On October 14th 2015, the New England Journal of Medicine published a new study attacking dietary supplements titled, “Emergency Department Visits for Adverse Events Related to Dietary Supplements.” In this study, the authors recorded the number of emergency room visits related to dietary supplement use that took place at a few select hospitals between 2004 and 2013, and used this data to “estimate” the number of annual visits to the emergency room that are related to dietary supplements in the United States. The authors estimated that around 23,000 annual emergency room visits are related to dietary supplementsⁱ. 

While 23,000 annual emergency room visits sounds like a lot, the Council for Responsible Nutrition (CRN) uses this number to put the safety of dietary supplements into perspective. According to CRN, out of the 150 million Americans who use dietary supplements annually this study indicates:

“That far less than one tenth of one percent of dietary supplement users experience an emergency room visit annually. That percentage becomes even smaller when you eliminate the products that are not dietary supplements and exclude the ER visits that resulted from eye drops, ear drops, and other OTC and non-dietary supplement products inaccurately included by the researchers to make their projections for dietary supplements.”

These numbers suggest that a very low percentage of Americans who use dietary supplements actually experience adverse events related to dietary supplements. It should also be pointed out that this “projected” data is actually quite different than what is officially reported in the Food and Drug Administration’s (FDA) Adverse Events Reporting (AER) database, which indicates there are approximately 3,500 adverse events related to dietary supplement usage annuallyⁱⁱ. Regardless of whether you believe the AERD numbers for adverse events or the NEJM estimates, when comparing these figures to the number of adverse events related to pharmaceutical usage (Between 1.2 to 2 million reports annually), it is easy to see that dietary supplements are incredibly safe. The safety of dietary supplements is even more apparent when considering statistics from the Center for Disease Control (CDC) that show that in the year 2013 there were 22,767 deaths caused by prescription drugs. In 2013, there were exactly 0 deaths caused by dietary supplementsⁱⁱⁱ.

It should also be noted one of the major causes for the emergency room visits included choking on capsulesⁱ. In fact, about 40% of supplement-related emergency room visits for people 65 and older were caused by choking on pills. The media frenzy claiming that this study shows that the ingredients in dietary supplements are unsafe is very misleading— choking on a dietary supplement is an entirely independent issue. Furthermore, for something as simple as pill capsule size, requiring a warning label regarding the possibility of a pill as a choking hazard can easily be remedied within the existing legal framework of the industry. 

The majority of the emergency room visits reported for younger people were largely related to stimulant-like energy products and weight-loss productsⁱ. This category of dietary supplements has always been a problem in the industry as there are a few internet, fly-by-night outfits that don’t adhere to good manufacturing practices and give the responsible industry members a bad name. This is one of the many reasons that we DO NOT sell stimulant-based weight loss products here at Natural Grocers^iv.

Importantly, despite the fact that the FDA has the authority to police this area of the industry more strictly, it seems that they are more interested in using this small fraction of supplement manufacturers as an example of why the entire industry should be subject to heavy federal oversight. The industry wants these bad-players to be identified and disciplined as much as anyone else. This is evidenced by the fact that during the ten year span analyzed in this study, the industry lobbied for and helped to enact key dietary supplement legislation and regulation to improve consumer safety. These include the Anabolic Steroid Control Act of 2004, the Adverse Event Reporting law of 2006, Good Manufacturing Practices in 2007, and the Designer Anabolic Steroid Control Act of 2014. 

References Available Upon Request