Aiming Dietary Supplements at Kids

Dietary supplement companies have begun aggressively targeting children and parents as consumers of their products, among them powerful chemicals designed to help kids gain strength, lose weight or treat illnesses ranging from colds and flu to depression and even attention deficit disorder.

As a result, increasing numbers of children are swallowing supplements, often with the knowledge, urging and even insistence of parents in search of “natural” remedies or “healthy” alternatives for youngsters who eat too many cupcakes or drink too much soda. One survey recently found that almost 20% of parents were giving their children supplements.

In Vancouver, Wash., Nutrition Now Inc., for example, created a cuddly rhinoceros cartoon character to promote its line of dietary supplements for children, including Rhino Pops containing the herb echinacea, a cold treatment. “100% natural, Moms love the soothing support, kids love the all-natural taste, vegetarian approved,” reads the legend on the box.

From Saco, Maine, Fresh Samantha Inc. ships to supermarket shelves nationwide “body zoomer” fruit smoothies that carry cartoon pictures of children to catch the eye. A 16-ounce bottle of “Oh, Happy Day” contains 100 milligrams of the herb St. John’s wort “to lift the spirits.” Many adults in search of an alternative to antidepressants such as Prozac take a 300-milligram tablet of St. John’s wort three times a day.

Although some products may be helpful, the surge in supplements use by children and adolescents is causing rising alarm among pediatricians, children’s health advocates and federal and state medical officials. At the least, many of the products may be useless. At the worst, some may be dangerous, they say. Supplements are largely untested and unregulated. The full short- and long-term impact of these substances on young bodies is virtually unknown. And in some cases, there’s evidence they may be harmful.

“Physicians use medications that have been tried and tested, with known side effects,” said Rossanne Philen, chief of environmental hazard epidemiology at the federal Centers for Disease Control and Prevention in Atlanta. “When children are given herbal preparations, they are at the mercy of the adult who is experimenting on them.”

Companies offer discounts and rebates in some states to high school coaches who supply creatine, a powerful body-building nutrient, to their athletes.

Some products even include the stimulant ephedra, which is still recommended for children by some supplement salespeople for attention deficit disorder, even though the Food and Drug Administration has linked it to serious illness and even death. Much of the industry warns youngsters under 18 away from it.

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Because there’s no central source of information about adverse reactions to supplements, it is difficult to get an accurate accounting of whether they are causing widespread problems. But almost all supplements can produce some unpleasant side effects, and their overall safety remains far from clear.

The reason for this is that dietary supplements, as defined by the 1994 Dietary Supplement Health and Education Act, may be sold without pre-market clearance by the FDA or a detailed scientific evaluation of their safety and effectiveness. Also, unlike prescription drugs, supplements must be proved dangerous by the FDA before they can be removed from the market. As a result, thousands of products are sold over the counter to anyone who wants them--including children--with far less scrutiny than prescription drugs.

Mark Blumenthal, executive director of the American Botanical Council, an herb advocacy group, acknowledged that no one has done a “formal risk-benefit review” of dietary supplements, including those designed specifically for children. But he noted that many herbal remedies have been used for hundreds or even thousands of years and are well known outside the United States.

“With only a few exceptions, most of these herbs are some of the best-researched in the world,” Blumenthal said. “In Europe, where they are sold in pharmacies, they have a stellar record of safety.”

A Worrisome Gap in Regulation

Unlike pharmaceutical firms, supplement companies are not required by law to report serious product problems to the government. Agencies rely on sporadic voluntary reports that frequently come from inexpert sources.

The American Assn. of Poison Control Centers, which collects data from 65 locations in all but a few states, in 1998 listed 704 reports of bad experiences with dietary supplements involving youngsters ages 6 to 18.

The association’s list of supplements does not include ephedra, used primarily by adults to boost energy or lose weight and the subject of a virulent controversy between the herbal industry and the federal and state agencies seeking to regulate it.

In a report earlier this year, the FDA documented 134 cases linking serious side effects or death to ephedra during a 33-month period ending in March 1999. Ten of the reports involved children younger than 18.

In one case, a 15-year-old girl was hospitalized with severe chest pain after taking six ephedra tablets and drinking a pair of “double-shot [coffee] lattes,” the FDA report said. The labeled dosage was two tablets, three times daily to lose weight, but the 125-pound victim decided to take all six pills at once.

The FDA has also documented cases of adverse effects from other supplements. Echinacea and ginseng produce minor and infrequent problems. The same is true of St. John’s wort.

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A substance known as DMAE, included in products marketed as alternatives to Ritalin for the treatment of attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), can cause side effects similar to Ritalin’s: insomnia, hives, headache, drowsiness and involuntary muscle movement.

Creatine, taken to enhance the body’s ability to deliver energy to muscles, also causes muscles to accumulate water, which can lead to weight gain, cramping, muscle strains, dehydration, diarrhea and gastrointestinal pain. The University of Tennessee recently banned creatine after 14 of its football players had cramping episodes during one game.

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Many of creatine’s bad effects can be avoided by cautious use, but caution is not a trait generally ascribed to the young.

“High school kids don’t have a clue about how to take it,” said sports nutritionist Ruth Carey, a registered dietitian in Portland, Ore. “I don’t find a whole lot of awareness on the part of parents, either. They don’t realize it’s an unstudied drug.”

At the same time, there has been little research on creatine’s long-term effects, and virtually none regarding its effects on young bodies.

Finally, studies have shown that the potency of many herbal supplements--including St. John’s wort, ginseng and ephedra--often does not match the potency advertised on the bottle. A survey of 20 ephedra products conducted by the University of Arkansas in May found that the potency of half of them was either much greater or much less than what was indicated by the dosage listed on the bottle.

“Support for this type of thing [supplements] is simply not there. We don’t know proven effectiveness. We don’t know contaminants, or the concentration bottle-for-bottle,” said Susan S. Baker, chairwoman of the American Academy of Pediatrics’ committee on nutrition. “It’s pretty serious. It’s like taking a vial of water and not knowing whether it comes through a filter or from the sewer--and then drinking it.”