What’s in your wallet? Perhaps less money if you have bought a lot of dietary supplements. But do you know what’s in your dietary supplements? If you think only natural ingredients, take a look at a study just published in JAMA Network Open.
For the study, a team (Jenna Tucker, MPH, Tessa Fischer, DVM, MPH, Laurence Upjohn, PharmD, David Mazzera, PhD, and Madhur Kumar, MS, PhD) from the Food and Drug Branch of the California Department of Public Health searched through the U.S. Food and Drug Administration’s (FDA’s) Tainted Supplements database entries from 2007 through 2016. They eventually came up with a total of 776 adulterated dietary supplements, all of which included unapproved drug ingredients. But if you have taken these supplements, you may not have even known what you were taking as 97.6% of these unapproved drug ingredients were not even listed on the product’s label.
What was the most commonly marketed purpose of these adulterated dietary supplements? It isn’t hard to guess. Or maybe it is. Close of to half (45.5%) of these products were for “sexual enhancement.” Talk about tainted love. The most common ingredient in 47% or 166 of of the 353 adulterated sexual enhancement supplements was sildenafil, which happens to be the active ingredient in Viagra. Hmmm. Over a fifth (20.4%) or 72 of the 353 contained tadalafil, the active ingredient in Cialis. Then 5 of the products had vardenafil, the active ingredient in Levitra. See a trend here? These “sexual enhancement” dietary supplements, which in some cases were marketed as “natural”, actually had ingredients regularly used in medications manufactured by pharmaceutical companies.
But erectile dysfunction medications weren’t the only pharmaceutical ingredients in “sexual enhancement” dietary supplements. Dapoxetine, an antidepressant that the FDA has not approved for use in humans, appeared in 14 of the 353 adulterated “sexual enhancement” supplements. Then, 2 products had sibutramine, a common ingredient in weight loss supplements that was pulled from the US market in 2010 due to cardiovascular risks. Isn’t that taking the weight loss leading to sex thing a bit too far?
Speaking of weight loss, the next most common marketed purpose for adulterated dietary supplements was weight loss (40.9% or 317 of the products). The majority (84.9%) of these “weight-loss” supplements had sibutramine. Nearly a quarter (23.7%) had phenolphthalein, which the FDA removed from the US market in 1999. Seventeen of the 317 “weight loss” supplements (5.4%) had fluoxetine, a prescription antidepressant, perhaps to feel better just in case you didn’t lose weight? Oh, and here’s something that sticks out: 3.8% (12 of the 317 weight loss supplements) had sildenafil or something similar. Maybe in this case, trying to lose weight may lead to sex.
The third most common marketed indication for these adulterated dietary supplements was muscle building (92 or 11.9% of them). Gee, take a wild guess of what ingredients most (89.1%) of these “muscle-building” supplements had. Unless you are a muscle head, the right guess should be anabolic steroids or steroid-like substances. But the majority (73 of 92) of these supplements didn’t even say steroids on their labels because how many people would knowingly take steroids. Well, 9 of the products actually included anabolic steroids or steroid-like substances on their labels. Ten of the products listed on their labels aromatase inhibitors, medications normally used to block estrogen receptors for the treatment of breast cancer in postmenopausal women.
Pharmaceutical ingredients also existed in the 14 adulterated supplements marketed for other reasons such as joint pain, muscle pain, osteoporosis, bone cancer, sleep issues, gout, and prostate health. These dietary supplements included a pharmacy of ingredients such as diclofenac (a prescription nonsteroidal anti-inflammatory drug), dexamethasone, (a corticosteroid), chlorpheniramine (an antihistamine), and indomethacin (a prescription nonsteroidal anti-inflammatory drug).
If you are waiting for the FDA to yank all such tainted supplements from the market, you may be waiting a long, long time. The FDA can issue warning letters and ask for volunteer recalls. But in many cases, the FDA cannot force companies to pull such supplements from the market. Dietary supplements aren’t as regulated as legitimate medications. In fact, the dietary supplement firm voluntarily recalled the product less than half the time, 46.4% or 360 of the 776 adulterated products.
Of course, not all dietary supplements have pharmaceutical ingredients. Many supplements may include what their labels say that they include. But compared to real pharmaceutical products, the dietary supplement industry is highly unregulated. False claims may be rampant. So you may not know what you are really getting. As this CBS This Morning segment shows, previous reports have found various dangerous substances in dietary supplements:
Before you take dietary supplements for sexual enhancement, weight loss, muscle building, or other indications such as bone cancer, prostate health, or sleep issues, think. Can you really trust those supplements? Will they really do anything? What’s really in them? Just because something says that it is natural, doesn’t mean that it is really natural. You may think that you are taking something for weight loss, but Mr. Happy may say otherwise.