Mislabeled workout supplements abound, can cause heart woes, researchers say

MIAMI, July 17 (UPI) -- Exercise enthusiasts should examine supplements that claim to include plant-based performance enhancers because some don't contain all the ingredients on the label or could include undisclosed, possibly harmful, substances.

In a study published Monday in JAMA Network Open, researchers reported that 89% of the dietary supplement labels of products they analyzed did not accurately list botanical ingredients -- and 12% included substances prohibited by the Food and Drug Administration.

"The more you learn about this, you just can't believe it," Dr. Pieter Cohen, who led the study, told UPI. Cohen is an associate professor of medicine at the Cambridge Health Alliance in Massachusetts.

"These products are openly sold on Amazon or on store shelves, and [consumers think] the FDA must somehow ensure these products aren't dangerous for human consumption," Cohen told UPI in a telephone interview.

"So it's really hard to get our brain around what's actually going on here, and we realize how that system [of monitoring] does not exist."

The implications from the misidentifications -- mostly within the sports-energy category of supplements -- could lead to heart attacks and possibly death, Cohen said. For professional or amateur athletes, using supplements with undisclosed ingredients could lead to a ban on participation.

The powder, capsule and tablets studied were generally promoted as fat burners, pre-workouts or increased energy-focused supplements.

"We'd be worried about arrhythmias or the heart rhythm getting dangerously out of whack," Cohen said.

"The other thing that we worry about in these kinds of stimulants, if you take too much and then you're exercising, are bleeding strokes. If the blood pressure gets too high, and your heart's pumping too fast, you can bleed into the brain."

To conduct the study, researchers scanned the supplement market for products that contained promoted plant extracts methylliberine, halostachine, turkesterone, octopamine and Rauwolfia vomitoria. They purchased and analyzed 57 products that claimed to contain at least one of them.

After analyzing the ingredients, findings showed that one of the stated ingredients was not detected in 23 of the 57, or 40%, of the products. When the ingredient was detected, its quantity ranged from 0.02% to 334% of what was stated on the label, researchers said.

They also found that 7 of 57, or 12%, of the products contained at least one ingredient prohibited by the FDA. Five different prohibited compounds were found in that analysis, the study said.

One of the seven products -- which promoted an intense, sustained ability to generate body heat and boost metabolism -- contained four FDA-prohibited ingredients. Researchers did not find halostachine in that product, even though it was listed on the label.

Another product, promoted as a fat burner, did not contain the listed Rauwolfia vomitoria root extract, but did contain 319 mg. of octodrine -- 20 times the standard dose.

Octodrine was developed in the United States for inhalers in 1946, but was withdrawn from the market. It also was sold in Germany as an oral drug to treat asthma and increase blood pleasure. Standard dosages are about 16 mg,

"If you took this 'Rauwolfia vomitoria' product with 319 mg. of octodrine, it's got like more than 10 or 20 times more Octodrine than the highest medication formulated ever in Germany," Cohen said.

Cohen said his level of concern is "off the charts" after seeing the results from the study.

"In animal studies, it's [shown to] increase pumping of blood in the heart and increases blood pressure," Cohen said.

"So that's probably why someone's putting it in a sports supplement because it would be expected to have the effect of increasing heart beating and pressure in the body. That's something that could get very dangerous because exercise itself normally increases blood pressure.

"So you're giving 10 times the normal dose of a drug, that probably shouldn't be taken pre-exercise anyway. That's where the risks are probably the highest."

Omberacetam, oxilofrine, deterenol and 1,4-dimethylamylamine (1,4-DMAA) were among the other -- sometimes undisclosed -- prohibited ingredients found in the supplements that were analyzed.

Octodrine, oxilofrine and 1,4-DMAA are among substances prohibited by the World Anti-Doping Association, which monitors drug use in sports, including at the Olympics. Use of the substances also could lead to suspensions in the NFL, MLB, NBA, MLS, NHL and on other professional, college and high school athletic platforms.

Omberacetam is marketed in Russia as a nootropic, a supplement to boost brain function. It is not approved in the United States.

Oxilofrine is a pharmaceutical drug developed in Europe in the 1930s, but never approved by the FDA. The stimulant is prescribed to stimulate the heart and increase blood pressure.

Deternol, another substance not approved by the FDA, was formerly available in Europe to treat glaucoma. And 1.4, DMAA has never been approved as a medication.

The FDA can prohibit ingredients in supplements, but doesn't pre-approve contents before they are sold.

"All these products are introduced into the market with no FDA oversight whatsoever," Cohen said.

"The FDA only plays a role in trying to find products that have caused harm. ... So it's a situation where consumers, even healthy athletes, should be extremely cautious about what they put in their body."

Cohen said manufacturers' noncompliance with the law and lack of enforcement by the FDA are among the reasons behind the misidentification and inaccuracy of ingredient labels.

Several previous studies found that many FDA-recalled supplements still sold -- and still included the banned ingredients.

He recommended that consumers look for USP- or NSF-certified products. They can also use the Defense Department's operation supplement safety website to check for supplements that are safe.