More than 50 percent of U.S. adults regularly take over-the-counter nutritional products, such as multivitamins. However, many of those dietary supplement users do not realize the products can cause serious side effects. While most people do not overuse them as bad as former Los Angeles Laker Lamar Odom reportedly did, issues from dietary supplements, such as herbal or nutritional products, cause over 23,000 Americans to land in Emergency Rooms and thousands to be hospitalized annually because of adverse effects, according to a study published Wednesday.
The data published in the New England Journal of Medicine shows the types of issues that are sending people to ERs because of multivitamins, diet pills, energy boosters, herbal products, and other nutritional substitutes. Typical issues involve cardiovascular problems (such as palpitations or chest pain) caused by weight-loss or energy products for younger adults and swallowing problems, often with micronutrients, for older adults. In fact, the study found that 25 percent of the ER visits were related to weight-loss products, while 10 percent were tied to energy supplements. For seniors, 38 percent sought medical attention because a pill or pill fragment became lodged in their throat or esophagus.
Funded by the Department of Health and Human Services, the study involved data obtained at 63 emergency rooms across the country from 2004 through 2013. Using a surveillance system from the U.S. Centers for Disease Control and Prevention, the Food and Drug Administration and the Consumer Product Safety Commission, the researchers examined records showing that people went to the ER because they knew they were having adverse reactions to dietary supplements or it was determined to be cause of their symptoms. The actual number of ER visits caused by dietary supplements could be much higher than the study’s estimates because patients do not mention their supplement use when asked if they took “drugs.”
The research team found that 20 percent of the supplement-related ER visits involved children who swallowed the products while unsupervised. This is largely because, with the exception of iron pills, supplements do not have to be packaged in child-resistant containers. However, they did not that iron supplements – which are required to be in child-resistant packaging because they can be fatal to children in large doses – were actually the second most common cause of a supplement-related ER trip for kids.
While the number (over 23,000) of ER visits annually resulting from dietary supplements is a small fraction of the amount of drug-related ones that land people there, the concern is the lack of regulation or attention paid to supplemental use. It is estimated that the herbal and nutritional product market represents one-third of what Americans spend on prescription or over-the-counter medications. However, it does not have the same regulatory oversight.
Prescription and over-the-counter medications undergo significant testing. They are required to list possible side effects on their packaging and also indicate things that may cause an adverse reaction (such as a label stressing the need to take the product with food or conversely on an empty stomach). Additionally, they do not have to indicate that people with medical issues, such as a heart condition, or who take prescription medication regularly should check with a doctor or pharmacist before they start taking that supplement. And, in spite of the senior swallowing problems, the FDA does not limit supplement pill sizes.
The market for nutrition, vitamins, herbal products and other supplements is huge, and estimated to be a $35 billion industry. Approximately 150 million Americans use such products and, while the fact that over 23,000 of those users land in ERs annually from dietary supplement issues is a small fraction, the study does show that people should not assume they are safe for everyone’s use.
Written and edited by Dyanne Weiss
New England Journal of Medicine: Emergency Department Visits for Adverse Events Related to Dietary Supplements
Washington Post: Dietary supplements send more than 23,000 people to the ER each year
USA Today: Side effects from dietary supplements send 23,000 people a year to ER
Photo of B Vitamin Supplement Tablets by Ragesoss – Creative Commons license