Which supplements are most likely to land you in the ER?
A young man was recently brought to the ER by friends who were concerned by his sudden behavior change, restlessness and abnormal sweating. He was complaining of chest pain. On the cardiac monitor, his heart rate was accelerated and his blood pressure was spiking.
I usually consider a broad differential diagnosis for such an ER patient that includes infection, heart attack, drug overdose or environmental exposure. His friends denied any knowledge of him having medical problems or taking prescription medication. And they denied drug abuse.
While ruling out an infectious cause, I was able to bring down his heart rate and blood pressure with some intravenous anxiety-reducing medication and fluid hydration. When he was more alert, he was able to tell us he had earlier consumed two energy drinks back-to-back before working out.
As I’ve discussed in previous columns about apple cider vinegar and vitamins, the supplement industry in the U.S., which includes energy drinks, is grossly underregulated. The dearth of quality research limits our critical evaluation of which supplements are effective. We are flying just as blind when it comes to knowing which supplements are potentially harmful.
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Consumers are under the dangerous misconception that if you can buy a supplement over-the-counter without a prescription, it must be safe. But because the FDA does not evaluate all supplements for safety, consumers cannot be sure that all the ingredients – or the combination – in a supplement are safe.
The most common supplement culprits that could land you in the ER are weight loss pills and energy drinks.
Weight loss supplements
A landmark 2015 study showed that dietary supplements such as weight loss pills send an average of 23,000 people to the ER annually. That’s out of a massive 150 million Americans who combined spend more than $2 billion a year on weight-loss pills.
Companies typically promise their product will help you lose weight through one of these mechanisms:
- Speeding up metabolism
- Slowing down fat production or absorption
- Appetite suppression
"Fat burners" are the most well-known weight loss supplement and typically include high doses of caffeine, green tea extract, carnitine, yohimbe, soluble fiber and a slew of other herbs. The amount of weight loss from these ingredients is minimal, according to the limited research we have. The strongest evidence for calorie burning is for caffeine.
Patients quickly get into trouble when they take powerful prescription weight loss medication outside a doctor’s supervision, combine multiple weight loss supplements – particularly stimulants aimed to speed up metabolism – with illegal stimulants like methamphetamine or cocaine. They present to the ER with an accelerated heart rate and elevated blood pressure, altered or agitated mental status, potential damage to liver or kidneys, and diarrhea or rectal bleeding.
Energy drink use was associated with 20,000 ER visits in the U.S. in 2011. Toxicity occurs via one or both of the following pathways: either via an extremely high dose of caffeine or from the compounding effect of caffeine with other ingredients.
The safe limit of caffeine for adults 18 and older is up to 400mg a day. For those 12 to 18, the limit is 100mg. Energy drinks contain 70mg to 240mg of caffeine per serving. For example, Java Monster contains 100mg, and 5-Hour Energy includes 200mg. As a comparison, a cup of coffee contains about 100mg. Energy drinks also contain excess sugar that make them easy to down, and compared with the slow sipping of coffee, can lead to caffeine toxicity if consumed quickly.
By themselves, most of the ingredients in energy drinks are commonly found in our diet or occur naturally in our body and are not inherently dangerous:
- Taurine: a common amino acid found in meat and fish
- L-carnitine: a chemical compound involved in our metabolism
- B vitamin complex
However, the amounts of the aforementioned ingredients packaged into the energy drinks is often significantly higher than what is typically found in foods and plants. Combined with high levels of caffeine, and you have a perfect storm of cardiac toxicity.
As with weight loss supplements, a study in the Journal of the American Heart Association found that rapid or overconsumption of energy drinks can alter the heart's electrical activity and lead to an elevated or irregular heart beat (known as arrhythmia) and increased blood pressure, both of which put strain on the heart. This can be exacerbated in people with underlying heart conditions. In some extreme cases, these ingredients have been known to cause thickening of blood in the coronary arteries and have led to cardiac arrest.
What you need to know
In the ER, our treatment options are limited for the toxicity from either weight loss pills or energy drink supplements. Common treatments include medications to reduce the stress on the heart and intravenous fluid for hydration.
Bottom line: Thoroughly review the full list of ingredients for any supplement you are considering. Pay particular attention to the amount of caffeine and be sure to not drink more than the recommended amount daily. If your goal is calorie-burning, a much safer option is a pre-workout cup of coffee that is sipped slowly. Also, remember there's no magic bullet for weight loss. Any weight loss program should combine healthy eating choices with cardio or strength training, both of which are effectively at burning fat per new research. If your program includes a weight loss pill, please take it only under the direct supervision of a physician and be wary of combining that with other supplements.
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