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According to a national survey, a third of adults who’ve made serious attempts at weight loss have tried using dietary supplements, for which Americans spend literally billions of dollars every year. Most mistakenly thought that over-the-counter appetite suppressants, herbal products, and weight-loss supplements had to be approved for safety by some governmental agency, like the FDA, before being sold to the public—or at least include some kind of warning on the label about potential side effects. Nearly half even thought they had to demonstrate some sort of effectiveness. None of that is true.

The Food and Drug Administration estimates that dietary supplements in general cause 50,000 adverse events annually––most commonly liver and kidney damage. Of course, prescription drugs don’t just adversely effect, but kill more than 100,000 Americans every year. But, at least you notionally have the opportunity to parse out the risks versus benefits, thanks to testing and monitoring requirements typically involving thousands of individuals.

When the manufacturer of the ephedrine-containing supplement Metabolife 356 had it tested—on 35 people—only minor side effects were found, such as dry mouth, insomnia, and headaches. However, once unleashed on the populace, nearly 15,000 adverse effects were reported before it was pulled from the market, including heart attacks, strokes, seizures, and deaths.

Given the lack of government oversight, there’s no guarantee that what’s on the label is even in the bottle. FDA inspectors have found that 70 percent of supplement manufacturers violated so-called Good Manufacturing Practices, which are considered the minimum quality standards. This includes things like basic sanitation and ingredient identification. Not 7 percent in violation; 70 percent.

DNA testing of herbal supplements across North America found that most could not be authenticated. In 68 percent of the supplements tested, the main labeled ingredient was missing completely, and substituted for something else. For example: a “St. John’s wort” supplement containing nothing but senna, a laxative that can cause anal blistering. Only 2 out of 12 supplement companies had products that were accurately labeled.

This problem isn’t limited to just fly-by-night phonies in some dark corner of the internet. The New York State Attorney General commissioned DNA testing of 78 bottles of commercial herbal supplements sold by Walgreens, Walmart, Target, and GNC. “Four out of five [bottles] did not contain any of the herbs on their labels.” Instead, capsules were often little more than cheap fillers like powdered rice “and houseplants.”

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