What Are Health Supplements?
Health or dietary supplements refer to a diverse group of products commonly consumed for the purpose of supplementing the diet and enhancing health.
These products typically contain ingredients from natural sources and are not meant to prevent, treat, cure or alleviate the symptoms of medical diseases or conditions.
They usually come in dosage forms such as capsules, soft gels and tablets. Some examples of health supplements include vitamins, minerals (e.g. calcium, iron, magnesium) and herbal supplements (e.g. Echinacea, Guarana).
How Are Health Supplements Regulated in Singapore?
Unlike medicines, health supplements are currently not subject to approvals, licensing or registration before they can be sold locally. They are also not assessed for their effectiveness by the Health Sciences Authority (HSA), unlike medicines which are studied for their efficacy based on data from stringent clinical trials before they are granted approval to be administered to patients. This practice is similar to that found in regulatory systems of developed countries such as USA.
Dealers (which include manufacturers, importers, wholesalers/distributors, re-packers and retailers) are responsible for the safety and quality of their health supplements. They generally do not need to apply for a permit from HSA before they advertise their products. However, they must ensure that:
- Products do not contain prohibited ingredients
- Products do not make claims to treat illnesses or diseases
- Product claims are accurate and truthful
- Product labels and packaging contain sufficient information for consumers to review when purchasing and consuming the products
- Information is printed in a clear and legible manner
In line with the approach adopted in the regulatory systems of developed countries, there is a post-market surveillance programme in place to monitor the safety of health supplements and to initiate timely product recalls when necessary. The programme includes risk-based surveillance to sample products in the market, and adverse reaction monitoring, which draws on HSA’s network of healthcare professionals and international regulatory partners to pick up signals of adverse reactions to products.
Notwithstanding these safeguards, you should also practise personal caution. Here's why:
- Health supplements are not subject to approvals, licensing, and evaluation for effectiveness of the products. The onus is on dealers to be ethical, accurate and honest in claims.
- Advertisements of health or dietary supplements do not need to be screened by the HSA before publication. Dealers and advertisers are responsible for ensuring that the information provided for the advertisement and promotional material is clear, accurate and truthful.
- Despite some claims, results from health or dietary supplements are slow and usually not obvious.
- Natural ingredients do not mean no-risk. Overdosing, combining supplements or taking them with some medicines may cause harm. In general, patients scheduled for surgery should inform their doctor about any supplements they are taking. They may be required to stop taking them before the operation.
What Can Go Wrong?
Case Study 1: Slimming Product Leads to Hallucinations
In December 2014, a teenager was hospitalised when she suffered hallucinations after consuming ‘Nutri Drops Grapefruit Diet’ for more than a month to lose weight. She had purchased the product over the internet, which was labelled to contain all natural ingredients but was tested by HSA to contain a banned ingredient, sibutramine. Sibutramine was a prescription medicine which has been banned for sale in Singapore since October 2010 due to increased cardiovascular risks.
Case Study 2: Five Undeclared Potent Ingredients Found in Health Supplement Sold Locally
In April 2014, HSA detected five potent western medicinal ingredients, including a steroid, in “Herbal Health Jointcare” sold locally. Several consumers had experienced rapid pain relief after consuming the product. This effect could be due to the presence of the steroid, which is usually prescribed for inflammatory conditions and should only be used under strict medical supervision. Long term unsupervised use of oral steroids can cause increased blood glucose levels leading to diabetes, high blood pressure, cataracts, muscular and bone disorders, increased risk of infections and Cushing's syndrome, which is characterised by a round face or ‘moon face', and upper body obesity with thin limbs.
How to be a Smart Consumer
Here are some tips to help you when purchasing health supplements:
- Be cautious of exaggerated claims and over-promises
Products that promise “quick cures” and “easy solutions” to problems are often not backed by scientific evidence. For instance, there is no scientific evidence to prove that stem cell oral therapy can prevent or treat diseases and conditions, despite some claims. Unscrupulous health supplement dealers may produce and sell health supplements with undeclared potent medicinal ingredients to achieve a “quick cure” effect. Taking such products can be extremely harmful to your health.
- Recognise dubious marketing strategies
Some information and phrases are not easily verifiable, such as:
- Case clinical histories
- Complex data/statistics
- Personal testimonies
- Statements that claim the product is endorsed by the government, the medical profession or research scientists
- Impressive-sounding scientific terminology such as stem cell therapy
- Statements such as:
- “Used safely by millions”
- “Proven effective by thousands"
- “Proven traditional remedies”
- “New secret” formulations
- “No-risk, 100% safe, money back guaranteed”
- “Recommended by doctors/pharmacists/scientists”
- Buy from reputable sources
Get your health supplements from reputable sources such as a pharmacy or established retail store.
As a general rule, be cautious when purchasing health products online or from unfamiliar sources, even if they are recommended by well-meaning friends or relatives. You cannot be certain what these products contain, and where and how they were made. They could contain potent ingredients, or could be counterfeit or substandard.
- When in doubt, walk away
Make informed choices about the supplements you will be consuming. Get advice from your doctor or pharmacist if you are unsure which product suits you.
Always remember - health supplements should not replace prescribed treatment or medication from your doctor, nor can they treat or manage a medical condition.
Examples of Exaggerated or Misleading Claims
Statements like the following are misleading and should be viewed with caution:
- “…strengthens your immune system against recurring infections and diseases”
This is misleading as health supplements support or maintain the healthy functions of the human body and do not protect against recurring infections and diseases.
- “…burns fat fast, reduces cellulite and helps you to slim quickly”
This is usually an exaggeration. If it isn’t, the product may contain prohibited potent ingredients that can cause dangerous side effects.
- “…reduces cholesterol effectively and prevents heart diseases”
There is usually no scientific evidence behind such a claim in health supplements.
- “Efficacy or effectiveness guaranteed or clinically proven”
Efficacy of the product cannot be guaranteed without stringent clinical studies. Be mindful that health supplements, including their clinical trials, are not evaluated by HSA.
- “100% safe” or “no side effects”
No product can offer such a guarantee, including supplements made with all natural ingredients.
- “For the first few days, you will feel some side effects such as sweating, diarrhoea, rashes, etc. Thereafter, the symptoms will subside as your body becomes adjusted to the product. ”
Health supplements should not cause such side effects.
- “Detoxify your body”
There is no scientific evidence behind this. Such products work by promoting water loss or stimulating bowel movements and may not be safe or suitable for everyone. They can cause adverse effects such as headaches, fatigue, dehydration, gastro-intestinal cramps and even decreased bowel function and dependency in the long run
- “Anti-stress” or “reduce stress”
This is false and misleading as stress results from demanding circumstances.
- “HSA approved”
HSA does not provide assessment or approval for health supplements. Dealers are responsible for the safety and quality of the products.
Some local companies may use the Lion Head symbol on their products to identify themselves with Singapore. It should not be regarded as an official endorsement by HSA and/or the Government of the companies and/or their products.
What Should I Do When Problems Arise?
If you suspect that the health supplement you are taking makes you unwell, see your doctor or pharmacist immediately.
You can also get in touch with HSA at Tel: 1800 2130 800 or Email: email@example.com.