Journal of Medical Toxicology

, Volume 13, Issue 3, pp 227–237 | Cite as

An Increase in Dietary Supplement Exposures Reported to US Poison Control Centers

  • Nisha Rao
  • Henry A. Spiller
  • Nichole L. Hodges
  • Thiphalak Chounthirath
  • Marcel J. Casavant
  • Amrit K. Kamboj
  • Gary A. Smith
Original Article



The objective of this study was to investigate the epidemiology of dietary supplement exposures in the USA.


A retrospective analysis was conducted of out-of-hospital dietary supplement exposures reported to the National Poison Data System from 2000 through 2012.


There were 274,998 dietary supplement exposures from 2000 through 2012. The annual rate of dietary supplement exposures per 100,000 population increased by 46.1% during 2000–2002, decreased 8.8% during 2002–2005, and then increased again by 49.3% from 2005 to 2012. These trends were influenced by the decrease in ma huang exposures starting in 2002. Miscellaneous dietary supplements accounted for 43.9% of all exposures, followed by botanicals (31.9%), hormonal products (15.1%), and other supplements (5.1%). The majority of dietary supplement exposures (70.0%) occurred among children younger than 6 years old and were acute (94.0%) and unintentional (82.9%). Serious medical outcomes accounted for 4.5% of exposures and most (95.0%) occurred among individuals 6 years and older. Ma huang products, yohimbe, and energy products were the categories associated with the greatest toxicity.


There was an overall increase in the rate of dietary supplement exposures from 2000 through 2012. Although the majority of these exposures did not require treatment at a health care facility or result in serious medical outcomes, exposures to yohimbe and energy products were associated with considerable toxicity. Our results demonstrate the success of the FDA ban on ma huang products and the need for FDA regulation of yohimbe and energy products in the USA.


Dietary supplement Poison control center Ma huang Yohimbe Energy products 



American Association of Poison Control Centers


Against medical advice


Critical care unit


Food and Drug Administration


Health care facility


National Poison Data System


Poison control center


Toxic Exposure Surveillance System


United States


Compliance with Ethical Standards

Conflicts of Interest

The authors have no conflicts of interest or financial disclosures relevant to this study to disclose.

Sources of Funding


Financial Disclosure

The authors have no financial disclosures relevant to this study.


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Copyright information

© American College of Medical Toxicology 2017

Authors and Affiliations

  • Nisha Rao
    • 1
    • 2
  • Henry A. Spiller
    • 2
    • 3
  • Nichole L. Hodges
    • 1
    • 2
  • Thiphalak Chounthirath
    • 1
  • Marcel J. Casavant
    • 1
    • 2
    • 3
  • Amrit K. Kamboj
    • 1
    • 4
  • Gary A. Smith
    • 1
    • 2
    • 5
  1. 1.Center for Injury Research and Policy of the Research Institute at Nationwide Children’s HospitalColumbusUSA
  2. 2.The Ohio State University College of MedicineColumbusUSA
  3. 3.Central Ohio Poison CenterColumbusUSA
  4. 4.Mayo Clinic, Division of General Internal MedicineRochesterUSA
  5. 5.Child Injury Prevention AllianceColumbusUSA

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