Weight Loss and Dietary Supplements Linked To Thousands Of Emergency Room and Hospital Stays Annually

Andrew I. Geller, MD Medical Officer in the Division of Healthcare Quality Promotion at CDC.

Dr. Andrew Geller

MedicalResearch.com Interview with:
Andrew I. Geller, M.D
From the Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention

Medical Research: What is the background for this study? What are the main findings?

Dr. Geller: In recent years some dietary supplement products have been recalled for having unapproved ingredients or contaminants, but there is very little national data about how frequently dietary supplements that are not included in such recalls cause health problems. This study looks at how often people went to emergency departments (EDs) for problems caused by dietary supplements.

  • Supplements include herbals, complementary nutritionals (such as amino acid supplements), and vitamins and minerals.
  • We studied records from 63 emergency departments from 2004-2013.
  • We calculate that every year, dietary supplements cause:
  • More than 23,000 ED visits, and
  • More than 2,000 hospitalizations.
  • More than a quarter (28%) of these ED visits were among young adults (20-34 years).
  • More than half (56%) of the ED visits made by young adults were for problems with products for weight loss or increased energy.
  • Cardiac symptoms (irregular/fast heartbeat or chest pain) were common among patients with weight loss or energy supplement problems.
  • More than 20% were young children who got into supplements meant for someone else.
  • ED visits were less common among older adults, but more than 1 in 3 (36%) of these ED visits by older adults were for swallowing problems, such as choking on a pill, most commonly vitamin/mineral supplements.

Medical Research: What should clinicians and patients take away from your report?

Dr. Geller: Take-away messages for consumers/patients:

  • 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.

Take-away messages for clinicians:

  • Ask patients about dietary supplement use.
  • Consider the possibility of adverse effects from supplements (e.g., chest pain or palpitations in a young adult).
  • Encourage patients keep supplements up, away, and out of sight of children.

Dr. Geller: Did anything surprise you?

Dr. Geller: –     It was notable that while most emergency room visits due to pharmaceuticals involve older adults, most emergency visits attributed to dietary supplements involve young people.

Medical Research: What are some study limitations?

Dr. Geller: Some dietary supplements are commonly considered to be foods by consumers (e.g., certain protein shakes, certain energy drinks).  We did not include such products although they are regulated as supplements under the 1994 Dietary Supplement Health and Education Act.

–          Linking specific harms to specific active ingredients in supplements is challenging because a single product might be used for very different purposes, multiple ingredients are often combined in a single product, and several products might have very similar names each of which may be reformulated over time.

Medical Research: How does the number of emergency department visits for dietary supplement adverse events compare to those from OTCs/pharmaceuticals?

Dr. Geller: The number of ED visits for adverse drug events related to dietary supplements is less than 5% of the number of ED visits for adverse events caused by OTCs or pharmaceuticals.  However, dietary supplements are regulated under the presumption of safety.

  • New drugs must have demonstrated benefits before they are approved; dietary supplements are not required to demonstrate that they have specific health benefits.
  • Safety requires balancing risks of a product with the benefits of a product; without information on benefits, it can be hard to assess relative risks.
  • This study shows certain risks are more common with certain dietary supplements, and offers the opportunity to focus attention on reducing common risks, such as choking or other swallowing problems associated with supplements among older adults.

Medical Research: The study mentions inclusion of some products that are not dietary supplements. Were there lots of those?

Dr. Geller: A small number (2%) of the estimated visits involved a handful of products that do not fall under the technical, regulatory definition of dietary supplements. As stated in the article, these include some herbal products typically used on the mouth or skin (e.g., tea tree oil) and homeopathic products. We included these products because they are commonly perceived and used by consumers as supplements (i.e., to promote health or well-being). The inclusion of a handful of non-dietary supplements does not change our conclusion of thousands of ED visits related to dietary supplements occurring annually. In addition, as we state in the article, we excluded other products from the study that are “technically” dietary supplements (e.g., many energy drinks) as consumers commonly perceive and use these products like foods. If these products were included, the overall estimates of emergency visits would be higher than those reported.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Geller: We are building on our findings to focus prevention efforts. For example, exactly why were swallowing problems from vitamins such a problem for older adults? Are some pills too large? Are older adults taking too many pills at once?  The answers will help target interventions.


Emergency Department Visits for Adverse Events Related to Dietary Supplements

Andrew I. Geller, M.D., Nadine Shehab, Pharm.D., M.P.H., Nina J. Weidle, Pharm.D., Maribeth C. Lovegrove, M.P.H., Beverly J. Wolpert, Ph.D., Babgaleh B. Timbo, M.D., Dr.P.H., Robert P. Mozersky, D.O., and Daniel S. Budnitz, M.D., M.P.H.

N Engl J Med 2015;373:1531-40.

DOI: 10.1056/NEJMsa1504267

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Andrew I. Geller, M.D (2015). Weight Loss and Dietary Supplements Linked To Thousands Of Emergency Room and Hospital Stays Annually