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Over half of Americans take some sort of dietary supplement, according to the Food and Drug Administration (FDA). But they’ve long been controversial—do they help, hurt, or actually do nothing at all? And do supplements really contain what you think they do?

Sounds straightforward, but it might not actually be that simple: According to a new study from the JAMA Open Network, 776 different dietary supplements from 2007 to 2016 were shown to contain unapproved pharmaceutical ingredients that weren’t on their label.

Sexual enhancements, weight loss, and muscle-building supplements were among the most risky. Of the supplements shown to include unapproved ingredients, 46 percent were for sexual enhancement, 41 percent for weight loss, and 12 percent for muscle-building—the latter two which may be especially applicable for the active, running population.

“Twenty percent of the products had more than one unapproved ingredient,” study researcher Madhur Kumar, Ph.D., M.S, told Runner’s World by email. What’s more, 28 products were named in two or three FDA warnings about their unapproved ingredients.

[Want to start running? The Big Book of Running for Beginners will take you through everything you need to know to get started, step by step]

The common drug ingredients found in the weight loss supplements were sibutramine—an appetite suppressant that was taken off the market in 2010 after it was found to cause serious cardiovascular issues and liver damage—the laxative phenolphthalein, and the prescription antidepressant fluoxetine. Sibutramine, for instance, was detected in 85 percent of the weight loss supplements that were adulterated, and phenolphthalein in 24 percent.

In total, 25 percent of the adulterated weight loss supplements contained more than one hidden drug ingredient.

And muscle-building supplements also had some scary results, too. Of the 92 muscle-building supplements that were adulterated, 73 were deemed by the FDA to contain undeclared anabolic steroids or steroid-like substances.

“Overall, the study found that active pharmaceutical ingredients continue to be identified in dietary supplements, especially those marketed for sexual enhancement or weight loss, even after the prior public FDA warnings,” says Dr. Kumar. “The drug ingredients have the potential to cause serious adverse health effects due to misuse, overuse, or interaction with other medications, underlying health conditions, or other pharmaceuticals within the supplement.”

And another warning: If you’re ordering your supplements online, you should be extra careful. The study found that from 2014 to 2016, 39 percent of adulterated samples were identified through online sampling, and 34 percent were ID’ed through the examination of international mail shipments.

So how can you choose safe supplements? Honestly, it’s tricky. As the study noted, dietary supplements are not subject to premarket approval for safety and effectiveness by the FDA. That means the FDA is not authorized to review dietary supplements for safety and effectiveness before they are marketed—it’s up to the supplement manufacturers to make sure supplements are safe before they’re put on the market.

But doing your research can help. Seek information about the supplement you’re interested in from a non-commercial site, like the National Institute of Health’s (NIH) Office of Dietary Supplements, the FDA, and the United States Department of Agriculture.

The same goes for supplements with third-party verification seals like USP and NSF International. The seals don’t guarantee safety or effectiveness, but can be beneficial in ensuring the supplement contains the amount of ingredient stated on the label and isn’t adulterated with dangerous additives.

And consult your doctor before taking anything. As shown, the supplement you may want to take could contain pharmaceuticals or other ingredients that could interact negatively with medication you’re already taking, or make a condition you already have worse.

If you’re struggling to kickstart your diet, turning to natural weight-loss supplements might seem like an easy solution. 

With obesity levels among Australians on the rise – currently the figure sit at 65 per cent of adults – the market for weight-loss supplements is overrun.

‘People are looking for a quick fix,’ Sydney-based dietitian and exercise physiologist Gabrielle Maston told Femail. ‘So when supplement companies advertise pills that claim to help you lose weight without doing very much, it’s an easy sell.’

From hemp seeds to coffee extracts, we take a look at some of the more popular supplements and reveal which work and which you should avoid.

Sydney-based dietitian and exercise physiologist Gabrielle Maston (pictured) said with the rise in obesity it’s no wonder more are turning to supplements to help with weight loss

1. Garcinia Cambogia

Garcinia Cambogia is a tropical fruit which looks a little bit like a small pumpkin.

It contains a large amount of Hydroxycitric Acid (HCA) – an ingredient which is claimed to aid weight loss.

‘Products containing Garcinia are believed to increase metabolism and decrease appetite at the same time,’ Ms Maston said.

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Garcinia Cambogia is a small tropical fruit which looks a little bit like a small pumpkin

‘It’s quite trendy at the moment, but with a lot of these types of supplements there is no evidence to support it and there’s been very little research done to show it actually does anything different to a placebo.’

Verdict: Garcinia Cambogia hasn’t been shown to be effective

2. Hemp seeds

Hemp and marijuana are from the same species, however, industrial hemp, as it is known, can safely be used as a food, without any fear of it causing an altered state.

Hemp products and seeds been available in Australia since 2017. 

It’s become a new staple on the shelves of many health food stores and has been heralded as a superfood because it comes packed with fibre and protein.  

‘There’s nothing harmful about eating hemp, the expert said, ‘as it’s a popular alternative to meat and whey protein.

‘In terms of fat burning, protein makes you feel fuller for longer so theoretically if you have a high-protein diet, rather than one that’s high in carbs, you are less likely to overeat.’

Verdict: Hemp seeds are a good source of protein 

Hemp seeds and products have become a new staple on the shelves of many health food stores 

3. Caffeine supplements

Throughout history, caffeine has been used as a way to boost energy and also as a way to suppress the appetite.

Caffeine, including extracts and straight shots of coffee, do have a stimulating effect on the metabolism, the expert said.

‘Caffeine is an ingredient that’s used in a lot weight loss supplements because it does have a fat-burning element.’ 

Ms Maston said there is some research showing caffeine and caffeine-based supplements can assist with weight loss, however, the overall amount wasn’t significant.

‘There may be a 10 per cent improvement compared to someone who wasn’t using it,’ she said.

Throughout history, caffeine has been used as a way to boost energy and also as a way to suppress the appetite

While Ms Maston tended toward the view caffeine supplements could help some with weight loss, Dr Nick Fuller told News.com.au green coffee extracts, in particular, were of little use.

‘There is no scientific evidence to suggest green coffee extract assists with weight loss,’ Dr Fuller said.

Verdict: Caffeine does speed up the metabolism 

4. Capsaicin

Capsaicin is the flavour compound found in chillies and capsicums in smaller amounts.

It’s thought the active ingredient can boost metabolic rate as well as increasing thermogenesis, or the rate at which your body burns fat.

‘Studies that have supplemented in capsaicin have shown no difference between people taking the supplement and people who were eating normally.’

Verdict: Capsaicin hasn’t been shown to be effective

5. Bitter orange

In recent years, bitter orange, also known as the Seville orange or the marmalade orange, has become a popular ingredient in weight loss supplements.

It contains an alkaloid called synephrine, which is similar to ephedra, a drug banned in 2004 by the US Food and Drug Administration for its numerous side effects.

In recent years, bitter orange, also known as the Seville orange or the marmalade orange, has become a popular ingredient in weight loss supplements

And while the extract is available as a fat-burning supplement in Australia, Ms Maston said there is ‘limited scientific evidence to suggest it increases metabolism and fat burning while decreasing appetite at the same time.’

Verdict: Bitter orange hasn’t been shown to be effective

Lastly, the dietitian offered a few words to those who may be struggling with weight loss and finding themselves wanting to turn to supplements as a way to help:

‘You have to do the time. You need to exercise and eat right because there is no magic pill.’