Are dietary supplements as nutritious as they claim?

The FSSAI, India’s top food regulator, conducted a survey from 2019 to 2022 and found that 4,890 samples of dietary supplements were unsafe, 16,582 were substandard, and 11,482 had labelling defects or misleading information. Image: Shutterstock
 
With the Covid-19 pandemic making more people prioritise their health, there is an ever-increasing focus on health care products by consumers today. This demand has resulted in a surge of brands offering dietary supplements and nutraceuticals to help consumers meet their nutrition requirements in the form of pills, gummies, powders, liquids, and other dosage formats. These products promise to improve overall health and boost immunity. But the question is, are these brands delivering on their promises?

When Karan Sharma, a Mumbai-based, 26-year-old influencer marketing professional first started consuming a protein powder recommended by his gym trainer in 2019, he would feel dizzy, weak and nauseous. “I consumed the powder for a month, and would get sick almost every other day, but didn’t realise it was because of the protein powder. I blamed other aspects like eating junk food or not getting proper sleep, because everyone at the gym was on some protein supplement or the other. But when I ran out of possible reasons for the repeated nausea, I realised it is the powder,” he says.

Sharma went off protein powders for three years, up until a month ago when he started consuming a different one. “I was sceptical, but I need one protein supplement for the gym. So far this one hasn’t shown any side effects,” he says.

Sharma is not alone. With a plethora of supplements available over-the-counter, people buy into their claims. “Since marketing is an important part of selling any product, more often than not advertisements target a specific group of audience and may not completely give a clear picture of the product,” says Dr Rebecca Pinto, a physiotherapist.  

Pinto would consume iron supplements, which she saw advertised, to boost her immunity. However, each time she tried a new supplement, she felt nauseous, dizzy, and even fainted at times. It was then that she consulted a gynaecologist and learnt she was anaemic, and that iron supplements weren't the solution. “I’m anaemic and iron levels in my body are already very high. What I needed was Vitamin C for iron absorption in the body. This is a common mistake most of us make. Some people keep taking calcium supplements while being deficient in Vitamin D which is needed for calcium absorption. The excess calcium can make bones brittle if the body is Vitamin D deficient,” she explains. She emphasises the need to consult a health care professional before consuming supplements.

Not all supplements are nutritious

According to Dr Cyriac Philips, a hepatologist and clinician-scientist, dietary supplements are marketed as health-promoting or disease-preventive agents, and don't go through rigorous testing for benefits or safety like medicines. There is often no clear evidence to support the claims made by these supplements. “For instance, the marketing of probiotics for promotion of gut health is inaccurate as gut health is undefined and unmeasurable, and there is no evidence that a few strains of bacteria can actually prevent or beneficially modify any clinical outcomes in a healthy person,” he explains, adding that a large number of dietary supplements do not contain the ingredients that they claim to have or have ingredients that are not disclosed or contain ingredients in suboptimal amounts.

Herbal and dietary supplements, and the nutraceutical industry, have been a continuing topic in Philips’s medical research and peer-reviewed publications. “Consumer demand, driven by promotions and advertisements that have no realistic checks in place, has led to the proliferation of the industry. Its demand and easy availability are proof of declining scientific temperament among people,” he says.

The dietary supplements market is projected to register a CAGR of 16.2 percent over the next five years, according to Research and Markets. According to the National Library of Medicine (NLM), a US-based medical library, a total of 936 vitamin formulations alone are available in India, with nutrient profiles of multivitamin products varying widely. However, there are concerns over the lack of uniformity in the naming and labelling of vitamin and mineral supplements in India, with many products containing undisclosed ingredients or suboptimal levels of nutrients, according to NLM. A study by NLM, for instance, highlights how a fixed-dose combination of vitamins B1, B6, and B12 in supplements is banned by the US Food and Drug Administration, but is not banned in India and is available in the Indian market.

Despite these concerns, the market for dietary supplements continues to grow, with significant gaps in regulatory mechanisms. As these supplements do not fall in the same category as medicines, and are instead categorised as food products, they are regulated by the Food Safety and Standards Authority of India (FSSAI). The Association of Consumer Protection (ACP), a non-profit organisation run by former FSSAI employees, claims that there are no testing guidelines or parameters in place for supplements and nutraceuticals. In a survey conducted by the ACP in February 2021, many supplements were found to contain false or misleading claims, with some containing dangerously high levels of nutrients. For instance, Vitamin D supplements contained 5,000 International Units (IUs), which is more than eight times the prescribed limit.

Most dietary supplements are not rigorously tested for clinical benefits or safety, says Philips. “The mechanism of action of many dietary supplements, especially multi-ingredient formulations, remain unknown and thus safe or clinically beneficial dosage levels are not well understood,” he says.

The FSSAI, India’s top food regulator, conducted a survey from 2019 to 2022 and found that 4,890 samples of dietary supplements were unsafe, 16,582 were substandard, and 11,482 had labelling defects or misleading information. The FSSAI has initiated criminal proceedings against 4,946 supplement makers. On March 10, it asked its state units to take action against non-compliant nutraceuticals and health supplements and has called for more vigilant checks on the products' manufacturing.

The ACP is concerned about the gaps in regulatory mechanisms and asks for stringent regulations to be put in place by FSSAI to ensure the efficacy of dietary supplements in India.

Digvijay Singh, a nutritionist and personal trainer, suggests steps for the immediate need of strengthening checks and balances from FSSAI to promote healthy lifestyle choices: “Strict label requirements should be set in place. Once a product is on the market, it should be monitored for safety and efficacy. A dosage limit should be set to prevent harmful implications of overconsumption. Most importantly, stricter advertising guidelines and action against companies that make false or misleading claims is the need of the hour.”

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The growing demand

The Covid-19 outbreak has been the primary accelerator to boost the sale of vitamin and mineral supplements in India. “In the absence of any therapeutics and vaccinations for the viral infection, consumers sought any means to bolster their immunity, including vitamins C and D and zinc supplements. As a result, the $2,5 billion Indian vitamins and dietary supplements market recorded double-digit growth in 2020 and 2021,” according to GlobalData, a London-based data analytics and consulting company.



Ecommerce platforms are becoming hotspots for the sale of health supplements and nutraceuticals. Kindlife, an ecommerce platform with more than 2.5 lakh consumers, is witnessing rising demand for such products on its platform. “We are witnessing a month-on-month increase in this segment and it is a core category for us. As consumers look for supplements and nutraceuticals that supplement their daily diets, they are open to trying new brands and formats,” says Radhika Ghai, founder and CEO of Kindlife.

Nyumi, one such supplement brand, has reported a staggering 450 percent increase in sales over the past year. According to Ananya Agarwal, the founder and CEO of Nyumi, the brand has been successful in demonstrating the impact of their products on people's health and well-being by sharing the experiences of actual users. “This is especially important for first-time supplement users who may be hesitant to try supplements due to a lack of understanding or skepticism about their effectiveness,” she says.

Agarwal emphasizes that transparency is a core value of the brand and that all the necessary details about the ingredients, sourcing, and benefits are provided on the label. “We use science and clinical trials to show efficacy, highlighting actual clinical trial stats to quantify results,” she adds.

Kindlife screens brands based on how organic, toxin-free, eco-conscious, or cruelty-free they are. “Through an AI tool, we examine the ingredients of each product, and scrutinise them to ensure there are no harmful toxins and that all ingredients are within permissible limits. We also check individual certifications from each brand to ensure all checks and balances are maintained,” Ghai says.

“Indians have a high propensity for herbal and botanical supplements owing to their trust in indigenous healing systems, such as Ayurveda, Siddha, and Unani. As a result, dietary supplement makers are incorporating Ayurvedic herbs, such as Ashwagandha (Indian winter cherry) and Brahmi (Indian pennywort) into products to localise them and overcome consumer resistance. Products that target specific groups such as babies, the elderly, prenatal/pregnant/nursing women, and working adults are gaining favour,” GlobalData states.

According to Mintel, a London-based market research firm, 37 percent of the Indian population consumes vitamin and mineral supplements (VMS), of which 58 percent consumers are female. Of these, only half the consumers follow doctors’ prescriptions. 

Any new product that promises improved health does well in India because consumers do not put in the effort to understand them, says Khushboo Jain Tibrewala, a nutritionist and diabetes educator. “Today, personal trainers are recommending supplements without having the right knowledge on the subject and people are buying them. Health influencers are promoting brands on social media and people are buying into those too. So the real change has to come from the consumers. They need to educate themselves or find a trustworthy person for these recommendations,” she says.

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“People must understand that dietary supplements have very little evidence for health benefits or disease modification or prevention,” says Philips. “They have a higher risk profile due to poor regulation, poor manufacturing, and potentially toxic ingredients, adulteration, and contamination. Incorporation of these in overall health and wellness plans must not be performed without discussion and disclosures with a registered and qualified medical practitioner, especially if they have underlying disease conditions.”

How to be careful

Tibrewala believes consuming supplements can have beneficial results if one is careful about the kind of supplements they take. According to her, supplements such as curcumin and omega 3 are both blood thinners and taking them together could be harmful. Additionally, taking a specific supplement for too long could lead to toxicity due to higher levels.

How can one be careful of the kind of supplements they consume? “Along with a health care professional’s guidance, one should buy local brands only. Importing can give the opportunity for someone in the middle to play with them. And always buy a reputable brand,” she says.

Consumers should consider supplements as an addition to a healthy diet and lifestyle choices, and not rely on them as substitutes for proper nutrition. “It is important to continue to consume a varied and nutrient-rich diet, engage in regular physical activity, and manage stress levels,” says Singh.