Doctors say eating a well-balanced diet is the best way to get the nutrients your body needs. People who think they may need a little extra help often reach for food supplements. These are diet aids, such as vitamins, herbal extracts and fish oil. The companies that sell them suggest they’ll make people healthier. But scientists warn that some of these products actually can make people ill.
Drug stores, groceries and health food shops all sell these products. They’re known as supplements because they are not strictly needed for health. They just supplement — or add to — what people already eat.
They might contain nutrients that are otherwise available from foods. Or they might provide plant-derived materials that work in the same way that drugs do. This might be to boost immunity, increase metabolism (how the body uses energy) or improve how organs of the body work. The caffeine pills that people take to stay awake on long drives are one example of supplements. So are the zinc-based lozenges that people take to fight colds.
Explainer: Some supplements may not have what it takes
Most of these diet aids just provide more of something that is already in the diet. As such, these supplements are supposed to be as safe as food.
Yet each year, a new study finds, food supplements send more than 23,000 people across the United States to emergency rooms (ERs). Each patient had suffered some sort of bad reaction. Doctors refer to such reactions as adverse events. Some people developed chest pains or heart palpitations — a feeling that the heart is beating too fast or hard. Others got headaches or felt dizzy. Still others might have suffered stomach pains, nausea or vomiting.
The study tallying these reactions to food supplements appeared October 15 in the New England Journal of Medicine.
Unexpected number of teens and young adults affected
For the study, researchers collected 10 years of data. These came from the ERs at 63 U.S. hospitals. Supplements had sickened 3,667 of these ER patients, they found. Then the researchers used statistics — various math techniques — to scale up how many times this likely happened if all U.S. hospitals had experienced a similar trend.
The authors were comfortable analyzing these data and making these extrapolations to other hospitals. They all work at the Centers for Disease Control and Prevention (CDC) in Atlanta, Ga., or for the U.S. Food and Drug Administration (FDA) in Washington, D.C. These are government agencies. CDC scientists and doctors make sure Americans receive safe, high-quality health care. The FDA, as its name implies, regulates the safety of food and drugs. For instance, it requires that prescription drugs and over-the-counter medicines (like cough syrups and aspirin) must be tested to show that they are safe and effective. Without tests that show that, FDA won’t let manufacturers sell these products.
Dietary supplements are considered neither foods nor drugs. So for a long while, no government agency had control over their safety or any claims made by the products’ makers. Then, in 1994, Congress wrote a law that ordered FDA to treat supplements like a special kind of food. Back then, FDA said it would assume that supplements are safe enough to sell without going through safety tests. And companies that created new supplements would only have to give FDA data showing why these products were likely to be safe.
The only statement a supplement maker could not make is that its product would cure a disease or condition. That would instantly turn the product into a “drug.” Then, as with other drugs, it would now need to go through strict testing and government controls.
healthy dinner
Andrew Geller is a CDC physician who led the new study. His team was concerned that supplements were not as safe as had been assumed. Why? In the past, he notes, “FDA has recalled supplements that contained unapproved ingredients or were contaminated.”(A recall is when a company must take back a product from stores, hospitals or consumers, usually because of problems with its safety or reliability.) “We didn’t know how many [other types of supplements] caused problems,” Geller says.
So his team reviewed the hospital data. They paid special attention to how old patients were, their symptoms and what supplements they had taken. Then the scientists used data from the studied hospitals to estimate what might be occurring nationally. Adverse events, they found, were not occurring just in older or unhealthy people. Young people were at risk, too.
“Adverse reactions to drugs are usually more common in older people,” noted Geller. “It was surprising," he said, that many adverse reactions to supplements showed up in young people. After all, he notes, these are the people one would expect to be healthiest.
About 11 in every 100 adverse reactions occurred in people between the ages of 5 and 19. Across the United States, that would translate to more than 2,500 ER visits every year by kids and teens. Another 28 out of every 100 adverse events occurred in young adults, aged 20 to 34. That would translate to nearly 6,500 more ER visits yearly. Heart symptoms, such as chest pain and heart palpitations, were the most common effects among young adults.
Not all supplements equally risky
More than half of all side effects that sent people under age 35 to the hospital came from two types of supplements: weight-loss aids and energy boosters.
Weight-loss products come in many forms. They include pills, bars, liquids and powdered-drink mixes. There is no standard formula that all brands share. There also is no consistent list of safe ingredients.
vitamin c
The label on this bottle of vitamin C tablets notes that the evidence that this supplement reduces cancer risk is not conclusive. If a manufacturer were to make a claim that a product reduces cancer risk, that product would be regulated as a drug, not a supplement.
ROEL SMART/ISTOCKPHOTO
One popular brand of these products, Hydroxycut, includes supplements containing plant-based stimulants such as green-coffee-bean extract and caffeine. Those chemicals can rev up the body’s metabolism — how fast it burns energy. Burn enough and people should lose weight.
But in 2009, FDA ordered Hydroxycut to recall many of its products. Their use had been linked to 23 cases of liver damage. In one case, a 19-year-old boy died.
In a 2013 survey of U.S. high school students, the CDC found that more than 6 out of every 100 high school girls reported taking diet aids without first talking to a doctor. If that trend holds nationally, it would equal roughly 500,000 adolescent girls.
Ruth Milanaik is a pediatrician at Cohen Children’s Medical Center in Lake Success, N.Y. She worries about how diet aids affect teenage bodies. For example, she says Hydroxycut “raises your core body temperature to speed up your metabolism. But teens are growing fast already," she notes. "So making your system run faster can be harmful.”
The company that makes these diet aids says its products are now safe. Still, the products’ labels say these supplements should not be used by anyone under age 18.
Energy supplements also can contain a broad mix of ingredients. These can include caffeine, herbs that produce caffeine-like effects, vitamins and enzymes that are already in our bodies. Some also contain a lot of sugar, especially drinks and those supplements that come in the form of a snack bar.
Some users have complained to the FDA about problems they claim such energy supplements have caused them. Common symptoms include chest pain, the feeling of a racing heart and dizziness. In 2013, the American Medical Association called for a ban on advertising energy drinks to people under age 18 if those products contain “massive and excessive amounts of caffeine.”
These products likely contain stimulants, says the CDC’s Geller. “Symptoms like heart racing and chest pain are very similar to what you see in kids who have taken too much caffeine or … Ritalin.” That last drug, he notes, is a powerful stimulant used to treat ADHD (attention-deficit hyperactivity disorder).
Bulking up?
Pediatricians also worry about body-building supplements. These products promise to help users build muscle. That’s a common goal among teens who play sports, especially games where size is important, such as football.
One of the most popular sports supplements is creatine (KREE-uh-teen). The body already produces some creatine. In muscles, the compound helps produce a chemical called ATP, or adenosine triphosphate (Ah-DEN-oh-seen Try-FOS-fate). ATP carries and releases chemical energy that the body uses for many tasks. One example: ATP provides the energy to power muscle contractions during activities such as lifting weights.
protein supplements
Some supplements, such as creatine, are advertised to athletes and body-builders. But doctors worry that they may not be safe for anyone under age 18.
DAVID VAN DER MARK/FLICKR (CC-BY-SA 2.0)
“The more muscle your body has, the more creatine it makes,” says Milanaik. “But if you don’t have a lot of muscle mass yet and you take creatine, your body will try to get rid of it.” It would excrete the chemical as a waste. And in the process, she says, “That could damage your liver or kidneys.”
Milanaik led three recent studies in which college students posed as 15-year-olds. They called hundreds of health-food stores and pretended to shop for supplements. Girls asked about weight-loss supplements, including Hydroxycut. Boys said they were looking for creatine and products containing the hormone testosterone, which also supports muscle growth.
None of these products are recommended for users under age 18. But many sales clerks recommended them, or were willing to sell them to 15-year-olds, when the callers asked. These studies will be submitted to medical journals within the next few months.
“It’s a lesson that teens need to do their own research,” Milanaik now says. “Warning labels are there for a reason. Just because something comes from a vitamin shop or health food store doesn’t mean it’s good for you.”
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