Page 136 - JSOM Summer 2020

by OPSS is Rauwolfia yomitoria root bark extract (yohimbine) TABLE 2 OPSS Questions to Risk Stratify Supplements as Likely
or “standardized for yohimbine” or yohimbine HCl. Reports Safe vs Likely Unsafe
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suggest this ingredient is being synthetically produced in some Questions Yes = 1 No = 0
products, and ingesting it could result in severe side-effects or 1. Is any one of these third-party certification
interact with other ingredients. Some countries outside the seals on the product label? (i.e., BSCG,
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United States have banned this ingredient due to potential se- Informed Sport, NSF Certified Sport, USP)
rious health effects. 2. Are there less than six ingredients on the
Supplement Facts label?
Finally, we found multiple hidden compounds in the products 3. Is the label free of the words proprietary,
analyzed. Eighteen (75%) products had compounds detected blend, matrix or complex?
that were not present on the labels, with an average of 3.1 un- 4. Can you easily pronounce the names of
listed ingredients per product. These consisted of amino acids each ingredient on the Supplement Facts
label?
or other acids typical of flavoring agents or preservatives; ad- 5. Is the amount of caffeine listed on the label
enosine or an adenosine-derivative; the stimulants/drugs 1,5- 200mg or less per serving? (If caffeine is not
DMHA and 1,3-DMAA (not dietary ingredients according to listed mark “Yes”)
the FDA); and various phenethylamines (PEA) such as β-PEA, 6. Is the label free of questionable claims or
hordenine (on FDA advisory list), demelverine (a synthetic statements?
drug) and halostachine. PEAs are stimulant, psychoactive, and 7. Are all the % Daily Values (%DV) on the
hallucinogenic substances with structures similar to amphet- Supplement Facts label less than 200%
amine, catecholamines, and other substances: none of them (If % DV is not listed, mark “No”)
should be in dietary supplements. 19,20 Finally, caffeine was Read the label on your supplement and mark 1 for “yes” and 0 for
detected in a product that explicitly claimed to be decaffein- “no”.
ated. For any of these products, it is unclear whether (and how Total: Add up the “1’s”. 4 or more is okay. Less than 4 is a “no-go”.
much of) these ingredients were added and what the source
was: synthetic or a plant extract? FIGURE 1 Dietary supplements screened according to Operation
Supplement Safety Scorecard for Relative Safety.
How Many Products on the Market
Contain These Red Flag Ingredients Identified?
We analyzed only 24 of at least 650 products on the mar-
ket; the fact that other brain health products might also
contain red flag ingredients was considered. We searched Nat-
ural Medicines to quantify how many products, regardless of
claimed use, were being marketed as dietary supplements and
contained red flag ingredients listed above. As shown in Ta-
ble 1 (right column), over 600 products are currently on the
market containing the ingredient ‘vinpocetine’ alone, an in-
gredient the FDA has tentatively concluded does not meet the
definition of a dietary ingredient. The more recent safety risks
of dietary supplements containing vinpocetine for women of
child-bearing age support the conclusion it should not be in
dietary supplements. Yet we still see it on Supplement Fact Take-Home Messages
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labels. Also, at least 268 products contained DMAA, which
the FDA declared did not meet the definition of a dietary sup- • Evidence indicates that many dietary supplement products
plement over 5 years ago. marketed for brain health or cognitive enhancement con-
tain ingredients (either present on or hidden from the label)
OPSS Scorecard: Identification of Red Flags that are ‘red flag’ ingredients or unapproved drugs. Check
With Operation Supplement Safety with OPSS to find the names to watch out for.
On the Operation Supplement Safety [OPSS.org] website, an • OPSS.org is an important resource for SOF community and
interactive scorecard is available to screen for red flags when provides updated and trusted, evidence-based information.
reading the Supplement Facts labels before considering a di- o Use the Ask The Expert feature when you have ques-
etary supplement. It is an educational tool and resource to tions about dietary supplements.
help consumers within the Department of Defense community o Become familiar with the Prohibited List of Ingredients.
make informed decisions: you need to read the label and an- o Check the High Risk List of Products that OPSS has
swer seven simple questions to make an informed go/no go available, when considering dietary supplements.
determination about a specific product. Table 2 presents the o Use the OPSS scorecard algorithm to screen a product
seven yes/no questions providing a quick screening for risk for relative safety.
stratification. Figure 1 shows the percentage of the 24 prod-
ucts scoring a 1 for each question, and the total score. Over- Summary
all, only one product had a score of 4 or greater and would
be considered “Likely Safe.” This product contained only one The dietary supplement market is booming with nootropic
ingredient listed on the label and was also verified to contain and cognitive enhancement products as brain health and cog-
only that one ingredient. Remember more does not mean bet- nitive performance becomes a public focus. It is likely SOF
ter; quality is better than quantity. It is important to note that communities will be a prime target for advertisements, which
the scoring algorithm has no relevance to effectiveness. could be deceptive and promoting potentially unsafe products.

134 | JSOM Volume 20, Edition 2 / Summer 2020