Dietary Supplements Lead to 20,000 E.R. Visits Yearly, Study Finds
By Anahad O'Connor

A large new study by the federal government found that injuries caused by dietary supplements lead to more than 20,000 emergency room visits a year, many involving young adults with cardiovascular problems after taking supplements marketed for weight loss and energy enhancement.

The study is the first to document the extent of severe injuries and hospitalizations tied to dietary supplements, a rapidly growing $32 billion a year industry that has attracted increased scrutiny in the past year and prompted calls for tougher regulation of herbal products.

Critics of the industry said that the findings provided further evidence that the relatively low level of regulation in the United States put many consumers at risk. But industry representatives said that the products were used by roughly half of all Americans and that the data showed only a tiny fraction sustained major injuries.

The new study was published Wednesday in The New England Journal of Medicine and led by health authorities at the Food and Drug Administration and the Centers for Disease Control and Prevention. The researchers tracked emergency room visits at a large network of hospitals around the country over a 10-year period and then analyzed those in which a dietary supplement was implicated.

Among the injuries cited were severe allergic reactions, heart trouble, nausea and vomiting, which were tied to a broad variety of supplements including herbal pills, amino acids, vitamins and minerals. Roughly 10 percent, or about 2,150 cases yearly, were serious enough to require hospitalization, the researchers found.

In comparison, prescription drugs are responsible for 30 times as many trips to the emergency room each year.

One finding was that emergency room visits caused by supplements occurred predominantly among young people, whereas those for pharmaceutical products occurred in large part among older adults, said Dr. Andrew Geller, a medical officer at the division of health care quality promotion at the C.D.C. and the lead author of the study. “The contrast is striking,” he said.

More than a quarter of the emergency room visits occurred among people ages 20 to 34, and half of these cases were caused by a supplement that was marketed for weight loss or energy enhancement, commonly producing symptoms like chest pain, heart palpitations and irregular heart rhythms.

These products typically contain a variety of herbs and extracts and are widely advertised online, in magazines and on television with names like Hydroxycut, Xenadrine, Raspberry Ketones and Black Jack Energy, the researchers said.

It was unclear how many, if any, of these cases are fatal because the study tracked hospital visits, not deaths. Weight loss supplements and energy boosters have been implicated in serious problems, including one outbreak in 2013 that sickened 97 people and caused at least one death and three liver transplants.

Medical experts say that these products can be particularly hazardous because they have potent effects on the body and are frequently adulterated with toxic chemicals. The new study found that cardiovascular problems were even more commonly associated with weight loss and energy supplements than prescription stimulants like amphetamine and Adderall, which by law must carry warnings about their potential to cause cardiac side effects.

Dietary supplements marketed for weight loss and energy, however, do not have to carry such a label. Under a 1994 federal law that has been widely criticized by health authorities, supplements are considered safe until proved otherwise. Unlike prescription drugs, they do not have to be approved by the F.D.A. before they are sold to consumers, nor are they required to list major side effects.

“This is very disheartening,” said Dr. Pieter Cohen, an assistant professor at Harvard Medical School who was not involved in the new research. “What we’re seeing from this study is that the system has failed. It’s failing to protect consumers from very serious harms.”

The study also pointed to other flaws in the regulations. The F.D.A., for example, recommends limits on the physical size of prescription drugs, but no such regulations exist for supplements. The new study found that about a third of supplement-related emergency room visits for people 65 and older were caused by choking on pills like calcium and other vitamins and minerals. A large proportion also had allergic reactions.

But Duffy Mackay, a spokesman for the Council for Responsible Nutrition, a supplement industry trade group, said that if anything, the new research highlighted how relatively safe supplements are given how many people took them.

“We have over 150 million Americans taking these products each year,” he said. “This suggests that far less than one-tenth of 1 percent of supplement users will visit the emergency room.”

Mr. Mackay said that choking and other hazards highlighted by the study could be addressed by the F.D.A. “If they think that capsule sizes in the elderly are an issue, they could put out an advisory and the industry would respond,” he said. “The current law as it’s written has everything in it to make this change.”

Related:

·                Retailers to Stop Sales of Controversial Supplements

·                F.D.A. Warns Supplement Makers of Stimulant Dangers

·                Ask Well: Vitamin Expiration Dates

營養補充品惹禍 美每年2萬人掛急診

還相信營養補充品「有病治病，沒病養身」嗎？美國政府主持的一項大規模研究顯示，美國平均每年有2萬3000人次因為服用營養補充品而掛急診，其中許多案例是2、30歲的成人在服用號稱能減重或增加活力的補充品後，出現心血管問題。

這是第一份呈現「營養補充品導致的嚴重傷害與住院行為」的研究。營養補充品產業成長迅速，年產值達320億美元（約台幣一兆元）。

批評營養補充品產業的人說，這份研究證實，美國對補充品管制太鬆，讓許多消費者陷入險境。補充品產業則說，美國有半數人口都在吃補充品，這份研究呈現的只是其中極少數受到重大傷害的人。

研究由美國食品藥物管理局與疾病管制中心主持，報告發表在十四日號的「新英格蘭醫學期刊」上。研究人員追蹤2004到2013年全美各地多家醫院的急診紀錄，分析涉及營養補充品的案例。

研究提到的傷害包括嚴重的過敏反應、心臟問題、惡心、嘔吐等，這些症狀與多種補充品有關，包括草藥丸、氨基酸、維他命與礦物質。研究顯示，每年掛急診的人次中，約有10%、也就是2150人次嚴重到必須住院。

研究人員發現，因為吃補充品而掛急診的主要是年輕人，因為吃處方藥而掛急診的多半是年長者。研究第一作者、美國疾管中心醫療品質促進部門官員蓋勒說：「這對比真讓人驚訝。」

研究顯示，掛急診的人次之中，28%的年紀介於20到34歲之間，其中又有半數是因服用號稱能減重或增強活力的補充品，常見症狀有胸痛、心悸與心律不整等等。

研究人員說，這種補充品往往含有多種草本植物與萃取物，通常在網路、雜誌或電視上做廣告。目前不清楚這些因為吃補充品而掛急診的人之中，有多少人死亡，因為這份研究並不追查死亡紀錄。減肥與增加活力的補充品曾涉及嚴重問題，例如曾在2013年造成97生病，至少1人死亡，3人接受肝臟移植。

醫學專家指出，這類補充品有可能危害很大，因為對人體效力強，而且經常摻了有毒化學物。這份研究顯示，心血管疾病跟減重、增強活力補充品的關聯，比跟處方興奮劑如安非他命、Adderall的關聯更強。處方興奮劑依法須標註「服用後可能引發心臟方面的副作用」警語，補充品卻無須標註。

未參與研究的哈佛大學醫學院助理教授柯漢說：「這真的很讓人沮喪，從這份研究可以看出，管理制度失靈，沒法保護消費者不受重大傷害。」

美國疾管中心官員蓋勒建議，吃營養補充品應注意下列事項：

．吃減肥或增強活力補充品的年輕人應留意，這類補充品之中，有些會影響心臟功能，不能吃太多。如果你的心臟有問題，請在服用前請教醫師。

．年紀較長者請在吞服補充品時，注意咀嚼或吞嚥問題，不要一次吞好幾顆，不要吞下太大顆的藥丸，服用時記得配上大量的水。如果你很難吞下補充品藥丸，請告訴醫師，看看能否換成別種藥丸，或將它切成兩半。

．如果你有吃補充品，務必告訴醫師。

．處方藥和補充品都要保存在幼童拿不到的地方。

原文參照：
http://well.blogs.nytimes.com/2015/10/14/dietary-supplements-lead-to-20000-e-r-visits-yearly-study-finds/

2015-10-17．聯合報．A17．國際．編譯李京倫