Your Skepticism Is Warranted

On November 2nd, 2024, @NatGeo posted an article titled, “5 things you should know before trusting that supplement”, which National Geographic originally published in February 2024.

The JAMA Network study, Presence and Quantity of Botanical Ingredients With Purported Performance-Enhancing Properties in Sports Supplements (published in July, 2023), to which the National Geographic article refers assessed the presence and quantity of botanical-based ingredients in supplements that purported to have performance-enhancing properties in sports.

The results were alarming. The authors reported that of the 57 sports supplements analyzed, only about 11% (6 of the 57) contained accurate (within 10%) amounts of the listed ingredient. In addition, 40% of the products did not contain detectable amounts of the labeled ingredient and, of those that did contain detectable amounts, the actual quantity ranged from 0.02% to over 300%. Even more troubling, about 12% of tested supplements contained substances banned by the FDA.

Why This Matters

In a Q&A in March of 2024, Dr. Roach from the FDA’s Division of Drug Information suggested that approximately 75% of Americans take a dietary supplement*. She also estimated that there are over 100,000 supplement products on the market. If we extrapolate these data - for illustration purposes only - we might estimate that of the 100,000 products on the market, 40,000 don’t contain the ingredients they say they contain.

So, lots of people take supplements and there are lots of supplements on the market promising to do lots of things - and even before the JAMA findings, consumers were skeptical. Like any consumer, they want to know they are getting what they pay for.

How Did This Happen

Unlike prescribed drugs, the FDA does not review dietary supplements for safety or efficacy or accuracy of product labeling before they are sold to the public. The FDA considers dietary supplements a subcategory of food so regulations for dietary supplements are fairly loose with a very small percentage of manufacturing facilities being audited each year. The FDA requires that dietary supplements are accurately labeled, do not claim to prevent or treat a medical condition (with a few exceptions), and contain at least 100% of their claimed amounts of ingredients. However, the FDA does not normally check or test products for compliance with these rules, and it is quite common that products do not live up to them.

What Are The Big Red Flags

Be skeptical of bold claims and products promising extreme results (e.g., “miracle”, “cure”, “quick fix”, “FDA approved”, “pharmaceutical grade”).
Watch out for supplements that contain “proprietary blends” as part of the formula, without listing ingredients and quantities of each.
If an ingredient sounds exotic or unfamiliar, research it.
Some “warning signs” that a supplement isn’t one you should be taking include:
Claims using the words “100% pure” or “all-natural”

Choosing a Safe and Effective Supplement

To navigate this confusing market, keep the following tips in mind:

Opt for third-party tested products: Look for certification marks such as NSF, USP, or BSCG—these organizations test supplements for purity and banned substances.
Read ingredient labels meticulously: Scrutinize the source, check if you can verify the plant or compound listed, and ensure amounts are specified rather than hidden in blends.
Make sure the following information on their label:

Product name
A statement that says “dietary supplement”
Name and location of the manufacturer
A “Supplement Facts” panel that lists names and quantities of all active ingredients, serving size, and number of servings per container
An ingredients statement that lists all inactive ingredients
An address or phone number to report serious side effects

Avoid mega-doses: More doesn’t guarantee better results; extremely high concentrations can be dangerous.
Buy from reputable retailers and established brands with a history of good manufacturing practices.
Consult with a health or sports nutrition professional before taking a supplement.

The Bottom Line

The latest research makes it clear: the supplement industry, especially for sports and performance products, is still a “buyer beware” marketplace. Labels can be misleading, and contents are unpredictably variable. Due diligence and health professional consultation can help consumers be more confident that they are getting what (and in the amounts) they pay for.

*A dietary supplement, as defined by congress in 1994, “contains a "dietary ingredient" intended to supplement the diet.” Dietary ingredients can include vitamins, minerals, herbs, amino acids, enzymes and live microbials (e.g., probiotics), concentrates, metabolites, constituents, or extracts.

Dietary supplements may also contain “other ingredients,” which are things like fillers, binders, excipients, preservatives, sweeteners, and flavorings.