What's in your supplement?

While makers of prescription medications like lisinopril and morphine are required to meet manufacturing standards and are subject to mandatory FDA inspections, things we buy over the counter enjoy much looser regulations. Because over-the-counter products (such as vitamins, minerals, and herbals, to name a few) are classified differently than prescriptions in the United States, manufacturers of these products don’t have the same high standard to prove the integrity of their products or the safety of their manufacturing conditions. Why should we care? Surely a company wouldn’t sell a tainted, or “adulterated” product (to use pharmacy speak).

An article published in the Journal of the American Medical Association (JAMA) in July 2023 provides a bleak and honest response to these questions. The study authors examined 57 over-the-counter products claiming to have “fat-burning,” "energy-boosting," or "sports-enhancing benefit." The authors then analyzed the chemical content of each supplement to look for the active ingredient(s) and screen for a handful of hazardous compounds (you can read the full article here). In pharmacy, we are trained to think of medications in terms of “efficacy” (how well does the drug lower blood pressure, kill infectious bacteria, improve memory, etc.) and “safety” (how likely is this drug to cause a mild side effect like nausea or a life-threatening side effect like an arrhythmia?). In terms of efficacy, the study article found that 40% percent of the tested products did not contain a detectable amount of the active ingredient listed on the label. Zero. Purchasers of these products were paying for a placebo (at best) or consuming something else entirely, and potentially something dangerous (to be discussed shortly).

If laboratory testing did show the product contained the claimed ingredient, the actual quantity ranged from 0.02% to 334% of the quantity on the label. Imagine your barista handing you a cup with a 300% increased dose of your daily espresso without warning! On the safety side, 12% of the products tested contained one or multiple FDA-prohibited ingredients. This lineup included an unapproved drug available in Russia, 3 drugs formerly available in Europe but removed from the market, and 1 compound never approved for medical use in any country.

In summary, 89% of the dietary supplements tested did not match the labeling on the outside of the bottle in either the advertised strength or active ingredient. Roughly 1 in 10 contained an ingredient banned by the FDA for safety concerns. While these results are not generalizable to all dietary supplements for every company, it raises serious questions. What fillers or ingredients are present in my supplement that aren’t stated on the label? What unsafe chemicals or additives are mixed into my product? Was it made in a clean environment and will it actually help with the reason I bought it in the first place? What companies can I trust to make a high-quality product without required oversight?

Because of our concerns about dietary supplement integrity, the Summit RX team has been extremely selective about what products we carry in our store. When you come to our pharmacy or schedule a nutrient consult, you can expect us to make recommendations in line with our company values of integrity, excellence, and transparency. If you use dietary supplements, are unsure where to start, or just want to discuss more about this topic, speak with our nutritional support pharmacist today by calling 816-524-8444 or filling out this form to schedule a consult.

Reference: Cohen PA, Avula B, Katragunta K, Travis JC, Khan I. Presence and Quantity of Botanical Ingredients With Purported Performance-Enhancing Properties in Sports Supplements. JAMA Netw Open. 2023;6(7):e2323879. doi:10.1001/jamanetworkopen.2023.23879