Tens of thousands of Americans are treated in hospital emergency rooms each year for problems caused by dietary supplements, federal health officials are reporting.
The complications include heart problems such as irregular or rapid heartbeat or chest pain, says Dr. Andrew Geller of the federal Centers for Disease Control and Prevention, who led the study published Wednesday in the New England Journal of Medicine.
Two other big problems are children ingesting supplements purchased by an adult, or older people choking on pills, he says. Nearly three-fourths (71.8 percent) of the ER visits were related to the use of weight-loss or energy-boosting supplements.
The analysis, based on data collected between 2004 and 2013, is the first national estimate of complications that result from using dietary supplements, Geller says.
Using data from 63 emergency rooms, he and his colleagues calculated that 23,005 emergency room visits occur each year because of dietary supplements. Among those cases, 2,154 patients are hospitalized to receive further treatment.
The analysis did not include anyone who might have died on the way to the hospital or in the ER because those deaths are not recorded in the database used for the study.
Geller says it's hard to know which products can cause problems or why. Unlike standard over-the-counter medications or prescription drugs, the companies that make dietary supplements are not required to prove to the Food and Drug Administration that their products are safe and effective before selling them.
"We don't have information about what's contained in these products," Geller says. "And often times multiple active ingredients are combined into a single product." In addition, similarly named products can have very different active ingredients, he says.
"For all those reasons it can be hard for consumers, clinicians and public health agencies to determine which, if any, of the specific active ingredients caused the observed effects," Geller says.
In recent years, some dietary supplements have been recalled when they are found to contain unapproved ingredients or contaminants. But Geller says "there's very little national data about how products that are not included in such recalls cause health problems."
Dietary supplements have become increasingly popular in the United States. Americans spend nearly $14 billion a year on vitamins, minerals, herbal remedies to treat a wide range of conditions, including colds, arthritis and immune system problems, and to promote weight loss.
Critics of the dietary supplement industry are welcoming the new research.
"This is the most important study that been published on supplements in the last 20 years," says Dr. Pieter Cohen, who studies supplements at Harvard Medical School.
"What this study does is find entirely flawed the underlying premise that supplements are safe," Cohen says. "In fact, supplements are now shown by this elegant CDC study to send tens of thousands of people to emergency rooms every year."
The findings, he says, show there's a need to better track problems caused by supplements so the FDA can identify and remove dangerous supplements from the market sooner.
Dietary supplement companies, however, see the study as demonstrating the relative safety of supplements.
"If you put it in context that over 150 million Americans take dietary supplements each year, we have, 'Far less than one-tenth of 1 percent of supplement users will visit the ER,' " says Duffy MacKay, a naturopathic doctor and the senior vice president for scientific and regulatory affairs at the Council for Responsible Nutrition, a trade group.
MacKay argues that the study overestimates the dangers by including problems caused by products that aren't supplements — such as homeopathic remedies.
He also says any problems caused by supplements could be minimized by keeping the products away from children, developing pills that won't choke older people, and educating young people about how to use the products more carefully.
AUDIE CORNISH, HOST:
Tens of thousands of Americans are rushed to emergency rooms every year after taking dietary supplements. That's according to the first study to calculate the risks posed by these products nationally. NPR's health correspondent Rob Stein has the details.
ROB STEIN, BYLINE: Dietary supplements are wildly popular in the United States, and Andrew Geller of the Centers for Disease Control and Prevention says people use them for all sorts of health reasons.
ANDREW GELLER: Dietary supplements include a wide range of products from folate to fish oil, magnesia to energy supplement pills.
STEIN: But there's a big difference between these products and other things people take for their health.
GELLER: In contrast to pharmaceutical drugs which have to have demonstrated benefits, dietary supplements do not have to have specific benefits demonstrated before they can be sold.
STEIN: In other words, they don't have to prove they work, and they don't have to prove something else - whether they're safe. So Geller and his colleagues decided try to find out. They analyzed data from 63 emergency rooms from 2004 to 2013. They report what they found in this week's New England Journal of Medicine.
GELLER: We calculate that every year, dietary supplements cause more than 23,000 emergency room visits and more than 2,000 hospitalizations.
STEIN: Often it's people in their 20s and 30s who taking supplements to lose weight or get extra energy. They end up in the ER with heart problems like dangerously irregular heartbeats or chest pain. Geller says it's hard to know which products are causing problems or why.
GELLER: We don't have information about what's contained in these products. And oftentimes, multiple active ingredients are combined into a single product. And similarly named products can have very different active ingredients. So for all those reasons, it can be hard for consumers, clinicians and public health agencies to determine which, if any, of the specific active ingredients caused the observed effects.
STEIN: Geller says part of the problem is children getting into products purchased by an adult in their house. And some of the cases involve something that can happen with regular medications - older people choking on the pills. Critics of the dietary supplement industry say the new research is long overdue.
PIETER COHEN: This is the most important study that's been published on supplements to the last 20 years. It's a tremendously important study.
STEIN: Pieter Cohen studies supplements at Harvard Medical School.
COHEN: What this study does is find entirely flawed the underlying premise that supplements are safe.
STEIN: Cohen says the study shows that supplements need to be tracked much more closely so the FDA can identify and remove dangerous products from the market sooner. But the companies that make supplements disagree. They say the new research actually shows how safe the products are. Duffy MacKay is with the Council for Responsible Nutrition which represents the dietary supplements industry.
DUFFY MACKAY: If you put it in context that over 150 million Americans take dietary supplements each year, we have far less than one-tenth of 1 percent of supplement users will visit the ER.
STEIN: MacKay argues the study overestimates the dangers by including products that aren't even supplements. And, MacKay says, any problems could be minimized by doing things like keeping supplements away from children and educating people about how to use them more carefully. Rob Stein, NPR News. Transcript provided by NPR, Copyright NPR.