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August 27, 2019

Choking on Supplements

The size of many vitamins and supplements can be a problem for older adults. Here's what helps.

The effectiveness and safety of most dietary supplements is unproven, and now a new study shows they can be hazardous to your health in ways you may not have even considered. The physical size of some of the pills can pose a physical threat to your well-being. Choking on dietary supplements is a hazard, particularly for senior citizens.

Dietary supplements are regulated by the U.S. Food and Drug Administration (FDA), but under a different set of rules from those covering prescription drugs. There are limits to pill size for prescription medicines, for example, but dietary supplements are not subject to those guidelines. Gagging or choking problems that occur when taking drugs or supplements can be reported by the public to the Center for Food Safety and Applied Nutrition Adverse Event Reporting System (CAERS).

Three deaths resulted from airway obstruction or aspiration after people tried to swallow a large, hard pill.

Government researchers with the FDA reviewed 10 years of data submitted to CAERS concerning dietary supplements. They measured the size of reported supplements and categorized the information by ingredient or common reasons they are used, and documented the gender and age of people who reported difficulty swallowing a supplement.

An Age-Related Danger

Nearly 21,000 adverse events with dietary supplements were reported over the course of the 10-year study, and almost 4,000 were for swallowing difficulties. Age was included in about 65 percent of the reports, and among those reports, about three-fourths were from people age 65 or older. Eighty-five percent of the reports were from women, and of those, a fourth of the reports were complaints of problems with swallowing dietary supplements.

Choking was the number one adverse event reported, and it was described as serious in 14 percent of cases. Three deaths resulted from airway obstruction or aspiration after people tried to swallow a large, hard pill.

Multivitamins were the type of pills most likely to lodge in the throats of older people. They accounted for nearly three-quarters of reports, followed by calcium and other bone health supplements.

Ten supplements prompted the most adverse events and accounted for over 76 percent of the reported cases of swallowing difficulty. All ten products exceeded the FDA’s recommended pill size for prescriptions of 17 millimeters in length.

Among the top ten offenders, seven products were multivitamins for women or calcium supplements. Four out of the top ten reports of swallowing difficulties involved one multivitamin product for women.

Just over a third of older adults take multivitamins, and as many as 24 percent take calcium supplements. Given the fact that senior adults tend to experience higher rates of swallowing difficulties compared to younger people, there is cause for concern.

How to Protect Yourself
The researchers offer some suggestions to supplement manufacturers to decrease the risk of swallowing complications such as adding coatings to the pills to make them easier to swallow, offering lower doses and making them available in chewable form.

Try to avoid purchasing very large pills or capsules. Choose smaller pills at lower dosages if necessary. Never try to swallow several pills at once. Pills should be washed down with plenty of water, too.

Ten supplements prompted the most adverse events. All ten exceeded the FDA’s recommended pill size for prescriptions of 17 millimeters in length.

If you have difficulty swallowing pills, talk to your doctor or pharmacist. Some supplements may be available as a liquid, in smaller sizes or in chewable forms. Some can be crushed and dissolved in water while others can be cut in half. You need to get that information from a pharmacist though.

Keep in mind, too, that many, if not most, supplements aren’t worth much from a health perspective. Your body benefits more from getting its vitamins and minerals from food, but if you are going to take supplements, pay attention when swallowing them, and take the precautions outlined above.

The study is published in the Annals of Internal Medicine.

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