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Nearly two-thirds of American adults take dietary supplements, a broad category that includes vitamins, minerals and herbal products, according to the Council for Responsible Nutrition, an industry trade group. The most commonly used include multivitamins, calcium and omega-3, the group says. Allegedly natural over-the-counter treatments that promise to melt pounds, build muscle or boost energy are also widely used.
Most supplements are consumed without raising safety concerns. Still, the products are much less closely scrutinized than drugs, which are tested extensively and must win FDA approval before going on the market. Supplements that are made from products that were on the U.S. market before 1994 -- as most commonplace ones are -- can be sold without being reviewed by the FDA beforehand. Companies that include newer substances are supposed to inform the agency before they go on the market, but don't have to wait for approval.
Consumer advocates have long called for tougher rules. Officials at the Council for Responsible Nutrition say no new laws are needed, citing new FDA manufacturing standards for supplements, which are now being phased in, as well as a requirement for supplement makers to tell the FDA when they get reports of serious side effects, which took effect at the end of 2007.
A Senate Judiciary subcommittee plans a hearing this month focused on dietary-supplement safety. FDA officials say they are boosting their enforcement efforts, but it is a challenge to oversee the large and fast-growing supplement industry. 'We do the best we can with the resources we have available,' says Janet Woodcock, the head of the FDA's drug center. 'Consumers have to be vigilant as well.'
Since last December, the FDA has issued warnings about more than 70 weight-loss supplements that included potentially dangerous ingredients. The ingredients included prescription drugs, and the agency said the side effects could include seizure, heart attack and stroke. In July, the FDA warned consumers to avoid bodybuilding supplements that claimed to contain steroid-like ingredients, but actually included steroids. The agency, which issued a general warning but also named some specific brand names, said it had received reports of men with serious liver injuries, stroke, kidney failure and pulmonary embolism potentially linked to such products.
People who want to take a supplement should talk to a doctor, says Travis Tygart, chief executive of the U.S. Anti-Doping Agency, a nonprofit that oversees drug-testing of American Olympic hopefuls and some other top athletes. He says he advises athletes that they take all supplements at their own risk.
Along with talking to a physician, people can do their own research. Many herbs have been tested in major studies and shown no benefits. Some have been linked to side effects, even without the presence of undisclosed drugs. A 2007 article by a National Institutes of Health researcher in the journal Clinics in Liver Disease listed comfrey, chaparral and kava among other herbs potentially tied to liver damage.
Before they take a supplement, consumers should also check for potential interactions between any herb, vitamin or mineral and their prescriptions. They should also be particularly sensitive if they have existing health issues. For instance, those with heart conditions should be careful about supplements that act as stimulants, which can involve ingredients such as bitter orange and guarana, in addition to caffeine.
Consumers should closely read the ingredients. Potentially dangerous substances often won't be disclosed. But sometimes they are -- if you know what to look for. One step is to look for drugs banned for top athletes, or variations on those names. The World Anti-Doping Agency list is at www.wada-ama.org under 'Resources for Athletes.' Certain suffixes in chemical names are common for steroids or tweaked versions of them. Among them are -one, -ene, -iol and -bol, though these can also appear in the names of legitimate ingredients. Some products also use versions of steroid names in their brands, like 'tren' to connote trenbolone.
But consumers shouldn't necessarily feel secure just because a product doesn't set off warning bells. Kicker Vencill, 31, a former competitive swimmer who is now a lifeguard living in Santa Monica, Calif., flunked an athletic drug test several years ago and claimed it was due to a dietary supplement. The Court of Arbitration for Sport ruled that, as Mr. Vencill argued, a multivitamin that he took contained banned steroids, it was the supplement that caused him to fail the test, and that he didn't know the capsules contained drugs. But he was still suspended from competition for two years.
'The last one that I thought would be the culprit was the multivitamin,' Mr. Vencill says. A spokesman for Ultimate Nutrition Inc., which made the multivitamin, had no comment.
Finally, people should watch carefully for any symptoms that start after they take a new supplement. Among the warning signs cited by the FDA in its public-health advisory on products that may contain steroids are nausea, weakness or fatigue, fever, abdominal pain, chest pain, shortness of breath, yellow corneas and skin, and discolored urine. Most of those are signs of liver or heart problems.
2009-10-21
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