number of ED visits linked to supplements because their use is underreported by patients, and physicians may not always identify the adverse effects associated with supplements, the authors cautioned.”

Dr. Pieter Cohen of Harvard and Cambridge Health Alliance in Somerville, Mass., was not involved in the study. An expert on the topic, he told MedPage Today that the paper highlights the how poorly supplements are regulated.

“This study is the most important research published since the passage of DSHEA and sends a clear message: Not only does the regulatory framework make no sense, it’s posing imminent threats to the public’s health,” Cohen said. “The publication of this new CDC study will hopefully be a watershed in regulating supplements in the U.S.”

He said that now, regulations are “based on the premise that all supplement ingredients are safe. If they are entirely benign ingredients that pose no danger, then there would be no reason to include warnings on the labels, to standardize production or even to register products with the FDA. But with the new CDC study we learn that these products are anything but safe.”

If you’re considering using a dietary supplement, make sure you discuss it with your doctor. Follow the directions carefully and don’t take any supplement in combination with any other supplement or medicine. And did we mention that you probably shouldn’t be taking one at all?

Learn more from Patrick’s newsletter, “Eat, Drink and Be Wary: The Truth About Diet Supplements and Sports Drinks.” 

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