The sick patient had eaten candle nuts, but the symptoms were unexpected.
Walnuts, also known as Cashew Nuts and sometimes marketed as a weight loss supplement, are known to cause nausea or vomiting in some cases. However, an emergency room doctor told the Maryland Poison Center that this patient was in the hospital with a slow heart rate, low blood pressure and a high level of potassium in his blood.
Poison center experts had an idea: Although the product the patient ordered on Amazon was labeled as Cashew Nut, it could contain a poisonous plant called yellow oleander. A similar case was reported in Minnesota.
The tests confirmed his suspicions.
“We were surprised that this mix-up could have occurred,” said Dr. Joshua King, medical director of the Maryland Poison Center.
Yellow oleander is so toxic that eating it is considered a form of self-harm in Sri Lanka. The patient could have died without treatment, King said (doctors can administer an antibody antidote called Digibind for yellow oleander poisoning), although the person made a full recovery.
In the past month, the Food and Drug Administration and the Centers for Disease Control and Prevention have issued warnings about cases in which yellow oleander has been passed off, without disclosure, as supplements sold for supposed weight loss benefits. .
In its report, the FDA warned that several products labeled as Indian Walnut and sold online through platforms such as Amazon, Walmart or eBay may instead be yellow oleander. The agency named two brands: Nut diet max. and All Organic Natural Products, which voluntarily withdrew the products. But the FDA warned that other walnut supplements “with similar trade descriptions may also contain yellow oleander.”
Then on Thursday a CDC report described a young boy in New Jersey who became ill after eating his mother’s tejocote root supplement, a substance derived from the Mexican hawthorn plant that is also marketed for weight loss. The product turned out to be made entirely of yellow oleander.
All parts of the yellow oleander plant contain poisonous compounds and consumption can cause a burning sensation in the mouth, nausea, vomiting, stomach pain, diarrhea, dizziness, irregular heartbeat, or death.
The boy, who was almost 2 years old, experienced vomiting, low blood pressure and a slow heart rate, but recovered after treatment. After the incident, the New Jersey Poison Information and Education System tested 10 supplement products labeled as tejocote and found that none contained tejocote root, while all but one tested positive for yellow oleander.
TO study 2021 It also found that tejocote sold under the Alipotec brand contained yellow oleander. Armando González-Stuart, a professor of herbal medicine at El Paso Community College, said that product falsely claimed to be approved by the FDA.
In the case of the Maryland patient who consumed yellow oleander, King said, “I have no reason to think that (the substitution) was malicious, with the intent to kill, but it is quite possible that they were more available than walnuts because they resemble ”.
Still, he added, “if you’re digging up seeds, you should have an idea of what they are.”
Dr. C. Michael White, head of the Department of Pharmacy Practice at the University of Connecticut, said doctors generally won’t know how to prescribe a treatment for yellow oleander poisoning unless patients mention that they took a botanical supplement.
“Many people think that because they’re taking a dietary supplement, it’s not a prescription drug, it must be safe, and if they have a problem, well, it couldn’t be because of that. They don’t think to mention it and sometimes in the healthcare system, people don’t even think to ask,” he said.
Dietary supplements do not require FDA approval, although the agency requires that companies who manufacture, package, label or store supplements test their ingredients and limit contamination.
However, the FDA does not require proof that companies are doing so, experts said.
“It is up to the FDA to find these products and then test them and show that they are unsafe before the products can be removed from the market,” White said.
Therefore, he added, people should be “very, very skeptical about purchasing any product that is not verified by an independent laboratory.” He encouraged consumers to seek certifications from the U.S. Pharmacopeial Convention or the National Sanitation Foundation.
Both tejocote and walnuts are sold under various names, which can create additional confusion. Candle nuts are sometimes called “botanical food,” “Indian nuts for weight loss,” “slimming seeds,” “Indian seeds for weight loss,” or “dietary seeds,” according to the FDA.
Dosing instructions are also often inconsistent.
“If you look at some of these websites that promote them, that sell them, they give you different amounts, different doses,” González-Stuart said. “The information is often contradictory or not enough for someone to really know how much to take.”
King said the Maryland patient couldn’t read the Spanish instructions for the product he ordered.
“So they took the whole 12-pack of nuts,” he said. “They received a higher dose, which certainly led to them having higher degrees of symptoms.”
Even if a product is pure candlenut, experts said, consuming too much of it can cause an upset stomach. Too much tejocote root can also cause an upset stomach, arrhythmiadifficulty breathing and low levels of blood cells or plateletsalthough González-Stuart said most versions sold online do not pose serious risks.
There is no evidence that any of the supplements help with weight loss, he said.
“There is a lot of money made with these products because they say it is miraculous and natural, that it has no side effects and neither of those things are true,” González-Stuart said, adding: “In my personal opinion, it is just a scam. “