Unregulated Herbal Products and Supplements Send 23,000 People to the Emergency Room Annually in the U.S.

Many times, I have written about the risks of herbal remedies and dietary supplements, and about the folly of not regulating these and requiring the scientific testing for safety and efficacy that is required of real medicine (e.g. 1, 2, 3, 4, 5). A recent article in the New England Journal of Medicine adds further evidence to the risks of such unregulated products.

Geller, A. et al. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med 2015; 373:1531-1540

This study found that the major causes of harm from supplements included accidental ingestion by children, and heart problems in young, otherwise health adults using them for weight loss or for greater “energy.” However, even micronutrients were responsible for emergency room visits and hospitalizations in older Americans.

Nothing that has a measurable effect on the body, even if it has benefits, is without risk, and these products won’t be safe or useful until we require manufacturers to produce reliable scientific evidence about their effects before they are allowed to sell them.


We used nationally representative surveillance data from 63 emergency departments obtained from 2004 through 2013 to describe visits to U.S. emergency departments because of adverse events related to dietary supplements.


On the basis of 3667 cases, we estimated that 23,005 (95% confidence interval [CI], 18,611 to 27,398) emergency department visits per year were attributed to adverse events related to dietary supplements. These visits resulted in an estimated 2154 hospitalizations (95% CI, 1342 to 2967) annually. Such visits frequently involved young adults between the ages of 20 and 34 years (28.0% of visits; 95% CI, 25.1 to 30.8) and unsupervised children (21.2% of visits; 95% CI, 18.4 to 24.0). After the exclusion of unsupervised ingestion of dietary supplements by children, 65.9% (95% CI, 63.2 to 68.5) of emergency department visits for single-supplement–related adverse events involved herbal or complementary nutritional products; 31.8% (95% CI, 29.2 to 34.3) involved micronutrients. Herbal or complementary nutritional products for weight loss (25.5%; 95% CI, 23.1 to 27.9) and increased energy (10.0%; 95% CI, 8.0 to 11.9) were commonly implicated. Weight-loss or energy products caused 71.8% (95% CI, 67.6 to 76.1) of supplement-related adverse events involving palpitations, chest pain, or tachycardia, and 58.0% (95% CI, 52.2 to 63.7) involved persons 20 to 34 years of age. Among adults 65 years of age or older, choking or pill-induced dysphagia or globus caused 37.6% (95% CI, 29.1 to 46.2) of all emergency department visits for supplement-related adverse events; micronutrients were implicated in 83.1% (95% CI, 73.3 to 92.9) of these visits.


An estimated 23,000 emergency department visits in the United States every year are attributed to adverse events related to dietary supplements. Such visits commonly involve cardiovascular manifestations from weight-loss or energy products among young adults and swallowing problems, often associated with micronutrients, among older adults. (Funded by the Department of Health and Human Services.)


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10 Responses to Unregulated Herbal Products and Supplements Send 23,000 People to the Emergency Room Annually in the U.S.

  1. R says:

    A lot of supplements are gobbledygook, people don’t seem to realize that the supplements have to be metabolized by the liver, so in a dog that is sick already. Now they have to deal with the increased nausea, etc.

    That being said, I use less and less supplements. However I have had excellent results keeping my cholesterol level wnl with a niacin product (endur-actin). And I still take a daily fish oil for myself and give one to my pets.

  2. Phil says:

    My partner suffered liver damage from an unregulated over the counter “fat blocker” pill. Fortunately, the damage was not permanent–just excruciating pain for a few days, and extremely elevated liver enzymes for a few months. These products are extremely dangerous.

  3. KP says:

    I can only imagine what damage or pain has been caused to pets/animals because of “good intention” use of supplements. They basically have no voice and are subject to the whims of their owners and whatever “kick” their owner is on at the time.

  4. Mary Anne Whitonis says:

    I think I believe that it is true that if you buy the things without knowing the manufacturer, time of harvest and time they processed that you will get an inferior product. Afterall, it is all about making the most money by many companies. On the other hand, if you are highly recommended by a few scientists who have done studies in their laboratory using a few reputable pharmaceutical company’s products in their studies which were proven to be top pharmacy grade quality, than, they can be helpful in treating certain ailments and problems. Everyone has to do their research and not just buy “snake oil” from any Tom, Dick or Harry that comes along touting this or that about their products. I was told that many companies process the glucosamine in such a way that you might as well not be taking it all because heat destroys their properties but certain companies make it the right way and than it is more effective. The problem is that many western treatments do not work at all or do not work well so people turn to alternative forms of treatments. For example, chemo has always been a hallmark for treating cancer but now they are moving towards immunosuppressive therapy because chemo is so barbaric on the living body destroying everything in its sight. But, immunosuppressive therapy is so expensive that only people in trials or people who very wealthy can afford the 60,000 a month to pay for it!!! But, eventually chemo needs to go the way of the ice age, it needs to stop!

  5. skeptvet says:

    ” For example, chemo has always been a hallmark for treating cancer but now they are moving towards immunosuppressive therapy because chemo is so barbaric on the living body destroying everything in its sight.”
    The problem is that this simply isn’t true. I treat dogs with lymphoma with chemotherapy all the time, and they live happily with virtually no side effects for years. It is misleading and wrong to make an argument for alternatives based on saying things about conventional treatment which are simply untrue.

  6. Mary Anne Whitonis says:

    If this is so, than why are they moving away from traditional chemo to immunosuppressive treatments to treat cancers in human beings? But, unless you are wealthy you cannot afford the 60,000 a month for the treatments so they are doing this in studies for the fortunate few who get selected. If chemo worked so great they would not be looking for alternatives. Than they claim they came up with a miracle drug that only targets the cancer cells. Yet, the Chinese have used those things for over 4,000 years now! Rather say they came up with something new they should say they have finally opened up their minds and intellects to these ancient ingredients that pose unlimited possibilities in treating diseases. Perhaps some cancer treatments have made great strides since 2008 when I lost my last dog to hermangiosarcoma cancer or in 1999 when I lost my other dog to mast cell cancer but my experiences were dismal. My dogs stopped eating and when I asked for appetite stimulants so their quality of life wouldn’t be in the tank for the time they had left I was refused!!! This was by one of the leading private hospitals in the country and by an ivy league school likewise, not some fly by night outfit. I make this argument from my own personal experiences with chemo on two different dogs that I owned and loved so don’t insult my intelligence by telling me I am being misleading or wrong to make this argument. I lived through it myself. Also, when I employed the use of a famous holistic veterinarian for my dog that had cushings, he rebounded and lived another 6 months. He had gotten so bad he could not pick his head up off the floor, like a rag doll. And all conventional medicine kept telling me was the same broken record comment, “There is nothing else we’d add to the mix at this time.” I was going to have to carry him in to be put to sleep so I felt I had nothing to lose but only a lot to gain if it worked. He went from being on 120mgs of vetoryl to only 30 and if I had done this a lot earlier perhaps the vetoryl wouldn’t have caused the tumor to go from being a micro tumor to a macro tumor. He still would have died from cushings eventually, but, at least his quality of life would have been far better. And it is not anecdotal as I have seen you say too many times to mention already. The blood work kept indicating there was less of a need for the vetoryl with the holistic intervention. It was proof enough for me! Now I am told that there is no treatment that works for histiocytic sarcoma and that chemo works briefly, if it works at all, so there is no course of treatment. Than people like yourself say that we should not look outside conventional treatment and medicine because it is too dangerous. Is it more dangerous than letting your dog die when there may be something that can help them at least slow down the progression of this terrible disease? I spoke with several scientists about different Chinese remedies that have worked invitro in a few people and animals and if you think I will not take the chance to see if it can keep my dog around for while longer, or cure her, than you really haven’t gotten a clue as to how pet owners feel about their dogs and all assorted animals. Oh yes, I’ll wait for the FDA to approve it for testing in 2 years, and than wait another 10 years before it can be used in treatment. Yes, that will really help my dog now that is dying from it. Sorry, you have your opinion and I have mine and that’s it. And, if there is another substance I need to obtain to add to it to make it work I’ll do whatever it takes to get it for her.

  7. skeptvet says:

    “If this is so, than why are they moving away from traditional chemo to immunosuppressive treatments to treat cancers in human beings? ”

    We’re not, this is just something else you have claimed that isn’t true. We are always adding and exploring new therapies is science-based medicine, but the very real increases in life expectancy for many cancers, and the cure of some, have come from conventional treatments, including chemotherapy, and you can’t simply ignore this because it’s inconvenient for your belief system.

    “Than people like yourself say that we should not look outside conventional treatment and medicine because it is too dangerous. Is it more dangerous than letting your dog die when there may be something that can help them at least slow down the progression of this terrible disease?”

    No, no one is saying we shouldn’t look for new therapies. We should look using the same rigorous scientific testing which has so successfully improved our health and well-being over the last century. We shouldnt’ just believe claims about these therapies because we want to believe them without testing them.

    And yes, it is more dangerous to guess or grasp at straws than most people realize. One study, for example of an alternative therapy for terminal pancreatic cancer found that not only did people who used it die sooner than those using conventional therapy but they had lower quality of life. Another has shown patients with cancer who choose alternative medicine die sooner than those who don’t.

    You exaggerate or make up benefits and ignore the risks of alt med, and you exaggerate the harm and ignore the benefits of science-based medicine because you are a true believer, and your belief matters more to you than the truth.

  8. Mary Anne Whitonis says:

    I own four animals. One died last year from cushings and if it had been caught before it went full blown he would most likely be here today. Elevated liver enzymes are often missed as being the beginning of cushings in dogs. I was very suspicious of holistic medicine and remedies because there are so many goofballs out there just trying to turn a buck at the expense of the pet parents and their pet kids. So, I began to research and speak to people. Several years later, holistic medicine, natural chinese supplements which have been helping people for thousands of years, all of my animals are healthy and happy having a great quality of life. Without holistic medicine I would have an entire new group of animals because they would be gone now. By the time my cushings dog died his dose of vetoryl was down to 30mg a day from 60mg twice a day. His quality of life was better but the thromboembolisms got him. My dog Wilma was diagnosed with histiocytic sarcoma with vascular and lymphatic invasion and given very little time to live and I was told it was resistant to chemo. Again, I turned to a holistic physician who began me on a regimen of medicinal mushroom powders and supplements. It will be one year post Wilma’s lobectomy and there are no symptoms and she is thriving and doing great. My dog Fred could not be figured out by anyone and thousands of dollars later I saw my dog slipping away from me and could not do anything to stop it. I put him on the same regimen my dog Wilma was put on by the holistic vet who has done this for over 40 years now, and he added some things to the mix. Fred acts like he is a 1 year old dog going on 1 mile walks every day and eating on his own without being forced, twice a day. We still don’t know what is wrong with him but holistic medicine is holding it at bay. My most recent case Betty has severe IVDD and an MRI confirmed many disk problems in her back. Surgery is not an option. I had to take her places on stretchers and thought she would be gone soon as I would not let her have this type of quality of life. I attacked it with holistic medicine again. Aggressively took her for acupuncture treatments that were electro sensory in nature, with trigger point injections, and had the holistic doctor on the case again. He recommended things, etc. and I now use a tens unit to control her pain level. I was told nothing would work except steroids. She is not on steroids and is being weaned off the pain meds and is walking on her own with minimal pain. Perhaps western medicine is skeptical of holistic medicine but if you have not tried it, have not learned about it, and have not seen the results it can work for the animals than it seems that you are not informed to make an informed opinion or statement about it. All I know is that my one dog walks, my one dog lives from cancer and my other dog lives from his problems. It wasn’t that others didn’t want to help them or didn’t try to help them but they just did not have the additional knowledge that would help them survive and live. It is why integrated medicine is so important for the animals. We are actually weaning my dog off his seizure meds and Chinese herbs may have to be added to the mix if seizures return.

    I also cannot understand why doctors don’t automatically add a liver supplement/detox to dogs they prescribe things like steroids for when they know it will trash the liver in the animals. I have my guys on them and thankfully we were able to clean up their livers in time. If you prescribe these drugs than at least have the sense to prescribe a liver detox for the animals. It’s not complicated.

  9. Jenny says:

    If a multivitamin has an “recommended by vets” seal of approval, should I believe and trust it?

  10. skeptvet says:

    Meaningless marketing.

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