New England Journal Report: Supplement Safety

The media headlines were quite concerning: “Health supplements send 23,000 to emergency rooms in US each year.”[1] Generally when I hear about nutritional supplements being bashed in the media I conduct my own research. Often it is sensationalism and this latest report was no exception.

The study was recently published in the New England Journal of Medicine and it involved researchers gathering data from 63 US hospitals over a 10 year period (from January 1, 2004 through December 31, 2014).[2] Researchers identified 3,667 emergency room visits due to adverse events from supplements. Then using this data they estimated that more than 23,000 emergency department visits and 2,154 hospitalizations annually in the United States during these years were for adverse events associated with dietary supplements.

While it is certainly possible for someone to have an adverse reaction to a supplement, the same could be said for anything we touch, inhale, or ingest. For example, food allergy reactions are responsible for more than 200,000 emergency department visits per year.[3] Does that mean we stop eating food?

A breakdown of this study will be more telling since the mainstream media won’t provide this type of data. The first thing to note is that 21% of all estimated emergency department visits involved unsupervised ingestions by children. So one-fifth of the adverse events were due to poor adult supervision and safety practices. It had nothing to do with supplements at all. The same concern exists with pharmaceutical medications that have a much higher risk of serious or fatal adverse events.

The study also noted that among older adults, swallowing problems caused nearly 40% of ER visit. What does this have to do with the inherent safety of a nutritional supplement? If one has a swallowing problem they can end up in the ER from ingesting anything, including food and pharmaceuticals. Obviously people with swallowing problems need to use discernment in terms of what pill size they are able to swallow.

In addition, 28% of adverse events related to an emergency department visit involved young adults between the ages of 20 and 34 years. More than half of these visits were associated with weight-loss or energy products. Heart symptoms such as palpitations, chest pain, and tachycardia were common symptoms. I do recommend that any person taking a supplement that contains stimulants (which is most common in weight loss and energy formulas) consult with a doctor or practitioner trained in evaluating supplement safety. Quick fix weight and energy products that use stimulants always have the potential for adverse effects.

Research has shown that at least half of the American public takes dietary supplements. This means 160 million Americans take nutritional supplements. As Dr. MacKay from the Council for Responsible Nutrition states, “we estimate that far less than one tenth of one percent of dietary supplement users experience an emergency room visit annually. That percentage becomes even smaller when you eliminate the products that are not dietary supplements and exclude the ER visits that resulted from eye drops, ear drops, and other OTC and non-dietary supplement products inaccurately included by the researchers to make their projections for dietary supplements.”[4]

Of course it is impossible for the researchers to know if the emergency room doctor was able to decipher whether an adverse reaction was actually due to a dietary supplement or pharmaceutical agent (over the counter or prescription). Most Americans commonly use over the counter or prescription drugs on a regular basis. How do we know the emergency room doctor reported the correct agent that caused the reaction?

I heard a news commentator on a major cable TV station discuss this study and she stated that the FDA has no jurisdiction over supplements. Her “expert” guest was a conventional MD who agreed that this lack of FDA authority over nutritional supplements was a problem. Obviously, neither of the two must have read the study. In the second paragraph the authors stated, “The Food and Drug Administration(FDA) is tasked with the oversight of dietary supplements; if a dietary supplement is found to be unsafe, the FDA can have the manufacturer remove the product from the market.”[5]

The reality is that dietary supplements are very safe. The number of people who have adverse reactions and especially fatalities from dietary supplements is negligible compared to over the counter and prescription drugs. It is undisputable that pharmaceutical agents are responsible for hundreds of thousands of deaths each year. However, if you are considering a weight loss or energy supplement that contains any type of stimulant consult with a Naturopathic Doctor or other trained professional with a background in nutrition.

[1] Foxnews.com. Accessed October 18, 2015 at http://www.foxnews.com/health/2015/10/15/health-supplements-send-23000-to-emergency-rooms-in-us-each-year/

[2] Geller, Andrew et al. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med 2015;373:1531-1540.

[3] Food Allergy Research& Education website. Accessed October 18, 2015 at https://www.foodallergy.org/facts-and-stats

[4] MacKay, Duffy. The Council For Responsible Nutrition Website. Accessed October 18, 2015 at http://www.crnusa.org/CRNPR15-ContextKeyAERNEJM101415.html

[5] Geller, Andrew et al. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med 2015;373:1531-1540.