Sublethal toxicities of 2,4-dinitrophenol as inferred from online self-reports

Abstract

Introduction: 2,4-dinitrophenol (DNP) is a mitochondrial toxin sometimes used as a weight loss agent. Reports of fatalities from DNP have been increasing since 2000, suggesting an increase in use. Our understanding of DNP toxicity in humans comes from reports to Poison Control and postmortem analyses, sources that are biased to more extreme presentations. This leads to a gap in our knowledge about the adverse effects of DNP at nonlethal doses. Here we investigate the doses and effects of DNP as reported online.

Methods: We analyzed publicly available Internet posts that we collected from 2017-2019. The posts came from anonymous users or users who voluntarily self-identified. We collected data from websites whose terms of use allow for the secondary analysis of data that their users agree to make public. We used natural language processing techniques that we had previously developed to extract doses, effects, and substances mentioned in each post.

Results: We collected 1,630 posts across 5 online forums and the Reddit forum r/DNP. The posts were from 1,234 unique usernames. The most commonly reported doses were between 150 to 300 mg each day followed by 300 to 450 mg each day. At those doses, the most reported adverse effects were profuse sweating and fatigue. Reports of thermoregulatory (sweating, feeling hot flashes or flushed), fatigue-related, and neurologically related symptoms were statistically significantly more frequent at reported daily doses greater than 150 mg than doses below 150 mg (post-hoc χ2-test with Bonferroni correction). The effects were judged as plausible by two board-certified medical toxicologists. Triiodothyronine, clenbuterol, testosterone, and trenbolone, an androgenic anabolic steroid were the most significantly co-mentioned substances.

Conclusions: Fatigue, increased body temperature, and paresthesias from DNP are reported more frequently at doses greater than 150 mg each day than at doses less than 150 mg each day. Online discussions of DNP frequently mention androgenic anabolic steroids and other weight loss agents.

Fig 1. Schematic of study flow.

DNP, 2,4-dinitrophenol. BB, online bulletin boards also called discussion forums.

Fig 2. Distribution of doses mentioned for a single DNP ingestion.

X-axis, dose (mg). Y-axis, number of posts mentioning each dose. Bin size 150 mg. Insets show distribution of individual sources, (online web) forums (right top) and Reddit (right bottom). X- and Y-axes of insets and main figure use the same units.

Fig 3. Reported effects of DNP.

Y-axis, reported dose in mg. X-axis, number of mentions. Color of bar indicates dosage.

Fig 4. Distribution of substance mentions over all unique posts.

Y-axis indicates name of substance; IUPAC or generic name used when possible. X-axis indicates number of posts in which substance was mentioned on log scale. Horizontal dashed line indicates threshold for statistical significance after Benjamini-Hochberg correction.