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Supplements Send 23,000 People to the ER Every Year

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Dietary supplements have created a booming, $32-billion-a-year industry—one that isn’t regulated by the federal government like other medications. Now, in the first study of its kind, the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) have teamed up to get some hard stats on the injuries and hospitalizations that result each year from supplements, including herbal pills, amino acids, vitamins, and minerals. (Ask the Diet Doctor: Is there a difference between Plant-Based and Synthetic Supplements?)

In the study, published last week in The New England Journal of Medicine, researchers looked at data from 63 emergency departments in the U.S. spanning a 10-year period. They found that an estimated 23,000 emergency department visits per year are caused by the adverse effects of dietary supplements, including heart problems, allergic reactions, nausea, and vomiting. Of those visits, an average of 2,154 are serious enough to require hospitalization.

While the study authors point out that 23,000 ER visits is a small fraction (less than 5 percent) of those related to prescription drugs, the danger lies in the fact that many people don’t realize supplements can cause such dangerous effects. After all, under the federal Dietary Supplement Health and Education Act of 1994, supplements are considered safe until proved otherwise. Manufacturers aren’t even required to list side effects, and are asked to report problems with their products on a voluntary basis. Another potential danger? Many patients don't even tell their doctors they're taking supplements, because they don't consider it a "medicine," explains Jeanmarie Perrone, M.D., professor of Emergency Medicine at the Hospital of the University of Pennsylvania. 

While some of these ER visits were caused by choking or swallowing issues in older adults, the study found that more than a quarter of the visits (28 percent) involved young adults between the ages of 20 and 34 years. Among this age group, weight loss and energy supplements accounted for more than half of the ER visits, with patients experiencing cardiovascular problems such as chest pain, heart palpitations, and irregular heart rhythms. 

David Heber, M.D., Ph.D., the founding director of the UCLA Center for Human Nutrition, posits a majority of these visits were "minor reactions" to otherwise entirely safe caffeine and caffeine-containing supplements such as guarana in individuals who rarely drink coffee. Young adults should simply read the labels and be sure their total caffeine intake doesn't exceed the 400mg per day limit set by the FDA (a typical cup of coffee contains about 120 mg), he explains. "What is needed here is not more regulation, but effective education of doctors and the public," he says.

Other experts beg to differ. "This is a really big issue and this industry definitely needs regulation," argues Perrone. "We have had many cases through my years as a medical toxicologist consulting through the Philadelphia Poison Center of patients with significant adverse events from supplements including contaminated substances, drug interactions, and significant cardiac effects in the case of ephedrine, which was a weight loss/energy supplement taken off the market because of associated cardiovascular and stroke events in the 1990s. We have long proposed that this industry needs oversight."

At least one good takeaway from the otherwise scary news? The Council for Responsible Nutrition, a trade group for the dietary supplement industry, issued a statement reporting that companies have already responded to some of the concerns raised in the study, such as the choking issue, and are offering options such as liquids, gummies, melts, and powders in lieu of pills.

To make sure you're safe when it comes to supplements, be sure to always tell your doc what you're taking, and check out these precautions you can take to suss out un-safe supplements.

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