Can You Trust Amazon Supplements?

Author: Dr. Stephen Chaney 

Question MarkI am often asked whether you can trust supplements purchased on Amazon. I have avoided answering that question publicly because I don’t wish to have any legal issues with Amazon.

However, I recently came across a published study (C Crawford et al, JAMA Network Open. 2022;5(8):e2226040 ) that partially answers that question. Normally, I review and comment on articles I share. However, today I will only use direct quotes from the article without comment to avoid any personal legal jeopardy.

Why Was The Study Done?

In the words of the authors,

Immune Support“Cold, flu, and immunity supplement sales have skyrocketed since the start of the COVID-19 pandemic…Supporting immunity or boosting the immune system has become an important reason for using dietary supplement products even though some of the claims may be misleading or not scientifically accurate. In addition, information regarding whether there are any risks associated with such products and ingredients is lacking.”

“The growth in e-commerce, sales, and manufacturing of dietary supplements, coupled with the limited resources for regulating dietary supplements, has created a challenge in keeping up with the market. Adulteration, misbranding, and misleading claims are regularly reported.”

“Since December 2020, Amazon has been requiring sellers to provide outlined quality control documentation and a certificate of analysis (testing results) for supplements sold on that platform. These new requirements could help ensure products are less risky and not adulterated.”

“In this case series, 30 products…marketed to support and boost the immune system…were selected and purchased from Amazon since the introduction of the new requirements by Amazon in December 2020. We tested the products to determine whether their product labels were accurate and whether any product was misbranded or adulterated.”

How Was The Study Done?

In the words of the authors,

clinical study

“On the Amazon website, we searched the key word immune in ‘all departments’ and then sorted results by ‘featured’. The first 30 dietary supplement products that appeared as results with 4 or more stars [highest rated] were eligible and selected for analysis in May 2021.”

“One sample of each selected product was purchased and sent to the University of Mississippi’s National Center for Natural Product’s Research for product analysis. Liquid chromatography-mass spectrometry was used to determine the quality of the 30 dietary supplement products…The list of ingredients detected through analysis for each product was compared with the ingredients on the product’s Supplement Facts label to determine whether the product’s label was accurate.”

 

What Did The Study Show?

In the words of the authors,

Shocking“Seventeen of the 30 products tested had inaccurate labels based on the product analysis. Of the 17 products with inaccurate labels:

  • 13 had ingredients listed on the labels that were not detected through analysis, such that their labels were misbranded. Ingredients missing from products ranged from 1 to 6 ingredients from any single product.
  • Nine products had substances detected but not claimed on the product label…some of which may be considered adulterated. [For example] One ingredient not claimed on the label but found in 3 products marketed as containing elderberry was Orza sativa (black rice seed).
  • Five [products] were misbranded and contained additional components not claimed on the label.”

“The 30 immune health dietary supplements tested and analyzed had claims related to immune support, immune defense, and bolstering of the immune system.

  • Examples of such claims included “all seasons immune support”, “immune strengthening ingredients,” “a powerhouse immune system booster”, and “booster up your immune system”.
  • Fifteen of the products tested additionally had scientific sounding claims by using terms such as “research-based” or “research supported”, “clinically studied”, “scientifically proven”, “supported by…gold-standard clinical studies,” and “backed by science.”

“The price of these products ranged from $11.93 to $90.48 for an approximate 30-day supply with the median cost of $25.33 per month…The mean price of the 17 products scoring less than 4 [This is a different scoring system than the one used on the Amazon website. It is a scoring system based on the quality of the product. Less than 4 represents lower quality products] was approximately $25 for a 30-day supply, and the mean price for those scoring 4 or more [higher quality products] was $31.”

What Did The Authors Say About The Results?

Scientists-ConversingIn the words of the authors,

“Dietary supplements, which consumers buy to improve their health can be costly…The public has a right to know that they are buying what is stated on the label when spending money on dietary supplements. This is certainly not always the case, as we found that only 13 of the 30 products were accurate…Although we cannot assume any product will confer a benefit, we would certainly not expect any harm; however, there is a risk that misbranded and/or adulterated products could cause harm.”

“Claims made on the labels of most dietary supplement products [in this study] seem to stretch what would be considered as allowable claims, which can by statute and/or FDA regulations be made for dietary supplements. Some other claims sounded scientific but did not have any peer-reviewed publication cited. Therefore, it is unknown how or whether these claims were substantiated.”

The Bottom Line 

The authors concluded,

“This case series analysis suggests that quality control measures have not been sufficient for most immune health dietary supplements advertised and sold on the Amazon website. Moreover, some claims made on most of these immune support products do not appear consistent with any of the categories of claims defined by FDA regulations. Most products tested had inaccurate labels, and the claims made on these labels may mislead consumers into purchasing products when information on whether they are actually beneficial is limited. Consumers should be aware that these products may potentially not contain what is stated on the label.”

For more details on this study, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

It’s Buyer Beware In The Food And Supplement Industries

How Can You Identify High Quality Products?

When it comes to the food and supplement industries a paraphrase of the famous introduction to “A Tale Of Two Cities” comes to mind; “It is the best of worlds, it is the worst of worlds.”

There are companies who value your health more than their bottom line. They insist on the highest quality ingredients, verify the purity of their ingredients, and run extensive quality controls on their final product. It’s an expensive process, but you are worth it.

I wish I could tell you that all companies cared enough about your health to produce products that are pure and potent. Unfortunately, I cannot.

Some products don’t contain the amount of active ingredient claimed on the label. Some products contain potentially toxic contaminants. These errors are usually due to poor manufacturing processes and/or lack of proper quality controls.

Even worse, some products are adulterated. That means the manufacturer substituted a cheaper ingredient for the active ingredient. That cannot be accidental. Adulteration is a willful act to deceive the consumer.

I also wish I could tell you the USDA and the FDA are protecting you by making sure food and supplement products are pure and potent. Unfortunately, I cannot.

It’s not that they aren’t trying. They are simply overwhelmed.

  • There are hundreds of charlatans in the marketplace.
  • It often takes 2 to 5 years of litigation to put bad actors out of business.
  • And, as soon as they put one out of business, another one pops up. It’s like that “Whack A Mole” game at the county fair.

Normally, I see reports of poor quality products every few months. But when five product horror stories crossed my desk in a few weeks, it is time to speak up. This week I will share reports on quality control and adulteration issues with:

  • Turmeric supplements.
  • Lavender essential oils.
  • Bitter orange supplements.
  • Avocado oil.
  • CBD products.

Adulteration Of Turmeric Supplements

Turmeric supplements are “hot” right now. Their sales have almost doubled in the last couple of years. Whenever a product becomes this popular, unscrupulous manufacturers are tempted to jump into the market. Looking to make a quick buck they substitute inactive, less expensive ingredients for the active ingredients – a process called “adulteration”.

To better understand how turmeric supplements are adulterated, let’s look at how turmeric supplements are made. The active ingredients in turmeric supplements are a class of compounds called curcuminoids that come from the root of the Curcuma longa plant.

1) The simplest way to create a turmeric supplement is to simply grind the root into a powder and put the resulting turmeric powder into a capsule or tablet.

    • However, turmeric powder is often adulterated by substituting the less expensive Curcuma zeodoria root (from wild turmeric) for the Curcuma longa

2) The more potent turmeric supplements extract the active curcuminoids from turmeric powder.

    • However, turmeric extracts are often adulterated by substituting synthetic curcumin for the natural extract.

Fortunately, the American Botanical Council has created a program called Botanical Adulterants Prevention Program (BAPP) to identify bad players in the botanicals (meaning anything coming from plants) market. In a recent bulletin on turmeric adulteration, they reported:

  • In one test of turmeric powder, all the samples tested had more Curcuma zeodoria powder than Curcuma longa
  • In another test of turmeric powder, 4 out of 6 samples were adulterated with Curcuma zeodoria
  • In a test of turmeric extracts, 4 out of 5 samples were adulterated with synthetic curcumin.

Is Curcuma zeodoria powder as safe and effective as Curcuma longa powder? Nobody knows.

  • Curcuma zeodoria root has a different mix of curcuminoids than Curcuma longa root, and some concerns have been raised about the safety of Curcuma zeodoria

Is synthetic curcumin as safe and effective as natural turmeric extract? Nobody knows.

  • The FDA views synthetic versions of natural botanical compounds as different from the botanical itself, Thus, if a supplier correctly identified their extract as containing synthetic curcumin, they would be required to file an NDI notification with FDA, including proof of safety, for products containing their extract to be legally sold in the US.
  • The use of synthetic curcumin may replace the other curcuminoids found in natural turmeric extracts. In other words, you would not be getting the full spectrum of curcuminoids you would find in a natural extract standardized to 95% curcuminoids.

Note: The American Botanical Council Bulletin did not address turmeric products that are available on the marketplace. They reported on the major suppliers of the raw materials that manufacturers purchase to make their turmeric products. This has two important implications for consumers like you and me:

  • Many companies base their label claims on the specifications provided by the supplier of their raw ingredients. However, unless they run independent quality control tests on the raw ingredients, they actually have no idea what is in their product.
  • That means when comparing turmeric products, we should not rely on label claims or price alone. We should ask about the company’s quality control process, particularly whether they run independent quality control tests on the ingredients they use.

Adulteration Of Lavender Essential Oil

Lavender oil has been around for hundreds of years. It has long been prized for its calming effect. It has traditionally been used in aromatherapy for relief of stress, anxiety, depression, and to improve sleep.

With the recent “essential oil” craze, it has been reclassified as an essential oil with an impressive list of additional “benefits” – such as relieving headaches, getting rid of acne and eczema, reducing menstrual cramps, and reducing inflammation to name a few.

As you might expect, the market for lavender essential oil is exploding. It is expected to almost double between 2016 and 2024.

However, lavender oil is hard to come by. The lavender flowers are steamed to release the volatile components, and the oil is then distilled. Only a tiny fraction of the lavender plant ends up in the final product. You might suspect that manufacturers would be tempted to cut corners. You would be correct.

Once again, the American Botanical Council’s Botanical Adulterants Prevention Program (BAPP) comes to the rescue. Recently BAPP tested lavender essential oils in the marketplace. Their newly-released bulletin reported that 82% of lavender products on the market were adulterated.

  • Some of the adulterated products used oils from related plant species.
  • Some products used oils from unrelated plant species like rosemary.
  • Other products used synthetic oils.

All the adulterated products used oils that were less expensive than genuine lavender oil. To the untrained consumer the adulterated products may smell like lavender oil, but there is no evidence that the oils substituted for lavender oil have the same benefits as lavender oil.

This is not simply a quality control issue. It was not accidental. You don’t start with plant species other than lavender and expect to end up with lavender oil. And you really don’t start with synthetic oils and expect to end up with natural lavender oil. This is deception, pure and simple.

Poor Quality Control Of Bitter Orange Supplements

Bitter orange is another name for the Seville Oranges you may have seen in your local market. Unripe Seville Oranges are quite bitter, and this is the form used in supplements.

Traditionally, bitter oranges have been used as a digestive aide. More recently, some unscrupulous manufacturers have advertised bitter orange as a fat burning supplement and have marketed it as a sports nutrition and weight management supplement.

Any supplement marketed as “fat burning” attracts a lot of attention. Once again, sales have skyrocketed, and manufacturers have been tempted to cut corners. This attracted the attention of the USDA, who recently published a study assessing the quality of supplements containing bitter orange.

The USDA purchased 59 products available in the US that either contained bitter orange as the primary ingredient or as one of the major ingredients in a proprietary formula. They tested these products using state-of-the-art analytical techniques. What they found wasn’t pretty.

  • Only 5 of the products had the amount of active ingredient claimed on the label. This could be a quality control issue, but it is not reassuring to you, the consumer.
  • Some of the products had higher amounts of minor compounds found in the bitter orange than they did of the active ingredient. It is hard to imagine how this occurred unless those manufacturers used what was left over after other companies had extracted the active ingredient. And there is no research on the effects of these minor compounds in humans.
  • 7 of the products had synthetic ingredients that had never seen a bitter orange. Once again, there is no evidence these compounds are either safe or effective.

Poor Quality & Adulterated Avocado Oil

Avocado

Avocados are in. They are prized as a source of antioxidants and healthy monounsaturated fats. Avocado oil has all the benefits of raw avocados, plus it has an extremely high smoke point, making it ideal for high temperature cooking.

It’s no wonder that sales of avocado oil have soared by 52% in the last couple of years alone. Once again, there will be manufacturers who are tempted to cut corners.

Fortunately, scientist at University of California, Davis recently published a study on the quality of avocado oil. Unfortunately, they found that most of the avocado oil sold in the US was oxidized, mislabeled, or misbranded.

The scientists purchased 14 brands of avocado oil from local markets and purchased an additional 8 brands online. Here is what they found:

  • 82% of the 22 brands they tested were either oxidized or mixed with other oils. Specifically:
    • 15 of the brands were oxidized, which compromises both the taste and the health benefits of avocado oil.
    • 6 of the brands were adulterated with cheaper oils, including sunflower, safflower, and soybean oil.
    • 3 of the brands contained little or no avocado oil. They were mixtures of other oils. This is even worse than simple adulteration. These products should not have even been labeled as avocado oil.
      • Interestingly, 2 of the 3 brands with no avocado oil were labeled “extra virgin” avocado oil, which is supposed to indicate the highest quality oil. Did I mention “buyer beware”?

CBD Horror Stories

I don’t need to tell you that the CBD industry has taken off in recent years. Most of the claims for CBD products are unproven, but that is another story for another time.

Even more worrisome are quality control issues for CBD products. In fact, it is so worrisome that congress asked the FDA to study quality controls in the CBD industry and report back to them, which they did last month.

Let me start with a little history. Congress has asked the FDA to set safety, efficacy (product claims), and quality standards for CBD products.

1) The FDA is farthest along with product claims. They have rejected most product claims for CBD products and have initiated legal actions against several companies that have refused to stop making these product claims.

2) With respect to safety they have specified that CBD products should contain less than 0.3% THC (marihuana) but have not yet completed safety studies on other CBD ingredients.

3) With respect to quality controls, they have started by surveying the quality of CBD products currently available in the US. They tested 147 products, and the results weren’t pretty. As described in their report to congress:

    • 9 CBD products contained no CBD.
    • 18 products were less potent than advertised. They contained less than 80% of the amount claimed on the label.
    • 38 products were more potent than advertised. They contained more than 120% of the amount claimed on the label.
    • 72 products (49% of the total) contained impermissible levels of THC.

How Can You Identify High Quality Products?

As I said in my book “Slaying The Supplement Myths” there are ethical supplement companies that care about your wellbeing and produce high quality products. However, there is also a dark underbelly of the food and supplement industries.

In the article above I have shared examples of products that:

  • Contained little or no active ingredient.
  • Contain less or more of the active ingredient than claimed on the label.
  • Contain potentially harmful contaminants.
  • Are adulterated by substituting cheaper ingredients which may not be effective for the active ingredient.

At this point you are probably asking, “How do I protect myself? How do I make sure that I am not wasting my money and jeopardizing my health when I buy a supplement? I cover the answer to this question in my book, “Slaying The Supplement Myths“. Here is a shortened version:

  • Ignore the slick marketing.
  • Don’t base your decision on price alone. That can be a trap.
  • Do your research. Ask questions. Only choose reputable companies that do quality
    controls on both the raw ingredients and the finished product.

The problem, of course, is that every company claims to run stringent quality control tests. My
suggestion is to ask them about their quality control process. Here are the questions to ask (you will find more in my book):

1) Do you run tests to confirm the purity of your raw ingredients, or do you accept the claims of your suppliers?

2) How many quality control tests do you run on your final product? If it is a single nutrient product, the number should be in the dozens. If it is a multivitamin, the number should be in the hundreds. For more complex products, you should expect a thousand or more quality control tests.

3) Do you run quality controls on every batch…or, put another way…How many quality controls do you run each year? Those should run into the tens of thousands.

4) What kind of analytic methods do you use?

These are tough questions, but they are the right questions to ask before you pick a supplement company. After all, you are entrusting your health to their products.

The Bottom Line

There are ethical food and supplement companies that care about your wellbeing and produce high quality products. However, there is also a dark underbelly of both the food and supplement industries.

In the article above I have shared examples of products that:

  • Contained little or no active ingredient.
  • Contain less or more of the active ingredient than claimed on the label.
  • Contain potentially harmful contaminants.
  • Are adulterated by substituting cheaper, less effective ingredients for the active ingredient.

I shared reports of quality control and adulteration horror stories with:

  • Turmeric supplements.
  • Lavender essential oils.
  • Bitter orange supplements.
  • Avocado oil.
  • CBD products.

I also shared how to find companies that make high quality products you can trust.

For more details, read the article above.

To find which supplements I recommend, click here.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

 

Health Tips From The Professor