What is there can be worse than what isn’t

What is there can be worse than what isn’t

There was a recent brouhaha recently out of New York over the fact that supplements did not contain what the label indicated they should contain.

There was no there there.

This is a recurrent issue with supplements.


I worry more about what they do contain, since some supplements can have toxic metals, such as ayurvedic herbal medicine products.

One of 5 Ayurvedic HMPs produced in South Asia and available in Boston South Asian grocery stores contains potentially harmful levels of lead, mercury, and/or arsenic.

The problem is not limited to just supplements. Probiotics are equally sketchy, with

Organisms were improperly identified in 9/21 (43%) human and 8/23 (35%) veterinary products. Contents of 5/20 (25%) human and 3/17 (18%) veterinary products were misspelled. In only 9 human and 2 veterinary products were the contents adequately identified.

and mentioning organisms

such as “Lactospore sporogenes,” that do not exist.

The organisms can be non-viable (ie dead) and therefore worthless.

Worse, probiotics have been found to probably contain antibiotic resistance genes.

But now probiotics have been implicated in the death of a child: Fatal Gastrointestinal Mucormycosis in a Premature Infant Associated with a Contaminated Dietary Supplement. The child was given a probiotic to prevent necrotizing enterocolitis but died of an invasive mold in the GI tract.

Unopened bottles of ABC Dophilus Powder from the lot received by the infant were cultured by the hospital microbiology laboratory; the samples yielded Rhizopus species, a mold capable of causing mucormycosis. CDC later confirmed these isolates as Rhizopus oryzae.

As the CDC notes

However, dietary supplements such as ABC Dophilus Powder are not regulated as drugs by the FDA. Therefore, these products are not subject to FDA’s premarket review and approval requirements for safety and effectiveness, nor to the rigorous manufacturing and testing standards for drugs. Rather, dietary supplements are regulated by FDA as foods with good manufacturing practice requirements specific to the commodity.

I always mention on rounds when a heroin patient gets an infection that heroin is not sterile and it is not as if the manufacturers are trying to make a sterile product. Saying the heroin is contaminated suggests they were trying to make it bacteria and fungus free.

There are worse things than have empty supplements. When they contain nothing, it is amusing. When they contain poisons and pathogens it can be fatal.  

And there is no way to know.

Points of Interest 03/03/2015
Points of Interest 03/02/2015

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