U.S. kids overdosing on dietary supplements

Children under age 6 are often the most affected.
Over a 13-year period, the annual rate of accidental exposures to dietary supplements rose in the U.S. by nearly 50 percent, and 70 percent of those exposures involved young children. (For Spectrum Health Beat)

A curious toddler opens a bottle of melatonin found on the kitchen counter, and accidentally overdoses on a supplement typically used by adults to help with sleep.

In that case, the doctor who treated the child only had to deal with a very tired 3-year-old, but it might have been a far more serious scenario if a different dietary supplement, such as the energy product ephedra or the male enhancement herb yohimbe, had been swallowed.

“We see it all the time,” said Dr. Barbara Pena, research director of the emergency medicine department at Nicklaus Children’s Hospital in Miami.

Indeed, a new report from researchers bears out Pena’s observations: From 2005 through 2012, the annual rate of accidental exposures to dietary supplements rose in the United States by nearly 50 percent, and 70 percent of those exposures involved young children.

“The biggest increase [in accidental overdoses] was in children under 6. It got our attention,” said study author Henry Spiller, director of the Central Ohio Poison Center of Nationwide Children’s Hospital in Columbus. Ninety-seven percent of the time, the children swallowed the supplements while at home, the study found.

It is a particularly difficult problem to try to solve: Dietary supplements are not regulated by the U.S. Food and Drug Administration as drugs, so they’re not subject to the same scrutiny and oversight. The FDA can only take action if the supplements are shown to cause harm.

During the 13 years of the study, Spiller’s team also found an increase from 2000 to 2002, when the rates of calls to U.S. poison control centers involving supplements rose 46 percent each year. From 2002 to 2005, the researchers found the rates of calls declined. Spiller suspects that is because the FDA banned ephedra in 2004, after supplements containing it had been linked with adverse heart events and deaths.

Overall, only about 4.5 percent of the cases in the study had serious medical outcomes. During the 13-year period tracked, 34 deaths were attributed to supplement exposure, Spiller said.

The supplements most often associated with the greatest toxicity were ephedra (also known as ma huang) products, yohimbe (found in male enhancement and other products) and energy supplements.

While ephedra is now banned, yohimbe is not, and nearly 30 percent of yohimbe exposure calls in the study resulted in moderate or major harm. Yohimbe can cause heartbeat rhythm changes, kidney failure, seizures, heart attack and death, the researchers noted.

Often, children find the supplements on a kitchen counter, Spiller said. Parents and others often equate dietary supplements with being natural, and therefore safe. Parents usually don’t keep track of how many pills are left in a supplement bottle, he said, making it more difficult to tell poison control staff how many pills were taken in an accidental exposure.

One common scenario, Spiller said, is that a child finds a product containing yohimbe, opens it and takes it.

Another common occurrence, Spiller said, is that high school athletes going to preseason football practices take an energy product loaded with caffeine and other ingredients and have abnormal heart rhythms or even a heart attack.

The researchers said their findings point to need for the FDA to regulate yohimbe and energy products.

Both Spiller and Pena suggest parents and others become more aware of the potential problems with supplements. If young children are in the house, keep supplements high on a shelf or in a locked cabinet, Spiller said.

Pena, who was not involved with the study, tells parents to ”treat these supplements the same as they would treat prescription or over-the-counter medicines.” Supplements are especially scary, she noted, because it’s not always possible to know the potency of the product.

The study was published July 24 in the Journal of Medical Toxicology.

SOURCES: Henry Spiller, M.S., director, Central Ohio Poison Center, Nationwide Children's Hospital, Columbus; Barbara Pena, M.D., Ph.D., research director, emergency department, Nicklaus Children's Hospital, Miami; July 24, 2017, Journal of Medical Toxicology, online.

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