The Grapevine

Diet Supplements Often Contain Unsafe Ingredients Not Mentioned On The Label

The marketing of dietary supplements can often be described as a miracle in a pill, promising to induce quick weight loss, enhance sexual pleasure, or provide a shortcut to a muscular physique. But are they as "all-natural" and safe as they claim to be?

Not quite, according to a new review which examined records of the Food and Drug Administration. Over the period from 2007 to 2016, researchers found close to 750 warnings issued against supplements containing unapproved pharmaceutical ingredients.

These ingredients have the potential to cause serious damage to health as a result of "accidental misuse, overuse, or interaction with other medications, underlying health conditions, or other pharmaceuticals within the supplement," they write in the paper, published in JAMA Network Open on Oct. 12.

They illustrate with an example where someone avoids erectile dysfunction medication as it might react in a harmful way with their blood pressure medication. As an alternative, he might try to buy an "all-natural" sexual enhancement supplement. The problem is the supplement could secretly contain the very ingredient (in this case, sildenafil citrate) he needs to avoid. Due to poor regulation, many labels do not name all the ingredients used in the supplement.

Previously, research has revealed almost 23,000 emergency department visits in the nation every year can be linked to adverse events related to dietary supplements.

"This is a remarkable finding. And it’s really inexplicable," said Pieter Cohen, an internist affiliated with Harvard Medical School. "How can it be that the FDA has done the analytical work, the chemistry, to determine these supplements have hidden drugs, and then not do the obvious next step of ensuring they’re removed from the market?"

It appears to highlight a weakness in the agency, which does not regulate supplements the way it does so with prescription medications and drugs. Cohen notes that supplements do not require evidence of safety or efficacy before being sold to the public.

So while the FDA has the power to remove such products from the market, it typically does so only after an instance of adverse reaction. But here, the review sheds light on another flaw in regulation — the agency only seemed to recall 48 percent of the supplements found to contain unapproved drugs.

The solution may involve changing the way the agency deals with supplements and the associated manufacturers, perhaps by involving stricter laws that go beyond simple warning letters.

It is highly recommended that people avoid supplement unless they are specifically recommended by their doctor. However, should they choose to opt for them, Cohen strongly advises people to use only single-ingredient supplements. Furthermore, any supplement that includes grand promises and medical benefits in their advertising is likely not a safe one.