Earlier this month, the Journal of the American Medical Association (JAMA) published an article that adds to a strong body of evidences showing that Over the Counter supplements are not always as harmless as most people think.
I’ll never forget a night when I was on-call during residency and a young lady came to the ER. Her husband brought her in, she was very anxious, to the point that she couldn’t talk. Her heart rate was very high, blood pressure up, she was trembling, sweaty and cold. Her labs showed all sorts of electrolytes imbalances. We were puzzled, what’s going on with this previously healthy young lady? Once we stabilized her, she started talking: “I’m taking a natural supplement to help me lose weight”. Her husband brought the pill bottle and we sent it to the lab to be analysed. We were shocked when the results came back. This “natural supplement” contained not one but three unapproved ingredients: a strong diuretic, an amphetamine and thyroid hormones!
On this Original Investigation article published by JAMA, the researchers found that from 2011 to 2016, a total of 776 adulterated dietary supplements were identified by the FDA, and 146 different companies were implicated. We need to keep in mind, that the FDA does not require premarket safety and effectiveness testing for dietary supplements, only postmarket adverse effects are investigated. Most patients don’t associate adverse reactions to supplements therefore most times they go unreported. Given these facts, we can assume, that there are more adulterated supplements out there that have not been identified yet.
The study showed that most of the supplements with unapproved ingredients were marketed for sexual enhancement, weight loss or muscle building. For sexual enhancement, the most common adulterant was sildenafil (Viagra); for weight loss, sibutramine; and for muscle building, anabolic steroids. There were other adulterants in the supplements as well, all of which were not included in the labels and they were not supposed to be there!
This is a multi-billion dollar industry, more than 50% of Americans report taking at least one OTC dietary supplement. We can only imagine how competitive this business is and how much it’s invested on marketing to convince the public and create the need to buy their products.
So, with this in mind: