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Ganson KT, Nagata JM. Prevalence and correlates of appearance- and performance-enhancing drugs and substances use among a national sample of college students aged 18-30. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1336-1340. [PMID: 35623043 DOI: 10.1080/07448481.2022.2076104] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
Objective: To identify the lifetime prevalence and correlates of appearance- and performance-enhancing drugs and substances (APEDS) use among a national sample of US college and university students. Participants: Student participants from the 2020-2021 Healthy Minds Study (N = 7,401; ages 18-30 years). Methods: Lifetime prevalence of five forms of APEDS was estimated. Modified Poisson regression analyses were conducted to determine the sociodemographic correlates of protein and creatine supplement use. Results: Lifetime protein (23.8%) and creatine (7.7%) supplement use were most common among the sample. Older age within young adulthood, male sex, perceiving oneself to be normal weight or somewhat overweight, any athletics participation, and 2-3 or ≥ 5 h/week of exercise were associated with greater likelihood of lifetime protein and creatine supplement use. Conclusions: Awareness and prevention efforts on the potential harms of APEDS use are needed on campuses, particularly among males and those who participate in athletics and high-frequency exercise.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
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Ganson KT, Sinicropi E, Nagata JM. Analyzing Social Media Policies on Muscle-Building Drugs and Dietary Supplements. Subst Use Misuse 2024; 59:380-387. [PMID: 37919881 DOI: 10.1080/10826084.2023.2275557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Use of legal and illegal muscle-building drugs and dietary supplements has been linked to many adverse health and social outcomes. Research has shown that social media use is associated with the use of these drugs and dietary supplements; however, it remains unknown whether social media companies have specific policies related to the content and advertising of muscle-building drugs and dietary supplements on their platforms. Therefore, this study aimed to assess the content and advertising policies of eight popular social media companies related to muscle-building drugs and dietary supplements. METHODS Content and advertising policies for YouTube, TikTok, Instagram, Snapchat, Facebook, Twitter, Twitch, and Reddit were analyzed in November 2022 to determine whether there were any provisions related to legal (e.g., whey protein) and illegal (e.g., anabolic-androgenic steroids) muscle-building drugs and dietary supplements. Policies were classified as either none, restricted, or prohibited. RESULTS All eight social media platforms had explicit policies prohibiting user-generated content and advertising of illicit drugs and substances (e.g., anabolic-androgenic steroids). User-generated content and advertising policies related to legal muscle-building dietary supplements across the platforms varied; however, none of the eight social media companies had a specific policy regarding user content. CONCLUSIONS Findings underscore the need for stronger social media content and advertising policies related to legal muscle-building dietary supplements.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Eliana Sinicropi
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, ON, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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Jagim AR, Harty PS, Erickson JL, Tinsley GM, Garner D, Galpin AJ. Prevalence of adulteration in dietary supplements and recommendations for safe supplement practices in sport. Front Sports Act Living 2023; 5:1239121. [PMID: 37841887 PMCID: PMC10570429 DOI: 10.3389/fspor.2023.1239121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
The prevalence of dietary supplement use among athletes continues to rise with 60-80% of athletes often reporting current or previous use of dietary supplements. While select dietary ingredients have been shown to improve acute performance and enhance training adaptations over time, it is important to still consider the risk vs. reward for athletes before opting to consume a dietary supplement. Previous work has indicated that certain dietary supplements may pose risks for inadvertent doping, may be susceptible to mislabelling, could be banned by certain governing bodies of sport, or pose health risks for certain populations. The purpose of the current narrative review is to summarize the prevalence of adulteration in dietary sport supplement products, outline the risks of inadvertent doping for athletes, and highlight best practices regarding safe supplementation strategies. Analytical studies have found anywhere from 14 to 50% of samples analyzed from dietary supplement products have tested positive for anabolic agents or other prohibited substances. It is important for the consumer to adhere to safe supplementation strategies, which include following serving size recommendations, cross-referencing ingredient profiles with the list of prohibited substances, choosing quality products that have been verified by a third-party certification program, and being cognizant of consuming multiple dietary supplement products with overlapping ingredient profiles. Once these practices have been considered, it is reasonable for an athlete to utilize dietary supplements as a strategy to optimize performance and health, with a low risk of failing a drug test (adverse analytical finding) and experiencing adverse events.
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Affiliation(s)
- Andrew R. Jagim
- Sports Medicine, Mayo Clinic Health System, La Crosse, WI, United States
| | - Patrick S. Harty
- Exercise & Performance Nutrition Laboratory, Lindenwood University, St. Charles, MO, United States
| | - Jacob L. Erickson
- Sports Medicine, Mayo Clinic Health System, La Crosse, WI, United States
| | - Grant M. Tinsley
- Energy Balance & Body Composition Laboratory, Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, United States
| | - Dan Garner
- BioMolecular Athlete, LLC., Wilmington, DE, United States
| | - Andrew J. Galpin
- BioMolecular Athlete, LLC., Wilmington, DE, United States
- Department of Kinesiology, Center for Sport Performance, California State University, Fullerton, CA, United States
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Nasr A, Yosuf I, Turki Z, Abozeid A. LC-MS metabolomics profiling of Salvia aegyptiaca L. and S. lanigera Poir. with the antimicrobial properties of their extracts. BMC PLANT BIOLOGY 2023; 23:340. [PMID: 37365525 DOI: 10.1186/s12870-023-04341-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 06/10/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Salvia L. (Lamiaceae) found in almost all countries in temperate and tropical regions. Both S. aegyptiaca L. and S. lanigera Poir. have a rather wide distribution in Egypt (Mediterranean region, Gebel Elba and nearly the whole Sinai). Salvia species showed antibacterial and antifungal activities against several groups of food microorganisms and pathogens, so they are considered as a natural foods preservatives. AIM Investigate the phytochemical profiles of S. aegyptiaca & S. lanigera collected from their natural habitats in Egypt and test the antimicrobial activities of both species against some bacteria and fungi pathogenic strains. METHODOLOGY In the present study, S. aegyptiaca and S. lanigera were collected from their natural habitat. Total phenolics and flavonoids contents were measured for aerial parts of both Salvia spp.. The separation and identification of the pure active materials of both Salvia sp. by using LC-MS system (UHPLC-TSQ Quantum Mass Spectrometer). The antimicrobial activities of the ethanol, water and benzene extracts of the two species were tested against different pathogenic strains and compared with the standard antimicrobial drug (Gentamycin). Antimicrobial activity was determined by using agar disk diffusion method. RESULTS The phenolics content in S. lanigera 132.61±6.23 mg/g and S. aegyptiaca 125.19±4.97 mg/g, while the flavonoids content was 35.68±1.84 and 40.63±2.11 mg/g, respectively. Through LC-MS analysis, two compounds were detected in both species; heptadecanoyl coenzyme A, that the highest percentage (13.5%) in S. aegyptiaca and (11.5 %) in S. lanigera. Oenin, in a peak area of 3.1% in S. aegyptiaca and 1.2 % in S. lanigera. Ethanol extract of the two species had the most inhibitory effect against all tested microorganisms that exceeded the effect of the standard, except for Mucor reinelloids which was more sensitive to the water extract. Moreover, S. lanigera ethanol extract showed larger inhibition zone than S. aegyptiaca in all tested microorganisms except for Pseudomonas aeruginosa. CONCLUSION This study shows the important phytochemicals that improve the antibacterial and antifungal activities of Salvia aegyptiaca and S. lanigera.
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Affiliation(s)
- Alyaa Nasr
- Department of Botany and Microbiology, Faculty of Science, Menoufia University, Shebin Elkoom, 32511, Egypt
| | - Israa Yosuf
- Department of Botany and Microbiology, Faculty of Science, Menoufia University, Shebin Elkoom, 32511, Egypt
| | - Zaki Turki
- Department of Botany and Microbiology, Faculty of Science, Menoufia University, Shebin Elkoom, 32511, Egypt
| | - Ann Abozeid
- Department of Botany and Microbiology, Faculty of Science, Menoufia University, Shebin Elkoom, 32511, Egypt.
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Ganson KT, Hallward L, Cunningham ML, Murray SB, Nagata JM. Use of Legal Appearance- and Performance-Enhancing Drugs and Substances: Findings from the Canadian Study of Adolescent Health Behaviors. Subst Use Misuse 2023; 58:289-297. [PMID: 36576273 DOI: 10.1080/10826084.2022.2161318] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Use of appearance- and performance-enhancing drugs and substances (APEDS) is common among adolescent and young adults. Many APEDS are legally sold "over-the-counter," however research has documented contamination of legal APEDS and many adverse effects of use. Despite this, little research has been conducted on legal APEDS use in Canada, particularly regarding the prevalence and sociodemographic predictors of use, which was the aim of this study. METHODS Data from the Canadian Study of Adolescent Health Behaviors (N = 2,731) were analyzed. Prevalence and frequency of use of 10 common APEDS in the past 12 months were estimated overall and across genders. Multiple modified Poisson regression analyses were conducted to determine the sociodemographic predictors of APEDS use. RESULTS Overall, use of caffeine was most common among the sample (71.3%), along with protein bars (63.4%), and whey protein powders or protein shakes (63.1%). Boys and men reported greater prevalence of use of eight of the 10 APEDS, with the exception of diuretics or water pills and probiotics, compared to girls and women and transgender/gender non-confirming participants. Over three quarters (82.5%) of boys and men reported use of whey protein powders or protein shakes and 50.3% reported use of creatine monohydrate. Use of APEDS varied based on several key sociodemographic identifiers. CONCLUSIONS This study is the first to document legal APEDS use among a sample of Canadian adolescents and young adults, providing important implications for health care and policymaking professionals. Further research is needed to gain greater insight into APEDS use among Canadian young people.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Laura Hallward
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,School of Kinesiology, Western University, London, Canada
| | | | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
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6
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Beer C, Keiler AM. Androgenic properties of the dietary supplement 5α-hydroxy-laxogenin. Arch Toxicol 2022; 96:2139-2142. [PMID: 35344071 PMCID: PMC9151512 DOI: 10.1007/s00204-022-03283-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/14/2022] [Indexed: 12/02/2022]
Abstract
Dietary supplements sold for anabolic benefits or performance enhancement often contain substances, which are non-approved and might lack quality controls. With regard to athletes, the inclusion of substances or methods in the prohibited list of the World Anti-Doping Agency is based on medical or scientific evidence. 5α-hydroxy-laxogenin is a synthetic spirostane-type steroid, which is contained in dietary supplements and advertised as anabolic agent. To date, evidence is missing on anabolic or androgenic activity of 5α-hydroxy-laxogenin. We investigated its androgenic potential in two in vitro bioassays. While no activity was observed in the yeast androgen screen, 5α-hydroxy-laxogenin was able to trans-activate the androgen receptor in human prostate cells in a dose-dependent manner. Interestingly, a biphasic response was observed with antagonistic properties at lower concentrations and agonistic effects at higher concentrations tested. The demonstrated androgenic properties of the higher concentrations demonstrate that further investigations should focus on the safety as well as on potential anabolic effects of 5α-hydroxy-laxogenin. This is of interest with regard to abuse for doping purposes.
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Affiliation(s)
- Carolin Beer
- Institute of Doping Analysis and Sports Biochemistry Dresden, Kreischa, Germany
| | - Annekathrin M Keiler
- Institute of Doping Analysis and Sports Biochemistry Dresden, Kreischa, Germany. .,Environmental Monitoring and Endocrinology, Faculty of Biology, Dresden, Germany.
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Crawford C, Walter AR, Avula B, Lindsey AT, Hunter AM, Ikhlas AK, Deuster PA. Relative safety and quality of various dietary supplement products U.S. Service Members ask about. Clin Toxicol (Phila) 2022; 60:737-744. [PMID: 35156875 DOI: 10.1080/15563650.2022.2036751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
CONTEXT The purpose of this project was to determine types of dietary supplement products U.S. Service Members frequently ask about and identify risks associated with select products that consumers should be aware of when considering their use. METHODS Forty-one dietary supplement products frequently asked about through the Operation Supplement Safety's (OPSS.org) Ask-the-Expert portal were selected. Product analysis was performed to verify whether select products were accurately labeled and to identify any risky ingredients contained in these products. Operation Supplement Safety Risk Assessment Scorecard criteria were additionally used as a screening tool to assess a product's relative safety potential. RESULTS Among the select dietary supplements, 12 (29.3%) were marketed as pre-workout products; 14 (34.1%) for weight loss; four (9.8%) for male enhancement/testosterone boosters; and 11 (26.8%) as body building supplements. Eleven (26.8%) products had accurate labels; only eight of these had accurate labels plus no risky ingredients listed on the labels. Twenty-six (63.4%) products were misbranded; 10 (24.4%) were adulterated, and six (14.6%) were both misbranded and adulterated. Risky ingredients appeared on 23 (56%) of all product labels. Eight of these 23 products also had additional risky ingredients not listed on the labels but detected through analysis. According to the Scorecard based on label claims, 35 (85.4%) received a rating of "no-go/risky". CONCLUSIONS U.S. Service Members and the public at large should be aware that dietary supplements may contain risky ingredients and know how to identify ingredients on the label to evaluate potential risk.
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Affiliation(s)
- Cindy Crawford
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Abraham R Walter
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Bharathi Avula
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Andrea T Lindsey
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Aimee M Hunter
- Department of Laboratory Animal Resources, Uniformed Services University, Bethesda, MD, USA
| | - A Khan Ikhlas
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
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8
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Dwyer JT, Saldanha LG, Bailen R. Dietary supplement databases: Public health tools. J Food Compost Anal 2022. [DOI: 10.1016/j.jfca.2021.104244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Crawford C, Boyd C, Brown L, Costello R, Cordell J, Frushour K, Junker C, Khan I, Ross J, Deuster PA. Prioritized research recommendations and potential solutions: addressing gaps surrounding dietary supplement ingredients for boosting brain health and optimizing cognitive performance. Nutr Res 2021; 96:9-19. [PMID: 34890857 DOI: 10.1016/j.nutres.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/31/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
In the market of dietary supplements, a low level of certainty exists in the state of the science, coupled with not always knowing what is in the product. Together these issues make weighing benefits/risks difficult and hinder the ability to guide evidence-based practice decisions. The authors sought to identify priorities and develop potential solutions to address research gaps so that information disseminated, can ultimately, be relied upon, when trying to make appropriate and safe decisions. Using a modified-Delphi process, 8 panelists reviewed evidence, provided from systematic review, on dietary supplement ingredients for brain health, and prioritized gaps identified and offered potential solutions. Research gaps specific to dietary supplements research included the need for quality testing of products, the question of bioavailability and absorption of ingredients, and optimal composition and standardization of supplements under investigation. Other gaps related to populations studied; a general sense of bias towards focusing research on diseased rather than maintaining or optimizing performance in healthy populations. Additionally, the lack of uniform cognitive performance measures and metrics used across research is a gap, as well as whether the metrics are accurate representations of or even generalizable to "real-life" participants wishing to optimize their performance. Methodological quality and ethical concerns in the conduct and reporting of science encompass all issues. If resources map to potential solutions outlined in this paper, then these proposed next steps offered will help facilitate meaningful research, move evidence into practice recommendations, and ultimately develop better decision-making tools for consumers to trust and rely upon for making safe supplement decisions.
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Affiliation(s)
- Cindy Crawford
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20817, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.
| | - Courtney Boyd
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20817, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - LaVerne Brown
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20817, USA
| | - Rebecca Costello
- Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20817, USA
| | | | - Katie Frushour
- Special Warfare Human Performance Squadron, Kirtland AFB 87123, NM, USA
| | - Caesar Junker
- Department of Defense, Joint Artificial Intelligence Center, Bethesda 20817, MD, USA
| | - Ikhlas Khan
- National Center for Natural Products Research, University of Mississippi 38677, MS, USA
| | - Jared Ross
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20817, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20817, USA
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Matura JM, Shea LA, Bankes VA. Dietary supplements, cytochrome metabolism, and pharmacogenetic considerations. Ir J Med Sci 2021; 191:2357-2365. [PMID: 34734388 DOI: 10.1007/s11845-021-02828-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dietary supplement use has continued to rise. In addition to supplement-drug interactions, it is prudent to consider how dietary supplements may interact with a patient's specific pharmacogenetics. Variations in genes associated with CYP 450 enzymes have evidence of impacting drug metabolism and adverse effects. AIMS This research was performed to evaluate CYP P450 enzyme activity of the top 15 dietary supplements used in the USA in order to initiate pharmacogenetic considerations specific to commonly used dietary supplements. METHODS The most common dietary supplements used in the USA were obtained from the National Health and Nutrition Examination Survey (NHANES). Primary literature detailing supplement CYP P450 activity was compiled from PubMed using MeSH search terms: supplement name(s), cytochrome P450 enzymes, metabolism, and pharmacokinetics. Additional resources utilized for documented CYP enzyme genotypes were the pharmacogenetic databases from Clinical Pharmacogenetics Implementation Consortium and The Pharmacogenomic Variation Consortium. RESULTS Of the 15 most common dietary supplements used in the USA, 53% (cranberry, echinacea, garlic, ginkgo biloba, ginseng, melatonin, milk thistle, and valerian) exhibit CYP P450 metabolism, with some having possible induction activity as well. Melatonin and garlic are substrates of CYP1A2 and CYP2C19, respectively. Additionally, there is evidence of echinacea having possible CYP3A4 induction activity. CONCLUSION CYP P450 activity is an important consideration for any patient but becomes increasingly critical if patients have certain CYP P450 phenotypes that impact metabolism. These popular supplements have the potential for changes in supplement exposure, and adverse effects based on pharmacogenetic profiles. Furthermore, these sites of metabolism are shared with many medications, setting the stage for possibly more profound interactions between medications and supplements. This paper highlights the mechanisms in which dietary supplements may constitute a risk for patients with certain CYP P450 phenotypes. Further research is needed in the area of dietary supplements and their pharmacogenomic implications.
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Affiliation(s)
- Janelle M Matura
- School of Pharmacy, Regis University, 3333 Regis Blvd, Denver, CO, H-28, USA
| | - Leticia A Shea
- School of Pharmacy, Regis University, 3333 Regis Blvd, Denver, CO, H-28, USA.
| | - Victoria A Bankes
- School of Pharmacy, Regis University, 3333 Regis Blvd, Denver, CO, H-28, USA
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Cohen PA, Ellison RR, Travis JC, Gaufberg SV, Gerona R. Quantity of phenibut in dietary supplements before and after FDA warnings. Clin Toxicol (Phila) 2021; 60:486-488. [PMID: 34550038 DOI: 10.1080/15563650.2021.1973020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Phenibut is used to treat anxiety, insomnia, alcohol withdrawal and other conditions in Russia. The drug, however, has abuse potential and may cause lethargy, delirium, psychosis and coma. In the United States (US), the US Food and Drug Administration (FDA) has never approved the use of phenibut as a prescription medication, but the drug is available over-the-counter in dietary supplements. More than 80 cases of coma and death have been associated with phenibut consumption and withdrawal, and the FDA recently warned that the drug is not permitted in over-the-counter supplements. We designed our study to determine the presence and quantity of phenibut in over-the-counter supplements before and after the FDA warnings. METHODS Phenibut products were included if they (a) listed phenibut or a synonym as an ingredient on the label, (b) were labeled as a dietary supplement, and (c) were available for sale both before and after the FDA warning. Supplements were analyzed by liquid chromatography time-of-flight mass spectrometry; quantification was performed by isotope dilution method. RESULTS Four brands of dietary supplements labeled as containing phenibut met the inclusion criteria. Prior to the FDA warnings, two of the four brands contained phenibut, at dosages of 484 mg and 487 mg per serving. After the FDA warning, all four products contained phenibut, ranging in dosages from 21 mg to 1,164 mg per serving. Phenibut was first detected only after the FDA warnings in two brands, and the quantity of phenibut increased in three of four products after the FDA warnings. Quantities detected per dose were as much as 450% greater than a typical 250 mg pharmaceutical tablet manufactured in Russia. CONCLUSION Following FDA issuing an advisory that phenibut is not permitted in dietary supplements, the quantity of phenibut increased in 3 of 4 brands of over-the-counter phenibut supplements.
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Affiliation(s)
- Pieter A Cohen
- Department of Medicine, Cambridge Health Alliance, Somerville, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ross R Ellison
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California, San Francisco, CA, USA
| | | | - Slava V Gaufberg
- Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, Cambridge Health Alliance, Cambridge, MA, USA
| | - Roy Gerona
- Clinical Toxicology and Environmental Biomonitoring Laboratory, University of California, San Francisco, CA, USA
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Cohen PA, Avula B, Wang YH, Zakharevich I, Khan I. Five Unapproved Drugs Found in Cognitive Enhancement Supplements. Neurol Clin Pract 2021; 11:e303-e307. [PMID: 34484905 DOI: 10.1212/cpj.0000000000000960] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/23/2020] [Indexed: 11/15/2022]
Abstract
Objective To identify the presence of unapproved pharmaceutical drugs in over-the-counter dietary supplements marketed to improve memory and cognitive function. Methods Supplements were identified by searching 2 supplement databases for products labeled as containing omberacetam, aniracetam, phenylpiracetam, or oxiracetam, 4 drugs not approved for human use in the United States. Products were purchased online and analyzed using nontargeted liquid chromatography-quadrupole time-of-flight mass spectrometry methods. Results In the 10 products tested, omberacetam and aniracetam were detected along with 3 additional unapproved drugs (i.e., phenibut, vinpocetine and picamilon). By consuming recommended serving sizes, consumers could be exposed to pharmaceutical-level dosages of drugs including a maximum of 40.6 ± 0.4 mg omberacetam (typical pharmacologic dose of 10 mg), 502 ± 0.8 mg of aniracetam (typical pharmacologic dose 200-750 mg), 15.4 ± 0.3 mg of phenibut (typical pharmacologic dose 250-500 mg), 4.3 ± 0.1 mg of vinpocetine (typical pharmacologic dose 5-40 mg), and 90.1 ± 0.7 mg of picamilon (typical pharmacologic dose 50-200 mg). Several detected drugs were not declared on the label, and several declared drugs were not detected in the products. For those products with drug quantities provided on the labels, 75% (9/12) of declared quantities were inaccurate. Consumers could be exposed to up to four-fold greater than pharmaceutical dosages and as many as 4 unapproved drugs when using individual products. Conclusions Over-the-counter cognitive enhancement supplements may contain multiple unapproved drugs. The health effects of consuming untested combinations of unapproved drugs at unpredictable dosages without clinician oversight in supplements are unknown.
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Affiliation(s)
- Pieter A Cohen
- Department of Medicine (PAC), Cambridge Health Alliance, Somerville, MA, Harvard Medical School, Boston, MA; National Center for Natural Products Research (BA, YHW, IK), School of Pharmacy, University of Mississippi, University, MS; and Department of Biochemistry and Molecular Genetics (IZ), University of Colorado Denver-Anschutz Medical Campus, Aurora
| | - Bharathi Avula
- Department of Medicine (PAC), Cambridge Health Alliance, Somerville, MA, Harvard Medical School, Boston, MA; National Center for Natural Products Research (BA, YHW, IK), School of Pharmacy, University of Mississippi, University, MS; and Department of Biochemistry and Molecular Genetics (IZ), University of Colorado Denver-Anschutz Medical Campus, Aurora
| | - Yan Hong Wang
- Department of Medicine (PAC), Cambridge Health Alliance, Somerville, MA, Harvard Medical School, Boston, MA; National Center for Natural Products Research (BA, YHW, IK), School of Pharmacy, University of Mississippi, University, MS; and Department of Biochemistry and Molecular Genetics (IZ), University of Colorado Denver-Anschutz Medical Campus, Aurora
| | - Igor Zakharevich
- Department of Medicine (PAC), Cambridge Health Alliance, Somerville, MA, Harvard Medical School, Boston, MA; National Center for Natural Products Research (BA, YHW, IK), School of Pharmacy, University of Mississippi, University, MS; and Department of Biochemistry and Molecular Genetics (IZ), University of Colorado Denver-Anschutz Medical Campus, Aurora
| | - Ikhlas Khan
- Department of Medicine (PAC), Cambridge Health Alliance, Somerville, MA, Harvard Medical School, Boston, MA; National Center for Natural Products Research (BA, YHW, IK), School of Pharmacy, University of Mississippi, University, MS; and Department of Biochemistry and Molecular Genetics (IZ), University of Colorado Denver-Anschutz Medical Campus, Aurora
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13
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Blanckaert P, Balcaen M, Vanhee C, Risseeuw M, Canfyn M, Desmedt B, Van Calenbergh S, Deconinck E. Analytical characterization of "etonitazepyne," a new pyrrolidinyl-containing 2-benzylbenzimidazole opioid sold online. Drug Test Anal 2021; 13:1627-1634. [PMID: 34145779 DOI: 10.1002/dta.3113] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/07/2022]
Abstract
This paper reports on the identification and full chemical characterization of the substance colloquially called "etonitazepyne" or "N-pyrrolidino etonitazene" (2-(4-ethoxybenzyl)-5-nitro-1-(2-(pyrrolidin-1-yl)ethyl)-1H-benzo[d]imidazole), a potent NPS opioid of the 5-nitrobenzimidazole class. Identification of etonitazepyne was performed, on a sample purchased during routine monitoring of the drug market, using GC-MS, HRAM LC-MS/MS, 1 H NMR, and FTIR. The chromatographic data, together with the FTIR data, indicated the presence of a highly pure compound and already indicated a benzimidazole structure. The specific benzimidazole regio-isomer was confirmed using 1 H NMR spectroscopy, resulting in the unambiguous identification of etonitazepyne.
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Affiliation(s)
- Peter Blanckaert
- Belgian Early Warning System Drugs, Lifestyle and Chronic Diseases, Scientific Direction Epidemiology, Sciensano, Brussels, Belgium
| | - Margot Balcaen
- Belgian Early Warning System Drugs, Lifestyle and Chronic Diseases, Scientific Direction Epidemiology, Sciensano, Brussels, Belgium
| | - Céline Vanhee
- Laboratory for Medicines and Health Care Products, Scientific Direction of Physical and Chemical Health Risks, Sciensano, Brussels, Belgium
| | - Martijn Risseeuw
- Laboratory for Medicinal Chemistry, Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Michaël Canfyn
- Laboratory for Medicines and Health Care Products, Scientific Direction of Physical and Chemical Health Risks, Sciensano, Brussels, Belgium
| | - Bart Desmedt
- Laboratory for Medicines and Health Care Products, Scientific Direction of Physical and Chemical Health Risks, Sciensano, Brussels, Belgium
| | - Serge Van Calenbergh
- Laboratory for Medicinal Chemistry, Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Eric Deconinck
- Laboratory for Medicines and Health Care Products, Scientific Direction of Physical and Chemical Health Risks, Sciensano, Brussels, Belgium
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14
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Abstract
More than 25 years have passed since the Dietary Supplement Health and Education Act of 1994 classified dietary supplements as a subcategory of food, thereby exempting manufacturers from providing premarket evidence of product safety and efficacy. In this commentary, I discuss problems in the supplement industry through an examination of cases introduced or decided in US federal courts between 2010 and 2019. More than half the cases located involved defendants charged with introducing misbranded food or drugs into interstate commerce. Contaminants included anabolic steroids, erectile dysfunction medications, weight-loss drugs, workout stimulants and mind-altering substances. As the article points out, raw powders obtained in bulk quantities facilitate the practice of 'home brewing' and the introduction of prescription drugs into dietary supplements.
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15
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Skrzelowski M, Brookhaus A, Shea LA, Berlau DJ. Melatonin Use in Pediatrics: Evaluating the Discrepancy in Evidence Based on Country and Regulations Regarding Production. J Pediatr Pharmacol Ther 2021; 26:4-20. [PMID: 33424495 DOI: 10.5863/1551-6776-26.1.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/10/2020] [Indexed: 11/11/2022]
Abstract
Melatonin manufacturers in the United States have begun producing melatonin products specifically targeted for use in the pediatric population. This paper aims to critically evaluate the evidence available regarding the use of melatonin in children based on where the clinical trials are performed and the regulations regarding the production of melatonin in that country. Melatonin is regulated differently around the world with the least amount of regulation placed on OTC supplements in the United States. The majority of studies evaluating melatonin use in the pediatric population are conducted with children who have comorbidities, such as autism spectrum disorder or attention-deficit/hyperactivity disorder. Evidence supporting the use of US formulations of melatonin in the otherwise healthy pediatric population is non-existent. Based on the lack of safety regulations in place in the United States and the lack of evidence regarding US melatonin products, they should be used sparingly in the otherwise healthy pediatric population, if they are used at all.
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Breindahl T, Hindersson P, Kimergård A. New psychoactive substances (NPS) escape routine drug testing: a case report of phenibut. TOXICOLOGY COMMUNICATIONS 2020. [DOI: 10.1080/24734306.2020.1796342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Torben Breindahl
- Department of Clinical Biochemistry, North Denmark Regional Hospital, Hjørring, Denmark
| | - Peter Hindersson
- Department of Clinical Biochemistry, North Denmark Regional Hospital, Hjørring, Denmark
| | - Andreas Kimergård
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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