Between 2007 and 2016, the U.S. government identified nearly 800 food supplements that were contaminated with drugs. That’s the finding of a new study. Especially disturbing: Most of these tainted products were never removed from store shelves.
Food supplements include vitamins and minerals. They also include many products that make health-promoting claims. These might be capsules of supposedly heart-healthy fish oil. Other supplements (such as chondroitin) claim to aid sore joints. Capsules of powdered cinnamon claim to help improve blood sugar levels. More than half of American adults say they take dietary vitamins and other supplements.
The Food and Drug Administration, or FDA, regulates these products. It allows them to contain only foods and food-like ingredients. Drugs, such as muscle-building steroids, are not permitted. In all, an estimated 85,000 food supplements are sold in the United States that claim to help boost health in some way. That’s too many, FDA says, for the agency to test them all.
But FDA has logged reports on supplements that have been found to contain potentially harmful things. Prescription drugs would qualify. FDA’s database of those reports is open to the public. Researchers working in Sacramento for the California state government analyzed reports in that database. They focused on the drug contaminants found. They also looked at what the health claims were that companies had made about each supplement that had been tainted.
Ads for most of the products had promised help with weight loss, muscle building or Viagra-like male sexual enhancement. Jenna Tucker with California’s Department of Food and Agriculture and her colleagues reported their findings online October 12 in JAMA Network Open.
Food supplements are not tested or regulated in the same way that prescription drugs are. But if FDA learns of tainted supplements, it can issue public warnings. It also can suggest that supplement-makers recall — take back — those products from stores.
That approach raises questions, says Pieter Cohen. He works at Cambridge Health Alliance in Cambridge, Mass. A doctor of internal medicine, Cohen was not involved in the new study. Voluntary recalls don’t necessarily lead to a complete removal of an offending product from store shelves, his research has shown. What’s more, people may never learn about a products’ tainting so that they can decide to stop using it.
The new study turned up 776 supplements in the FDA database that were reported to have been contaminated with a drug. Of these, fewer than half were recalled, the study found. “What really jumped out at me,” Cohen says, is that “when the FDA detects drugs in supplements, more than half the time the product isn’t even recalled.”
Even without contaminants, supplements can pose health risks.
One 2015 study estimated that 23,000 people visit U.S. hospital emergency rooms each year for health problems triggered by food supplements. Almost one in every 10 affected patients was admitted to the hospital. Often they had symptoms related to heart trouble.
Liver damage can be fatal or require a liver transplant. And a 2013 report by the U.S. Centers for Disease Control and Prevention probed the likely cause of 29 cases of liver damage. All but five of these people had taken a food supplement for weight loss.
“The law allows companies to advertise supplements as if they’re good for your health, even if there’s no evidence in humans that that’s the case,” Cohen says. He started studying food supplements after noting that some of his patients who used them for weight loss developed health problems. Their symptoms included panic attacks, chest pain and kidney failure. One patient was suspended from his job when a drug test turned up what appeared to be amphetamine in his urine. The chemical was a breakdown product of the drug that tainted the weight-loss pills he had been taking.
Cohen’s recommendation? Avoid supplements “that promise you anything.”
ad Short for advertisement. It may appear in any medium (print, online or broadcast) and has been prepared to sell someone on a product, idea or point of view.
amphetamine A class of potent prescription drugs used to stimulate the nervous system. They work by altering levels of certain natural chemicals in the brain. Doctors prescribe these drugs to treat narcolepsy (a sleep problem), to boost nervous-system responses, to control symptoms in people with attention deficit hyperactivity disorder (ADHD), and sometimes to treat obese people for a few weeks as they start a reduced calorie diet and exercise program for weight loss. These drugs can be habit forming (somewhat addictive). In high doses, they can provide euphoria, delirium and other symptoms similar to cocaine.
blood sugar The body circulates glucose, a type of simple sugar, in blood to tissues of the body where it will be used as a fuel. The body extracts this simple sugar from breakdown of sugars and starches. However, some diseases, most notably diabetes, can allow an unhealthy concentration of this sugar to build up in blood.
Centers for Disease Control and Prevention An agency of the U.S. Department of Health and Human Services, CDC is charged with protecting public health and safety by working to control and prevent disease, injury and disabilities. It does this by investigating disease outbreaks, tracking exposures by Americans to infections and toxic chemicals, and regularly surveying diet and other habits among a representative cross-section of all Americans.
chemical A substance formed from two or more atoms that unite (bond) in a fixed proportion and structure. For example, water is a chemical made when two hydrogen atoms bond to one oxygen atom. Its chemical formula is H2O. Chemical also can be an adjective to describe properties of materials that are the result of various reactions between different compounds.
chondroitin A natural chemical found in the connective tissue of people and animals. Synthetic versions are sold as a food supplement to deal with joint pain, especially in people with arthritis.
colleague Someone who works with another; a co-worker or team member.
compound (often used as a synonym for chemical) A compound is a substance formed when two or more chemical elements unite (bond) in fixed proportions. For example, water is a compound made of two hydrogen atoms bonded to one oxygen atom. Its chemical symbol is H2O.
consumer (n.) Term for someone who buys something or uses something. (adj.) A person who uses goods and services that must be paid for.
contaminant Pollutant; a chemical, biological or other substance that is unwanted or unnatural in an environment (such as water, soil, air, the body or food).
database An organized collection of related data.
emergency room Also known as the ER. It's that part of the hospital where doctors initially attend to the immediate medical needs of accident victims and others who need critical care.
Food and Drug Administration (or FDA) A part of the U.S. Department of Health and Human Services, FDA is charged with overseeing the safety of many products. For instance, it is responsible for making sure drugs are properly labeled, safe and effective; that cosmetics and food supplements are safe and properly labeled; and that tobacco products are regulated.
internal medicine A branch of medicine where doctors diagnose and treat adults for conditions that don’t need surgery. Doctors who work in this field are known as internists.
kidney Each in a pair of organs in mammals that filters blood and produces urine.
liver An organ of the body of animals with backbones that performs a number of important functions. It can store fat and sugar as energy, break down harmful substances for excretion by the body, and secrete bile, a greenish fluid released into the gut, where it helps digest fats and neutralize acids.
mineral Crystal-forming substances that make up rock, such as quartz, apatite or various carbonates. Most rocks contain several different minerals mish-mashed together. A mineral usually is solid and stable at room temperatures and has a specific formula, or recipe (with atoms occurring in certain proportions) and a specific crystalline structure (meaning that its atoms are organized in regular three-dimensional patterns). (in physiology) The same chemicals that are needed by the body to make and feed tissues to maintain health.
muscle A type of tissue used to produce movement by contracting its cells, known as muscle fibers. Muscle is rich in protein, which is why predatory species seek prey containing lots of this tissue.
online (n.) On the internet. (adj.) A term for what can be found or accessed on the internet.
recall A procedure whereby companies remove particular products from the market (i.e. store shelves) because the products were defective, dangerous or might pose some newfound risk of harm. Or a product that had already been purchased (such as a car or lawn mower) might be recalled so that a manufacturer could fix a problem in it or give people their money back.
regulate (n. regulation) To control with actions. Governments write rules and regulations — laws — that are enforced by police and the courts.
risk The chance or mathematical likelihood that some bad thing might happen. For instance, exposure to radiation poses a risk of cancer. Or the hazard — or peril — itself. (For instance: Among cancer risks that the people faced were radiation and drinking water tainted with arsenic.)
steroid (in biology) A chemical that serves as a signaling molecule in living things. Steroids are usually hormones — which means they are released in the bloodstream to have effects throughout the body. They can serve as stress hormones or as hormones that make children develop sexually during puberty. (in sports) Some steroids help build muscle mass. Cheating athletes may use injections of steroid hormones to build extra muscle. This cheating is called doping.
supplement (verb) To add to something. (in nutrition) Something taken in pill or liquid form — often a vitamin or mineral — to improve the diet. For instance, it may provide more of some nutrient that is believed to benefit health. It may also provide some substance to the diet that is claimed to promote health.
symptom A physical or mental indicator generally regarded to be characteristic of a disease. Sometimes a single symptom — especially a general one, such as fever or pain — can be a sign of any of many different types of injury or disease.
taint To contaminate something with an unexpected, unnatural or illegal substance.
transplant (in medicine) The replacement of a tissue or an organ with that from another organism. It is also a term for the material that will be transplanted.
vitamin Any of a group of chemicals that are essential for normal growth and nutrition and are required in small quantities in the diet because either they cannot be made by the body or the body cannot easily make them in sufficient amounts to support health.
Journal: J. Tucker et al. Unapproved pharmaceutical ingredients included in dietary supplements associated with US Food and Drug Administration warnings. JAMA Network Open. Published online October 12, 2018. doi:10.1001/jamanetworkopen.2018.3337.
Journal: P. Cohen. The FDA and adulterated supplements — dereliction of duty. JAMA Network Open. Published online October 12, 2018. doi:10.1001/jamanetworkopen.2018.3329.
Journal: A Geller et al. Emergency department visits for adverse events related to dietary supplements. New England Journal of Medicine. Vol. 373, October 15, 2015, p. 1531. doi:10.1056/NEJMsa1504267.
Journal: V. Navarro et al. Liver injury from herbals and dietary supplements in the U.S. drug-induced liver injury network. Hepatology. Vol. 60, October 2014, p. 1399. doi:10.1002/hep.27317.
Journal: S. Park et al. Notes from the Field: Acute Hepatitis and Liver Failure Following the Use of a Dietary Supplement Intended for Weight Loss or Muscle Building — May–October 2013. Morbidity and Mortality Weekly Report. Vol. 62, October 11, 2013, p. 817.