By Nicolas Peters, MD
The nutrition supplement market is expected to reach $175 billion globally by 2020. As a comparison, worldwide pharmaceutical sales are expected to reach
$1 trillion, or about 10 times sales of supplements. FDA regulations are less stringent on supplements. People often wonder if they are as safe as prescription medications, or
as effective. Many articles are published in the medical literature –
for (in the case of specific supplements for specific metabolic functions)
and against (mainly in the case of specific supplements for a specific
The New England Journal of Medicine attempted to answer this question by reviewing data from 63 emergency
departments (EDs) collected over 10 years, then extrapolating the data
for the rest of the US. They estimated that 23,000 ED visits are made annually for adverse events
related to dietary supplements. This may seem like a lot, but it is only
3% of the estimated ED visits for adverse events from pharmaceutical drugs. If you do the math, that would be over 760,000 visits for pharmaceuticals.
Half of adults reportedly use at least one dietary supplement in the past month. Incidentally, this is the same rate who report using at least one prescription drug.
Based just on this data, it would appear that in terms of sheer numbers
of people injured, pharmaceutical drugs are much more dangerous than dietary
Looking into the information deeper, some startling trends are noted.
One fifth of ED visits related to dietary supplements are due to unsupervised
ingestion by children, i.e. when a parent is not looking, the child opens
a medicine container and swallows the pills.
As a result of the Poison Prevention Packaging Act of 1970, pharmacies are required to place child-resistant packaging on oral prescription
medications. This is not true for dietary supplements.
Requiring child-resistant packaging on dietary supplements may increase
their cost, however, fewer parents would have to make that frantic call
to the Poison Control Center (in the US: 1-800-222-1222) and there would
be fewer visits to the ED.
Even child-resistant packaging would not prevent every ED visit due to
accidental ingestion in children. Current guidelines for child-resistant
packaging require that
no more than 15% of children less than 5 years old are able to open the package
within 5 minutes. Yes, that means it is only designed to stop 85% of toddlers and only for
5 minutes. The only thing that may slow down a toddler with an unopened
bottle of vitamins is the foil seal. It sure slows me down!
Another interesting finding in the
New England Journal of Medicine article was that in adults 65 and older, swallowing problems were implicated
in 40% of their visits, particularly with calcium containing compunds.4
Swallowing issues can occur with any pill: vitamin, herb, mineral, or pharmaceutical.
It is illogical to implicate an adverse reaction in dietary supplements
that is just as likely to occur with pharmaceutical drugs.
In short, older adults have trouble swallowing large pills, no matter if
they came from the health food store or were made by a pharmaceutical company.
Of note, the FDA recommends limiting the size of a tablet or capsule 22 mm. This means it should comfortably fit inside the edges of a quarter. Many
people would still consider that a “horse pill.”
Finally, one disturbing trend involves the types of dietary supplements
implicated in adverse reactions. Outside of micronutrient supplements
such as multivitamin, iron, calcium, or potassium,
supplements for weight loss or to boost energy were implicated in over
half of the ED visits. Women had many more ED visits for weight-loss product adverse reactions
than men. Both fared equally for ED visits for energy products.
People are trying to increase energy and lose weight using dietary supplements
and are having serious adverse reactions to these products, causing them
to seek emergency medical attention.
As any Functional Medicine practitioner will say, there is no easy or quick
fix for low energy or to lose weight. There are a multitude of reasons
why someone may have low energy or fatigue.
For starters, poorly functioning adrenal glands as a result of chronic
stress may be the cause.
Low thyroid function is another very common problem.
Poor and unrefreshing sleep is often a cause as well.
Many of these issues also make it hard to lose weight, but one must not
forget to evaluate the diet.
Avoiding simple sugars and starches and focusing on organic, non-processed,
non-GMO, nutrient-dense foods is often the first step to a weight loss program.
There is an overwhelming number and variety of dietary supplements available
Remember that all supplement manufacturers are not alike. Some adhere to
GMP (Good Manufacturing Processing) standards. Some do not. It is expensive
to be GMP certified.
At the Arizona Center for Advanced Medicine, through a Functional Medicine
approach, we have designed ways to evaluate each person’s individual
nutrient and mineral needs. We have scoured the supplement market and
only recommend brands which we have found successful for patients and
which have volunteered for independent quality testing (GMP Certification).
When prescribed appropriately, we have found adverse events from dietary
supplements in our patients extremely rare.