How Dangerous are Health Supplements?

There has been significant coverage in the media recently about the dangers of using health supplements. According to one report, an estimated 23,005 emergency department visits per year are attributed to adverse effects associated with the use of dietary supplements.

Politicians, advocates and consumers have been calling on the FDA to make changes to improve the safety of dietary supplements and to take legal action against companies that sell unsafe products.

Much of this attention is warranted and will help to improve the status of the industry and – more importantly – the health of its customers. But the risks associated with the use of dietary supplements need to be put in the appropriate context. Numbers are meaningless if they are not properly framed.

As this article will show, dietary supplements are 98.84 times less likely to send someone to the Emergency Room than pharmaceutical drugs taken as prescribed. They are also 178.25 times less likely to send someone to the hospital than foodborne pathogens.

This risk also needs to be put into the context of the potential health benefits that can be derived from the safe, informed use of dietary supplements.

I personally take dietary supplements to promote an optimal state of mental and physical performance and to support my goal of living healthily until my 120th birthday.

While I believe it is vital for the industry to continue to improve the quality of dietary supplements and to invest more into research on safety and efficacy, it is wrong to nondescriptly characterize all supplements as dangerous.

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The Dangers of Dietary Supplements

The recent media attention to the negative health consequences of dietary supplements was largely provoked by the hospitalization of Lamar Odom. Odom, a professional basketball player with the Los Angeles Lakers, was hospitalized on October 13, 2015 after suffering several strokes and kidney failure.

Odom was found in a coma at the Love Ranch brothel in Crystal, Nevada. He was placed on life support for several days at a hospital in Las Vegas before he regained consciousness. It is believed that Odom will not be able to play professional basketball ever again.

Odom’s stroke was allegedly caused due the combined use of cocaine, alcohol and a supplement called “Reload”.

“Reload” has been called “herbal Viagra” and is a product designed to promote sexual function and libido. It was sold to Odom by the Love Ranch Brothel and he is said to have consumed 10 pills over the course of his three day stay, according to owner Dennis Hof.

According to a Public Notification published by the FDA, the supplement “Reload” was found to contain sildenafil, which is the active pharmaceutical constituent in the Erectile Dysfunction medication, Viagra. This means it should not have been categorized as a supplement at all, and instead falls under the classification of a drug.

In 2013, the FDA issued a notice warning consumers not to use this supplement and ordered a recall. Despite this warning, some establishments continued to sell the product. This is a clear case of adulteration and mislabelling.

No doubt, some of the blame for Odom’s medical state lies with the manufacturers of “Reload” for selling an adulterated product that contained sildenafil. This type of behavior is extremely dangerous – especially when consumers do not know what is in the products they are taking.

But the fact is, no supplement is safe when combined with cocaine and alcohol. Research shows that the use of cocaine increases the risk of stroke by 6-7 times in the 24 hour period following use. [1]

According to one article published in the Postgraduate Medical Journal, “The growing number of case reports describing cocaine?related stroke, and the increasing evidence supporting this aetiological link, suggests that cocaine use should always be considered as a possible cause of stroke…” [2]

Most of the articles discussing Odom’s stroke focused on the causative role played by the “Reload” supplement. With title such as, “Lamar Odom And The Hidden Dangers Of Herbal Sex Supplements” and “U.S. Health Authorities Warned Consumers About ‘Herbal Viagra’ Linked to Lamar Odom“, the message that some readers got was that his medical condition was caused by his use of a sex supplement.

My point is not that the “Reload” supplement did not have some causal role in Odom’s stroke. The chances are that it did play some role. But risks need to be understood in context.

The evidence suggests that cocaine and alcohol played a greater causative role in Odom’s stroke than the “Reload” product he was taking. While sildenafil has been theorized to increase risk of stroke by increasing platelet aggregation, this has only been demonstrated in vitro and not in vivo.

According to Fiona Kirkwood of the British Heart Foundation, “So far there have only been a small number of stroke or cardiovascular events in men taking Viagra, and it is still unclear if there is a link between the two.” [3]

What does this mean? In response to the Lamar Odom story, the media could do a much greater service to its readers by warning about the extremely serious dangers of cocaine use, particularly in combination with alcohol and Viagra.

The purpose of this article is not to defend suppliers of adulterated supplements like “Reload”. But rather, to point out how risk factors need to be appreciated within the proper contextual framework.

So what are the risks of serious adverse effects caused by health supplements and what context should these risks be understood under?

Hospitalizations Caused by Dietary Supplements

According to a study published in The New England Journal of Medicine, the use of dietary supplements resulted in 23,005 emergency departments visits per year between 2004 through 2013. [4]

Of those visits, 2,154 resulted in the hospitalization of the patient. [4]

21.2% of hospital visits were linked to unsupervised use of dietary supplements by children. [4]

25.5% of hospital visits were caused by weight loss supplements and 10.0% were caused by supplements for energy. Both of these product categories are likely to have stimulant ingredients designed to increase metabolism or promote alertness. [4]

These numbers are far too high and must be brought down. Part of this requires the implementation of increased regulatory enforcement to test supplements and ensure they do not contain contaminants, unidentified ingredients, or dangerous compounds.

We also believe that greater consumer education needs to play a role in promoting the safe, informed use of dietary supplements.

But would it change your perception of the risk of using dietary supplements if I told you that you are 98.84 times more likely to visit the hospital following an adverse reaction to a prescribed pharmaceutical drug? What if I told you that you were almost 178.25 times more likely to visit the hospital due to a pathogen found in something you ate?

My guess is that it would.

Hospitalizations Caused by Drugs

In the United States, the Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality under the Department of Health and Human Services (HHS) tracks statistics on hospitalizations caused by drug use.

According to a 2010 report, there are an estimated 4,916,328 Emergency Department visits in the United States every year caused by drugs – both pharmaceutical and illicit. [5]

In total, there are an estimated 136.3 million Emergency Department visits per year in the United States. [6] This means that drugs represent 3.607% of all Emergency Department visits per year in the USA. (In comparison, supplements account for 0.01687% of all visits.)

Of this number, SAMHSA estimates 2,301,050 Emergency Department visits are attributed to the use of illicit drugs, alcohol, and the non-medical use of pharmaceutical agents. [5]

106,041 visits a year are attributed to accidental ingestion of a drug (with 72,839 visits a year occurring in patients 5 years of age or younger.) [5]

Finally, SAMHSA estimates 2,273,844 Emergency Department visits are linked to adverse reactions to pharmaceutical drugs taken as prescribed by a doctor. [5]

Remember that ingestion of health supplements resulted in 23,005 hospital visits a year. This means that this is an estimated 98.84 times greater likelihood of visiting the emergency room due to ingestion of a pharmaceutical drug (even when taken as directed) than a dietary supplement.

Hospitalizations Caused by Foodborne Pathogens

Most of us don’t think of eating food as a particularly risky event, but you are almost 200 times more likely to be hospitalized from something you ate than a dietary supplement.

According to the CDC, there are 323,914 hospitalizations a year caused by foodborne diseases. There are also 5,194 deaths annually attributed to pathogens in food. [7]

This does not include food allergies. It only includes hospitalizations caused by viruses, bacteria, parasites, toxins, metals, and prions found in foods. [7]

While the CDC report does not provide a specific figure for the number of Emergency Department visits caused by foodborne pathogens, we can extrapolate this number based on other figures provided in the report. They estimate that 7.9% of hospital visits with gastrointestinal symptoms resulted in hospitalization. [7]

This would yield (323,914 hospitalizations / 7.9%) = 4,100,772 Emergency Department visits per year linked to foodborne illnesses.

Compare that to the 23,005 hospital visits a year linked to dietary supplements. That means you are 178.25 times more likely to visit the Emergency Room due to a foodborne contaminant than a health supplement.

What Can You Do to Protect Yourself from Dangerous Dietary Supplements

Dietary supplements pose significantly less risk of adverse effects than pharmaceutical drugs and foodborne pathogens. However, the fact that 23,005 Emergency Department visits a year are caused by supplements should still be unacceptable to the industry and to consumers.

There are several ways that we can reduce this number to ensure that supplements are used safely and to ensure that low-quality products never make it to market. Here are some of the things you can do to ensure that you stay safe while using health supplements:

1) Only buy supplements from companies that explicitly state they are manufactured in Current Good Manufacturing Practices (cGMP) compliant facilities. cGMP guidelines were established by the FDA and other regulatory agencies to ensure quality in manufacturing of supplements.

2) Ask supplement manufacturers or retailers for a COA (Certificate of Authenticity) certified by an authentic third-party lab. The COA should show the percentage of active ingredients found in the product, heavy metal content, other impurities, and microorganism plate counts. The Batch Number on the COA should match the batch number on the specific product you are purchasing. Do not accept outdated COAs.

3) Make sure to consult with a doctor who knows your medical history before taking any new dietary supplement. Tell your doctor about any other supplements or drugs you are taking to check for interactions. Ask your doctor for advice on the appropriate dosage and usage of this supplement before you start taking it.

4) Do your research. Make sure that you fully understand the potential effects and side effects of every supplement you use. It goes without saying that combining supplements with alcohol and cocaine will increase your risk of adverse effects. But there are lots of other potential interactions that you may not be aware of. Make sure you are fully informed before adding a supplement to your routine.

Finally, I am particularly concerned by the fact that 21.2% of hospital visits caused by supplements are attributed to unsupervised use by children. This suggests that we are making it too easy for children to access these products and use them without their parents’ knowledge.

Supplement manufacturers should respond by using child-proof bottles and lids to eliminate this danger. Supplements and other health products should also be kept out of the reach of children. Some supplements that are generally well tolerated by adults at normal doses may cause adverse effects in children. This problem is compounded if they inadvertently take an excessively large dose.

At Nootriment, we believe the safe and informed use of supplements can be a tool to improve health and support an optimal state of well-being. Dietary supplements are not without risks, but these risks need to be understood in context. Numbers are meaningless unless they are appropriately framed.

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