Supplement dangers exaggerated

A report out today in the New England Journal of Medicine and reported in The Independent shows nothing to be concerned about but press reports implying dangers of nutritional supplements that don’t exist if you actually read the study.

This was a ten year study of 23,000 reported adverse events to supplements, in other words 2,300 per annum in a population of 319 million, where maybe half take supplements. That means that, overall, one in 70,000 supplement takers has a reaction. In context, your annual chances of being killed in a road traffic accident are three times higher than this. But these weren’t for the large part, dietary or nutritional supplements.

The vast majority of adverse events were to weight loss, energy and sexual enhancement supplements. The most commonly reported symptoms were ‘palpitations, chest pain, or tachycardia’. We are talking about ‘natural’ stimulants which are neither allowed in the UK, nor would I ever recommend them. Too much caffeine, which many of these products contain, would do exactly the same thing.

A small number of adverse effects were recorded in relation to nutritional supplements. These reactions were:

  • ‘mild-to-moderate allergic reactions’ to micro-nutrients(excluding iron, calcium and potassium). These accounted for 40% of adverse events to nutritional supplements. Now, any supplement can contain things a person could be allergic to such as wheat, milk, yeast, fish (oil). Good supplements exclude these, except for fish oil capsules. If you are allergic do check the label carefully.
  • swallowing problems accounted for 41% of adverse events. The most common implicated were calcium supplements which tend to be large and, in my opinion, unnecessary.
  • abdominal symptoms associated with iron and potassium supplements. There is no need to supplement potassium. There’s more than enough in food.

So, there is nothing at all serious by nature here. Meanwhile, the American Association of Poison Control has issued its 30th annual report. Yet again, not one single death from a supplement – for 30 years! The same is true in the UK.

Actually it was claimed that one person might have died from vitamin supplements in the year 2012, according to AAPCC’s interpretation of information collected by the U.S. National Poison Data System. That single alleged “death” was supposedly due to “Other B-Vitamins.” Since the AAPCC report specifically indicates no deaths from niacin (B-3) or pyridoxine (B-6), that leaves folic acid, thiamine (B-1), riboflavin (B-2), biotin, pantothenic acid, and cobalamin (B-12) as the remaining B-vitamins that could be implicated. However, the safety record of these vitamins is extraordinarily good; no fatalities have ever been confirmed for any of them. So this case remains a mystery. I cannot see how any of these vitamins would harm anyone let along kill them.

Since this study was in the US we have to compare this to the estimated over 100,000 deaths from adverse drug reactions, and millions of adverse reactions every year.

The overall verdict: Nutritional supplements remain remarkably safe. If you’re allergic to something check it’s not in the supplement you take. Don’t supplement calcium or potassium on its own. Potassium is unnecessary and calcium, without vitamin D, is close to useless. Don’t take too much iron, more than 20mg – although doctors prescribe four times this. It is unnecessary. Don’t swallow pills you cannot swallow.