Prohibited Contaminants in Dietary Supplements

Abstract

Context:With the increasing use of unregulated dietary supplements, athletes are at continued risk from adverse medical events and inadvertent doping.Evidence Acquisition:A review of Clinical Key, MEDLINE, and PubMed databases from 2012 to 2017 was performed using search terms, including dietary supplement, contamination, doping in athletes, inadvertent doping, and prohibited substances. The references of pertinent articles were reviewed for other relevant sources.Study Design:Clinical review.Level of Evidence:Level 3.Results:Poor manufacturing processes and intentional contamination with many banned substances continue to occur in dietary supplements sold in the United States. Certain sectors, such as weight loss and muscle-building supplements, pose a greater threat because they are more likely to be contaminated.Conclusion:Athletes will continue to be at risk for adverse events and failed doping tests due to contaminated dietary supplements until legislation changes how they are regulated. In the interim, there are several steps that can be taken to mitigate this risk, including improved education of medical staff and athletes and use of third party–certified products.

Caffeine content of pre‐workout supplements commonly used by Australian consumers

“…Considerable differences have been observed between caffeine values provided on nutrition information panels of commercial coffee and the amounts found when independently assessed. Furthermore, contamination within the unregulated dietary supplement industry (either accidentally, due to poor manufacturing practices, or intentionally by unscrupulous manufacturers) is common . Inaccurate caffeine values on PWS nutrition information panels reduces consumer certainty over planned caffeine intakes.…”

Multiple incidence of the prescription diuretic hydrochlorothiazide in compounded nutritional supplements

“…[16][17][18] In particular, HCTZ was found as an adulterant not declared on the label in 14% of herbal formulations for weight loss. [16][17][18] In particular, HCTZ was found as an adulterant not declared on the label in 14% of herbal formulations for weight loss.…”

“…12 Diuretics, even if not included in the most commonly detected contaminants in generic supplements, have been often identified in those marketed for weight loss and body image. [16][17][18] In particular, HCTZ was found as an adulterant not declared on the label in 14% of herbal formulations for weight loss. 17 Even if there is some evidence of deliberate adulteration of products, 15 the presence of banned substances in nutritional supplements can be the result of non-intentional cross-contamination during manufacturing, processing, or packaging, 12 and despite ongoing improvements to regulatory and manufacturing guidelines, the potential for contaminated nutritional supplements to cause an AAF for an athlete remains a concern.…”

Hair analysis to discriminate voluntary doping vs inadvertent ingestion of the aromatase inhibitor letrozole

“…The risk of inadvertent ingestion of prohibited substances through contaminated food, water, supplements and medications is a growing problem, particularly if considering the increase of the instrument sensitivity and of the analytical performance in anti‐doping laboratories …”

“…The risk of inadvertent ingestion of prohibited substances through contaminated food, water, supplements and medications is a growing problem, particularly if considering the increase of the instrument sensitivity and of the analytical performance in antidoping laboratories. [16][17][18][19][20] All WADA-accredited laboratories must detect the presence of AIs, selective estrogen receptor modulators (SERMs), and other antiestrogenic substances at concentrations equal to or above the minimum required performance limit (MRPL), that is 20 ng/mL. 21 The MRPLs are mandatory analytical parameters of technical performance established by WADA, designed to harmonize the analytical performance of methods applied to the detection of non-threshold substances.…”