Background: 2,4-Dinitrophenol (DNP) is a re-emerging weight loss supplement that increases metabolism by uncoupling oxidative phosphorylation. Removed from the market in 1938 after multiple fatalities, DNP fatalities in adolescent and young adult males have been increasing since 2003. DNP is discussed on social media as more effective for weight loss than diet or stimulants. The goal of this study is to analyze social media to identify the doses, patterns of use, and co-ingestants described with DNP use
Methods: We used our previously published and validated computational methods to search online forums for discussions on DNP or synonyms and extract mentions of doses, effects, and other substances. We calculated the frequency with which substances were mentioned and the correlation between patterns of mentions of substances. We tabulated the effects associated with each mentioned dose of DNP. We assessed the statistical significance of the correlation using bootstrapping with a Benjamini-Hochberg correction for multiple comparisons, with a false discovery rate ot 0.05.
Results: We extracted a total of 1,486 unique posts from 661 discussion threads across 5 bulletin board forums from 2015-2018 that mentioned DNP or related keywords. The doses discussed ranged between 275 ± 100 mg daily, expressed as median ± interquartile range. At doses below 300 mg daily the most commonly reported unintended effects were sweating, difficulty sleeping due to sweating, fatigue preventing exercise, and yellowish discoloration of body fluids. At doses greater than 300 mg daily the most commonly reported unintended effects were rash, blurry vision, fatigue preventing any activity, and profound diaphoresis. The top five substances significantly co-mentioned with DNP were loratadine (p=0.033), cetirizine (p=0.04), quercetin (a polyphenol proposed to be an antioxidant, p=0.04), zinc (p=0.04), and 17α-Methyl-19-nortestosterone (a progestin, p=0.04). P-values are shown after Benjamini-Hochberg correction.
Conclusion: Social media can provide valuable insight into the patterns of use of unregulated substances, including doses and coingestants. The patterns here agree with reported case studies but extend surveillance to a larger population, including those without toxic ingestions.