How safe are dietary supplements? Many people assume that products such as vitamins, minerals or botanicals are safe because they are natural.
Emergency Department Visits Due to Dietary Supplements:
The CDC and the FDA have just collaborated on a study of visits to 63 emergency departments in different cities between 2004 and 2013. The investigators concluded that young adults (20 to 34 years old) and young children are especially susceptible to misadventures with such products.
Based on the data they collected, the researchers estimate that between 18,000 and 27,000 emergency department visits each year are due to bad reactions to dietary supplements. Approximately 2,000 of these individuals required hospitalization.
Watch Out for Children:
Unsupervised children were most likely to suffer because they had consumed vitamins or mineral supplements, probably imagining that they would be like candy. (Iron supplements must be sold in child-resistant containers because they are so toxic to children in a situation of this sort.)
Weight Loss Aids and Energy Boosters Are Culprits:
Herbal or other complementary products purported to aid weight loss or increase energy were responsible for more than 35 percent of these incidents, but they represented a majority (72%) of the visits that involved chest pain, heart palpitations or worrisome changes in heart rate. Women were more likely to show up in the emergency room because of a problem with a weight loss supplement, while men were more likely to have had trouble with a supplement purported to benefit sexuality.
Senior citizens (those over 65) were more likely to land in the emergency department because they had choked on a pill. Vitamin or mineral tablets accounted for the great majority of these situations.
The Legacy of DSHEA:
Ever since 1994 when Congress passed the DSHEA (Dietary Supplement and Health Education Act), dietary supplements in this country have been largely unregulated. The FDA steps in when it believes there is evidence that consumers are being harmed. (For example, Ephedra, also known as ma huang, was taken off the market in 2004 because of adverse events, including some that were fatal.) But for the most part, dietary supplements do not need to be proven safe or effective. Many consumers take it on faith that they will work, but with lax oversight of manufacturing, it is difficult or impossible to know whether any given supplement actually contains what the label claims.
The Anti-Supplement Docs Are Crowing
A lot of health professionals find dietary supplements offensive. They are convinced that vitamins, minerals, herbs and other products sold in health food stores are worthless or even dangerous. The new study published in the New England Journal of Medicine reinforces their anti-supplement attitude.
What you won’t hear from these critics is the comparison to prescription and over-the-counter drugs. They conveniently ignore the statistic that pharmaceuticals account for 30 times more emergency department visits than dietary supplements (JAMA, Oct. 18, 2006). Supplements represent less than 5 percent of those that have previously been estimated for pharmaceuticals, according to the authors of the current study.
Pieter Cohen, MD, of the Harvard Medical School told NPR:
“What this study does is find entirely flawed the underlying premise that supplements are safe…In fact, supplements are now shown by this elegant CDC study to send tens of thousands of people to emergency rooms every year.”
What Dr. Cohen fails to mention is that over 100,000 people die each year from reactions to drugs they receive in hospitals and nearly 200,000 die as a result of medicines they are taking as outpatients (Top Screwups Doctors Make and How to Avoid Them, 2011, pg. 12). We wish Dr. Cohen had the same level of concern for pharmaceutical reactions as he does for the dangers of dietary supplements.
Nonetheless, these data show that dietary supplements can do damage in some cases. They should never be left within the reach of children, and they should be used with the same caution that one would accord any medication.
