Toxic yellow oleander found in nine out of ten weight loss supplements marked as containing tejocote root, warns FDA
Key Takeaways
A toddler was rushed to the emergency room after ingesting a supplement labeled tejocote that was actually toxic yellow oleander.
Yellow oleander toxicity can lead to nausea, vomiting, and cardiac abnormalities, including bradycardia, AV blocks, and ventricular dysrhythmia. The child was successfully treated with digoxin-specific antibody fragments.
The FDA warns against buying certain supplements containing tejocote, while MDs suggest avoiding tejocote altogether.
A toddler in New Jersey was poisoned last September after accidentally ingesting an herbal supplement marketed as tejocote (Crataegus mexicana). She was rushed to the hospital, and it was later found that the supplement actually contained yellow oleander (Cascabela thevetia).
According to a Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention (CDC), the emergency physician treating the child called the New Jersey Poison Information and Education System (NJPIES) and reported that the child consumed Eva Nutrition Mexican Tejocote Root, which was marketed as a weight loss supplement and purchased by the child’s mother.[]
An electrocardiogram found sinus bradycardia, frequent premature ventricular complexes, and scooped ST segments (ST represents the interval between ventricular depolarization and repolarization) consistent with cardenolide toxicity.[] The NJPIES advised the physician to conduct a serum digoxin assay, which was obtained with a reported level of 0.5 ng/L. NJPIES interpreted this as being attributable to cross-reactivity with a nondigoxin cardiac glycoside. The child was given 40 mg of digoxin-specific antibody fragments (FAB, a digoxin overdose antidote), which led to stable blood pressure and ECG. A later ECG confirmed cardenolide toxicity, and the patient was given a second dose of FAB.
Kelly Johnson-Arbor, MD, a medical toxicology physician located in Washington, DC, tells MDLinx that yellow oleander is a flowering shrub that grows in tropical and warm climates and that all of its parts contain cardiac glycoside compounds, which can cause severe toxicity when consumed or even inhaled.
The natural compound cardenolide oleandrin is found in yellow oleander; oleandrin can lead to nausea, vomiting, and cardiac abnormalities, including bradycardia, various AV blocks, and ventricular dysrhythmia, according to the Utah Poison Control Center.[]
What MDs should know
The CDC says that MDs who suspect patient exposure to yellow oleander should know that:
Patients who’ve been poisoned by yellow oleander may have a positive serum digoxin result on immune assays caused by cross-reactivity.
Patients may respond to FAB, with some patients needing a higher dose.
Serum digoxin assays shouldn’t be used to detect thevetin B and cardiac glycosides other than digoxin.
Digoxin levels may not accurately reflect serum levels of other cardiac glycosides.
It’s important to ask patients if they have used weight loss supplements.
How does this mixup happen?
Misbranded or contaminated dietary supplements are, unfortunately, all too common. The FDA regulates supplements as foods—not drugs—and they aren’t regularly tested for safety.[][]
A 2021 report in Food Additives & Contaminants: Part A: Chemistry, Analysis, Control, Exposure & Risk Assessment tested tejocote samples and found that they also contained ingredients from yellow oleander.[]
“The rpoB barcode region was able to differentiate between tejocote and yellow oleander species. Moreover, it was also observed that three compounds, including thevetin B, neriifolin, and digitoxigenin, clearly distinguish between tejocote and yellow oleander samples,” the report read.
In fact, the aforementioned CDC report stated that NJPIES bought and tested 10 products labeled as tejocote and marketed as weight loss supplements. The agency found that nine out of the 10 products were actually made with yellow oleander, with no evidence of tejocote root.
“These readily available dietary supplements, upon testing, appeared to be mislabeled. Instead, they contained a toxic substance of concern to both clinicians and public health officials,” the CDC warned.
With so many people interested in natural alternatives to ozempic, tejocote and a similar supplement called Nuez de la India—potentially filled with yellow oleander—have been in demand, according to news reports.[][]
In fact, the Food and Drug Administration (FDA) issued a safety alert and recalls for two brands selling Nuez de la India: Nut Diet Max and Todorganic Natural Products. Both brands’ Nuez de la India products contained yellow oleander.[]
Staying safe
The FDA warns patients to avoid purchasing supplements (like those for weight loss, sexual enhancement, bodybuilding, sleep aid, and pain) without first checking if there have been any notifications from the FDA about said products. Patients and clinicians can check here for such notifications. Additionally, patients should be encouraged to check the FDA’s tainted products database.[]
“Due to the unregulated nature of tejocote weight loss supplement products, their high likelihood of undeclared ingredients, and their potentially lethal toxic effects, people should not purchase or use these products," Dr. Johnson-Arbor says.
Gina Posner, MD, a board-certified pediatrician at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, says that parents should be mindful of keeping supplements—even seemingly innocuous ones—out of reach of children. “Everything should be stored high up and in a child-safe cabinet. Controlled substances should potentially be locked as well.” More so, Dr. Posner says, “Never [refer to] vitamins as candy or anything other than medicine. Kids will sometimes take more of them because they think [they are] candy.”
Both Dr. Posner and Dr. Johnson-Arbor encourage patients and clinicians to call Poison Control at 1-800-222-1222 or to visit www.poison.org, available 24 hours per day.