Supplement quality, and how to read a label

How supplements are regulated in the UK

Food supplements are regulated as food, under general food law and the Food Supplements (England) Regulations 2003, with matching rules in Scotland, Wales and Northern Ireland [1]. They are meant to supplement the normal diet, and they are not intended to treat or prevent disease [1].

A product presented as treating or preventing a disease, or that acts on the body the way a drug does, is a medicine and needs a licence from the MHRA. The MHRA decides where that line falls by looking at what the product claims and contains, and at how it is presented, including online and on social media [2]. Products near the line are known as borderline products until their status is decided [2].

What a supplement label must show

A supplement sold in Great Britain must be labelled as a food supplement and carry a set of details that let you use it safely [1].

• The words food supplement on the pack
• A list of ingredients, with allergens emphasised
• The amount of each vitamin, mineral or other active substance
• The recommended daily dose, with a warning not to exceed it
• A statement that supplements are no substitute for a varied diet
• Advice to store it out of the reach of young children
• A best before or use by date, and the name and address of the business

Which health claims a label may make

A label may only make a health claim that appears on the Great Britain nutrition and health claims register, and only under the conditions set for it [3]. For example, a product may say that EPA and DHA contribute to the normal function of the heart only if it is a real source of them, with the benefit stated at a daily intake of 250 mg [3].

Medicinal claims are not allowed on food at all. Government guidance gives the example that a label may not say long chain omega-3 may prevent or improve symptoms of heart disease [4]. Even the word probiotic is treated as a health claim, which needs an authorised claim beside it [4].

A claim you cannot find on the register, or a promise to cure, cleanse or reverse a condition, is a reason to look elsewhere.

Herbal products and the THR mark

Many herbal products are medicines in law. A traditional herbal medicine licensed in the UK carries a Traditional Herbal Registration (THR) number and certification mark, or a product licence (PL) number, which shows it meets the required standards of quality and safety [5]. A THR is only granted for minor conditions that do not need a doctor’s supervision, such as a cold [6].

A herbal product without one of these numbers has not been through that assessment. Reports from the public to the MHRA have uncovered important safety issues with herbal products, including interactions between St John’s wort and hormonal contraceptives [5].

Signs of a well-made supplement

Quality is mostly invisible on a shelf, so look for signs that a maker takes it seriously. NICE advises that vitamin D supplements should undergo quality control checks to make sure they contain the correct dose, and the same standard is worth asking of any product [7].

• A clear amount of each ingredient per daily dose, in micrograms or milligrams, rather than a blend that hides the amounts
• A named form of the nutrient, such as cholecalciferol for vitamin D
• A business name and address you can contact
• Independent testing of each batch for content and contaminants, with results the maker will share
• Claims that match the register, with no promise to treat or cure
• A supplier you trust, since counterfeit products are a known risk online [1]

Products to treat with caution

Products sold for weight loss or sexual performance carry the highest risk of hidden drugs. A review of US regulator warnings from 2007 to 2016 found 776 adulterated supplements, and the most common hidden ingredients were sildenafil in sexual enhancement products and sibutramine in weight loss products [8]. Synthetic steroids or similar substances were found in 82 of the 92 adulterated muscle building products [8].

If you think a supplement or herbal product has caused a side effect, stop taking it and tell a doctor or pharmacist. You can also report it yourself through the MHRA’s Yellow Card scheme, with the product name, its ingredients, the maker and a photograph of the label [5].

How The Wellness can help

Bring what you take to a GP appointment, and a doctor will go through each label with you, check it against your medicines and tell you plainly what the evidence supports. Every doctor is GMC registered, and our clinics are on Baker Street in Marylebone and Eccleston Street in Belgravia.

When you know what you need, our shop is there when you want it.