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Calls to poison control centers about dietary supplements up 50 percent in recent years

Yohimbe, which is derived from the bark of an African evergreen tree
Yohimbe, which is derived from the bark of an African evergreen tree and often sold in pill or tablet form, was responsible for the largest proportion of serious medical outcomes.

The number of Americans making calls to poison control centers about dietary supplements jumped nearly 50 percent between 2005 and 2012, according to a study published Monday.

The centers receive, on average, a call every 24 minutes from someone worried about an exposure to a dietary supplement, the study reports. Most of those exposures occur at home and involve children younger than 6 years old.

The study also found that 1 in 20 calls about dietary supplements results in a serious medical outcome, including, in rare cases, death.

“Many consumers believe dietary supplements are held to the same safety and efficacy standards as over-the-counter medications,” said Dr. Gary Smith, the study’s senior author and director of the Center of Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, in a released statement. “However, dietary supplements are not considered drugs, thus they are not required to undergo clinical trials or obtain approval from the [Food and Drug Administration] prior to sale, unless the product is labeled as intended for therapeutic use.”

As Smith and his colleagues point out in their study, that lack of federal oversight has led to “inconsistencies in the quality of dietary supplements, product mislabeling, and contamination with other substances.”

Research has also repeatedly shown that dietary supplements offer no benefit to most healthy people and can sometimes be harmful. Yet, such products remain popular with consumers.  When surveyed, slightly more than half of adults say they’ve used a dietary supplement within the past 30 days. 

Dietary supplements include vitamins, minerals, herbs, botanicals or amino acids, as well as concentrates, metabolites, constituents or extracts of those ingredients. Such products included, therefore, not only vitamin and mineral supplements, but also herbal and homeopathic “medicines,” as well as “energy” drinks.

Study details

For the study, Smith and his colleagues analyzed 13 years (2000-2012) of data from the National Poison Data System, which collects call information from poison control centers across the country. They found that consumers made 274,998 calls to the centers about dietary-supplement exposures during that period.

The annual rate (per 100,000 population) of those calls rose by 46.1 percent during the period 2000-2002, decreased by 8.8 percent during 2002-2005 and then shot up again by 49.3 percent during 2005-2012.

The dip in calls during the years 2002-2005 was probably due, say the researchers, to the FDA’s 2004 ban of ma huang (ephedra), a botanical supplement that increases blood pressure and is associated with heart attacks and strokes. Of the 33,320 calls to poison control centers about ma huang-containing supplements during the study’s time frame, 5,437 involved serious health problems — and six resulted in death. But only one of those deaths occurred after the ban.

Seventy percent of all the dietary-supplement-exposure calls were about children under the age of 6. Most of these calls involved unintentional exposures — a child swallowing a supplement accidentally, for example.

The study also found that 12,243 of all the dietary-supplement calls to the centers  — or 4.5 percent — resulted in a serious medical outcome, and that 95 percent of the most serious outcomes were in people aged 6 or older. The dietary supplement categories with the highest proportion of serious medical outcomes were energy products, botanicals and cultural medicines. 

Tragically, 34 people for whom calls were made to the poison control centers died as a result of their dietary supplement exposure. 

Additional findings

Here are a few of the study’s findings regarding specific products or categories of dietary supplements:

  • Yohimbe, which is derived from the bark of an African evergreen tree and often sold in pill or tablet form, was responsible for the largest proportion of serious medical outcomes (28.2 percent) in the study. Yohimbe can lead to stomach problems, a rapid heartbeat, anxiety and high blood pressure. It’s also associated with heart attacks and seizures.
  • Calls to poison control centers about so-called energy drinks were more likely to involve males (60 percent) than females. A worrisome finding in this category was that almost 45 percent of the calls were about young children drinking the product accidentally. Energy drinks — or, more specifically, the high amounts of caffeine in them — can cause serious heart rhythm, blood flow, and blood pressure problems. One of the deaths reported in this study was associated with these products.
  • Homeopathic “medicines” accounted for about a third of the calls made to the poison control centers, although less than 1 percent of those calls resulted in a serious medical outcome. Most homeopathic preparations are just innocuous “sugar pills” packaged to look like medicine. But some homeopathic products — such as baby teething products containing the popular homeopathic ingredient belladonna — can be dangerous. Three of the deaths in the current study were attributed to homeopathic products.

Immediate regulatory change unlikely

As Smith and his colleagues point out, most exposures to dietary supplements reported to poison control centers do not end up requiring treatment at a health-care facility. Nor do they result in a serious medical outcome. Still, exposure to some of these products is associated with a considerable risk of toxicity.

Regulation could help reduce that risk, they add — as the FDA ban on supplements containing ma huang has demonstrated.

Given the current regulatory attitude of both the Trump administration and the Republican Congress, however, it’s unlikely the federal government will be taking any action soon on this issue.

So, consumers, as always: caveat emptor.

FMI: The study was published in the Journal of Medical Toxicology. You’ll find an abstract of the study on that journal’s website, but the full paper is, unfortunately, behind a paywall.

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