What supplements are you likely to send to the emergency room? What there is to know.


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A young man was recently brought to the emergency room by friends who were concerned about his sudden change in behavior, restlessness and abnormal sweating. He complained of chest pain. On the heart monitor, his heart rate sped up and his blood pressure skyrocketed.

I generally consider a broad differential diagnosis for such an ER patient which includes infection, heart attack, drug overdose, or environmental exposure. His friends have denied knowing about his medical problems or taking prescription drugs. And they denied drug abuse.

While ruling out an infectious cause, I was able to bring down his heart rate and blood pressure with intravenous anti-anxiety medication and hydration of fluids. When he was more alert, he was able to tell us that he had already consumed two energy drinks in a row before training.

As I mentioned in previous columns on apple cider vinegar and vitamins, the supplement industry in the United States, which includes energy drinks, is vastly under-regulated. The lack of quality research limits our critical appraisal of effective supplements. We fly just as blind when it comes to which supplements are potentially harmful.

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Consumers mistakenly believe that if you can buy an over-the-counter supplement without a prescription, it must be safe. But because the FDA doesn’t assess the safety of all supplements, consumers can’t be sure that all of the ingredients – or the combination – in a supplement are safe.

The most common supplements that could lead you to an emergency are diet pills and energy drinks.

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weight loss supplements

A landmark 2015 study found that dietary supplements such as diet pills send an average of 23,000 people to the emergency room each year. This is among the 150 million Americans who together spend more than $ 2 billion a year on diet pills.

Companies usually promise that their product will help you lose weight through one of these mechanisms:

  • Speed ​​up the metabolism
  • Slow down the production or absorption of fat
  • Suppression of appetite

“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 many other herbs. The amount of weight loss from these ingredients is minimal, according to the limited research we have. Caffeine is the strongest evidence for calorie burning.

Patients quickly get into trouble when they take potent prescription weight loss drugs outside of a doctor’s supervision, combine several weight loss supplements – especially stimulants aimed at speeding up metabolism – with stimulants illegal drugs like methamphetamine or cocaine. They present to the emergency room with an accelerated heart rate and high blood pressure, altered or restless mental status, potential liver or kidney damage, and diarrhea or rectal bleeding.

Energy drinks

Consumption of energy drinks was associated with 20,000 emergency room visits in the United States in 2011. Toxicity occurs through one or both of the following routes: either through an extremely high dose of caffeine or through the aggravating effect. caffeine with other ingredients.

The safe limit for caffeine for adults 18 years of age and older is 400 mg per day. For ages 12 to 18, the limit is 100 mg. Energy drinks contain 70 mg to 240 mg of caffeine per serving. For example, Java Monster has 100 mg and 5-Hour Energy has 200 mg. For comparison, a cup of coffee contains around 100 mg. Energy drinks also contain excess sugar which makes them easy to swallow and, compared to the slowness of coffee consumption, 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
  • Vitamin B complex

However, the amounts of the aforementioned ingredients packaged in energy drinks are often significantly higher than those typically found in foods and plants. Combined with high levels of caffeine, you get a perfect storm of heart toxicity.

As with weight loss supplements, a to study in the Journal of the American Heart Association found that fast or excessive consumption of energy drinks can alter the electrical activity of the heart and lead to a high or irregular heartbeat (called arrhythmia) and increased blood pressure, which both put pressure on the heart. This can be exacerbated in people with underlying heart problems. In some extreme cases, these ingredients are known to cause thickening of the blood in the coronary arteries and have led to cardiac arrest.

What would you like to know

In the emergency room, our treatment options are limited for toxicity from diet pills or energy drink supplements. Common treatments include drugs to reduce stress on the heart and intravenous fluid for hydration.

Bottom line: Carefully review the full ingredient list of any supplement you are considering. Pay close attention to the amount of caffeine and make sure you don’t drink more than the recommended amount per day. If your goal is to burn calories, a much safer option is a cup of pre-workout coffee that you slowly sip. Remember, too, that there are no quick fixes to weight loss. Any weight loss program should combine healthy food choices with cardio or strength training, both of which are effective at burning fat according to new research. If your program includes a weight loss pill, please take it only under the direct supervision of a doctor and beware of combining it with other supplements.

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