Health experts and government agencies have flagged the potential dangers of dietary supplements, some of which promise energy, weight loss, increased muscle mass or improved sexual performance. Although such products often are promoted as “herbal” or “natural,” they can contain synthetic ingredients and toxic chemicals not listed on their labels.
The U.S. Food and Drug Administration (FDA) warns that hidden ingredients are becoming increasingly common among over-the-counter supplements. In February 2017, the FDA issued advisories about five weight-loss products after lab analyses confirmed they contained a controlled substance that was removed from the market for safety reasons in 2010. In March 2017, the federal agency issued advisories for two sexual-enhancement products made with an ingredient that may reduce blood pressure and interact with some prescription drugs.
While the FDA regulates dietary supplements, it does not approve or check these products before they are sold to the public. The agency is responsible for taking action against products that are harmful or misleading once they are on the market. On its website, the FDA provides a searchable list of the nearly 800 potentially hazardous supplements containing hidden ingredients.
The form of “herbal Viagra” that basketball star Lamar Odom reportedly took before he lost consciousness and was placed on life support in 2015 has been on an FDA warning list since 2013. In 2015, attorney generals from 14 states sent a joint letter to Congress asking it to “launch a comprehensive congressional inquiry into the herbal supplements industry, and to weigh a more robust oversight role for the Food and Drug Administration.” Since then, some states, including New York, have individually reached agreements with manufacturers to improve quality control.
Despite potential health concerns, herbal supplements remain popular in the United States, where the overall market for dietary supplements reached an estimated $32.5 billion in sales in 2012, according to a paper published in The Journal of Nutrition. A 2016 study in the Journal of the American Medical Association indicates that more than half of U.S. adults take dietary supplements and that women are more likely to take them than men.
To help media professionals who are covering this issue, Journalist’s Resource has pulled together several studies that have been published in peer-reviewed, academic journals within the past several years. These studies look at dietary supplements from various angles, including usage rates, adverse health effects and marketing to teenagers. Another helpful resource is the U.S. Library of Medicine, which offers a searchable database of herbs and supplements and a helpful overview of herbal and dietary supplements. Some of the advocacy and trade associations representing the dietary supplement industry are the Council for Responsible Nutrition, Consumer Healthcare Products Association and American Herbal Products Association.
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“Scientific and Regulatory Perspectives in Herbal and Dietary Supplement Associated Hepatotoxicity in the United States”
Avigan, Mark I.; Mozersky, Robert P.; Seeff, Leonard B. International Journal of Molecular Sciences, 2016. DOI: 10.3390/ijms17030331.
Summary: This paper offers a broad overview of the health concerns posed by herbal supplements as well as some background on the federal government’s actions in recent years to remove harmful products from the market. A summary of federal action related to the controversial weight-loss supplements OxyELITE Pro and Hydroxycut are included.
Usage rates
“Household Expenditures on Dietary Supplements Sold for Weight Loss, Muscle Building, and Sexual Function: Disproportionate Burden by Gender and Income”
Austin, S. Bryn; Yu, Kimberly; Liu, Selena Hua; Tefft, Nathan. Preventive Medicine Reports, 2017. DOI: 10.1016/j.pmedr.2017.03.016.
Summary: Male-only households were generally more likely to buy muscle-building supplements. They spent a weighted average of $88.66 a month on muscle-building supplements while female-only households spent $51.29 a month on muscle-building supplements. Households comprised of both males and females spent $58.99 a month on muscle-building supplements, on average. Households headed by women were most likely to purchase weight-loss products. Male-only households spent a weighted average of $71.66 per month on sexual-function supplements – almost twice what other household types spent.
“Trends in Dietary Supplement Use Among US Adults From 1999-2012”
Kantor, Elizabeth D.; Rehm, Colin D.; Du, Mengmeng. Journal of the American Medical Association, 2016. DOI: 10.1001/jama.2016.14403.
Summary: This study sought to determine how often U.S. adults use a wide range of dietary supplements, including green tea, ginkgo biloba and saw palmetto. The authors found a reduction in the use of multivitamins, but mixed results among the various supplements.
“Use of Herbs Among Adults Based on Evidence-Based Indications: Findings From the National Health Interview Survey”
Bardia, Aditya; et al. Mayo Clinic Proceedings, 2007. DOI: 10.4065/82.5.561.
Summary: This study relies on data collected as part of the 2002 National Health Interview Survey, a nationally representative survey of U.S. adults. Of the 30,617 people surveyed, 19 percent reported consuming herbs in the past 12 months, and most said the herbs were used to treat a health condition. A key finding: “With the exception of echinacea and ginseng, two thirds of respondents did not use commonly consumed herbs in consonance with a scientific standard.”
Adverse health effects, hospitalization
“Emergency Department Visits for Adverse Events Related to Dietary Supplements”
Geller; Andrew I.; et al. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMsa1504267.
Summary: The authors of the study examine data collected from 63 hospitals between 2004 and 2013 to see how often people went to emergency rooms complaining of adverse effects from dietary supplements, including those used for sleep, weight loss or energy. They estimate that more than 23,000 emergency department visits a year, on average, were related to dietary supplements. One-fifth of visits related to supplements involved children.
“Liver Injury from Herbals and Dietary Supplements in the U.S. Drug-Induced Liver Injury Network”
Navarro, Victor J.; et al. Hepatology, 2014. DOI: 10.1002/hep.27317.
Summary: This study suggests herbal supplements and dietary supplements can cause severe liver damage and death. Bodybuilding products were the most common cause of liver injury among individuals using supplements.
Product quality
“DNA Barcoding Detects Contamination and Substitution in North American Herbal Products”
Newmaster, Steven G.; et al. BMC Medicine, 2013. DOI: 10.1186/1741-7015-11-222.
Summary: Researchers tested the authenticity of 44 herbal products representing 12 companies. They found that 59 percent of the products contained species of plants not listed on their labels. About 33 percent contained contaminants or fillers not listed on their labels. The authors also found that key ingredients were missing and had been substituted with other ingredients. “In our study, we found contamination in several products with plants that have known toxicity, side effects and/or negatively interact with other herbs, supplements, or medications.”
Supplements and children
“Dietary Supplements and Young Teens: Misinformation and Access Provided by Retailers”
Herriman, Maguire; et al. Pediatrics, 2017. DOI: 10.1542/peds.2016-1257.
Summary: Teen athletes often take dietary supplements to try to improve their athletic performance. For this study, a male researcher posed as a 15-year-old athlete and called 244 health food stores nationwide to ask what supplements sales associates would recommend to help him increase his muscle strength. About 67 percent of sales associates recommended creatine, a weight gain supplement, and about 10 percent recommended a testosterone booster. Both the American Academy of Pediatrics and American College of Sports Medicine recommend against teenagers using these two supplements.
“Patterns of Energy Drink Advertising Over U.S. Television Networks”
Emond, Jennifer A.; Sargent, James D.; Gilbert-Diamond, Diane. Journal of Nutrition Education and Behavior, 2015, Vol. 47. DOI: 10.1016/j.jneb.2014.11.005.
Summary: The American Medical Association supports a ban on marketing energy drinks, which contain stimulants and ingredients, to teenagers. This study looks at how much airtime U.S. network and cable television channels devote to advertising energy drinks. Six of the 10 channels that gave the most airtime to energy drinks ads include adolescents in their base audience. MTV2 ranked first in airtime dedicated to energy drink ads.