The vitamin, mineral and nutritional supplement industry is one of the fastest-growing industries in the world. Millions of people take these supplements, from elite level athletes and sport and exercise enthusiasts, who hope to further their athletic aspirations or achieve better bodies, to everyday men and women seeking to defy the ageing process or who are generally interested in healthy living and well-being.
It’s big business. The supplements industry cleared US$32 billion in revenue in 2012, a figure which is projected by the Nutritional Business Journal to increase to $60 billion by 2021. In UK sales are expected to rise from some £670m (US$1 billion) to £786m (US$1.2 billion) by 2018.
However, while growing at a rapid pace, the supplements industry is highly under-regulated. Indeed, its growth has been facilitated in large part by the ease at which supplements may be produced and sold, and their widespread availability in general health stores, pharmacies, and the internet among other places.
In the UK the majority of supplements are considered to be foods and are therefore regulated under established food laws by the Food Standards Agency and the Department of Health (FSADH). In general, unless a medical claim is made by the manufacturer, supplements are not regulated as a medicine by the Medicines and Healthcare Regulatory Agency (MHRA).
This means that supplement manufacturers do not need prior approval from the MHRA before producing or selling their product and there is no requirement for supplements to be licensed. Further, supplements sold in the UK have not been subjected to the same scientific scrutiny as medicines and are not as strictly regulated.
Most importantly, supplements are not tested on product safety, quality and efﬁcacy before they hit the shelves because there is no legal obligation for supplement manufacturers to take part in testing products.
There is a growing body of research which indicates that many supplements sold in the UK may be contaminated with “banned” and often dangerous substances. A 2004 study, for instance, tested 634 supplements purchased in 13 countries from 215 different suppliers. Of the 634 samples analysed, 94 (14.8%) contained anabolic androgenic steroids (AAS), 18.8% of which were purchased in the UK. Further, a study in 2008 found that 10% of supplements and weight loss products purchased and tested in the UK were contaminated with steroids and/or stimulants. A more recent study tested 24 products sold in fitness shops in the UK that were suspected of containing AAS. Of the 24 products tested, 23 contained steroids including known anabolic agents.
It is not just a UK phenomenon. Mounting evidence indicates similar problems throughout Europe and North America. For example, in addition to being contaminated with illegal substances, several supplements have also been found to contain ingredients not listed on the label, or cheaper alternatives and fillers – such as grass, wheat or rice – substituted for ingredients that are often used to bulk up herbal supplements and may cause allergies. Some have false and misleading claims surrounding the health benefits of the product.
The contamination of nutritional supplements is a risk to both public health and to athletes unaware that their legal supplements may contain substances banned by anti-doping authorities. The chronic consumption of such products could unwittingly expose users to significant health risks. For instance AAS such as testosterone may have particular side effects, from acne and lowered HDL to testicular atrophy and liver damage, to name a few.
Where supplements are mislabelled or contain fillers, users may be subject to mild to severe reactions as a result of unlisted ingredients. Even where supplements contain no “harmful” ingredients, replacing advertised supplements with something other than what is claimed on the label, or making false claims surrounding the quality of the product, is tantamount to consumer fraud.
In the case of athletes, using contaminated supplements may result in a positive doping tests, having detrimental effects on their athletic career. A review of the available data indicates that between 40–70% of athletes use supplements and that between 10 and 15% of supplements may contain prohibited substances. Consequently, there is considerable risk of accidental or inadvertent doping through the consumption of supplements. In fact in 2012, the UK Anti-Doping (UKAD) reported that approximately 44% of positive dope tests in the UK were thought to have been the consequence of prohibited substances in supplements.
More stringent regulation and oversight is clearly necessary to ensure the safety and quality of supplements for everyday consumers and athletes alike. But supplement users can employ strategies to minimise their risk.
The first is abstinence – is supplementation necessary, or is it beneficial? The majority of consumers may be better off considering what they eat and whether they can get the same benefits from eating a proper diet. In addition to this the widely perceived benefits of certain supplements have been called into question by many in the medical community and that the excessive use of supplements may be linked to certain health risks.
If individuals decide to use legal supplements, they should ensure they choose products that contain only the substance they require – and purchase supplements from a reputable manufacturer. Athletes, in particular, have to take care by choosing supplements that have been rigorously tested and approved prior to sale as they take personal responsibility for the risks that supplements carry.
None of this guarantees protection from possible contaminations and rather than placing responsibility for safety in the hands of often naive supplement consumers, the state should take on a greater role in the regulation of the industry.