Title: Let food be thy medicine<br/>Author: Brian Corwell<br/><a href='http://umem.org/profiles/faculty/294/'>[Click to email author]</a><hr/><p>
Over half of U.S. adults in the United States consume dietary supplements. </p>
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Study design: A quality improvement study using data from the FDA’s Center for Drug Evaluation and Research, Tainted Products Marketed as Dietary Supplements</p>
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Dates: 2007 through 2016. </p>
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Results: <strong>Unapproved pharmaceutical ingredients were identified in 776 dietary supplements.</strong></p>
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146 different dietary supplement companies were involved.</p>
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Most of these products were marketed for sexual enhancement (353 [45.5%]), weight loss (317 [40.9%]), or muscle building (92 [11.9%].</p>
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157 adulterated products (20.2%) contained more than 1 unapproved ingredient.</p>
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A 2015 NEJM study estimated that <strong>23,000 ED visits per year are attributed to adverse effects associated with dietary supplements.</strong></p>
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Estimated 2154 hospitalizations annually.</p>
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Frequently involve young adults between 20 and 34 years of age in addition to unsupervised children.</p>
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Excluding children, almost 66% of ED visits involve herbal or complementary nutritional products and 31.8% involved micronutrients.</p>
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Products for weight loss or increased energy were commonly implicated.</p>
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Finally, <strong>herbal and dietary supplements now account for 20% of cases of hepatotoxicity in the US.</strong></p>
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The major implicated agents include anabolic steroids, green tea extract, and multi-ingredient nutritional supplements.</p>
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Anabolic steroids (marketed as bodybuilding supplements) typically induce a prolonged cholestatic, self-limiting liver injury.</p>
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Green tea extract and many other products, in contrast, tend to cause an acute hepatitis like injury.</p>
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<fieldset><legend>References</legend>
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Tucker J, et al. Unapproved Pharmaceutical Ingredients Included in Dietary Supplements Associated With US Food and Drug Administration Warnings. <em>JAMA Netw Open.</em> 2018;1(6).</p>
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Geller et al. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med 2015;373: 1531-1540.</p>
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Navarro VJ, et al. Liver injury from herbal and dietary supplements. Hepatology. 2017 Jan;65(1):363-373.</p>
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