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Jagged little pills or panacea for health?

- Lem Chetty

Vitamin and nutritional supplements are big business, but are they effective or just a waste of money – or even dangerous? 

There was something oddly familiar about a recent superfood trend. Matcha is a green tea from East Asia, similar in taste to spirulina, and found everywhere from coffee to confectionery. Both are powerful antioxidants, but are these and other nutritional supplements formulas for longevity and vitality or just expensive snake oils?

Pills and health care | Curiosity 16: #Drugs ©                    

Energy, youth, beauty for all in a bottle

Associate Professor Neelaveni Padayachee, in Clinical Pharmacy and Pharmacy Practice at Wits, says that the vitamins and supplements industry is growing. “Demand escalated during the pandemic because people believed they reduce the risk of Covid-19-related complications… which, as a matter of fact, is yet to be proven,” says Padayachee.

The South African health supplements industry is worth more than R2 billion. But who is consuming these products? The answer is everyone from students on Omega-3 supplements, to athletes looking to increase performance, middle-aged adults to preserve youth, and older people seeking alternative nutrition options.

But do they work?

The disclaimer on supplements is standard: Always ask advice from a healthcare professional and consider the scientific evidence before you try something new, particularly in conjunction with chronic, acute, and over-the-counter medicines. Padayachee adds that people should not replace seeking professional healthcare advice with supplements which they believe will cure them.

“Health benefits are also based on what supplements are taken and in what quantities. Here, the concept of ‘less is more’ applies. For instance, high doses of vitamin C and B6 can lead to kidney stones and toxicity respectively,” she says.

Padayachee believes that administered correctly, some supplements do work. 

Omega-3 fatty acids, such as fish oil, have been proven to be effective in reducing inflammation, supporting heart health, and improving cognitive function.

Supplements are commonly recommended for vitamin D deficiency, as this is important for bone health, immune function, and overall well-being.

CoQ10 is involved in cellular energy production and acts as an antioxidant. It may be beneficial for individuals with heart conditions, migraines, and certain neurological disorders.

But there are many others that don’t work and/or are downright dangerous: Ephedra, also known as ma huang, was used for weight loss and athletic performance enhancement but due to cardiovascular events and fatalities, was banned in many countries.

St. John’s Wort is used to manage mild to moderate depression, but it can interact with medications including antidepressants, birth control pills, and anticoagulants, reducing their effectiveness.

Vitamin E can be dangerous especially for people taking blood-thinners.  Despite its being an essential nutrient with antioxidant properties, excessive intake through supplements may increase the risk of bleeding and haemorrhagic stroke.

Melamine in protein shakes

The work of Dr Gary Gabriels in the Department of Pharmacology and PhD student Mandisi Sithole has highlighted the use of harmful substances in protein supplements, including melamine, a chemical compound used in products including cabinets and countertops.

Gabriels’ 2015 paper reads: “These supplements may contain adulterated substances that may potentially have harmful short- and long-term health consequences to the consumer. ‘Scrap Melamine’ is such an example, which has been implicated in the kidney failure and death of animals.”

Sithole says, “My additional research in 2022 found two other compounds, cyanuric acid and uric acid, both related to melamine, present in protein supplements. Research has shown these substances to be more toxic to the kidneys when found in combination with melamine, which was the case in most of the supplements that were studied.”

Melamine is rich in nitrogen and can artificially and inexpensively enhance the protein content of protein supplements. While the additive may be banned in one country, it could appear in animal feed elsewhere, reaching the consumer in other ways.

Gabriels’ advice is to be cautious as these products could have health consequences later on.

“We’ve seen this in athletes who use supplements during the peak of their careers and only feel the negative effects decades later,” says Gabriels.

He also suggests that consumers read labels. “A shake will say ‘100% protein’ and is often a lie. If you cannot understand the ingredients, phone the manufacturer and ask for an explanation.”  Padayachee says that there’s a regulatory deficit between vitamins and supplements, and scheduled medicines.

“Medicines are regulated for safety, quality, and effectiveness by the South African Health Products Regulatory Authority (SAHPRA) – unlike complementary and alternative medicines (CAMS) including vitamins and supplements. However, in 2017, after amendments to the General Regulations of the Medicines and Related substances Act 101 of 1965, SAHPRA has been making strides in regulating the CAMS sector.”

Gabriels concludes: “The aim isn’t to demonise the products. The purpose is to regulate them instead. If we don’t control the environment, we will be dealing with the consequences.”

  • Lem Chetty is a freelance writer.
  • This article first appeared in Curiosity, a research magazine produced byWits Communications and the Research Office
  • Read more in the 16th issue, themed: #Drugs, where we highlight the diversity, scope, and multi-dimensional nature of drug-related research at Wits University.