Aaron Deere is a sports nutritionist, functional medicine consultant and advanced personal trainer. He is based in London.
The dietary supplement industry is big business. In 2013 it was worth an estimated $104bn, according to the Nutrition Business Journal Report, with expected annual growth of 6%. There are approximately 29,000 dietary supplements currently on the market, which were made up of more than 600 supplement ingredients. So it may come as a surprise that for such a huge and growing industry, dietary supplements remains a largely unregulated business.
When compared to highly-regulated markets, such as clinical drugs, the quality control of dietary supplements is extremely limited. Whereas clinical drugs must first be proven safe before being approved for market, essentially the opposite exists with dietary supplements, where a supplement must be proven harmful before it is removed from the market. The supplement industry is also not required to: prove any of the claimed benefits associated with the product; show safety with acute or chronic administration; provide any type of quality assurance for the product; or have standardised labelling requirements.
Independent evaluations have sometimes returned shocking results in relation to the contamination of dietary supplements. For example, an FDA analysis – reported by the National Council Against Health Fraud – of one popular spirulina product was found to contain ‘15 flies, 164 adult fly fragments, 41 maggots, 59 maggot fragments, one ant, five ant fragments, one adult cicada, one cicada pupa, 763 insect fragments, nine ticks, four mites, 1,000 ostracods, two rodent hairs, four bird feathers and 10,500 water fleas’.
An independent analysis of 16 dehydroepiandrosterone (DHEA) products found that only seven of the 16 products tested contained between 90-110% of the stated DHEA amounts, with one containing 150% of the stated amount and three containing no traces of DHEA at all.
One of the most revealing evaluations ever carried out into supplement regulation conducted random testing of a variety of supplements in 13 different countries. The net result show of the 634 products tested, 94 (14.8%) showed traces of anabolic agents within the product, with the UK showing contamination in 18.9% of all products tested.
There are two main classifications of product contamination: malpractice and accidental cross-contamination. A quick search will show seven-figure fines levied on malpracticing producers, who deliberately spiked products with illegal agents in order to try and boost sales. Supplements containing undeclared and banned ingredients can lead to potential severe outcomes, especially for professional athletes.
Failure to declare correct ingredient content and amounts has also had much more dire outcomes.
A review into the adverse reactions to ephedra alkaloid containing supplements showed 43 cases of adverse reactions were directly attributed to consumption of dietary supplements, with ten events resulting in death and 13 in permanent impairment.
To combat supplement contamination agencies within the UK, such as Informed-Sport, have been established. Informed-Sport is a quality assurance programme for sports supplement products, and supplement manufacturing facilities. The programme tests for banned substances and certifies that all nutritional supplements bearing the Informed-Sport logo are free of any banned products.
1 Parasrampuria J, Schwartz K, Petesch R. Quality control of dehydroepiandrosterone dietary supplement products. JAMA 1998;280:1565.
2 Geyer H, Braun H, Burke LM, et al. Inadvertent doping. In: A-Z of nutritional supplements: dietary supplements, sports nutrition foods and ergogenic aids for health and performance—part 22. Br J Sports Med 2011;45:752–4.
3 Haller, C.A. and Benowitz, N.L., 2000. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. New England journal of medicine, 343(25), pp. 1833-1838. de Hon, O. and Coumans, B., 2007. The continuing story of nutritional supplements and doping infractions. British journal of sports medicine, 41(11), pp. 800-5; discussion 805.