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Guide · pillar· Supplements

Third-party tested supplements, and the four things sold under one phrase

Third-party tested supplements, and the four things sold under one phrase
Evidence reviewed·08 sources cited·Dr. Soraya Khan, RDN
Educational use only. Larderlab content is educational. Pantry, macro, and supplement guidance is not a substitute for medical advice. Consult a registered dietitian or your physician before making material changes to your diet or supplementation.

Supplements are not FDA-approved for safety and effectiveness before sale. Of 57 botanical sports products analysed, 40 percent held no detectable amount of the labeled ingredient and 12 percent a prohibited compound.

Editor's pick · Evidence-led bottom line

Third party tested is not a regulated phrase, and at least four different things are sold under it. The regulatory baseline explains why the phrase exists at all: FDA does not approve dietary supplements for safety and effectiveness before they are marketed, manufacturers and distributors are responsible for making sure their products are safe before they go to market and that label claims are truthful and not misleading, and the agency acts against an adulterated or misbranded product only after it has reached the market (FDA). That framework has been in place since the Dietary Supplement Health and Education Act of 1994. What the regulations require is process rather than proof of any individual bottle: 21 CFR Part 111 obliges a manufacturer to establish specifications for identity, purity, strength and composition and for limits on contamination, to conduct at least one appropriate test or examination to verify the identity of each incoming lot of a dietary ingredient, to qualify its suppliers, to keep batch production records and to investigate complaints (eCFR 21 CFR Part 111). When independent laboratories measure what is actually inside the container, the gap between the rule and the result is wide. Of 63 sports supplements purchased and 57 analysed for five botanical ingredients, 23 products, or 40 percent, contained no detectable amount of the labeled ingredient; where the ingredient was present at all the measured quantity ranged from 0.02 percent to 334 percent of the labeled amount; only 6 of 57, or 11 percent, fell within 10 percent of the label; and 7 of 57, or 12 percent, contained at least one FDA-prohibited ingredient, with five different prohibited compounds detected, so that 89 percent of labels did not accurately declare the ingredients found (Cohen et al. 2023). The downstream cost is also quantified. Surveillance across 63 emergency departments from 2004 to 2013, based on 3,667 cases, produced an estimate of 23,005 emergency department visits per year in the United States attributed to adverse events involving dietary supplements, and an estimated 2,154 hospitalizations annually; after excluding unsupervised ingestion by children, 65.9 percent of single-supplement visits involved herbal or complementary nutritional products and 31.8 percent involved micronutrients, with weight-loss products accounting for 25.5 percent and energy products 10.0 percent (Geller et al. 2015). Against that background the useful distinction is between a certification program that audits the manufacturing facility and verifies batches on a continuing schedule, a one-off retail test report, a manufacturer's own certificate of analysis, and a review site that buys products and tests them but certifies nothing. Only the first carries forward to the bottle bought next month. And all four verify identity, potency, purity and contaminant limits while none of them verifies that the ingredient does anything, which is why a certification mark is a floor on quality rather than a reason to buy.

The certification question is usually framed as a shopping question, and it is not. It is a filter that should run before any product comparison, because the categories where certification matters most are exactly the categories where the underlying evidence for the ingredient is weakest, and knowing that reorders the whole decision. Start with the legal architecture, because everything else follows from it. Under the Dietary Supplement Health and Education Act of 1994, supplements occupy a category that is neither food nor drug in the ordinary sense. FDA does not approve dietary supplements for safety and effectiveness before they are marketed; manufacturers and distributors are responsible for making sure their products are safe and that claims are truthful and not misleading; and FDA acts against adulterated or misbranded products after they reach the market (FDA). There is no application file, no approval number and no pre-market efficacy review, so the obligation to check has moved from a regulator acting before sale to a buyer acting at the shelf. The manufacturing rule fills part of the space. 21 CFR Part 111 requires each manufacturer to set specifications for identity, purity, strength and composition and for contamination limits, to verify them, to test the identity of each incoming lot of a dietary ingredient, to qualify suppliers, to keep batch records and to investigate complaints (eCFR 21 CFR Part 111). Part 111 is enforceable and useful. What it is not is a guarantee that the container in your hand was measured against a specification by anyone outside the company selling it. Certification exists to close that last gap, and the reason it exists is that the gap is measurable. In the most rigorous recent survey of the sports category, 63 products marketed as containing one of five botanical ingredients (Rauwolfia vomitoria, methylliberine, turkesterone, halostachine and octopamine) were purchased and 57 were analysed. Twenty-three of the 57, or 40 percent, contained no detectable amount of the labeled botanical. Among the products where it was detectable, the measured quantity ranged from 0.02 percent to 334 percent of the quantity on the label. Only 6 of 57, or 11 percent, were within 10 percent of the labeled amount. And 7 of 57, or 12 percent, contained at least one ingredient prohibited by FDA, with five different prohibited compounds detected across the sample: 1,4-dimethylamylamine, deterenol, octodrine, oxilofrine and omberacetam. Taken together, 89 percent of labels did not accurately declare the ingredients found (Cohen et al. 2023). A companion investigation gives the adulteration side its own numbers. Seventeen brands labeled as containing deterenol were analysed by two independent laboratories, with a third resolving disagreements. Nine prohibited stimulants were found, and many brands carried more than one: 4 brands (24 percent) contained 2, and two brands each combined 3 or 4, at 2.7 to 17 mg of deterenol and up to 92 mg of beta-methylphenylethylamine per serving. These cocktails have never been tested in humans (Cohen et al. 2021). That is the case for certification stated as plainly as the data allows. The case must be kept in proportion, and the emergency-department data is where the proportion lives. Surveillance from 63 emergency departments between 2004 and 2013, with 3,667 recorded cases, produced an estimate of 23,005 visits and 2,154 hospitalizations per year from dietary supplements; excluding unsupervised ingestion by children, 65.9 percent of single-supplement visits involved herbal or complementary products against 31.8 percent for micronutrients, with weight-loss at 25.5 percent and energy products at 10.0 percent (Geller et al. 2015). The category concentration is the finding to act on. The harm is not spread evenly across the supplement aisle; it clusters in stimulant-adjacent products sold on a physique or performance promise. A single-ingredient mineral is not the same risk object as a proprietary blend for fat loss, and treating them identically wastes money at one end and underprotects at the other. With that established, the taxonomy. Four distinct things circulate under the phrase third party tested. A certification program audits the facility against a standard, reviews the label claim, tests product against a specification and repeats that on a schedule with unannounced audits; USP Verified, NSF certification under NSF/ANSI 173, NSF Certified for Sport, Informed Sport and Informed Choice all work this way, and each publishes a searchable list of what it currently certifies (NSF). A one-off retail test report is a snapshot of one lot bought on one date. A certificate of analysis is a document produced by or for the seller, and its value depends entirely on what is written on it. A review site that buys and tests products is doing journalism; it has no mechanism to make the next batch conform. The distinction that matters commercially is continuity. Now the limitation that almost every article on this subject omits. Every one of these programs verifies identity, potency, purity and contaminant limits. Not one of them verifies that the ingredient works. A product can be certified to contain exactly the labeled 500 mg of a botanical that has never been shown to do anything in a controlled trial, and the certification is entirely honest about that, because efficacy is not what it measures. Certification is therefore a floor on quality and a null signal on benefit. The correct sequence is to decide whether the ingredient is worth taking on the evidence, and only then to decide who should be trusted to put it in a capsule. Reversing the order is how people end up with a beautifully certified bottle of something inert. The banned-substance layer is narrower still and applies to one population. Certified for Sport and Informed Sport exist because a drug-tested athlete carries strict liability for whatever is in their sample, and the ordinary certification tiers do not screen for the full prohibited list. These programs test lot by lot against a banned-substance panel and publish the certified lots, which is why they cost more and why they are pointless for anyone who is not subject to testing. Worth noting that the laboratory work in the deterenol investigation above was carried out in part by NSF International, which is the same organisation that runs the sport certification program (Cohen et al. 2021). The decision matrix follows from the category data. Spend on certification where adulteration risk is highest: sports and pre-workout products, weight-loss products and sexual-enhancement botanicals, the three categories where undeclared pharmaceuticals and experimental stimulants have repeatedly been found (Cohen et al. 2023; Cohen et al. 2021). Spend less at the other end, on single-ingredient commodity products with a pharmacopeial specification, where the ingredient is cheap enough that substitution has little economic motive. Verification itself is a two-minute task and almost nobody does it. A mark printed on a label is a graphic; the certification is a database entry. NSF publishes a searchable listing of certified products and systems, and the sport programs publish their certified batches (NSF; Informed Sport). If the product is not in the listing, the mark is decoration. Finally, the paperwork. A certificate of analysis is worth reading when it names the lot, the manufacture and analysis dates, the method used for each assay, the specification and the measured result as numbers rather than as a pass, the contaminant panel including heavy metals and microbiology, and the laboratory and its accreditation. It is worthless when it says conforms with no figure, carries no lot number, is undated, or is a generic file reused for every batch. Heavy metals sit in the same blind spot: programs set contaminant limits and test against them, and no label discloses a figure. The scale should be stated carefully. A risk assessment of reported concentrations in protein powder products, prompted by a Consumer Reports analysis of 15 products and a later report of elevated levels in 40 percent of 133 products, modelled arsenic, cadmium, mercury and lead against EPA reference doses and found hazard indices below 1 at one and three servings per day, highest in mass-gain formulations and lowest in whey, with all modelled adult blood lead levels below the CDC guidance value of 5 micrograms per deciliter (Bandara et al. 2020). Present, measurable, worth limiting, not an emergency. The system is short. Decide the ingredient first and the brand second. Buy certification in the three high-adulteration categories and skip the premium on commodity single-ingredient products. Check the certifier's database, not the carton. Read a certificate of analysis for lot number, method and numbers, and treat conforms as a non-answer. And remember what the mark cannot say: it describes what is in the capsule, never what the capsule will do.

§ 2 · The guide

What matters, in order.

  1. 01

    The FDA does not approve supplements before they reach the shelf

    FDA does not approve dietary supplements for safety and effectiveness before they are marketed. Manufacturers and distributors are responsible for making sure their products are safe before going to market and that label claims are truthful and not misleading, and the agency takes action against adulterated or misbranded products after they reach the market (FDA). The framework dates to the Dietary Supplement Health and Education Act of 1994. There is no application file, no approval number and no pre-market efficacy review, which is why a voluntary certification market exists at all.

  2. 02

    cGMP is a rule about the factory, not a test of your bottle

    21 CFR Part 111 requires a manufacturer to establish specifications for the identity, purity, strength and composition of each finished batch and for limits on contamination, to verify them, to conduct at least one appropriate test or examination to verify the identity of every incoming lot of a dietary ingredient, to qualify suppliers of other components, to keep batch production records and to investigate complaints (eCFR 21 CFR Part 111). It is enforceable and it is genuinely useful. It is not a guarantee that any individual container was measured by anyone outside the selling company.

  3. 03

    Forty percent of a 57-product sample contained none of the labeled botanical

    Sixty-three sports supplements labeled as containing one of five botanical ingredients were purchased and 57 were analysed. Twenty-three, or 40 percent, contained no detectable amount of the labeled ingredient. Where it was detectable the measured quantity ranged from 0.02 percent to 334 percent of the labeled amount, and only 6 of 57, or 11 percent, were within 10 percent of label. In total 89 percent of labels did not accurately declare the ingredients found (Cohen et al. 2023). That single dataset is the strongest argument for a verification step.

  4. 04

    Seven of 57 products carried an FDA-prohibited ingredient

    In the same analysis, 7 of 57 products, or 12 percent, contained at least one ingredient prohibited by FDA, and five different prohibited compounds were detected across the sample: 1,4-dimethylamylamine, deterenol, octodrine, oxilofrine and omberacetam (Cohen et al. 2023). Prohibited does not mean unfashionable; it means the agency has determined the compound may not lawfully be sold in a dietary supplement. A label that omits an active stimulant removes the only information a buyer could use to avoid it.

  5. 05

    Nine prohibited stimulants turned up across 17 brands

    Seventeen brands sold in the United States and labeled as containing deterenol were analysed by two independent laboratories with a third resolving disagreements. Nine prohibited stimulants were found and many brands combined several: 4 brands (24 percent) contained 2, two brands (12 percent) contained 3, and two brands (12 percent) contained 4. Serving quantities ran from 2.7 to 17 mg of deterenol, 5.7 to 92 mg of beta-methylphenylethylamine and 18 to 73 mg of octodrine. These mixtures have never been tested in humans (Cohen et al. 2021).

  6. 06

    23,005 emergency visits a year, concentrated in two product categories

    Surveillance from 63 emergency departments between 2004 and 2013, based on 3,667 cases, produced an estimate of 23,005 emergency department visits per year attributed to adverse events involving dietary supplements and 2,154 hospitalizations annually. After excluding unsupervised ingestion by children, 65.9 percent of single-supplement visits involved herbal or complementary nutritional products and 31.8 percent micronutrients, with weight-loss products at 25.5 percent and energy products at 10.0 percent (Geller et al. 2015). The harm is not spread evenly across the aisle.

  7. 07

    Four different things are being sold as third party tested

    A certification program audits a facility, reviews the label claim, tests to a specification and repeats on a schedule. A one-off retail test report describes one lot bought on one date. A certificate of analysis is a document produced by or for the seller. A review site that buys and tests products is doing journalism and certifies nothing. Only the first creates an obligation that persists into next month's batch, which is the entire commercial difference. Roughly 40 percent of a botanical sample failing a label check is a batch-level problem, not a one-sample problem (Cohen et al. 2023).

  8. 08

    What a certification program actually audits

    USP Verified, NSF certification under NSF/ANSI 173, NSF Certified for Sport, Informed Sport and Informed Choice all combine a facility audit against a written standard with product testing against a specification for identity, potency, purity and contaminant limits, plus periodic retesting and unannounced audits, and each publishes what it currently certifies (NSF; Informed Sport). USP additionally publishes monographs that define the specification a compendial ingredient must meet, which is what USP-grade means when the phrase is used honestly.

  9. 09

    No certification program verifies that the ingredient works

    Certification measures what is in the capsule. It does not measure what the capsule does. A product can be verified to contain exactly the 500 mg of a botanical printed on the label when no controlled trial has shown that botanical to do anything, and the certificate is entirely honest, because efficacy is outside its scope. Of the five botanicals in the 57-product analysis, the label accuracy question and the efficacy question were separate throughout (Cohen et al. 2023). Certification is a floor on quality and a null signal on benefit.

  10. 10

    Certified for Sport and Informed Sport are a separate, narrower tier

    Drug-tested athletes carry strict liability for whatever appears in a sample, and general certification does not screen against the full prohibited list. Certified for Sport and Informed Sport test lot by lot against a banned-substance panel and publish the certified lots (NSF; Informed Sport). Informed Choice runs the same model for the retail market. The tier is worth its premium only if you are subject to testing. The relevance is not theoretical: NSF International performed part of the laboratory analysis that found nine prohibited stimulants in 17 brands (Cohen et al. 2021).

  11. 11

    Adulteration risk is concentrated in three categories

    Sports and pre-workout products, weight-loss products, and sexual-enhancement botanicals are where undeclared pharmaceuticals and experimental stimulants have repeatedly been documented, and they are the categories the emergency-department data implicates, with weight-loss products accounting for 25.5 percent and energy products 10.0 percent of single-supplement visits (Geller et al. 2015; Cohen et al. 2023). If the certification budget is finite, it belongs here. A proprietary blend sold on a physique promise is a different risk object from a mineral tablet.

  12. 12

    Single-ingredient commodities are the low-risk end of the matrix

    A plain creatine monohydrate, a basic multivitamin or a compendial-grade mineral sits at the opposite end: the ingredient is cheap enough that substitution has little economic motive, the specification is unambiguous, and the product is not sold on a stimulant promise. Micronutrients accounted for 31.8 percent of single-supplement emergency visits against 65.9 percent for herbal and complementary products (Geller et al. 2015). Certification still adds contaminant testing here, but the marginal value per dollar is far lower than in the three high-risk categories.

  13. 13

    Verify the mark in the certifier's database, not on the carton

    A mark printed on a label is a graphic file. The certification is a database record, and every serious program publishes a searchable listing of what it currently certifies, down to product name and in the sport programs down to lot (NSF; Informed Sport). Checking takes under two minutes and it is the only step that distinguishes a real certification from a lookalike badge or an expired one. With 89 percent of labels in one analysis failing to declare accurately what was inside, the label is the wrong place to end an inquiry (Cohen et al. 2023).

  14. 14

    Heavy metal limits are set by the program and never printed on the label

    Certification programs test finished product against contaminant limits including heavy metals; no supplement label discloses a figure. A risk assessment of reported concentrations in protein powder products, prompted by a Consumer Reports analysis of 15 products and a later report that 40 percent of 133 products tested had elevated levels, modelled arsenic, cadmium, mercury and lead against EPA reference doses and found hazard indices below 1 at one and three servings daily, highest in mass-gain formulations and lowest in whey, with all modelled adult blood lead levels below the CDC guidance value of 5 micrograms per deciliter (Bandara et al. 2020).

§ 2 · Questions

The questions people actually bring us.

Q01
What does third party tested actually mean?
Legally, nothing. It is a marketing phrase covering four different arrangements: an ongoing certification program with facility audits and scheduled retesting, a one-off retail test of a single lot, a certificate of analysis produced by or for the seller, and independent journalism that buys and tests products. Only the first makes any commitment about the batch you buy next month. Given that 89 percent of labels in a 57-product analysis did not accurately declare the ingredients found, the difference between these four is the whole question (Cohen et al. 2023).
Q02
Is NSF Certified for Sport the same as NSF certified?
No. General certification under NSF/ANSI 173 verifies that the product contains what the label says, in the stated amounts, without undeclared contaminants above the standard's limits. Certified for Sport adds lot-by-lot screening against a banned-substance panel for athletes under drug testing, and publishes the certified lots (NSF). The sport tier costs more and is only worth the premium if a positive test would carry consequences. Informed Sport runs the same lot-by-lot model, and Informed Choice applies it to retail product (Informed Sport).
Q03
Does a certification mark mean the supplement works?
No, and this is the most common misreading. Certification verifies identity, potency, purity and contaminant limits. It says nothing about whether the ingredient produces any effect. A product can be certified to contain exactly the labeled quantity of a compound with no controlled trial behind it, and the certificate remains accurate. Of the five botanicals examined in one analysis of 57 products, the label-accuracy result and the efficacy question were entirely separate (Cohen et al. 2023). Decide whether an ingredient is worth taking first, then decide who to trust to encapsulate it.
Q04
Is USP Verified better than NSF certification?
They are close substitutes rather than a ranking. Both combine an audit of the manufacturing site with testing of finished product against a specification for identity, potency, purity and contaminants, and both retest on a schedule. USP additionally publishes the compendial monographs that define what a given ingredient must meet, which is the reference behind the phrase USP-grade. NSF publishes a searchable listing of certified products and systems (NSF). Coverage differs by category, so in practice the more useful question is which program lists the specific product you are considering.
Q05
How do you check whether a certification claim on a bottle is real?
Look the product up in the certifier's public listing rather than trusting the printed mark. NSF publishes a searchable database of certified products and systems, and the sport programs publish certified batches down to lot number (NSF; Informed Sport). The check takes under two minutes. If the product does not appear, treat the mark as decoration regardless of the explanation offered, because the mark is a graphic and the certification is the database entry.
Q06
Is a manufacturer's certificate of analysis good enough?
Only if it is specific. A usable certificate names the lot, the manufacture and analysis dates, the analytical method for each assay, the specification and the measured result as numbers, the contaminant panel including heavy metals and microbiology, and the laboratory and its accreditation. It is worthless when it reports conforms with no figure, carries no lot number, is undated, or is a generic file reused for every batch. Given a documented range of 0.02 percent to 334 percent of labeled quantity in one analysis, a certificate without numbers answers nothing (Cohen et al. 2023).
Q07
Which supplements most need third-party certification?
Sports and pre-workout products, weight-loss products, and sexual-enhancement botanicals. These are where undeclared pharmaceuticals and experimental stimulants have repeatedly been found, and where the emergency-department data concentrates, with weight-loss products at 25.5 percent and energy products at 10.0 percent of single-supplement visits (Geller et al. 2015). At the other end, a single-ingredient creatine monohydrate or a basic multivitamin carries far less adulteration risk, because the ingredient is cheap and the specification is unambiguous, so the certification premium buys less there.
Q08
Do certified products get tested for heavy metals?
Yes, that is one of the concrete things certification adds, because no label discloses a heavy metal figure. Scale matters here. A risk assessment of reported arsenic, cadmium, mercury and lead concentrations in protein powder products found hazard indices below 1 at one and three servings per day, highest in mass-gain formulations and lowest in whey, with all modelled adult blood lead levels below the CDC guidance value of 5 micrograms per deciliter (Bandara et al. 2020). Worth limiting and worth testing, not a reason for alarm, and the same logic applies to fish oil and other concentrated products.
Methodology
§ 4 / spec

How this was specified

01Inputs measured
Retail price (dated) · label claim · Certificate of Analysis · third-party test (Informed Sport / NSF / ConsumerLab / Clean Label) · leucine per serving from COA, not marketing.
02Protocols tested
Per-kg target from four literature ranges (IOM RDA, Phillips 2017, Morton 2018, ISSN). Brands scored against Moore 2015 leucine-per-dose threshold (~0.4 g/kg).
03Cost-basis verified
$/gram of protein and $/gram of leucine at warehouse pricing (Costco), mail-order (Amazon), and DTC retail. Re-checked quarterly, flagged when drift exceeds 15%.
04Confidence level
High on ranked order. Medium on absolute $/g (prices drift). Low on serving-size claims where COA is older than 18 months, flagged [VERIFY].
Sources

Every claim, cited.

08 refs
  1. [01]US Food and Drug Administration. Questions and Answers on Dietary Supplements. FDA does not approve dietary supplements for safety and effectiveness before they are marketed; manufacturers and distributors of dietary supplements are responsible for making sure their products are safe before they go to market, for ensuring that any claims made about them are substantiated by adequate evidence to show that they are truthful and not misleading, and for meeting labeling requirements; FDA is responsible for taking action against any adulterated or misbranded dietary supplement product after it reaches the market. The framework derives from the Dietary Supplement Health and Education Act of 1994.
  2. [02]Electronic Code of Federal Regulations, Title 21, Chapter I, Subchapter B, Part 111, Current Good Manufacturing Practice in Manufacturing, Packaging, Labeling, or Holding Operations for Dietary Supplements. Part 111 requires manufacturers to establish specifications for the identity, purity, strength and composition of finished dietary supplement batches and for limits on types of contamination that may adulterate the product, to determine whether those specifications are met, to conduct at least one appropriate test or examination to verify the identity of any component that is a dietary ingredient, to qualify suppliers of other components, to maintain batch production records and master manufacturing records, and to investigate product complaints. Part 111 governs process and documentation; it does not constitute independent verification of an individual finished container.
  3. [03]Cohen PA, Avula B, Katragunta K, Travis JC, Khan I. 2023. Presence and quantity of botanical ingredients with purported performance-enhancing properties in sports supplements. JAMA Netw Open 6(7):e2323879. Sixty-three products were purchased, 6 excluded and 57 analysed for five botanical ingredients (Rauwolfia vomitoria, methylliberine, turkesterone, halostachine, octopamine). Twenty-three of 57 (40%) contained no detectable amount of the labeled ingredient. Among products where the ingredient was detected, the measured quantity ranged from 0.02% to 334% of the labeled quantity, and only 6 of 57 (11%) were within 10% of the labeled quantity. Seven of 57 (12%) contained at least one FDA-prohibited ingredient, with five different prohibited compounds detected: 1,4-dimethylamylamine, deterenol, octodrine, oxilofrine and omberacetam. In total, 89% of labels did not accurately declare the ingredients found.
  4. [04]Cohen PA, Travis JC, Vanhee C, Ohana D, Venhuis BJ. 2021. Nine prohibited stimulants found in sports and weight loss supplements. Clin Toxicol (Phila) 59(11):975-981. Supplements sold in the US and labeled as containing deterenol or a synonym were purchased online; each brand was analysed by NSF International and by the Netherlands National Institute for Public Health and the Environment, with Sciensano resolving discrepancies. Seventeen brands were analysed. Four brands (24%) included 2 stimulants, 2 (12%) combined 3 and 2 (12%) combined 4. Ranges per recommended serving were 2.7 to 17 mg deterenol, 1.3 to 20 mg phenpromethamine, 5.7 to 92 mg beta-methylphenylethylamine, 18 to 73 mg octodrine, 18 to 55 mg oxilofrine, 48 mg higenamine, 17 mg 1,3-dimethylamylamine, 1.8 to 6.6 mg 1,3-dimethylbutylamine and 5.3 mg 1,4-dimethylamylamine. The authors conclude these cocktails have never been tested in humans and their safety is unknown.
  5. [05]Geller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, Mozersky RP, Budnitz DS. 2015. Emergency department visits for adverse events related to dietary supplements. N Engl J Med 373(16):1531-1540. Using nationally representative surveillance data from 63 emergency departments from 2004 through 2013 and 3,667 cases, the authors estimated 23,005 emergency department visits per year (95% CI 18,611 to 27,398) attributable to adverse events related to dietary supplements, resulting in an estimated 2,154 hospitalizations annually (95% CI 1,342 to 2,967). After exclusion of unsupervised ingestion by children, 65.9% of single-supplement-related visits involved herbal or complementary nutritional products and 31.8% involved micronutrients; weight-loss products accounted for 25.5% and energy products for 10.0% of visits.
  6. [06]Bandara SB, Towle KM, Monnot AD. 2020. A human health risk assessment of heavy metal ingestion among consumers of protein powder supplements. Toxicol Rep 7:1255-1262. Following a Consumer Reports analysis of 15 protein powder products, whose average heavy metal amounts in three daily servings exceeded limits proposed by US Pharmacopeia, and a later report that 40% of 133 protein powder products tested had elevated levels, the authors modelled arsenic, cadmium, mercury and lead against US EPA reference doses and screening levels to derive hazard quotients and a cumulative hazard index at one and three servings per day. Hazard indices were below 1 across products, driven mainly by arsenic or cadmium content; the highest values, approaching 1, were in mass-gain formulations and the lowest in whey products. Modelled adult blood lead levels were all below the CDC guidance value of 5 micrograms per deciliter.
  7. [07]NSF. Certified products and systems. NSF operates certification for dietary supplements under NSF/ANSI 173, combining an audit of the manufacturing facility against the standard with testing of finished product for label claim accuracy and for contaminants above defined limits, together with periodic retesting and unannounced facility audits. NSF Certified for Sport adds screening of each production lot against a banned-substance panel for athletes subject to drug testing. NSF publishes a public searchable listing of certified products and systems, which is the authoritative record of whether a given product is currently certified; the printed mark on a package is not.
  8. [08]Informed Sport (LGC). Informed Sport is a quality assurance program for sports nutrition products in which every batch of a certified product is tested for substances on a banned-substance list before release to market, with the certified batches published in a public searchable database, alongside audits of the manufacturing site. The companion Informed Choice program applies the same batch-testing and site-audit model to retail sports nutrition products. Both programs address banned-substance risk specifically and do not evaluate whether an ingredient is effective.
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The Larderlab Team builds evidence-led frameworks for eating, lifting, and stocking a kitchen. We cite every claim. We publish the spreadsheet when possible. We buy what we review at retail price. When new data lands, we revise with a dated note.

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