A new study reveals that sports drinks contain misleading ingredient lists and, in some cases, FDA-banned drugs.

A new study on sports drinks found that several consumer products don’t actually contain the ingredients listed on their labels—but some contain ingredients banned by the Food and Drug Administration (FDA). Researchers say the results may diminish the credibility of ingredient labels and provide clues to why tens of thousands of patients end up in the emergency room each year due to supplements. A 2015 study found that an estimated 23,000 patients require emergency room care from supplements each year, with many of these cases involving sports supplements.^[][]

The authors of the new study, released this Monday, concluded that,“Given these findings, clinicians should advise consumers that supplements listing botanical ingredients with purported stimulant or anabolic effects may not be accurately labeled and may contain FDA-prohibited drugs.” 

“Consumers looking for supplements to improve their health and fitness are often barraged by advertisements for the latest plant-based solution,” says Pieter Cohen, MD, lead author of the study and associate professor of medicine at Cambridge Health Alliance at Harvard University. “Unfortunately… we found that consumers were just as likely to get what's listed on the label as they were to get an FDA-prohibited drug.”

What did researchers look at?

To conduct the study, the researchers tested 57 brands of sports supplements that claimed to contain at least one of the following five novel plant-based ingredients:

Rauwolfia vomitoria:  natural medicinal herb that has been used throughout history for treatment of hypertension as well as mental health disorders. Studies have found that bark from Rauwolfia vomitoria may improve immunity in animals.^[]

Methylliberine: An alkaline found in many types of coffee plants and thought to have similar benefits to caffeine. Studies have found that its short-term use is not harmful as a supplement.^[]

Turkesterone: A steroid in insects which some people take for muscle building.^[]

Halostachine: An alkaline extract sometimes used in pre-workout and fat-burning products to increase energy and fat loss.^[]

Octopamine: A natural stimulant that works with “fight-or-flight” transmitters and is thought to have minor weight loss effects.^[][]

Most of the products touting these ingredients were forms of pre-workout, fat-burning, or weight- loss supplements. And, according to the study, most of the products didn’t actually contain these ingredients, anyway.

What did researchers find?

In addition, the researchers did find FDA-prohibited drugs, Russian pharmaceuticals, and “a stimulant that has never been approved in any country,” which was alarming, says Dr. Cohen. Only six of the 57 products, or 11%, contained both a labeled ingredient and a labeled ingredient that was within 10% of its expressed quantity.

Prohibited ingredients discovered included:

• 1,4-Dimethylamylamine (1,4-DMAA): This is an ingredient introduced in the nasal inhalers in the U.S. in the 1940s. It has never been approved for medication use in the US or elsewhere.

• Deterenol: This was formerly used in Europe to prepare the eyes for glaucoma treatments but has never been approved by the FDA.

• Omberacetam: This is marketed in Russia as Noopept, but is not approved in the US. Its purpose is unknown, according to the researchers. 

• Octodrine: This is marketed in Germany as part of a multicomponent oral medication but is not approved for use in the US.

• Oxilofrine: This was developed in Europe in the 1930s and has cardiac stimulatory effects similar to ephedrine. The FDA never approved it.

Among the products studied, those labeled to contain halostachine or Rauwolfia vomitoria appeared to be the most likely to contain a prohibited ingredient. According to Dr. Cohen, these ingredients may be harmful, as “these drugs could strain the body by increasing blood pressure, heart rate, and heart contractions.”

“These FDA-prohibited drugs are expected to place unnecessary and potentially hazardous strain on the heart while exercising,” says Dr. Cohen. 

When talking to patients about their sports drink usage, he encourages caution around those claiming to contain “new botanical ingredients.” He suggests that patients select products based on advice from the US Defense Department's Operation Supplement Safety or sticking to a protein powder or creatine with familiar ingredients.^[]