Episode Overview
Episode Title: ENP104: Hidden Ingredients in Supplements
Podcast: Endocrine News Podcast
Host: Aaron Lohr, Endocrine Society
Guest: Dr. Meghana Patty Patti, Endocrinologist, Lafayette General Medical Center
Date: October 15, 2025
Main Theme:
This episode explores the hidden dangers posed by undisclosed or vaguely labeled ingredients in over-the-counter supplements, focusing on a real-world case where a patient experienced significant endocrine disruptions due to a commonly consumed "vitamin drink." Dr. Meghana Patty Patti discusses her recent case study and highlights the implications for both patients and healthcare providers.
Key Discussion Points & Insights
1. What Are “Hidden Ingredients”? (01:21 – 02:23)
- Definition: Ingredients that are not clearly labeled, hidden under umbrella terms ("natural flavors"), scientific names, or vague terms. Manufacturers may not have to fully disclose all components, especially in supplements, due to lax FDA regulation.
- Public Health Concern: Such substances can impact health, including triggering allergies, interacting with medications, or causing unexpected hormonal changes.
Quote [Dr. Patty Patti, 01:31]:
"By hidden ingredients, we mean substances that are either not explicitly named in ways consumers easily recognize, or they're present in small amounts but can still impact health..."
2. Testosterone, Insulin Sensitivity, & Hypoglycemia (02:23 – 03:04)
- Mechanism: Elevated testosterone can increase insulin sensitivity, making the body more effective at lowering blood glucose. In patients already on diabetic medication or with glucose regulation challenges, this can increase the risk of hypoglycemia.
Quote [Dr. Patty Patti, 02:36]:
"Testosterone can contribute to hypoglycemia indirectly because it can increase your body's insulin sensitivity, meaning your cells become better at using glucose..."
3. The Case Study: A Young Man with Mysterious Hypoglycemia & High Testosterone (03:04 – 08:02)
Patient Presentation (03:11 – 03:51)
- 26-year-old male, frequent hypoglycemic episodes, especially postprandial and fasting.
- Episodes severe enough to require hospitalization; accompanied by fatigue.
Diagnostic Workup (03:56 – 05:45)
- Labs: Elevated hemoglobin, hematocrit, and testosterone; low-normal glucose (~60s).
- Normal hemoglobin A1c (5.2).
- Extensive cancer and endocrine investigations (oncology team, testicular ultrasound, imaging, CGM monitoring)—all largely unremarkable except for the persistent high testosterone and hypoglycemia.
- CGM recorded sugar as low as 54 mg/dL.
The Investigation Deepens (05:45 – 06:46)
- Suspicion of exogenous androgen use: Young men sometimes unknowingly ingest androgens in OTC supplements.
- Detailed supplement/diet history revealed the patient regularly consumed a "vitamin drink" containing guarana seed extract (noted in fine print).
Quote [Dr. Patty Patti, 05:54]:
"...sometimes they take over-the-counter supplements that are contaminated with androgens. So we did a thorough history... and after excluding everything, patient stated that he was drinking a vitamin drink... in fine text, it states that it contains caffeine from this guarana seed extract."
Resolution (07:00 – 07:25)
- Patient stopped all supplements, including the drink.
- Follow-up: Testosterone normalized; hypoglycemic episodes improved.
Memorable Moment:
The simple act of discontinuing a seemingly benign supplement resulted in dramatic clinical improvement.
About Guarana (07:25 – 08:02)
- Native Amazonian fruit, high in caffeine.
- Traditionally used in Brazil as a stimulant and for “boosting sexual function.”
Quote [Dr. Patty Patti, 07:36]:
"...Guarana... is like a native fruit from the Amazonian basin and... mainly used as a stimulant because of its high caffeine content."
4. Advice for Clinicians and the Public (08:02 – 09:31)
For Providers (08:02 – 08:53)
- Always investigate supplement/diet use when faced with atypical clinical findings in otherwise healthy patients.
- Be alert for potential confounders from supplements or hidden ingredients, especially given today’s wide array of food choices.
Quote [Dr. Patty Patti, 08:17]:
"Every new patient... should be made aware of the food choices and should be educated about reading the labels before purchasing..."
For Patients (09:01 – 09:31)
- Read labels, including fine print, and investigate unfamiliar ingredients. Become informed consumers to protect personal health.
- Hidden or processed additives may go unnoticed without careful scrutiny.
Quote [Dr. Patty Patti, 09:01]:
"We should take some time to read the food labels and pay attention to the ingredients that sound unfamiliar and read through the fine text..."
Notable Quotes & Memorable Moments
-
On the difficulty of knowing what's in supplements:
"Sometimes I have no idea what some of those ingredients are... the FDA doesn't regulate supplements for safety and efficacy..."
— Aaron Lohr [00:00] -
On the “Aha!” moment regarding the vitamin drink:
"...patient stated that he was drinking a vitamin drink... in fine text, it states that it contains caffeine from this guarana seed extract."
— Dr. Patty Patti [05:54] -
On education and empowerment:
"This would empower our society to make more informed choices and know more about what we are eating."
— Dr. Patty Patti [09:01]
Important Timestamps
- 00:00 — Host Introduction and Episode Theme
- 01:21 — What Are Hidden Ingredients?
- 02:36 — Links Between Testosterone, Insulin Sensitivity, and Hypoglycemia
- 03:11 — Start of Case Study: Patient Presentation
- 05:45 — Discovery of the Vitamin Drink and Hidden Guarana Ingredient
- 07:00 — Patient Outcome After Discontinuation of Supplement
- 07:36 — Explanation of Guarana
- 08:17 — Recommendations for Healthcare Providers
- 09:01 — Tips for Patients on Reading Labels and Staying Aware
Episode Takeaways
- Supplements may contain significant undisclosed ingredients with real hormonal effects.
- Careful dietary and supplement history is critical in unexplained endocrine findings.
- Both clinicians and patients must stay vigilant, read labels, and question unfamiliar ingredients.
Final words: This episode highlights that even "healthy" supplements can have complex and unintended endocrine effects, reinforcing the importance of inquisitiveness and patient education in clinical practice.