van der Voet Gijsbert B, Sarafanov Andrey, Todorov Todor I, Centeno Jose A, Jonas Wayne B, Ives John A, Mullick Florabel G
Department of Environmental and Infectious Disease Sciences, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Biol Trace Elem Res. 2008 Oct;125(1):1-12. doi: 10.1007/s12011-008-8157-0. Epub 2008 Aug 16.
The use of dietary supplements has grown dramatically in the last decade. A large number of dietary and herbal supplements escape regulatory and quality control; components of these preparations are poisonous and may contain, among other toxins, heavy metals. Uncontrolled use of dietary and herbal supplements by special populations, such as the military, may therefore pose a health risk. Clinical symptoms are not always properly attributed to dietary supplements; patients often do not mention supplement use to their health care provider. Therefore, a health risk estimate is hard to make on either the individual or the population level. The literature on this issue was reviewed and discussed in the light of a representative clinical-chemical case study. This case study was performed on a host of preparations that were used by one single individual in the military. Both essential (chromium, copper, zinc, and iron) and poisonous (arsenic, lead, and nickel) trace elements were determined using inductively coupled plasma combined with optical emission spectrometry (ICP-OES) or with mass spectrometry (ICP-MS). Arsenic and lead were detected at exposure levels associated with health risks. These health risks were detected predominantly in hormone-containing supplements and the herbs and botanicals used for performance enhancement. To the extent that this is a representative sample, there is an underestimation of supplement use and supplement risk in the US military, if not in the general population. Since clinical symptoms may be attributed to other causes and, unless patients are specifically asked, health care providers may not be aware of their patients' use of dietary supplements, a strong support of laboratory diagnostics, such as a toxicological screening of blood or urine, is required. In addition, screening of the preparations themselves may be advised.
在过去十年中，膳食补充剂的使用急剧增加。大量的膳食和草药补充剂不受监管且缺乏质量控制；这些制剂的成分有毒，除其他毒素外，可能还含有重金属。因此，军人等特殊人群不受控制地使用膳食和草药补充剂可能会带来健康风险。临床症状并不总是能正确归因于膳食补充剂；患者通常不会向他们的医疗服务提供者提及补充剂的使用情况。因此，很难在个体或人群层面上进行健康风险评估。根据一个具有代表性的临床化学案例研究，对关于这个问题的文献进行了综述和讨论。该案例研究针对一名军人使用的一系列制剂进行。使用电感耦合等离子体结合光发射光谱法（ICP - OES）或质谱法（ICP - MS）测定了必需（铬、铜、锌和铁）和有毒（砷、铅和镍）微量元素。在与健康风险相关的暴露水平下检测到了砷和铅。这些健康风险主要在含激素的补充剂以及用于提高体能的草药和植物药中被检测到。就这是一个代表性样本而言，即使在普通人群中不存在低估情况，美国军人中补充剂使用和补充剂风险也存在被低估的问题。由于临床症状可能归因于其他原因，而且除非特别询问患者，医疗服务提供者可能不知道其患者使用膳食补充剂的情况，因此需要大力支持实验室诊断，例如对血液或尿液进行毒理学筛查。此外，可能建议对制剂本身进行筛查。
