A new study reveals dietary supplements lead to over 20,000 emergency room visits a year. Consumers trust manufacturers to create products that supplement their health. However, the $35 billion-a-year industry has created issues for consumers instead, particularly at the expense of children, young adults, and senior citizens. 
Shortcomings in Regulation of Supplements
The Centers for Disease Control and Prevention estimate that more than half of U.S. adults use dietary supplements.  From multivitamins, to energy boosters, to sleep aids, there are multitudes of products readily available for all ailments. When considering the time restraints of many Americans lives, supplements seem like an effective solution to many problems. But in an effort to save time and money, many have subjected themselves to costly and potentially life-threatening issues.
According to a study published in The New England Journal of Medicine, of the nearly 23,000 visits, 20% were unsupervised children. After the exclusion of children, senior citizens made up 38% of trips after experiencing issues swallowing pills. A quarter of trips were related to weight-loss supplements that produced symptoms like chest pains and heart palpitations. Also creating cardiovascular problems, energy supplements were responsible for 10% of patients. 
According to a 1994 federal law, supplements are considered safe until proven otherwise. The Food and Drug Administration regulates dietary supplements, but not as strictly as it does prescription drugs where extensive trials and tests are conducted. Dietary supplement firms do not need FDA approval to put a product on a shelf. 
Instead, companies merely state they have done the research needed to vouch for the safety of their products. Their information is rarely shared with the FDA and therefore it is never established what, if any, research has truly been done on the product. 
“Unlike companies that make prescription or over-the-counter drugs, those that manufacture supplements aren’t required to list possible side effects on their products,” according to the study. 
At this time, supplement manufacturers are not required to use child-resistant packaging. This leads to small hands getting a hold of potentially potent substances. The labels typically do not remind parents to store out of reach of children, but it is a crucial practice to mitigate unnecessary issues. 
The FDA also fails to regulate the physical size of supplements. Pills are frequently made too large for people to swallow easily, particularly affecting the elderly population. 
With so many shortcomings in regulation of supplements, healthcare advocates are urging for better practices and launching more investigations into the products on shelves.
Mainstream Retailers and Fraudulent Products
Just this month, GNC, the massive health and nutrition retailer, was sued for selling dietary supplements containing amphetamine-like substances. Oregon’s attorney general, Ellen Rosenblum, filed the lawsuit following an investigation in conjunction with the FDA. 
“It is scary to know that certain products sold by GNC contain an ingredient that is not even labeled — let alone approved in the United States,” Rosenblum said. 
One supplement contained an unapproved synthetic chemical called picamilon that is a prescription drug used to treat neurological disorders in countries like Russia. 
The other supplement in question contained BMPEA, an abbreviated form of a powerful amphetamine-like stimulant that is banned by the World Anti-Doping Agency for use by athletes. 
Rosenblum estimates that thousands of these questionable products were sold over the past couple of years. 
GNC has denied the claims. This is not the first time the company has come under fire for selling supplements that have controversial ingredients or lack of accurate labels. 
Earlier this year, the New York State attorney general’s office accused GNC, Walgreens, Walmart, and Target of selling unsafe herbal supplements. 
An investigation was launched and authorities tested the top-selling store brands of herbal supplements at each of the retailers. Investigators found that four out of five of the products were falsely labeled and did not contain any of the herbs listed. 
In lieu of the herbs, the pills were filled with powdered rice, vegetables and houseplants, becoming a danger to those with allergies and a total farce to the consumer. 
Specifically from the investigation, Walgreens’ brand of ginseng pills was found to contain nothing more than rice and powdered garlic. 
Walmart sold a product labeled as ginkgo biloba but in reality only contained powdered radish and wheat – a hidden threat to those with Celiac Disease.
Similarly at Target, herbs were left out of some supplements and replaced with powdered fillers. 
GNC was again found to have unlisted ingredients in some of its supplements. 
As healthcare advocates take action against the supplement industry, the nation awaits stricter regulations on the products so readily available on the shelves of major retailers.
What Consumers Can Do to Make Smart Supplement Choices
Americans make daily choices for their safety and health from wearing seat belts to applying sunscreen. While taking a vitamin or sleep aid may seem just as routine, do not let supplements go unresearched.
The FDA’s website provides some important information regarding supplements. Specifically, the FDA warns against the following: products masquerading as alternatives to anabolic steroids, sexual enhancement supplements promising immediate effects, products claiming to be alternatives to prescription drugs, and products marketed in mass e-mails. 
Utilize resources. The Mayo Clinic provides a comprehensive database of prescription and over-the-counter drug information on their website. When researching melatonin supplements for example, Mayo Clinic provides background on the drug, related terms or brand names, dosing, safety information, potential interactions, and the methodology behind it. 
Knowing your pre-existing conditions can be critical to avoiding complications from supplements. For example, for those with high blood pressure or cardiovascular disease are at risk for adverse side effects from weight-loss drugs. The stimulants in weight-loss products like Hydroxycut and Dexatrim are especially problematic for those prone to atrial fibrillation (an irregular heartbeat). 
Patients often forget to list supplements currently in-use at the time of appointments or feel it is not of importance. Always let your doctor know what supplements you are taking to prevent an interaction with any prescriptions you may be prescribed. Additionally, pharmacists can provide insight to products on their shelves and their efficacy.
Practicing diligence and being knowledgeable of what you ingest are crucial to avoid a trip to the emergency room due to an unsafe supplement.
1.^ Park, Madison (April 13, 2011). “Half of Americans use supplements.” CNN.com, Retrieved October 25, 2015.
2.^ Geller, A.I., Shehab N., Weidle N.J., Lovegrove M.C., Wolpert B.J., Timbo B.B…Budnitz, D.S. (2015). Emergency Department Visits for Adverse Events Related to Dietary Supplements. New England Journal of Medicine 2015; 373:1531-1540 doi: 10.1056/NEJMsa1504267. Retrieved from: http://www.nejm.org/doi/full/10.1056/NEJMsa1504267
3.^ O’Connor, Anahad (October 14, 2015). “Dietary Supplements Lead to 20,000 E.R. Visits Yearly.” NYTimes Well Blogs. Retrieved October 25, 2015.
4.^ Szabo, Liz (October 15, 2015). “Side effects from dietary supplements send 23,000 people a year to ER.” USATODAY.com. Retrieved October 25, 2015.
5.^ Wattles, Jackie (October 22, 2015) “GNC accused of selling supplements laced with ‘amphetamine-like’ substance.” Money.CNN.com. Retrieved October 26, 2015.
6.^ Grover, Natalie (October 26, 2015). “Oregon Attorney General says GNC sold spiked products.” Reuters.com. Retrieved October 26, 2015.
7.^ O’Connor, Anahad (February 3, 2015). “New York Attorney General Targets Supplements at Major Retailers.” NYTimes Well Blogs. Retrieved October 25, 2015.
8.^ “Beware of Fraudulent Dietary Supplements” FDA.fgov. Retrieved October 26, 2015.
9.^ “Melatonin Background” MayoClinic.org. Retrieved October 26, 2015.
10.^ Theobald, Mikel. “The Risky Side of Weight Loss Drugs: Disrupting Heart Rhythm.” EverydayHealth.com. Retrieved October 26, 2015.