Endocrine News Podcast Summary: ENP88 – Glucocorticoids in Supplements

Release Date: August 7, 2024

The Endocrine News Podcast episode titled "ENP88: Glucocorticoids in Supplements", hosted by Aaron Lohr of the Endocrine Society, delves into the hidden dangers of glucocorticoids present in over-the-counter (OTC) arthritis supplements. Featuring an in-depth discussion with Dr. Kevin Way from the Los Angeles General Medical Center USC program, the episode highlights critical research findings, clinical implications, and the urgent need for increased awareness among both patients and healthcare providers.

1. Introduction to the Issue

Aaron Lohr sets the stage by addressing the widespread use of OTC supplements for various health reasons, particularly for managing arthritis pain. However, he raises a significant concern: "some may contain glucocorticoids... which may cause harm" (00:00).

2. The Hidden Threat of Glucocorticoids in Supplements

Dr. Kevin Way elaborates on why the presence of hidden glucocorticoids in supplements is alarming. He explains that “patients take these supplements thinking nothing of it”, unaware of the long-term side effects associated with glucocorticoid use (01:14). These side effects range from adrenal insufficiency symptoms like fatigue and nausea to severe consequences such as liver toxicity, gastrointestinal bleeding, and even death.

Way emphasizes the lack of regulation in the supplement industry: “they are not all FDA regulated... FDA themselves have to issue warnings, but those warnings can become lost in a sea of other information” (02:00). This regulatory gap leaves consumers vulnerable, as illustrated by his observation that many patients remained unaware of the harmful ingredients in popular supplements like Archer King and Artisans.

3. Why Are Glucocorticoids in Supplements?

The conversation shifts to the motivations behind adding glucocorticoids to supplements. Dr. Way points out that “the marketing behind these supplements is very convincing”, promoting them as cures for muscle aches, arthritis pain, osteoporosis, and even bone cancer (03:28). This persuasive marketing leads to widespread dependency, as the supplements interfere with the body's natural steroid equilibrium.

He explains the physiological impact: “when exogenous cortisol... is introduced into the body, this excess steroid amount essentially tells the adrenal gland to shut down in producing steroids” (04:30). Prolonged use results in physical signs of excess cortisol, such as "moon facies," "abdominal striae," and "dorsal cervical fat pad" (05:00). These signs often alert clinicians to the underlying issue of supplement-induced steroid dependency.

4. Dr. Way’s Study on Supplement-Related Adrenal Dysfunction

Dr. Way presents his study, a case series involving 12 patients evaluated for adrenal dysfunction linked to OTC arthritis supplements containing glucocorticoids. The study analyzed symptoms, physical findings, and the necessity for steroid replacement therapy upon discontinuing the supplements.

Key findings include:

• Median Age: 52 years; 33% Female (07:12)
• Common Symptoms Post-Cessation: Nausea, vomiting, fatigue, abdominal pain, and dizziness
• Physical Exam Findings: Moon facies (66%), central adiposity (66%), abdominal striae (50%), dorsal cervical fat pad (33%), and bruising (33%) (08:13)
• Clinical Interventions: Three patients required ICU admission; 11 out of 12 were prescribed glucocorticoid tapering replacements (08:13)

A surprising revelation from the study is the extent of dependency: “most patients who had become dependent... have not yet been able to wean off the taper completely” (09:00). This indicates long-term or potentially permanent adrenal suppression due to prolonged steroid exposure from supplements.

5. Implications for Clinical Care

Dr. Way underscores the critical need for clinician awareness regarding OTC supplements. He advises that “clinicians should make a thorough history of the exact names of the supplements” when patients present with symptoms suggestive of steroid excess (10:53). Additionally, he warns against abrupt discontinuation of supplements, which can precipitate adrenal crises, advocating instead for “a slow taper” of steroid replacement therapy (11:30).

He recounts a case where a patient “was admitted to the ICU for shock” after abruptly stopping supplements, highlighting the life-threatening risks of improper management (12:00). Dr. Way calls for comprehensive patient histories and cautious clinical approaches to managing supplement-induced adrenal dysfunction.

6. Conclusion: Raising Awareness and Ensuring Safety

Aaron Lohr wraps up the discussion by emphasizing the importance of awareness raised by this research. “This is a bit of a wake up call and I hope we were able to raise some awareness of this very important issue” (13:16). Dr. Way echoes this sentiment, expressing hope that his findings will prompt healthcare providers to more diligently inquire about supplement use and better manage the associated health risks.

Key Takeaways

• Hidden Glucocorticoids: Many OTC arthritis supplements contain undisclosed glucocorticoids, posing significant health risks.
• Regulatory Gaps: The lack of stringent FDA regulation on supplements contributes to patient vulnerability and misinformation.
• Clinical Vigilance: Healthcare providers must thoroughly assess supplement use in patients presenting with symptoms of steroid excess or adrenal insufficiency.
• Safe Management: Gradual tapering of steroid replacements is crucial to prevent adrenal crises in affected patients.
• Long-Term Consequences: Prolonged use of glucocorticoid-containing supplements can lead to lasting adrenal suppression and dependency.

This episode serves as a crucial reminder of the potential dangers lurking in seemingly innocuous OTC supplements and the imperative for both patients and healthcare professionals to exercise caution and due diligence.

Timestamp References:

• 00:00 - Introduction by Aaron Lohr
• 01:14 - Dr. Way on glucocorticoid concerns
• 02:00 - Lack of FDA regulation
• 03:28 - Reasons for glucocorticoids in supplements
• 04:30 - Impact on steroid equilibrium
• 05:00 - Physical signs of excess cortisol
• 07:12 - Study overview by Dr. Way
• 08:13 - Study findings
• 09:00 - Dependency and tapering challenges
• 10:53 - Clinical care implications
• 11:30 - Importance of slow tapering
• 12:00 - Case of ICU admission
• 13:16 - Conclusion and awareness