Dietary supplements and their safety and efficacy.

Buying nutritional supplements: The U.S. and China

Written by Leann Poston M.D.

Nutraceutical is a broad term for vitamins, minerals, amino acids, herbs, or botanicals. More than 50% of American citizens use nutraceuticals. Fifty-eight percent of users use these supplements for overall wellness, and 42% use them to avoid nutritional deficiencies (Barnes et al., 2016). Many Americans trust nutritional supplements more than pharmaceuticals because they believe they are 100% natural and are therefore healthier and safer. They also generally cost less (ElAmrawy, 2016).

Contaminated nutritional products are a considerable health risk. They may be contaminated with pesticides, herbicides, and heavy metals. Additionally, some companies add ingredients that are not listed on the label to make the product more effective (ElAmrawy, 2016).

The role of the FDA

The U.S. Food and Drug Administration defines dietary supplements as products intended to supplement the diet and contain one or more nutritional ingredients, including vitamins, minerals, herbs, botanicals, amino acids, and other substances. The Dietary Supplement Health and Education Act (DSHEA) passed in 1994, gives the FDA minimal control over dietary supplements. The FDA regulates the labeling of the products and puts restrictions on what must and must not appear on the label but does not monitor the safety and effectiveness of the product (Dickinson, 2011).

Product labeling

The US FDA is stringent in product labeling requirements. You should expect the following information on any nutritional product:

  • Product name
  • Net quantity
  • Nutrition (if any)
  • Ingredient list
  • Name and place of manufacturer/importer
  • Country of origin

In 2016, the FDA found that 776 dietary products contained ingredients not found on the label. The label should not contain any claim to treat or prevent disease unless the company can supply documentation that supports these statements. Despite these measures, in 2018, there were 54,085 consumer complaints made to the U.S. regulatory body regarding supplements(Kovachevska, 2020).

Under existing law, including the Dietary Supplement Health and Education Act passed by Congress in 1994, the FDA can take action to remove products from the market, but the agency must first establish that such products are adulterated (e.g., that the product is unsafe) or misbranded (e.g., that the labeling is false or misleading).

U.S. Food & Drug

What the FDA does not do

The FDA requires a list of ingredients in supplements but does not test them for safety or screen them for contaminants. The FDA will request a recall of a product if there are numerous adverse reports linked to the supplement.

American’s demand for supplements

Supplement sales in the U.S. reached $46 billion in 2018 and are predicted to exceed $52 billion by 2020 (Loria, 2020). In the United States, 77% of Americans report that they consume dietary supplements with the highest usage in the 35-54 age group. According to a CRN Consumer survey, the top reasons Americans take these products are for overall health and wellness benefits followed by:

  • Increased energy: 24%
  • Immune health: 20%
  • Fill nutrient gaps: 19%
  • Healthy aging: 18%
  • Heart health: 18% (CRN USA, 2019).

Overview of supplements and American confidence in product safety and efficacy

Americans have confidence in the safety and quality of dietary supplements. CRN Consumer survey found the following:

CategoryPercent ConfidenceMost popular products
Vitamins and Minerals96%Multivitamins and Vitamin D
Specialty products75%Probiotics and omega-3 fatty acids
Herbals and botanicals72%Green tea, turmeric, and CBD
Sports nutrition63%Protein
Weight management53%Protein
CRN Consumer Survey 2019

What Americans believe:

  • Seventy-one percent of Americans trust in the safety of supplements.
  • Forty-eight percent of Americans think supplements have been tested for safety by the FDA.
  • Thirty-eight percent of Americans think supplements are safer than prescriptions or over-the-counter drugs.
  • Thirty-three percent of Americans interpret the word natural to mean safe or wholesome.
  • Thirty-two percent of Americans think supplements work as well as prescription drugs (Loria, 2020).

How much Americans spend on supplements

The average American spends approximately $56 per month on dietary supplements, which equals over $32 billion per year. Additionally, Americans spend nearly $155 per month on health and fitness. Online sales for dietary products are growing at a rate that is 12% faster than other eCommerce products. Amazon leads in online sales, followed by Vitacost. Nature’s Bounty Co is the most significant player in the U.S. nutrition supplement market. Bausch & Lomb PreserVision is the biggest seller in the U.S. vitamin market (Kovachevska, 2020).

Chinese demand for supplements

China defines health foods as any products belonging in one of the following categories:

  • foods with specific health functions
  • nutritional supplements (SEO Agency China, 2020).

Why the Chinese do not buy their supplements domestically

In April 2019, The Chinese Nutrition Society released a white paper on imported nutrition products consumption. The report stated that 57.69% of the 4598 people interviewed said they bought imported health food. Of these, 53% prefer to buy imported health food products rather than buy domestic (Health Products Association China, 2019). Over half of the buyers for health products in China are under the age of 30. Sports nutrition is the fastest growing sector while vitamin and dietary supplements are the most popular. GNC, Swisse, Herbalife, Met-rx, Blackmores, Puritan’ s Pride, D-Cal, and Caltrate are popular international brands on China’s Tmall (Daxue Consulting, 2016).

The growing market in China for supplements

The market for nutraceuticals has grown in China due to increasing awareness of health benefits, increased purchasing power with a higher level of disposable income, and an increased level of health consciousness. The market value of vitamin sales in China has grown from 2.6 billion USD in 2014 to an expected 22.3 billion USD in 2020 (SEO China Agency, 2020).

Many Chinese are very health conscious, and country of origin matters to them, especially for products in which the domestic quality may be questionable (Chung, 2012). The Chinese are particular about where they are buying imported supplements.  Australia, New Zealand, and the United States are most popular with the Chinese. International brands have captured over 70% of the vitamin and dietary supplement market in China (SEO China Agency, 2020). Amway is the biggest direct seller in China (Euromonitor, 2019). Centrum is the leading multivitamin brand in the Chinese market.

Chinese consumers belief about safety and efficacy

According to research by the Chinese Central Station, only 3% of Chinese consumers believe that vitamins and dietary supplements have the effect they claim, and 60% believe they have a partial effect. Consumers lost trust in Chinese products because they promoted fake results, lied in advertising, and failed to obey regulations (Daxue Consulting, 2015).

“Chinese consumers have lost faith in the quality of their own domestic products and are willing to pay, on average, between four and ten times more for high quality North American ones” 

Bell, 2007, p27

When comparing domestic and international production of supplements, Chinese consumers believe:

  • Foreign companies invest more in research and development than domestic companies do.  
  • Many small and medium domestic companies lack quality control.
  • International companies possess greater research capabilities and up-to-date technologies than domestic companies (Asia Pacific Biotech News, 2003).

Made in China

Americans are becoming increasingly dependent on China for active pharmaceutical ingredients and nutritional supplements, according to Richard A. McCormack author of Manufacturing a Better Future for America. His concern is that there are few regulations in China. China has surpassed the U.S. as the largest exporter of vitamins and nutritional supplements, with a large part of their exports going to the U.S. In China, factory inspections must be announced in advance, and frequently the language barrier makes inspections challenging (American Jobs Alliance, n.d.).

Online leads the way

Chinese citizens buy the majority of their vitamins and dietary supplements using eCommerce. Social media platforms and influencers are important channels to reach customers. However, direct sales are used by most domestic brands. eCommerce allows international brands to have greater access to the Chinese market with fewer barriers, including tax barriers (SEO Agency China, 2020).

The number one place Americans buy supplements is Amazon (Kovachevska, 2020). Gary Collins, former special agent and forensic investigator for the U.S. Food and Drug Administration, warns that this practice undercuts legitimate companies. He says that cheap products are:

  • either counterfeit and probably dangerous
  • useless expired products that have been repackaged as new.
  • stolen products released on the black market without any quality control (Collins, 2013).

Summary

The NIH reports that the majority of Americans take dietary supplements, and the market continues to grow. Studies have found that some dietary products have little to no benefit, and others may be contaminated with harmful ingredients. One 2015 study showed that side effects from dietary supplements led to an estimated 23,000 emergency room visits. The quality of these products varies widely. Though companies are responsible for having evidence that their nutritional supplements are safe and that their labels are truthful and not misleading, this is difficult to enforce (NIH, 2019).

Consumers must know what they are buying and consult licensed health care providers for advice before purchase (NIH, 2019). Invigor Medical has convenient telemedicine appointments for consulting with health care providers.

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider.  You should always consult a practicing professional who can diagnose your specific case.  The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice. 

References

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