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Supplements may be hidden, unauthorized drugs

More than half of American adults take supplements, a category of products containing over-the-counter vitamins, minerals, botanicals, amino acids, and enzymes. But the supplement industry is loosely regulated by the Food and Drug Administration (FDA), and a new study reveals how many of these products contain unauthorized and potentially dangerous prescription drugs. Even though the FDA only inspected a small percentage of the dietary supplements sold in the US each year, the agency issued warnings about 776 different products containing "undeclared, unauthorized pharmaceutical ingredients" between 2007 and 201

6, according to the study in this review Week published in JAMA Network Open .

Experts have been warning of these problems in the pharmaceutical industry for years, but this is the first time that FDA warnings have been quantified to show the scale of the problem.

More than 98% of FDA's warnings during this period included dietary supplements marketed for sexual enhancement, weight loss or muscle gain. Most frequently, the FDA found traces of the drug sildenafil (the generic name for Viagra); Sibutramine (a weight loss drug that has been withdrawn from the market after it has been linked to heart attacks and strokes); and synthetic steroids or steroid-like ingredients.

Other hidden drugs include antidepressants, laxatives and stimulants. Some of these drugs have not been approved by the FDA – or have been banned by the FDA – and have been linked to serious side effects such as suicidal thoughts, abnormal bleeding and seizures.

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In addition to these three top categories, the study also found unauthorized ingredients in 14 supplements for joint pain, muscle pain, osteoporosis, bone cancer, sleep disorders, or gout Prostate health is marketed.

In total, the FDA sent warnings to 146 different supplement companies. More than 150 of the products mentioned in these warnings (about 20%) contained more than one unauthorized ingredient and 28 of them were cited in two or three warnings more than six months apart. In other words, even once these companies were warned, they continued to sell adulterated products, often with new unauthorized substances discovered the second or third time.

The authors of the study concluded that the drugs were found in food supplements "can cause serious adverse health effects", either through accidental abuse, overuse or interference with other medicines, supplements or existing health conditions. They also point out that hidden pharmaceutical ingredients may be one of the reasons why the use of dietary supplements is associated with 23,000 emergency medical visits and 2,000 hospitalizations per year in the United States.

The study also shows that the number of spoiled supplements reported by the FDA increased over the years and included both products purchased through international mail and those sold in the US. (Just today, a weight-loss supplement was recalled because of the discovery of a hidden drug.) "Corruption with pharmaceutical agents is not random," the authors wrote in their paper, "and unknowingly poses a serious risk to public health as a consumer these drugs on. "

Related: Supplements for cholesterol: what works?

Pieter Cohen, MD, Assistant Professor of Medicine at Harvard Medical School, wrote an editorial accompanying the new study. The number of adulterated products highlighted in this study was "no surprise at all," he says Health .

"We have known for years that companies provide medicines in dietary supplements, and we thought there might be 100 or 200 such products," he says. "Over time, more and more products were seen each year."

Dr. Cohen says the new study also highlights how few of these products were eventually recalled by the FDA. Even if this were the case, it might not have made much of a difference: his own research shows that non-FDA approved food supplements are still available and consumers are unaware of their potential dangers.

The US Government At present, enough is not being done to guarantee the safety of nutritional supplementation, Cohen wrote in his editorial, and Congress should reform the 1994 Diet and Nutritional Supplement Act to demand tighter testing and enforcement measures. In the meantime, he says it's largely up to consumers to be informed about the potential risks and benefits of supplements. He agrees that products marketed for sexual enhancement, weight loss and muscle gain pose the greatest risk for hidden drug components. Dietary supplements that are used for more general health and well-being (like multivitamins or fish oil capsules, for example) are less likely to contain dangerous drugs, he says – but that does not mean they do not have their own issues with inconsistent and misleading ingredients

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"They may not be exactly labeled in terms of the dosage you get, or the labels may misrepresent the health benefits," he says. Dr. Cohen says he regularly recommends vitamins and minerals to his patients who have (or are at risk for) deficiency symptoms, but – with the exception of multivitamins and calcium / vitamin D supplements – he encourages them to look for products with an ingredient , 19659004] "If your doctor tells you to take iron, look for a product that's all iron," he says. "If you decide to take Black Cohosh, look for something called Black Cohosh – not a mix of ingredients." He also recommends omitting dietary supplements with specific health benefits, as these claims are not to be deposited by research.

That's one of the most important things you can understand about supplements, he says. "When you buy a product that says it helps you lose weight or improve your training, there is no requirement that there be any signs that it actually works," he says. "This is the point where consumers need to be smarter about their choices and consult with their doctor about what they really need." To get our top stories in your inbox, sign up for Healthy Living Newsletter

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