Category Archives: Dietary Supplements

Are Dietary Supplements Sending People To The Emergency Room?

emergencyI routinely recommend the use of dietary supplements as part of my treatment plans with my patients.  Because of this my ears perked up when I heard a story on NPR a couple of weeks ago about the high number of people ending up in the ER due to adverse events related to dietary supplements. The story was about a study in the New England Journal of Medicine published on October 15th that found that an estimated 23000 emergency room visits each year were attributed to dietary supplements.

Now I am of the belief that it would be ideal to prevent any visit to the emergency room and so I was curious to look into the details of the study a little bit further.  23,000 sounds like a large number, but when you take into account that there are 136 million ER visits each year, this ends up being a very small percentage of total ER visits- .019% to be exact. To put this into perspective, 731,000 ER visits were associated with adverse events to the medical use of prescription drugs, 775,000 pediatric visits were for injuries associated with organized sports, 1.2 million visits were due to alcohol ingestion as the primary cause, and over 76,000 were for fire arm related injuries.

According to 2011 data 166 million Americans use dietary supplement and so there is only a .015% chance that someone taking a dietary supplement is going to end up in the ER because of an adverse event.   As I said, I feel that any preventable ER visit is too many, but taking dietary supplements seems like a relatively low risk behavior and not worthy of devoting the media attention to it that it has received.

Looking at the study even more closely, 20% of the visits were due to accidental ingestion by children under the age of 4. While this is a serious issue, it has nothing to do with the supplements themselves but instead has more to do with the childproofing of the home.  Of the close to 3000 visits that were attributed to those over the age of 65, over 60% were because of swallowing issues. Again this is a serious issue, but has less to do about the safety of the dietary supplements themselves.

This is not to say that there were no actual adverse events associated with supplements use. The products responsible for 42% of the total ER visits were supplements marketed for energy and weight loss. Many of these products contain stimulants and ingredients that are not really dietary supplements but instead should be classified as undeclared active pharmaceutical ingredients. While I agree that many of these supplements pose potential harm and should be taken off the market, the actual risk is still relatively low.

Can You Trust Your Supplements?

images35DGQ9E6If you are like more than 50% of Americans you took one or more dietary supplements today. The use of dietary supplements has been increasing over the past 20 years. What you once could only find in health food stores is now available in drug stores and grocery stores. It has even become common for conventionally trained medical doctors to recommend multivitamins, fish oil, probiotics and vitamin D. Most of the patients that I work with are taking multiple supplements before I start working with them.

While I recommend dietary supplements to many of my patients I do have concerns about the safety, interactions, and quality of dietary supplements. I will be addressing safety and interactions in future blogs, but in this blog I want to focus on quality issues with dietary supplements.

A recent quality evaluation by the company Consumer Labs found that 20% of the vitamin D products that they tested failed their quality testing. Two products contained almost twice as much vitamin D as was listed on the label, once product contained unacceptable levels of lead, and two products did not disintegrate within the expected 30 minutes. Trader Joe’s Calcium Citrate with Vitamin D contained 175% of the amount of vitamin D on the label and still had not disintegrated after an hour. So while you might save a little money on buying your calcium and vitamin D from Trader Joes, if it doesn’t break down in your digestive tract you might as well be throwing your money away.

In another evaluation they found that 16 of 42 multivitamins tested either had less of a nutrient or nutrients than the label stated, had more of a nutrient or nutrient than the label stated, or didn’t dissolve under normal circumstances. While the benefits of taking a multivitamin can be debated, if you are taking a multivitamin it would be good to know that it contains the amounts listed on the label and also that it is going to dissolve in your stomach as opposed to in the sewer.

Several years ago an analysis of Ayurvedic herbal products purchased from health food stores in the Boston area found that over 20% of them contained dangerous levels of lead, mercury, and arsenic. While the amounts in a single pill were not enough to cause a problem, if you were taking them every day for months, the toxic exposure could begin to have serious health consequences.

A study done at Bastyr University looking at the quality of probiotic supplements found that only one product out of twenty contained exactly what the label claimed it to contain.  30% of the products were contaminated with other organisms and 20% had no growth of any bacteria.

These examples unfortunately are just the tip of the iceberg. Other issues have included adulteration with anabolic steroids, high levels of toxic solvent residues, failure to contain the herb or probiotic species listed on the label, and inclusion of rancid oils.

While I have a great appreciation for dietary supplements, it has become clear to me that there is a great deal of variability in the quality of products sold as dietary supplements in the United States. While there has been an increased effort by the FDA to enforce basic quality standards, the supplement industry remains largely under regulated. The FDA does now require supplement companies to follow specific good manufacturing practices (GMP) in regards to the manufacturing of the product, but there is not the infrastructure to adequately enforce these and even if they did there is concern that the FDA standards may not be adequate enough to ensure that supplements are safe, free of contaminants and contain the substances that the label says that they do. The GMPs also don’t regulate the effectiveness of the product, the forms of the ingredients, where the herbs and nutraceuticals come from, or whether or not the additives or fillers used might have negative effects.

Fortunately there are some companies that have taken it upon themselves to make sure that they are producing high quality products. These companied not only follow the FDA regulations, they go beyond these standards to ensure that when you buy one of their products it contains the ingredients they say they do, in the amounts listed on the label and have been tested to make sure that they do not contain heavy metals, rancid oils, microbes, pesticide residues, solvents, or pharmaceutical drugs.

In order to find these companies, I have had any company that I recommend complete a detailed quality control survey so that I can tell if they meet the standards that I think are important to ensure that the supplements that I recommend to my patients are safe. In addition to the surveys I have sent out I have also had the students in the Supplementation and Whole Foods Nutrition course that I teach for the University of Western States send out the surveys as one of their assignments and so I have gotten to see a wide range of responses.

Based on those responses I have found several companies that I feel meet a high enough standard for me to recommend safely to my patients including: Thorne Research, Metagenics, Designs for Health, Integrative Therapeutics, Vital Nutrients, Biotics Research, Douglas Labs, and Pure Encapsulations.

Some of these companies can be found on the Order Supplements page of this website. In addition many of these can be purchased at Apothecary by Design in Portland and True North in Falmouth.

So the next time you are tempted to buy that cheap bottle of vitamins remember that you may be getting more (or far less) than you paid for! In my next blog I’ll take a look at some of the potentially dangerous interactions between dietary supplements and the medications that you may be taking.