Dietary supplements may contain hidden dangers

May 24, 2004|by ANDREA ROWLAND

Some dietary supplements promise a quick fix for people who want to bulk up, slim down or enhance their athletic performance. But that promise could be empty - and the reality deadly.

A dietary supplement - whether in the form of a tablet, capsule, liquid, powder or bar - is a product that's ingested, intended to supplement the diet and, among other requirements, contains a "dietary ingredient" such as vitamins, minerals, herbs, amino acids and dietary substances like enzymes, according to the U.S. Food and Drug Administration at on the Web.

The FDA recently banned dietary supplements that contain ephedra, an herbal stimulant that acts like an amphetamine. Some investigators blame ephedra for dozens of deaths. Major League Baseball is cracking down on the use of supplements - following the sudden death of 23-year-old Baltimore Orioles pitcher Steve Bechler, who used ephedra, in February 2003 and St. Louis Cardinals slugger Mark McGwire's admission that he used the potent muscle-building supplement androstenedione on the way to hitting 70 home runs in 1998.


"Andro" - which can upset the body's hormonal balance when it metabolizes into testosterone and estrogen - is among 12 dietary supplements labeled dangerous by Consumers Union, the nonprofit publisher of Consumer Reports magazine. The organization in April called on Congress to pass legislation to give the government authority to determine the safety of supplements before they are marketed.

For now, however, consumers are on their own.

"In the whole area of supplements, the biggest concern is that there's no quality control. We're years behind proving the danger in the supplement before it's on the market," said Dr. Tracy Ray, primary care sports medicine fellowship director at the American Sports Medicine Institute in Birmingham, Ala. "Tainted supplements is a huge problem."

Under current federal law, any dietary supplement can be marketed without advance testing. The FDA's 1994 Dietary Supplement Health and Education Act - which can be viewed online at - allows supplements to be sold to consumers of any age without rigorous safety testing and without meaningful oversight of product quality, Ray said. The only restriction is that the supplement's label can't claim the product will treat, prevent or cure a disease, he said. If serious problems are reported, the FDA must prove the problems are real before the agency can order a supplement off the market or impose other restrictions.

"There was a huge volume of evidence to show that ephedra is no good," Ray said. "That's when the government made a specific exception of sorts in getting involved with a supplement."

Valid scientific testing of supplements is rare; dietary supplement manufacturers do most of the so-called testing, he said.

"It's horrible," Ray said. "Quite frankly, everything you read on the Internet you have to say, 'That's crap.'"

He said his colleagues recently tested a random sampling of supplements that were readily available online, and found that "nothing had everything it said it had in it, and some of them had things they did not put on the label." One sample of supplemental creatine - which can help generate brief surges of muscle energy during certain types of athletic performance, but might also cause kidney problems - even contained a "full-blown steroid," presumably included to boost users' chances of desired improvement, Ray said.

He and other members of the American Medical Society for Sports Medicine are lobbying lawmakers "to do something at least to rein in the lack of supervision in the supplement industry." It's a tough sell because the supplement industry can afford expensive lobbyists of their own, he said.

The FDA states that dietary supplement sales tallied more than $17 billion in 2000, with consumer spending nearly doubling from 1994 to 2000 - and continuing to grow at a rate of more than 10 percent per year. A 2002 survey found that more than 158 million people use dietary supplements, according to the FDA.

While it's difficult to gauge the true extent of supplement use in the United States, "I think it's pretty plain to see that use by younger kids is increasing," Ray said.

And he's not just talking about high school kids. He said an increasing number of middle school students are taking creatine and other dietary supplements.

"It's got everything to do with how they look and not how they perform," said Ray, who has conducted extensive research on creatine, and served as an advisor to national sports teams. "I would give them the same recommendation I gave Major League Baseball players: Do not take them. Period."

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