Last September, a New Jersey toddler got ahold of a bottle of weight loss supplements. The product, purchased by the toddler’s mothers, was labeled as the dried root of tejocote, aka Mexican hawthorn, a large shrub-like plant found in Mexico and Latin America that produces crabapple-like fruits. Although there’s little data on the effects of the dried root—including any supporting its use for weight loss—tejocote is generally considered safe to consume.
But the toddler soon experienced nausea and vomiting. At an emergency department, doctors noted low heart rate, falling blood pressure, irregular heartbeats, and a telltale anomaly on an electrocardiogram.
The weight loss supplement was, in fact, not harmless tejocote root—it was entirely pieces of yellow oleander, a poisonous plant containing cardiac glycosides, including a toxic cardenolide, that can cause dysrhythmia and cardiac arrest, among other things.
The emergency department physicians didn’t know this. But, unsure of what was going on, they contacted the New Jersey Poison Information and Education System (NJPIES), who helped figure it out. The NJPIES recommended a blood test for digoxin, a type of cardenolide. The test returned positive, indicating cardenolide toxicity, and the toddler was then given a digoxin overdose antidote—digoxin-specific antibody fragments.
Fortunately, the toddler recovered, but the NJPIES wasn’t done. In a case report published Thursday, the New Jersey doctors and toxicology experts reported buying 10 tejocote products sold online as weight loss supplements and testing them. The products were tested by Flora Research Laboratories, which specializes in analyzing the chemical constituents of supplements. In this case, the company used ultra-high pressure liquid chromatography–accurate mass-time of flight mass spectrometry analysis, and consulted with an ethnobotanist.
“Highly toxic”
Nine of the 10 products tested were yellow oleander, with no trace of tejocote, according to the case report, which appears in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. The product ingested by the toddler was sold as Eva Nutrition Mexican Tejocote Root, which can easily be found online, including on Amazon. Other yellow oleander-containing products included those sold as Alipotec tejocote root pieces, Elv Alipotec Mexican tejocote root pieces, Niwali tejocote Mexican root pieces, Science Alpha Mexican tejocote root pieces, and Tejocotex tejocote root pieces, the report found.
The finding is particularly troubling since just last week, the Food and Drug Administration expanded a warning of other types of botanical weight loss products—sold as Aleurites moluccana seeds, aka candlenut, that were yellow oleander, too.
The agency noted that one person in Maryland was hospitalized after consuming Nut Diet Max brand Nuez de la India seeds, which turned out to be yellow oleander. The agency said mislabeled products may be sold as “botanical food,” “India Nuts for Weight Loss,” “slimming seeds,” “India seeds for weight loss,” or “diet seeds.” Two companies, Nut Diet Max and Todorganic Natural Products, have issued voluntary recalls.
“Ingestion of yellow oleander can cause neurologic, gastrointestinal and cardiovascular adverse health effects that may be severe, or even fatal,” the FDA warned. “Symptoms may include nausea, vomiting, dizziness, diarrhea, abdominal pain, cardiac changes, dysrhythmia, and more.”
“For public health officials, this is concerning because these supplements contain a highly toxic substance and are readily available from multiple retailers,” the New Jersey experts wrote. They urged clinicians seeing patients with symptoms resembling cardiac glycoside toxicity to ask them about weight loss supplements.
