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Additionally, 20 percent of the products contained more than one hidden drug ingredient.

Around 45 per cent of the dodgy products were marketed for sexual enhancement, while around 41 per cent targeted weightloss, and 12 per cent claimed to bolster muscle-building. However, due to a 1994 law known as the Dietary Supplement Health and Education Act, such products are regulated as food.

For a US$35 billion industry patronized by about half of American adults, it's possible this data could be just the tip of the iceberg, too.

Furthermore, of the 746 products found to be contaminated, less than half (48%) were recalled as a result, leaving the majority of adulterated supplements available for sale.

Design, Setting, and Participants In this quality improvement study, data were extracted from the FDA's Center for Drug Evaluation and Research, Tainted Products Marketed as Dietary Supplements_CDER database from 2007 through 2016.

For example, some muscle-building supplements were found to include actual steroids or similar ingredients, while sexual enhancement supplements were found to contain sildenafil, the active ingredient in Viagra.

A different study found earlier that dietary supplement use was associated with 23 000 emergency department visits and 2000 hospitalizations in the United States each year.

You can read about the methodology and specifics of the report here, Unapproved Pharmaceutical Ingredients Included in Dietary Supplements Associated With US Food and Drug Administration Warnings. They are not meant to treat or prevent disease and are not subject to premarket safety and efficacy testing.

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While dietary supplements are marketed as safe and all-natural, a recent study has found that many of them contain unsafe substances, including unapproved and unregulated pharmaceutically active ingredients.

Dr. Pieter A. Cohen of Cambridge Health Alliance in MA said that although the FDA discovered 746 adulterated supplements, it announced voluntary recalls for fewer than half of these products.

And among muscle-building supplements, synthetic steroids or steroid-like ingredients were the cause for concern almost 90 percent of the time, the researchers said. Even more disturbing, in 2015 and 2016, about 85% of adulterated supplements received only public notifications, and only 15% were voluntarily recalled.

"It's mind-boggling to imagine what's happening here", said Dr. Pieter Cohen, an associate professor of medicine at the Cambridge Health Alliance in MA. One would require manufacturers to register products with the FDA before they go on the market.

Though the FDA "has other enforcement tools at its disposal", the new study is consistent with previous research showing "major deficiencies in the FDA's regulation of supplements", wrote Cohen, who was not involved in this study.

Even after taking action against companies, the FDA sometimes "faces several challenges in deterring fraudulent marketing of these types of products", including relabeling of products to evade detection, Haake wrote. Approximately one-fifth (157) of the products contained more than one adulterant and in two cases, up to six contaminants were identified.

The illicit drugs found in the supplements "have the potential to cause serious adverse health effects owing to accidental misuse, overuse, or interaction with other medications, underlying health conditions, or other pharmaceuticals within the supplement", the study warns.


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