The Misleading Supplement Stats: An Estimated 23,005 ER Visits Due to Supplements per year from 2004-2013
On October 15th, the New England Journal of Medicine released a study that was once again sensationalized by the media and misleading to the public. These stories left many supplement savvy practitioners and consumers shaking their heads in annoyance.
The study used data from a nationally representative sample of 63 emergency departments over a 10 year span (from 2004 through 2013) in order to assess the adverse events attributed to dietary supplements. The researchers recorded 3,667 cases from the obtained results, which led them to estimate that 23,005 emergency department visits were attributed to dietary supplements. The researchers further concluded that approximately 2,154 hospitalizations ensued due to these events.
The majority of the cases involved young adults (20-34 years, 28%) and unsupervised children (21.2%). Excluding the unfortunate events of unwatched little ones, about 66% of the events involved herbal or complementary products, and approximately 32% involved micronutrients.
Here’s the important part…weight loss (25.5%) and increased energy products (10%) were “commonly implicated,” causing 71.8% of supplement-related adverse events related to palpitations, chest pain, or tachycardia.
Furthermore, according to the study results, “Among adults 65 years of age or older, choking or pill-induced dysphagia or globus caused 37.6% (95% CI, 29.1 to 46.2) of all emergency department visits for supplement-related adverse events; micronutrients were implicated in 83.1% (95% CI, 73.3 to 92.9) of these visits.”
Let’s break that down a little bit:
- 2% adverse events occurred as a result of children’s unintentional imbibing
- 6% cases resulted from swallowing difficulties from older adults
This makes 58.8% of adverse events not directly linked to the supplements’ intended use.
- Finally 35.8% were due to weight loss or energy products which accounted for approximately 72% of the heart- rhythm adverse events.
Major caveat here is that many of these products are actually spiked with pharmaceuticals, which I’ll get into later.
A Little Perspective by Comparison
Although many of the headlines failed to report the whole story and consider all the facts as stated above, an article in the New York Times did, in fact, make several important considerations:
First they did a little comparison to drug adverse effects stating the findings from a 2006 study in JAMA. This article estimated that over a 2-year study period, 21,298 adverse drug event cases were reported. This translated to annual estimates of 701,547 individuals affected negatively by drugs and led to approximately 117,318 hospitalizations.
“In comparison, prescription drugs are responsible for 30 times as many trips to the emergency room each year,” the New York Times stated.
Let’s look at this point in more detail:
1. One drug, more reactions
According to the CBHSQ Report (2015):
In 2011, there were an estimated 54,397 ED visits involving tramadol, and 27,421 (50 percent) were attributed to adverse reactions. The number of tramadol-related ED visits involving adverse reactions increased 145 percent from 10,091 visits in 2005 to 25,884 visits in 2009, but then remained stable in 2010 (25,887 visits) and 2011 (27,421 visits) (Figure 1).
In other words, in a shorter period of time that took place in the current supplement study reporting on adverse effects, there were more harmful events attributed to a single drug, than to a whole category of dietary supplements. Yikes!
2. Drug Category, Drug Classes, Big Numbers
According to the Center for Disease Control (CDC) Adverse Drug Event Monitoring site:
It is estimated that more than 700,000 individuals are seen in hospital emergency departments for adverse drug events each year in the United States. Nearly 120,000 of these patients need to be hospitalized for further treatment. This is an important patient safety problem, but many of these adverse drug events are preventable….
So, 700,000 verses 23,005… there’s your 30 times more adverse reactions to drugs verses supplements.
What about for one class of drugs? Let’s take a look at antibiotics:
Antibiotics are one of the top medication classes resulting in emergency department visits for adverse drug events. There are over 140,000 emergency department visits for reactions to antibiotics each year.
Wowzers! 140,000 ER visits from one type of medication. That’s about 6x’s the amount of reactions from all the supplements combined in the highlighted supplement study!
A One in Five Chance
According to an article on Harvard University Center for Ethics’ site, new prescription drugs have a 1 in 5 chance of causing serious reactions. The author states, “Few people know that new prescription drugs have a 1 in 5 chance of causing serious reactions after they have been approved. That is why expert physicians recommend not taking new drugs for at least five years unless patients have first tried better-established options, and have the need to do so.”
(Hmm, way more troublesome than the Mac iOS 9.0 update, where I personally experienced all the kinks. Yet, not as headline worthy?)
Interestingly, the author also reports on two other important points
1. Adverse Events with Proper Use
According to the author, in systematic reviews of hospital charts, even properly prescribed drugs caused about 1.9 million hospitalizations a year. (No unsupervised children there!) Furthermore, 840,000 hospitalized patients are given drugs that cause a serious reaction leading to 2.74 million serious adverse drug reactions.
2. Death by Medicine in U.S .and Europe
The author also writes, “About 128,000 people die from drugs prescribed to them. This makes prescription drugs a major health risk, ranking 4th with stroke as a leading cause of death. The European Commission estimates that adverse reactions from prescription drugs cause 200,000 deaths; so together, about 328,000 patients in the U.S. and Europe die from prescription drugs each year. The FDA does not acknowledge these facts and instead gathers a small fraction of the cases.” (Note this number includes the U.S. and Europe.)
Supplement Safety Overview
Michael Murray made several good conclusions based on the facts above and the latest study in his article in Green Med Info:
- Dietary supplements are remarkably safe given their widespread use and lack of ER visits.
- Don’t use dubious natural products, especially those being marketed with weight loss, body building or sexual enhancement claims.
- If you are going to use a product containing caffeine, do so wisely and do not exceed the recommended dosage levels on the label, and also take into consideration additional intake of caffeine or other stimulants you ingest.
- If you have difficulty swallowing large pills, choose smaller pills or other delivery methods. Soft gels are generally easier to swallow and most supplements are now available in powder or liquid form.
- If you have children, make sure that your supplements are out of their reach.
(He also points out the FDA’s power in regulating supplements.)
A Note on Quality
Let’s get back to that New York Times article and another good point. The article mentions adulteration in over-the-counter products, including that drug spike I mentioned above:
Medical experts say that these products can be particularly hazardous because they have potent effects on the body and are frequently adulterated with toxic chemicals. The new study found that cardiovascular problems were even more commonly associated with weight loss and energy supplements than prescription stimulants like amphetamine and Adderall, which by law must carry warnings about their potential to cause cardiac side effects.
So, here’s my big soapbox.
My Big Supplement Soapbox
It’s not uncommon for people to buy supplements from a store or online and receive very little benefit or maybe even a negative response. This is not necessarily because of the nutrient, herb, or combination product. Although, selecting the wrong supplement or buying one based on hype verses science, is a legit reason why one may not be getting results. Still, let’s say the nutrient or herb does have science to back it up and it’s not working. It’s probably because of several factors:
1. Counterfeits & Quality Control
If a supplement doesn’t come from a reputable company adhering to quality standards, which are mostly made available through practitioners, re-sellers can basically put any ingredient in a pill (la supplement de sawdust). Then, they can slap a tag on the bottle that looks like it is legit (or worse, counterfeit a reputable brand’s label, putting this company’s good name on the line) and sell it to you way cheaper than your doc, who painstakingly selected a specific product with the right ratios just for you. So, your pocketbook gets a deal but your health gets a hit.
The company doesn’t take measures to ensure the product is not contaminated with lead, microbes, toxins, or pharmaceuticals.
I’m not talking about the other hyped headlines and the inappropriate use of DNA barcoding to make supplements appear tainted as discussed here, but legitimate alterations and quality issues that concern well-intentioned manufacturers.
3. Bad Sources
The product could be a double whammy of bad quality and non-absorbable or assimilated nutrients. For example, many supplements with calcium could contain carbonate verses its chelated form.
For all of the above reasons, various supplement companies like this one, this one, and this one are closing down retail sites that sell their products and advocating for consumers to buy their supplements from their practitioners. It makes these companies unfairly (understatement of the year) look bad when people buy fake products with sawdust, lead, and pharmaceuticals that aren’t theirs but are labeled as such.
Bottom line- Support Quality in Supplements by Buying from Reputable Sources
Buying supplements without researching their background and analyzing their quality control is a bad idea. The good news is, even with these factors taken into account, supplements and herbs have a safety profile that is incomparable to pharmaceuticals. Still, because they create an effect, it’s best to purchase products directly from the manufacturer and from sources you trust. It’s also best to buy supplements that aren’t your basic core supplements, only after consulting with a knowledgeable practitioner. No, it doesn’t have to be me, but it should be someone in the know.
This is one reason am now offering Health Wave on my website.
How many times have my clients gotten wonderful results the first few months of our consultations and then, all of sudden, symptoms pop back up? Sometimes it’s because they need to tweak their protocol; however, in more cases than I’d like, it’s due to them not buying their supplements from reputable sources. They wanted to get their products cheaper. The problem with cheaper is that you usually get what you pay for.
What you miss out on when you pass on reputable brands:
- Quality control
- Efficacy and Potency
- Correct dosage
- Proper form
- Reputable label claims
By the way, my core recommendations are:
- a multivitamin that helps with blood sugar
- a high quality fish oil
- a digestive enzyme
- a probiotic
All of these products, when purchased through Health Wave, come straight from a distributor supplied directly from the manufacturer, and are reputable companies that have been researched by professionals and cross-referenced by me. These are the same price you’d pay from your doctors or practitioners, so it’s not to entice you away from your suggested recommendations from them. You should stick with them, because because they put in the work and study to select what is best for you.
Rather, purchase from my dispensary, if you want core supplements that aren’t tainted, are high quality, high potency, and in proper dosage. Or, you can buy them if your practitioner is recommending supplements but not supplying them and wants a reputable source.
Make the investment to buy supplements that won’t give good nutritional companies a bad name. (Bon Jovi reference inserted here).
As a side note, you want to check in with your doctor or practitioner every 3-6 months to make sure you are still on the right products for you.
- You can schedule an appointment for a functional and naturopathic supplement consultation here.
- Check out the references below.
- Find out why you probably need at least the core supplements here.
What about Essential Oil Quality
Tune-in to my webinar on Wednesday on essential oils. Learn more here.
Geller AI, Shehab N, Weidle NJ, et al. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med. 2015 Oct 15;373(16):1531-40.
O’Connor A. Dietary Supplements Lead to 20,000 E.R. Visits Yearly, Study Finds. New York Times. Healthy Consumer. October 14, 2015. http://well.blogs.nytimes.com/2015/10/14/dietary-supplements-lead-to-20000-e-r-visits-yearly-study-finds/?_r=0
Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL.National surveillance of emergency department visits for outpatient adverse drug events. JAMA. Oct 18 2006;296(15):1858-66
D.M. Bush. The CBHSQ Report: Emergency Department Visits for Adverse Reactions Involving the Pain Medication Tramadol. 2015. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Rockville, MD. Available at: http://www.samhsa.gov/data/sites/default/files/report_1965/ShortReport-1965.pdf
Anson P. Tramadol ER Visits Soar as Prescriptions Rise. Pain Network Organization. May 2015.
CDC. Medication Safety Program. CDC website. June 13, 2014. Available at: http://www.cdc.gov/MedicationSafety/program_focus_activities.html
Light DW. New Prescription Drugs: A Major Health Risk With Few Offsetting Advantages. Harvard Ethics. June 27, 2014. http://ethics.harvard.edu/blog/new-prescription-drugs-major-health-risk-few-offsetting-advantages
Murray M. ER Visit Statistics Due to Dietary Supplements Misleading. Green Med Info. October 21, 2015.
Singer, Natasha. Ingredients of Shady Origins, Posing as Supplements. New York Times. August 27, 2011.
American Botanical Council. Botanical Adulterants Program. http://cms.herbalgram.org/BAP/BotanicalAdulterantsIndex.html#AdulterationNews