Adverse Event Reporting, Dietary Supplement Use and Safety
Hospitals collect data on emergency visits for all types of injuries, including adverse drug events (ADEs). When someone goes to the emergency room for an ADE, they are asked to identify the drugs, vaccines, and dietary supplements they have taken. This information helps the medical team determine treatment strategies. A case report is generated listing the name, dose, route, frequency and duration of every item named by the patient, regardless of whether it contributed to the ADE or not.
By now you may have seen headlines that “Supplements Send Thousands of Americans to Emergency Room Every Year, Study Finds”. Geller and colleagues searched data from 63 emergency departments (2004-2103) and identified 3,667 ADE cases involving dietary supplements. Extrapolating nationally, they estimated 23,005 emergency visits per year involve dietary supplements. 88% of the ADEs implicated only 1 supplement. Only 2% of cases implicated >1 supplement. The most likely supplement mentions were weight loss products (25.5%) and multivitamin or unspecified vitamin supplement (16.8%).
With 35% of American adults being obese and more being overweight , it is not surprising weight loss products are frequently mentioned. Weight loss products have been a challenge for the FDA to regulate because of illegal adulteration with prescription drugs (eg sibutramine) or illegal ingredients (eg. ephedra). The FDA maintains a list of weight-loss products with potentially harmful ingredients.
When almost 90% of Americans see value in using multivitamin, calcium and vitamin D supplements and the NIH Office for Dietary Supplements states that multivitamin-mineral supplements account for almost 1/6th of all dietary supplement sales, it is not surprising that many people report using them. A basic multivitamin-mineral supplement containing recommended nutrient intakes should pose no safety risk.
According to the CDC, the US has 136.3 million emergency room visits annually, over 1 billion in a 10 year period. 23,000 ADEs represents 0.0023% of all emergency room visits. As Duffy MacKay, senior vice president scientific and regulatory affairs, Council for Responsible Nutrition said, “The results of this study reinforce that dietary supplements are safe products, particularly when put into context with the number of people – over 150 million Americans – who take dietary supplements every year.”
Geller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, Mozersky RP, Budnitz DS. Emergency department visits for adverse events related to dietary supplements. 2015 NEJM doi: 10.1056/NEJMsa1504267
Dickinson A, MacKay D, Wong A. Consumer attitudes about the role of multivitamins and other dietary supplements: report of a survey. 2015 Nutr J doi: 10.1186/s12937-015-0053-9