Many supplements sold on the internet or even from box stores may contain unclaimed pharmaceuticals or adulterants. This is especially prevalent in the products that are marketed to men.
Most men desire to be fit, muscular, and sexy. Supplement companies have responded to this by marketing to these desires. The bad news is that a very high percentage of supplements for men are purposefully tainted.
What is an adulterated supplement?
While regulated by the FDA, dietary supplements are not required to submit evidence of safety. Instead, products are subjected to post-market surveillance, which tends to occur only when adverse events happen or after insider whistleblowing. With the sheer number of supplements available online and on shelves, only a fraction are subjected to government testing.
Adulteration of supplements may be accidental or purposeful. They are often sold as powders that are to be mixed up as a beverage. Products that are capsules are not immune to adulteration as some of these are created by an intermediate party, such as small and large supplement shops, both brick-and-mortar or online, who purchase raw ingredients and make the capsules or powder mixes. Many of these adulterated products come from China and Southeast Asia.
Supplements that are adulterated often have added ingredients that may include amphetamines, antidepressants, stimulants, erectile dysfunction, drugs, and hormones, including testosterone and prednisone, among other controlled substances. Many of the added substances are prescription medications.
Which products have the highest likelihood of adulteration?
When considering purchasing a supplement that is marketed for men, buyer beware! Adulteration happens to supplements for women, but not nearly as much as it occurs with products for men. Supplements touting to help with all of the following are risky:
male vitality, libido
sexual enhancement
metabolism
weight loss
muscle building, bodybuilding, athletic performance
energy, stamina
Products marketed for male sexual enhancement are most commonly adulterated with sildenafil. Those for weight loss, with sibutramine, an SNRI (serotonin and norepinephrine reuptake inhibitor). Those for muscle building most often contain synthetic anabolic steroids, which can damage the liver.
More about sibutramine... In some countries, this medication is prescribed for weight loss. A 2020 study on adult male rats found that rats given both sibutramine and the cholesterol mediaction, rosuvastatin had decreases in body weight gain, weight of the epididymis, ventral prostate and seminal vesicle; decreased sperm reserves and transit time through the epididymis; and androgen depletion.(1)
How common is it to get an adulterated supplement?
An FDA press release from 2020 shed significant light on unadulterated supplements marketed to men. In their own study, they purchased 26 products from Amazon and found that all 26 or 100% had undeclared active pharmaceutical ingredients. The FDA purchased 25 items from eBay and found that 20 out of 25, or 80%, contained adulterants.(2) Since 2007, the FDA has identified more than 1,050 tainted dietary supplements (3).
A 2023 review article that focused on athletes and sports-related supplements looked at other published studies from 1998-2023 that tested products in various categories for adulterants. Reviewers found that dietary supplement products marketed as multi-ingredient pre-workout supplements, performance-enhancing, anabolic, or those purported to promote weight loss and fat-burning often appear to be the ones with the highest prevalence of adulterants found. Studies included tested 4-33 products in supplement categories. Looking at the reviewed studies as a whole, each study found a minimum of 25% of the products containing undisclosed ingredients, with many finding 100% to be adulterated.(4)
The safe alternative
When it comes to any dietary or nutritional supplement, the safest option is to get them from reputable companies that do third-party testing. Third-party testing involves a qualified outside laboratory testing the ingredients present, the quantity of the ingredients matching the label, and verification of the absence of adulterants and additives.
Many of these products are available for purchase through FullScripts, an online distribution company. Physicians and other healthcare providers must recommend specific products to a person. Some physicians order the product wholesale and are able to distribute them directly to their patients. Both of these options are considered safe.
It is never a good idea to buy any supplements from Amazon or other online sources. Occasionally, I get a new patient who is buying pure encapsulation products from Amazon. I love pure encapsulation, but buyer beware. You never know what is actually in the bottles when you buy them from the Internet. Unfortunately, people will replicate the label and bottle to sell fake products, knowing that consumers want a particular premium branded product. Consider the lower prices found on the internet a red flag.
References:
E Silva PV, Borges CDS, Rosa JL, Pacheco TL, Figueiredo TM, Leite GAA, Guerra MT, Anselmo-Franci JA, Klinefelter GR, Kempinas WG. Effects of isolated or combined exposure to sibutramine and rosuvastatin on reproductive parameters of adult male rats. J Appl Toxicol. 2020 Jul;40(7):947-964. doi: 10.1002/jat.3955. Epub 2020 Feb 18. PMID: 32072669.
FDA press release. https://www.fda.gov/news-events/press-announcements/fda-warns-consumers-avoid-certain-male-enhancement-and-weight-loss-products-sold-through-amazon-ebay
US Food and Drug Administration (2021) Tainted products marketed as dietary supplements. https://www.accessdata.fda.gov/scripts/sda/sdnavigation.cfm?sd=tainted_supplements_cder (accessed January 2021).
Jagim AR, Harty PS, Erickson JL, Tinsley GM, Garner D, Galpin AJ. Prevalence of adulteration in dietary supplements and recommendations for safe supplement practices in sport. Front Sports Act Living. 2023 Sep 29;5:1239121. doi: 10.3389/fspor.2023.1239121. PMID: 37841887; PMCID: PMC10570429.
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