Natural Isn’t Necessarily Safe

Peter ForsterPhysical Conditions and Health

23,000 emergency room visits per year are the result of taking “natural supplements.”

Natural does not mean safe.

In 1994, Congress passed the Dietary Supplement Health and Education Act (DSHEA), with heavy backing from industry. By defining herbal supplements and botanicals as dietary supplements, DSHEA exempted them from the more rigorous standards used by the FDA in regulating food, drugs, and medical devices—essentially leaving it up to the industry to regulate itself.

Between 1994 and 2008, the number of dietary supplement products on the market increased from 4,000 to 75,000. summarized the results, just published in the New England Journal of Medicine, this way…

The results from a large, long-term study by the FDA and the Centers for Disease Control and Prevention (CDC) showed that:

  • 28% of visits involve young adults (age 20 – 34)
  • 21.1% involve unsupervised children
  • 23% of the visits involve adults age 50 or older

Weight loss and energy products were implicated in 65.5% of all emergency room visits. Cardiac adverse events such as palpitations, chest pain and tachycardia were most commonly associated with these products, and were most frequent in young adults. 

Micronutrient products such as multivitamins, iron calcium and potassium were associated with about 31% of all emergency room visits; adverse events associated with these products included mild to moderate allergic reactions and abdominal symptoms such as nausea and vomiting.

Among adults over age 65, swallowing problems caused 40% of all visits; this was especially a problem with calcium supplements. The authors noted that large amounts of nutrients are often packaged in a single large pill, a problem that could be addressed by decreasing pill size, or using alternative forms that are easier to swallow, such as liquids, gels or powders. 

Right now there is only one source of reliable information about supplements, tests supplements and regularly finds that many of those on the market are either not safe or don’t contain the ingredients that they claim to contain.

If you are taking a dietary supplement we strongly encourage you to subscribe.


Emergency Department Visits for Adverse Events Related to Dietary Supplements. Andrew I. Geller, M.D., Nadine Shehab, Pharm.D., M.P.H., Nina J. Weidle, Pharm.D., Maribeth C. Lovegrove, M.P.H., Beverly J. Wolpert, Ph.D., Babgaleh B. Timbo, M.D., Dr.P.H., Robert P. Mozersky, D.O., and Daniel S. Budnitz, M.D., M.P.H. N Engl J Med 2015; 373:1531-1540 October 15, 2015 DOI: 10.1056/NEJMsa1504267