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The Centers for Disease Control and Prevention is warning the public to avoid Diamond Shruumz chocolates, cones and gummies following an outbreak of severe illnesses that has led to 10 hospitalizations.

In an alert Wednesday to health care providers, the CDC said that a dozen people in eight states have gotten sick after eating the brand’s “microdosing” mushroom edibles. All but two needed to be hospitalized.

Symptoms included seizures, sedation, muscle stiffness, abdominal pain, abnormal heart rate and high or low blood pressure. None died, but several patients needed to be put on ventilators and were admitted to the intensive care unit, the CDC said. 

The actual scale of the outbreak may be even larger, according to Kait Brown, clinical managing director of America’s Poison Centers. Nationwide, poison centers have received 22 reports of illnesses potentially linked to Diamond Shruumz products and are seeing new cases every day, Brown said.

The CDC tally represents the most severe cases, she said, but poison centers are also aware of milder cases that were limited to gastrointestinal symptoms like nausea or vomiting, or feelings of sleepiness or light sedation.

Why are Diamond Shruumz potentially making people sick?

Diamond Shruumz says on its website that its products are meant for microdosing. Microdosing typically refers to consuming small amounts of psychoactive or hallucinogenic substances, enough to reap the benefits while minimizing more debilitating effects. 

However, the company also says on its website that its products don’t contain psychedelic substances. Several toxicology experts said the mushrooms listed as ingredients, such as lion’s mane or ashwagandha, don’t produce the potent effects that the company touts, like relaxation or euphoria.

“The mushrooms that they advertise that are in them are pretty innocuous and in a lot of other products that don’t make similar claims,” said Maryann Amirshahi, co-medical director of the National Capital Poison Center in Washington, D.C.

The CDC said in its alert that products containing psychoactive ingredients, such as mushroom extracts, are becoming more available and are often sold as gummy candies, chocolate or other snack foods. Such products may contain “undisclosed ingredients, including illicit substances,” the CDC said, “or potentially harmful contaminants that are not approved for use in food.”

Diamond Shruumz did not respond to a request for comment.

“At this point, what is causing these symptoms in these products are still under investigation,” Brown said. “It does speak to the uncertainty about what is in the product that could make such a wide array of symptoms.”

Are mushroom chocolates regulated? 

The market for mushroom-based products such as coffee or chocolate has swelled in recent years, as has demand for edibles with psychoactive properties, though psychedelic mushrooms are largely illegal in the U.S..

Toxicology experts said Diamond Shruumz products likely fall under the category of a dietary supplement based on their listed ingredients and how they’re advertised.

Dietary supplements don’t require approval from the Food and Drug Administration before being sold to customers, though the agency mandates that companies that manufacture, package, label or store supplements test their ingredients and limit contamination.

“It’s not like a prescription medication where you have to prove safety and efficacy before you can sell it,” said Steven Dudley, director of the Arizona Poison and Drug Information Center.

“With supplements, really it’s the other way around where there has to be reports of harm for the powers that be to be able to step in and then issue recalls, take products off the market, et cetera.”

That lack of regulatory oversight means that quality control is “murky at best,” said Dr. Chris Hoyte, medical director of the Rocky Mountain Poison Center in Denver.

In the past, some dietary supplements have been found to contain undisclosed ingredients that may cause harm. For instance, the FDA warned last year that yellow oleander — a poisonous plant — was masquerading as supplements sold for purported weight loss benefits. 

Amirshahi said the makeup of dietary supplements can also vary from batch to batch, which in theory could explain why Diamond Shruumz customers had a range of symptoms.

“At low doses, you may see one thing and higher doses may see the other,” Amirshahi said. “So at lower doses, they may be kind of really agitated, off the rails, have high blood pressure, have a high heart rate — but if they start taking more and more of it, the effects actually change.”

Experts also said it’s possible that psychedelics were illegally added to the products, or that the chocolates and gummies contained other legal substances that weren’t disclosed.

“We don’t know if this is a bad batch issue,” Dudley said. “We don’t know if it’s more widespread than that. What we do know is that it’s causing harm, so we’d really urge the public to not use these products.”

The FDA said Tuesday that consumers should discard and refrain from eating any flavor of Diamond Shruumz chocolate bars, cones or gummies. In a statement, the agency added that it “will continue to monitor the marketplace to identify products that pose risks and will take action within our authorities against unlawful products in order to protect the public.”

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