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    DIETARY SUPPLEMENTS
    Worrisome contaminants found

    What is EMS?

    EMS causes severe joint pain, swelling, fatigue, shortness of breath and other symptoms. People with EMS produce excess eosinophils - a type of white blood cell summoned by the immune system to fight infections. It's believed that in people with EMS, excessive numbers of eosinophils attack the body's own tissues.

    About 30 people died and more than 1,500 were sickened during the 1989 outbreak of EMS that was traced to contaminated L-Tryptophan pills.

    What is L-Tryptophan?

    L-Tryptophan is an essential amino acid (a component of protein). You can't survive without it. A reasonable diet easily provides all the L-Tryptophan that you need.

    L-Tryptophan also can be manufactured into a pill form. In the 1980s, it become popular to take L-Tryptophan pills as a "dietary supplement," touted to relieve a variety of symptoms.

    The U.S. government banned L-Tryptophan supplements after the 1989 EMS epidemic was traced to a contaminated batch produced by a Japanese company. That ban remains in effect.

    What is 5-HTP?

    5-HTP is an abbreviation for 5-Hydroxy-L-Tryptophan (5-OH-Trp), which is chemically very close to L-Tryptophan. Both L-Tryptophan and 5-HTP are precursors of serotonin, a neurotransmitter involved in mood, sleep, appetite and other functions.

    Marketers who sell 5-HTP supplements have touted it as a "safe" and "natural" alternative to L-Tryptophan, claiming that it improves headaches, insomnia, obesity, depression, anxiety and other conditions. Mayo Clinic doctors say there are no documented, scientifically scrutinized clinical trials to support such claims.

    What is peak x?

    Peak x is a contaminant that was found in each of the six brands of 5-HTP. The contaminated samples included both those produced synthetically and those promoted as being produced "naturally" from "seed extracts."

    In 1994, a group led by Esther Sternberg of the National Institute of Mental Health identified peak x as the contaminant associated with the development of EMS in a Canadian woman who had been exposed to a particular batch of 5-HTP in 1991. Mayo researchers have recently characterized the chemical structure of peak x for the first time. Furthermore, they have determined that peak x is in fact a family of nearly identical compounds. More research is necessary to understand this family of compounds.

    (There have been other scattered cases of EMS in people who have taken 5-HTP, but the Canadian case is the first in which the suspected contaminant has been documented.)

    What else is worrisome about peak x?

    The chemical structure of peak x is very similar to two of the specific L-Tryptophan contaminants that were associated with the 1989 epidemic of EMS.

    How much peak x was found in the six samples of 5-HTP?

    This is especially a concern given that physicians generally do not supervise the use of 5-HTP. In addition, a book currently on the market recommends consumption of 300 to 900 milligrams of 5-HTP per day. At that dosage, exposure to peak x could potentially reach the level of the Canadian case (assuming that the product contained quantities of peak x similar to those found in the Mayo study).

    researchers have informed the U.S. Food and Drug Administration of their findings. They also have provided a description of the testing methods to the six manufacturers of 5-HTP included in the study so that they could investigate the study's findings.



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