dietary supplements

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Report: Dietary Supplements Send Thousands To The ER Annually

Dietary supplements can make you sick.

That’s the quick takeaway from a new report, published in The New England Journal of Medicine, that might make you think twice about the supplements.

Researchers at the Centers for Disease Control and Prevention conclude that about 23,000 emergency department visits each year in the United States can be attributed to “adverse events” due to dietary supplements. “Such visits commonly involve cardiovascular manifestations from weight-loss or energy products among young adults and swallowing problems, often associated with micronutrients, among older adults,” the study says.

Researchers analyzed data on dietary supplement-related emergency department visits over a 10-year period, from Jan. 1, 2004, through Dec. 31, 2013, from 63 hospitals. Of the more than 23,000 ER visits, researchers report that 2,154 patients were then hospitalized for further treatment. (The new analysis did not include patients who may have died en route to the hospital.)

The backdrop to all this is that supplement sales are dramatically on the rise:

The estimated number of supplement products increased from 4,000 in
1994 to more than 55,000 in 2012 (the most recent year for which data are publicly available), and approximately half of all adults in the United States report having used at least one dietary supplement in the past month. In 2007, out-of-pocket expenditures for herbal or complementary nutritional products reached $14.8 billion, one third of the out-of-pocket expenditures for prescription drugs.

I asked the study’s lead author, Dr. Andrew Geller with the CDC, what consumers should make of the study. Here’s what he said, via email:

People may not realize that dietary supplements can cause any adverse effects, but each year thousands of people are treated in emergency departments for symptoms attributed to dietary supplements.

Young adults taking products to lose weight or increase energy should keep in mind that some of these products can have effects on their heart, and they should not take these products in excess. If you have a heart condition, talk to your doctor before starting a weight loss or energy supplement.

Older adults should be mindful of possible choking or other swallowing problems from taking supplements. They should avoid taking several pills at once, avoid extra large pills or capsules, and swallow supplements with plenty of water or other fluid. Tell your physician you are having difficulty swallowing pills and ask him/her or your pharmacist for other options or if you can cut the supplement in half.

Patients should always tell their doctors if they are taking dietary supplements, and which ones.

All medicines and dietary supplements should be stored up, away and out of sight of young children.

Pieter Cohen — an internist at Cambridge Health Alliance and asistant professor at Harvard Medical School who studies dietary supplements and has been critical of the federal law governing them — said the new study may trigger some long-needed changes.

“This study is the most important research published since the passage of DSHEA [the Dietary Supplement Health and Education Act of 1994] 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 says. “The publication of this new CDC study will hopefully be a watershed in regulating supplements in the U.S.”

He adds that the current regulations “are based on the premise that all supplement ingredients are safe.” But, he says, “with the new CDC study we learn that these products are anything but safe. In fact, the CDC found that supplements lead to tens of thousands of emergency room visits and thousands of hospitalizations each year.” Continue reading

Study: Dietary Supplement To Boost Sexual Performance Often Mislabeled, Posing Risks

If you’re not a man in the market for a natural way to boost your sexual performance, you may be unfamiliar with yohimbe. It’s an African tree whose bark yields a substance, yohimbine, which can be extracted and used as an aphrodisiac.

But for those who seek this common supplement, beware: according to a new study by Harvard researchers, the vast majority of yohimbe sold as a dietary supplement by mainstream retailers in the U.S. is mislabeled in a way that could pose a safety risk to consumers.

Dr. Pieter Cohen, an assistant professor at Harvard Medical School who studies dietary supplements, says of the 49 yohimbe products he and his colleagues tested, most had inaccurate data either about the quantity of active ingredient or an incomplete list of known side effects.

“These are completely misleading in terms of labels,” Cohen, the lead author of the new study and an internist at Cambridge Health Alliance, said in an interview. “If safe consumption of a product requires that both accurate quantity as well as known adverse effects be provided on the label, then only 4.1 percent of the yohimbine supplement brands analyzed provided sufficient safety information for consumers.”

(Rachel Zimmerman/WBUR)

(Rachel Zimmerman/WBUR)

But the real problem, Cohen says, is the federal law governing dietary supplements which regulates such products more like food than drugs and doesn’t require the kind of stringent pre-market testing for safety and effectiveness mandated for prescription drugs. “Every problem we found with yohimbe supplements brings us back to fundamental flaws in the law,” Cohen said.

Here’s the conclusion of his study, published today in the journal Drug Testing and Analysis: Continue reading

Citing Cancer Concerns, Watchdog Warns Consumers: Avoid Ginkgo

The nonprofit watchdog group Center for Science in the Public Interest today urged consumers to avoid the popular dietary supplement Ginkgo biloba, citing a new government study that found “clear evidence that the ingredient caused liver cancer in mice and some evidence that ginkgo caused thyroid cancer in rats.”

dav/flickr

dav/flickr

In light of the study, CSPI “downgraded” the supplement, also found in herbal teas and some energy drinks, from the “safe” to the “avoid” category in its Chemical Cuisine Guide of food additives.

Here’s more from the CSPI news release:

“Ginkgo has been used in recent years to let companies pretend that supplements or energy drinks or supplements with it confer some sort of benefit for memory or concentration,” said CSPI executive director Michael F. Jacobson. “The evidence for those claims has been dubious, at best. The pretend benefits are now outweighed by the real risk of harm.” Continue reading

Tainted Weight-Loss Supplement Still Widely Used Despite Recall

In the great battle between government regulators and dietary supplement peddlers, some think the regulators are losing.

According to Harvard Medical School researchers, a slew of dietary supplements contaminated with “a dangerous mix of banned pharmaceuticals” continue to be widely sold and used by women in the Boston area despite regulatory efforts to stop sales of the illegal products.

Indeed, nearly a quarter of the more than 550 women surveyed in the Harvard study were using or had previously used one product in particular, Pai You Guo, a weight-loss supplement made in China and known to be adulterated with the appetite suppressant sibutramine, which was pulled from the U.S. market because of increased risk of heart attack, stroke and cancer, and the laxative phenolphthalein, withdrawn from over-the-counter sales in 1997 “due to its carcinogenic properties,” the study says.

The U.S. Food and Drug Administration announced a “voluntary” recall of Pai You Guo in 2009, but researchers say the move had “little effect” on the number of women using it.

Study author Pieter Cohen, a general internist at Cambridge Health Alliance and Assistant Professor of Medicine at Harvard Medical School said that despite intense outreach by doctors and the FDA about the perils of taking such contaminated products, not a single woman interviewed in the study was aware of the FDA action. Moreover, the majority of those surveyed began taking Pai You Guo after the recall went into effect, he said.

Participants were a group of Brazilian-born women who attended a primary care clinic in Somerville, Mass., or one of several nearby churches. (Cohen said there was evidence that the weight-loss supplements were popular among these immigrants.) Researchers found that participants who were overweight, obese or lacked health insurance were more likely than normal weight and insured women to report taking Pai You Guo, which means “the fruit that sheds the fat” in Mandarin.

The study, published in the Journal of General Internal Medicine, focused only on Pai You Guo, a poster child for dangerous, drug-laden, over-the-counter products masquerading as natural slimming aids. (With nice marketing too, after all, who wouldn’t want to look like the hot, svelte, bikini-clad model on the box?) Taken as a capsule, or as a tea, Pai You Guo has been featured in news stories, and the general problem of contaminated supplements has been widely reported, for instance, in The New England Journal of Medicine, among other publications. But Cohen says there are literally hundreds of different tainted weight-loss supplements, with names like Super Slim and Planta Fruita, sold in shops around town. Continue reading