Food supplements: use them with discretion
Press release of the French National Academy of Medicine (*)
July 28, 2022
Food supplements (FS) are products intended to be taken in addition to food, in order to compensate for a real or supposed insufficiency of the daily intake (decree of April 15, 1996).
FS are the subject of several confusions. They contain many ingredients, including plants, for which the name FS is inappropriate. They are often confused with oral nutritional supplements (ONSs), which are high-energy or high-protein nutritional mixtures that may be necessary in cases of malnutrition. ONSs require a medical prescription.
FS are also often confused with drugs, due to their presentation (capsules, tablets, etc.) and their sale in pharmacies, where the border between FS and drugs is sometimes blurred [1,2]: depending on the dose, a substance may be a FS or a drug. Unlike drugs, FSs do not require a marketing authorization and are simply declared to the Competition, Consumer Affairs and Fraud Control Directorate (“Direction de la concurrence, de la consommation et de la répression des frauds”) (DGCCRF), which checks whether the composition complies with regulations, and carries out controls, as for other categories of foodstuffs.
Regulations set the list of authorized ingredients in FS (vitamins, minerals and plants), as well as the maximum daily doses not to be exceeded for vitamins and minerals. These lists, known as “positive” (everything that is not authorized is prohibited), can be consulted on the DGCCRF website. The list of herbal based FS published by DGCCRF in 2014 raises problems: it contains products with pharmacological but not physiological or nutritional properties; it sometimes does not provide sufficient data on safety of use because, depending on the dose used, some preparations see their physiological effect become a pharmacological effect potentially responsible for undesirable side-effects; parts of plants or extracts of plants included in this list are strictly medicinal and can only be sold in pharmacies.
For healthy people with a balanced diet and no documented deficiencies, FS are generally not necessary.
FS may have adverse effects due to overdose, misuse, or combination with drugs or other FS. In the case of plants, there are additional risks often associated with sales on the Internet: poor quality preparations (heavy metals, germs, mycotoxins, pesticides), confusion between very similar plants (some species of ginseng are dangerous), presence of illicit and dangerous substances deliberately introduced into a product without the consumer’s knowledge, so as to give an impression of efficacy (products for sportsmen or to lose weight). There is a risk of loss of opportunity for patients who substitute FS for their treatment without telling their doctor. Adverse effects must be reported to the French Food, Environment and Occupational Health Safety Agency (ANSES), which is responsible for nutrivigilance and can initiate control measures that may lead to changes in labelling or regulations, with even product withdrawals.
While recalling that a balanced diet should, in principle, cover nutritional needs, the French National Academy of Medicine
– Acknowledges that the increasing use of FS is a fact of society;
– Recommends that patients be informed of the importance of a supply via an authenticated circuit. Fragile populations (the elderly, children, pregnant women) should be particularly warned;
– Considers that the disorderly consumption of FS is harmful to health;
– Reiterates its recommendation that a statement be placed on the packaging indicating that FS may be dangerously incompatible with some medicines;
– Recommends that doctors and patients should be able to refer to a clearly identified list of FS that can be used if necessary and that the 2014 “list of plants” should be revised;
– Recommends that the training of physicians includes the FS topic enabling them to provide an advice on their use.
- Jaffiol C., Bourlioux P., Laplace J.P. Réflexions et propositions relatives aux allégations de santé et aux compléments alimentaires. (Rapport commun établi au nom des groupes de travail de l’Académie nationale de Médecine et de l’Académie nationale de Pharmacie). Bull. Acad. Natl Méd., 2011, 195 (1), 189-202.
- Cynober L. (Bien)faits et méfaits des compléments alimentaires. Bull. Acad. Natl Méd., 206 (2022) 660-666.
(*) Press release from the Academy’s Rapid Communication Platform validated by the members of the Board of Directors on July 27, 2022.