Lead in pharmaceutical products and dietary supplements

Contamination of trace, non-essential/heavy metals in nutraceuticals/dietary supplements: A chemometric modelling approach and evaluation of human health risk upon dietary exposure

Across the world, nutraceuticals/dietary supplements are commonly consumed without medical supervision, and believing these products are harmless to health. However, these products may contain trace (TMs) and non-essential/heavy metals (nHMs) as contaminants at levels higher than the recommended daily allowance (RDA), which can be hazardous to human health. Consequently, it is crucial to assess the levels of these metals to ensure the safety of these products. This study aimed to analyze the concentration of TMs (Mn, Cu and Zn) and nHMs (Al, Cr, Ni, Cd and Pb) in nutraceuticals/dietary supplements. Metal analysis was conducted using inductively coupled plasma-optical emission spectrometry (ICP-OES). Multivariate and bivariate analysis including principle component analysis (PCA), hierarchical cluster analysis (HCA) and Pearson correlation coefficient (PCC) were applied to understand inter-metal association and sources of these metals. Concentration ranges for TMs were found as, Mn (0.2-4.3 mg/kg), Cu (0.11-2.54 mg/kg), and Zn (0.1-22.66 mg/kg) while the nHMs concentration ranges were: Al (0.046-3.336 mg/kg), Cr (0.11-1.63 mg/kg), Ni (0.18-0.72 mg/kg), Cd (0.04-0.92 mg/kg), and Pb (0.18-1.08 mg/kg). The levels of tolerable dietary intake (TDI) for Cr and Ni, and the provisional tolerable monthly intake (PTMI) limit for Cd, exceeded the values set by the World Health Organization (WHO) and the European Food Safety Authority (EFSA). The estimation of the target hazard quotient (THQ <1), hazard index (HI < 1) and cumulative cancer risk (CCR <1 ✕ 10-3) indicated no significant non-carcinogenic and carcinogenic health risks associated with consuming these products. Therefore, the primary recommendation from this study is to use the nutraceuticals/dietary supplements should be under the supervision of dietitian.

Application of Liquid Chromatography Coupled to Mass Spectrometry in Quality Assessment of Dietary Supplements-A Case Study of Tryptophan Supplements: Release Assay, Targeted and Untargeted Studies

Dietary supplements are widely consumed in the EU and the USA. Based on their similarity to pharmaceuticals, consumers mistakenly believe that dietary supplements have also been approved for safety and efficacy. However, in the absence of mandatory testing, data on supplement quality is scarce. Thus, we applied liquid chromatography coupled with tandem mass spectrometry to analyse the quality of dietary supplements containing tryptophan (Trp). We examined 22 supplements in tablets or capsules, produced in the USA, Great Britain, Germany, France, Czech Republic, and Poland. Trp release, crucial for bioavailability and efficiency, was assessed. Additionally, we performed a qualitative analysis of the main ingredient and screened for contaminants. Among the contaminants, we detected Trp's metabolites, condensation products of Trp and carbonyl compounds, Trp degradation products, degradation products of kynurenine, and other contaminants such as glucosamine and melatonin. The main ingredient content was in the range of 55-100% in capsules and 69-87% in tablets. Surprisingly, almost no Trp release was noted from some supplements. Our study confirms the need to advance research on supplements. We believe that the high-quality analysis of supplements based on reliable analytical techniques will be an important contribution to the discussion on the regulatory framework of these products.

Heavy Metal contamination of Dietary Supplements products available in the UAE markets and the associated risk

A specific safety concern is the possibility that a dietary supplement could be contaminated with heavy metals. This research was undertaken to investigate the daily exposure levels of heavy metals in dietary supplements available in the UAE and to explore the factors associated with the contamination of dietary supplements with heavy metals. A total of 277 dietary supplement samples were collected from the UAE market and prepared for the analysis of selected heavy metal contamination. Inductively coupled plasma mass spectrometry (ICP-MS) was used to determine the presence of heavy metals. The average daily intake of cadmium was 0.73 μg [95% CI 0.61-0.85], compared to the acceptable daily intake (ADI) of 6 μg; the daily intake of lead was 0.85 μg [95% CI 0.62-1.07], compared to the acceptable daily intake (ADI) of 20 μg; and the daily intake of arsenic was 0.67 μg [95% CI 0.57-0.78], compared to the acceptable daily intake of 10 μg. Although the dietary supplements available in the UAE have low levels of heavy metal contamination, numerous individuals are consuming a number of different dietary supplements every day and thereby may experience a cumulative level of toxic exposure. Dietary supplements formulations (Categories), dosage forms and country of origin are strong determents of heavy metal contamination in dietary supplements products.

Food Supplements for Weight Loss: Risk Assessment of Selected Impurities

Nowadays, food supplements are widely consumed, often without any medical supervision. In this study, 25 food supplements for weight loss, randomly purchased from five different suppliers in the European Union, were analysed by Wavelength Dispersive X ray Fluorescence spectrometry (WDXRF). The aim of this study was the risk assessment of trace elements and the mixture of elements present in food supplements for weight loss. The obtained Hazard Index (0.11) showed no potential risk of non-carcinogenic effects to human health. However, since humans are frequently exposed by different routes and/or sources to toxic metals, the additional consumption of these products may cause potential toxicological risks that cannot be ignored. In one analysed food supplement (FS), the simultaneous presence of Pb and Mn in high concentrations was detected. In two, FS chromium concentrations were above the reference daily dose. Unconformities were detected between the labelled and the detected values, which emphasises the misinformation of labels. This highlights the need for a deeper surveillance of food supplements.

Contaminants: a dark side of food supplements?

Food supplements (FS) are often consumed as one of the strategies to fight ageing-associated pathologies, especially in the case of oxidative stress-related diseases. Despite the popularity of FS, some concerns about their quality and safety have been raised, especially regarding the presence of contaminants. This paper reviews and discusses the occurrence of contaminants in marketed samples of FS in the last two decades, considering both scientific literature and notifications registered on RASFF portal. The most relevant classes of contaminants were included namely metals, toxins, pesticides, dioxins and PCBs, as well as pharmacologically active ingredients. Variable amounts of contaminants were reported in a significant number of commercially available FS. Although the presence of contaminants does not necessarily mean that their levels exceed the regulatory limits or that the FS intake constitutes a risk to human health, it alerts for the need to further monitor FS safety. The evaluation of the risk associated to the consumption of FS, especially in the elderly population, is particularly challenging due to the frequent exposure to multiple toxicants and to different exposure sources, as well as due to possible pre-existing diseases and respective therapeutics. Therefore, improved quality control procedures and monitoring programs should be pursued in order to avoid undesirable products and assure the safety of FS.

Determination of Nickel and Manganese Contaminants in Pharmaceutical Iron Supplements Using Energy Dispersive X-ray Fluorescence

In this study, we investigate the capability of energy dispersive X-ray fluorescence (EDXF) spectrometry in a triaxial geometry apparatus as a fast and nondestructive determination method of both dominant and contaminant elements in pharmaceutical iron supplements. The following iron supplements brands with their respective active ingredients were analyzed: Neutrofer fólico (iron gylcinate), Anemifer (iron(II) sulfate monohydrate), Noripurum (iron(III)-hydroxide polymaltose complex), Sulferbel (iron(II) sulfate monohydrate), and Combiron Fólico (carbonyl iron). Although we observe a good agreement between the iron content obtained by the present method and that indicated in the supplement's prescribed dose, we observe contamination by manganese and nickel of up to 180 μg and 36 μg, respectively. These contents correspond to 7.2% and 14.4% of the permitted daily exposure of manganese and nickel, respectively, for an average adult individual as determined by the European Medicine Agency (EMEA). The method was successfully validated against the concentrations of several certified reference materials of biological light matrices with similar concentrations of contaminants. Moreover, we also validated our method by comparing the concentrations with those obtained with the inductively coupled plasma-atomic emission technique.

Determination of heavy metals in the common smokeless tobacco afzal in oman

OBJECTIVES

Afzal is an illegally sold smokeless tobacco product (STP) commonly used by youths and teenagers in Oman. The aim of this study was to analyse the composition of Afzal, also commonly known as sweekah, as it is believed to contain many carcinogens and toxic components. In particular, Afzal's heavy metal content includes cadmium (Cd), chromium (Cr), lead (Pb) and nickel (Ni).

METHODS

This study was conducted between March and June 2013. Three samples of Afzal were first dried and then ground to form a homogenous powder. The powder was digested prior to the heavy metal analysis by inductively coupled plasma-mass spectrometry (ICP-MS).

RESULTS

Afzal was shown to have high levels of all heavy metals except for Ni and Pb, which were detected in quantities below acceptable international limits. The concentrations of the tested metals were 15.75 μg/g, 1.85 μg/g, 1.62 μg/g and 1.57 μg/g for Cr, Cd, Pb and Ni, respectively. The estimated daily intake of heavy metals from Afzal was below the maximum permissible limit accepted by the Food and Agriculture Organization and World Health Organization, except for Cr and Ni which were found to be dangerously elevated when compared with international standards.

CONCLUSION

The results of this study showed that Afzal contains a number of heavy metals that may cause health problems. Therefore, urgent regulation of the illegal sale of Afzal is needed at the national level in Oman along with a campaign to address public health education and awareness of Afzal and its health risks.

Evaluation of heavy metals content in dietary supplements in Lebanon

BACKGROUND

The consumption of dietary supplements is widely spread and on the rise. These dietary supplements are generally used without prescriptions, proper counseling or any awareness of their health risk. The current study aimed at analyzing the metals in 33 samples of imported dietary supplements highly consumed by the Lebanese population, using 3 different techniques, to ensure the safety and increase the awareness of the citizen to benefit from these dietary supplements.

RESULTS

Some samples had levels of metals above their maximum allowable levels (Fe: 24%, Zn: 33%, Mn: 27%, Se: 15%, Mo: 12% of samples), but did not pose any health risk because they were below permitted daily exposure limit and recommended daily allowance except for Fe in 6% of the samples. On the other hand, 34% of the samples had Cu levels above allowable limit where 18% of them were above their permitted daily exposure and recommended daily allowance. In contrast, all samples had concentration of Cr, Hg, and Pb below allowable limits and daily exposure. Whereas, 30% of analyzed samples had levels of Cd above allowable levels, and were statistically correlated with Ca, and Zn essential minerals. Similarly 62% of the samples had levels of As above allowable limits and As levels were associated with Fe and Mn essential minerals.

CONCLUSION

Dietary supplements consumed as essential nutrients for their Ca, Zn, Fe and Mn content should be monitored for toxic metal levels due to their natural geochemical association with these essential metals to provide citizens the safe allowable amounts.

Toxic element contamination of natural health products and pharmaceutical preparations

BACKGROUND

Concern has recently emerged regarding the safety of natural health products (NHPs)-therapies that are increasingly recommended by various health providers, including conventional physicians. Recognizing that most individuals in the Western world now consume vitamins and many take herbal agents, this study endeavored to determine levels of toxic element contamination within a range of NHPs.

METHODS

Toxic element testing was performed on 121 NHPs (including Ayurvedic, traditional Chinese, and various marine-source products) as well as 49 routinely prescribed pharmaceutical preparations. Testing was also performed on several batches of one prenatal supplement, with multiple samples tested within each batch. Results were compared to existing toxicant regulatory limits.

RESULTS

Toxic element contamination was found in many supplements and pharmaceuticals; levels exceeding established limits were only found in a small percentage of the NHPs tested and none of the drugs tested. Some NHPs demonstrated contamination levels above preferred daily endpoints for mercury, cadmium, lead, arsenic or aluminum. NHPs manufactured in China generally had higher levels of mercury and aluminum.

CONCLUSIONS

Exposure to toxic elements is occurring regularly as a result of some contaminated NHPs. Best practices for quality control-developed and implemented by the NHP industry with government oversight-is recommended to guard the safety of unsuspecting consumers.

Association between blood lead levels and environmental exposure among Saudi schoolchildren in certain districts of Al-Madinah

Introduction

Both occupational and environmental exposures to lead remain a serious problem in many developing and industrializing countries. When humans are exposed to high levels of lead, there is damage to almost all organs and organ systems (most importantly, the central nervous system, kidneys, and blood), which often culminates in death.

Objective

To estimate the prevalence of blood lead levels (BLLs) and to identify the sources of environmental exposure and potential risk factors for elevated BLLs among Saudi schoolchildren.

Methods

A cross-sectional survey was conducted from March to May 2010. The study population included 557 Saudi school students of both sexes. A multistage random sampling technique was used. Information about socioeconomic status, house and school construction, and parents’ education and employment was collected using questionnaires. Lead was analyzed in a blood sample using an atomic absorption technique and hemoglobin was measured using a Sysmex hematological analyzer.

Results

The mean BLL was 4.94 ± 3.38 μg/dL (range 0.45–26.3 μg/dL). A total of 19% had BLLs <1.0 μg/dL, 16% had BLLs <2.5 μg/dL, 15% had BLLs <5.0 μg/dL, 20% had BLLs <7.5 μg/dL, 25% had BLLs <10.0 μg/dL, and about 6% had BLLs >10.0 μg/dL. Analysis of odds by controlling all risk factors (adjusted odds ratio [OR]) that affect BLLs (≥10 μg/dL) indicated that using cosmetics (OR = 18.5, confidence interval [CI] = 14.4–19.8), putting colored toys in mouth (OR = 15.7, CI = 3.6–16.2), eating canned food (OR = 9.8, CI = 7.0–10.1), and using newspaper during food preparation (OR = 7.6, CI = 6.3–8.2) are risk factors. There were significant correlations between BLLs and family habits (r = 0.225, P = 0.000), personal habits (r = 0.321, P = 0.000), eating habits (r = 0.128, P = 0.002) and school building characteristics (r = 0.469, P = 0.000). There was a significant correlation between BLLs and anemia in age group 6 < 12 years (P = 0.000) and age group 12 to less than 18 years, among males (P = 0.000) and females (P = 0.041).

Conclusion

The BLLs of children are affected by multiple factors. Female students have higher BLLs and lower hemoglobin concentration than males. The possible sources of lead exposure were use of toothpaste, use of kohl, putting colored toys in the mouth, use of both canned food and canned juice, use of lip gloss in females, and different methods of handling newspaper while preparing food.

Calcium supplements: an additional source of lead contamination

The risk posed by the quantity of heavy metal lead present in Ca supplements is of grave concern. Some lead levels have been measured up to the extent of regulatory limit set by the United States. Calcium supplements inevitably get contaminated with lead as both are naturally occurring elements having the same charge density. Therefore, it is imperative to indicate the level of this toxic metal in these supplements in order to create awareness among consumers. The calcium in the supplements is derived from natural as well as synthetic/refined sources (chelated or non-chelated). In this study, a sophisticated analytical technique, atomic absorption spectrometer (both with FAAS and GFAAS modes of atomization), was used for the purpose of analyzing Pb contents in 27 commonly used Ca supplements manufactured by different national and multinational companies. The daily intake of lead through these supplements was calculated. Only 10% of the calcium supplements analyzed met the criteria of acceptable Pb levels (1.5 μg/daily dose) in supplements/consumer products set by the United States. It was also found that Pb intake was highest in chelated calcium supplements whereas lowest through calcium supplements with vitamin D formulation. The Pb concentration in calcium supplements was significantly increased (p < 0.001) according to their composition. In order to validate our results from the study conducted, IAEA-certified reference material (animal bone, H-5) was analyzed for Pb levels. The limit of detection of the method used was 0.05 μg/g and a 95% lead recovery of IAEA-certified reference material (animal bone, H-5).

Exposure to multiple metals from groundwater-a global crisis: geology, climate change, health effects, testing, and mitigation

This paper presents an overview of the global extent of naturally occurring toxic metals in groundwater. Adverse health effects attributed to the toxic metals most commonly found in groundwater are reviewed, as well as chemical, biochemical, and physiological interactions between these metals. Synergistic and antagonistic effects that have been reported between the toxic metals found in groundwater and the dietary trace elements are highlighted, and common behavioural, cultural, and dietary practices that are likely to significantly modify health risks due to use of metal-contaminated groundwater are reviewed. Methods for analytical testing of samples containing multiple metals are discussed, with special attention to analytical interferences between metals and reagents. An overview is presented of approaches to providing safe water when groundwater contains multiple metallic toxins.

Analytical performance of a fast multi-element method for titanium and trace elements determination in cosmetics and pharmaceuticals by ICP-AES

A multi-element analytical method based on inductively coupled plasma atomic emission spectrometry (ICP-AES) was developed for trace elements in pharmaceutical tablets and cosmetics. Titanium was also included in the analytes since it is widely used in pharmaceuticals. Critical ICP conditions, like RF incident power, argon gas flow rate and nebulizer sample uptake flow rate were optimized. The most sensitive spectral line of each analyte was selected as optimum for further study. Detection limits in the low µg g−1 range were obtained. Prior to chemical analysis, the samples were decomposed by acid digestion, using various mixtures of HCl, HNO3 and HF. Yttrium was used as a suitable internal standard in order to correct for possible matrix effects. The method was applied to the analysis of six different pharmaceutical products (anti-biotic, anti-inflammatory, anti-hypertensive) in the form of tablets with film coating and also three cosmetic products like hair and face masks.

Lead in women's and children's vitamins

A survey was conducted to determine the extent of lead (Pb) contamination in vitamins labeled for use by women and children. The Pb content of 324 multivitamin-mineral products was determined using microwave assisted nitric acid digestion and inductively coupled plasma mass spectrometry. Cryogenic grinding was used to composite soft samples such as oil filled capsules and candy-like products such as gummies and jelly beans. Estimates of Pb exposures from consumption of these products were derived for four population groups: young children (0-6 yrs), older children (7+ yrs), pregnant or lactating women, and adult women. The estimated median and maximum Pb exposures were 0.123 and 2.88 microg/day for young children, 0.356 and 1.78 microg/day for older children, 0.845 and 8.97 microg/day for pregnant and lactating women, and 0.842 and 4.92 microg/day for adult women. The overall median value for Pb exposure was 0.576 microg/day. Five samples would have provided exposures that exceeded 4 microg/day. Estimates of exposures were assessed with respect to safe/tolerable exposure levels that have been developed for the specific age and sex groups. These safe/tolerable levels are referred to as the provisional total tolerable intake levels (PTTI) and are 6, 15, 25, and 75 microg Pb/day for young children, older children, pregnant or lactating women, and adult women, respectively. Estimates of Pb exposures were below the PTTI levels for the four population groups. Median and maximum values were used instead of the mean and standard deviation because of the skewed distribution of results toward lower mass fraction and exposure.