Over-the-Counter Supplement Overuse: A Rare Potential Cause of Arsenic Poisoning and Bradycardia

Sep 30, 2026

Uploaded by dabgoudw

A 71-year-old woman with no significant prior medical history developed progressive cognitive decline, fatigue, and weight loss over two years, alongside bradycardia, anxiety, depression, and mild dyspnea on exertion. Over five years she followed a strict diet and consumed smoothies plus 26 dietary supplements daily. Evaluation showed sinus bradycardia at 40 beats per minute, mild cognitive impairment, and markedly elevated urine arsenic (111.8 µg/L). After excluding other etiologies, arsenic exposure was considered a likely contributor, most plausibly related to supplement-associated arsenic toxicity.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

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Received 01/27/2025 Review began 05/14/2025 Review ended 10/30/2025 Published 12/08/2025 © Copyright 2025 Vankawala et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98745 Open Access Case Report Published via Proceedings of the UCLA Department of Medicine Over-the-Counter Supplement Overuse: A Rare Potential Cause of Arsenic Poisoning and Bradycardia Jay Vankawala 1, Eden Altweiss 2, Alexandra M. Glaeser 2 1. Internal Medicine, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA 2. Internal Medicine, University of California Los Angeles, Los Angeles, USA Corresponding author: Jay Vankawala, [jayvankawala1@gmail.com](jayvankawala1@gmail.com) Abstract A 71-year-old woman with no significant past medical history presented with progressive cognitive decline, fatigue, and weight loss over two years. Her symptoms included bradycardia, anxiety, depression, and mild dyspnea on exertion. The patient followed a strict diet fortified with smoothies and an extensive regimen of 26 dietary supplements, consumed regularly over five years. Initial workup revealed sinus bradycardia at 40 beats per minute, mild cognitive impairment, and an elevated urine arsenic level (111 .8 µg/L) . After careful consideration of other possible etiologies, arsenic exposure was deemed a likely contributor to her symptoms. Arsenic poisoning, typically caused by contaminated water or food sources, can present with fatigue, cognitive issues, and cardiovascular abnormalities such as bradycardia. Algae-based supplements, including spirulina and chlorella, are particularly susceptible to arsenic contamination due to their ability to absorb metals from the environment. In this case, the patient’s systemic symptoms were suggestive of arsenic toxicity, most likely secondary to dietary supplement use. This case highlights the importance of health care providers obtaining a thorough dietary and supplement history. When risk factors are identified based on history, selective screening for heavy metal toxicity is warranted. Enhanced regulation of supplements and population-level education about their potential dangers are imperative to prevent adverse outcomes related to supplement use. Categories: Environmental Health, Cardiology, Internal Medicine Keywords: aresenic, bradycardia, heavy metal toxicology, herbal supplements, progressive cognitive decline Introduction Arsenic is a metalloid element that is highly toxic and poses significant health risks [1] . Found naturally in the Earth 's crust, arsenic can contaminate groundwater, industrial byproducts, and crops. Its toxicity arises from its capacity to interfere with fundamental cellular processes, such as inhibiting oxidative phosphorylation in mitochondria and disrupting the function of critical enzymes involved in energy production and detoxification [2] . Given its tasteless and odorless nature, arsenic exposure often goes undetected without specialized testing, complicating its identification and management. Recent concerns have emerged regarding arsenic exposure through dietary supplements, particularly those derived from algae and herbal sources [3] . Supplements such as spirulina [4], chlorella [5], and ginkgo biloba [6] can accumulate high levels of arsenic when produced in contaminated environments. The inconsistent quality control and regulatory standards for dietary supplements heighten the risk of arsenic contamination. This may lead to significant health issues, such as cognitive impairment [7], peripheral neuropathy [8], increased risk of various cancers [9], and bradycardia [10] in consumers who are unaware of the potential risks associated with these products. Historically, supplements were re

FAQs

What symptoms did the patient develop, and over what time course?

The patient experienced progressive cognitive decline, fatigue, and weight loss over two years, with bradycardia, anxiety, depression, and mild dyspnea on exertion.

What dietary or supplement exposure was reported?

She followed a strict diet fortified with smoothies and took an extensive regimen of 26 dietary supplements regularly for about five years.

How was arsenic exposure assessed in this case?

Workup revealed sinus bradycardia and elevated urine arsenic (111.8 µg/L). After careful consideration of other possible causes, arsenic exposure was deemed a likely contributor to symptoms.

Sep 30, 2026

Uploaded by dabgoudw