How Do Hair And Nail Vitamines Work Scientific Explanation
Cureus. 2020 Jul; 12(vii): e9477.
Safety Concerns of Skin, Hair and Nail Supplements in Retail Stores
Monitoring Editor: Alexander Muacevic and John R Adler
Ariadna C Perez-Sanchez
1 Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, United states of america
Emily K Burns
2 Dermatology, Baylor College of Medicine, Houston, United states of america
Veronica M Perez
3 Public Health, Texas A&M Academy, College Station, The states
Evelyne Yard Tantry
4 Dermatology, Rice University, Houston, USA
Sahana Prabhu
4 Dermatology, Rice University, Houston, United states
Rajani Katta
five Dermatology, University of Texas Wellness Science Center at Houston, Houston, U.s.a.
vi Internal Medicine, Baylor College of Medicine, Houston, USA
Received 2020 Jun 29; Accepted 2020 Jul xxx.
Abstract
Background: Dietary supplements promoted for "skin, hair, and smash" health are condign increasingly popular, although there is a lack of regulatory oversight. As no centralized database or repository for these supplements is bachelor, the aim of this written report was to provide an overview of supplements in a sample of retail stores, with a focus on safety concerns.
Methods: Dermatology supplements were divers equally those that featured the words "peel", "hair", "nails", "beauty", or "glow" in the product proper name or tagline. Seven stores including drug, grocery, section, and cosmetics stores were surveyed within a 3-mile radius. Data were extracted from the Supplement Facts label of each product.
Results: A total of 176 separate supplements were identified, containing a total of 255 distinct ingredients. These included vitamins, minerals, nutrient extracts, botanicals, fauna products (collagen, fish oils), amino acids, a hormone, and distinct microbial strains.
Determination: This survey of "dermatology" supplements available in local retailers raised several safety concerns, including potential interactions, teratogenicity risks, a lack of independent third-political party testing, lack of warning labels, and nutrient "overdosing". Given limited regulation of dietary supplements, it is imperative that physicians brainwash patients on the potential risks. These include risks related to supplement ingredients and dosages, as well as risks related to the lack of regulatory oversight. Patients must likewise be educated about the multiple gaps in our knowledge of dietary supplements, especially in terms of efficacy and long-term safety.
Keywords: dietary supplements, supplement, human being skin, female pattern hair loss, male blueprint hair loss, smash diseases, u.s. fda, biotin, drug interaction
Introduction
Skin, hair, and blast supplements, also known every bit dermatology or beauty supplements, are becoming increasingly popular. Studies guess that over fifty% of the U.s.a. population take some class of a dietary supplement [one]. The global beauty supplements market place specifically was valued at approximately $three.5 billion in 2016, and is expected to achieve almost $7 billion by 2024 [2]. This rising is attributed in part to social media marketing and the use of celebrity endorsements.
In fact, such involvement often extends far beyond endorsements: actresses, reality Tv stars, social media influencers, models, and makeup companies accept all developed their own lines of "beauty" supplements [three]. Minimal regulation of the dietary supplement industry past the United States Food and Drug Assistants (FDA) allows a depression barrier to entry for the sale of new supplements. Any individual or visitor tin bring a new supplement to the U.S. market place, with no need for proof of safety or efficacy prior to sale [four].
Manufacturers accept significant leeway when choosing ingredients. The regulatory framework for dietary supplements, created in 1994, is known as the Dietary Supplement Health and Didactics Human activity (DSHEA) [5]. This human activity specifically "grandfathered" in any ingredients that were in use prior to passage of the law, although there is no authoritative list of pre-1994 ingredients. Also, apply of an ingredient prior to 1994 does non guarantee safety. Ephedrine-containing supplements, for example, were banned in 2004 due to many reported adverse events [5].
No centralized database or repository exists to certificate supplements available on the marketplace. Our goal was to certificate the number and variety of dietary supplements marketed equally skin, hair, boom, and beauty supplements available in local retailers. Nosotros sought to determine the types and doses of ingredients utilized in these products too as identify any potential safety concerns.
Materials and methods
Dermatology supplements (Effigy 1) were divers as those that featured the words "peel", "hair", "nails", "beauty", or "glow" in the product name or tagline. Seven stores including drug, grocery, department, and cosmetics stores were surveyed within a three-mile radius using a dermatology practise in Houston every bit a point of reference. Data were extracted from the label of each product between August and December of 2019.
Skin, Hair, and Blast Supplement Example
Results
A total of 176 separate supplements were identified.
Ingredients and formulations
A full of 255 distinct ingredients were identified on the Supplement Facts labels of these products (Tabular array 1). A total of 14 vitamins and fifteen minerals were included. A total of 188 unique food extracts and botanical ingredients were identified; 38 other substances, including ten singled-out microbial strains, animal products (fish oils, collagen), amino acids, and one hormone were included. We identified 59 collagen products in total but as many products did non specify the collagen source or type, these are all included under the one ingredient "collagen".
Table ane
Agile Ingredients in Supplements
MSM, methylsulfonylmethane; EPO: evening primrose oil; ALA: alpha linoleic acrid; GLA: gamma linoleic acid
| Category | List of Active Ingredients |
| Vitamins (In descending order of frequency of apply) | Biotin/B7, ascorbic acid/vitamin C, thiamine/vitamin B1, tocopherol/vitamin E, pyridoxine/vitamin B6, pantothenic acid/vitamin B5, vitamin A, riboflavin/vitamin B2, niacin/vitamin B3, cobalamin/vitamin B12, folate/vitamin B9, vitamin D, folic acid, niacinamide |
| Minerals (In descending order of frequency of utilize) | Zinc, calcium, copper, selenium, magnesium, chromium, iron, manganese, iodine, potassium, phosphorus, chloride, sulfur, molybdenum |
| Other ingredients (38 total. Only selected examples listed, in descending order of frequency of employ) | Collagen, silica, MSM, keratin, L-methionine, L-cysteine, melatonin, lutein, choline present in <1%: L-histidine, caffeine, EPO, fish oil, chondroitin, ALA, GLA, oleic acid, linoleic acid, L-lysine |
| Food extracts and botanicals (188 total. Merely selected examples listed) | Selected examples: acai, amla fruit, apple cider vinegar, borage seed oil, Boswellia, flaxseed oil, gotu kola, greenish tea extract, ashwagandha, organic Chlorella algae, organic Moringa (foliage), pepper extract, pine bark extract, pomegranate extract, propolis, saw palmetto drupe extract, Spirulina, turmeric, Bacillus coagulans, Bifidobacterium lactis, Lactobacillus rhamnosus |
A broad range of formulations were utilized, including tablets, gummies, capsules, chews, chocolates, powders, softgels, and liquids.
Dosing
A number of products contained vitamins and minerals at doses far exceeding the FDA-recommended daily value (DV) (Table two).
Table 2
Supplement Facts Labels Indicating Nutrients With Over 200% Recommended Daily Values
| Food | Labeled Dose | % of Daily Value |
| Biotin (vitamin B7) | 10,000 mcg | 33,333% |
| Vitamin B12 | 850 mcg | 14,167% |
| Riboflavin (vitamin B2) | fifty mg | iii,846% |
| Thiamin (vitamin B1) | xxx mg | 2,500% |
| Niacinamide | 500 mg | 2,500% |
| Vitamin B6 | 50 mg | ii,500% |
| Vitamin E | 134 mg | 893% |
| Chromium | 200 mcg | 571% |
| Vitamin C | 500 mg | 556% |
| Vitamin A (beta-carotene) | 25,000 IU | 500% |
| Selenium | 200 mcg | 363% |
| Zinc | xxx mg | 273% |
Seals of quality
Only six products (3.four%) displayed seals indicating 3rd-party testing by recognized organizations including U.S. Pharmacopeial Convention (USP) and the National Sanitation Foundation (NSF).
Warning labels
In our sample, a total of nine biotin (vitamin B7) supplements contained doses over 10,000 mcg. None listed a warning on potential interactions with laboratory testing.
No supplement contained information on tolerable upper intake levels (UL), the demand to consider dietary sources of nutrients, or pregnancy warning categories.
Discussion
In our survey of products advertised equally dermatology supplements, nosotros identified a total of 176 carve up supplements, utilizing 255 distinct ingredients encompassing a wide array of substances. Legally, in that location is no definition of what constitutes a "skin, hair, and boom" supplement. The legal definition of a dietary supplement, per the FDA, is that of an ingestible production containing a "dietary ingredient" merely 1 that is not marketed as a conventional food or "sole item of a meal or diet". A "dietary ingredient" can consist of a vitamin, mineral, herb or botanical, amino acid, dietary substance intended to increase the total dietary intake, or a "concentrate, metabolite, constituent, extract, or combination of the aforementioned items" [5]. This definition is broad enough to include a wide range of ingredients, with over 85,000 supplements reported utilizing multiple combinations of ingredients [six].
Supplements are regulated past the FDA as foods, non drugs, which has multiple safety implications. There is no need for manufacturers to prove safety or efficacy prior to sale [4]. There is no brake on doses of vitamins or minerals that may exist used, even for nutrients with defined tolerable ULs. Manufacturers may mix and match ingredients and combine them into a supplement, without the demand to document a lack of interactions between ingredients and/or other medications. While companies are expected by the FDA to attach to skillful manufacturing practices, no proof is required [four].
Our survey of skin, hair, and smash supplements highlights several condom concerns, including potential interactions, teratogenic effects, drowsiness, nutrient "overdosing", allergenicity, quality concerns, and risks related to unknown factors.
Drug interactions
The potential for supplements to interact with prescription medications, other supplement ingredients, and even laboratory tests is well documented. 1 literature review documented more i,400 unique interactions involving over 200 supplements and herbs [7]. Of concern is that many potential interactions accept yet to exist investigated or described.
Equally 1 instance, biotin (vitamin B7) has a long history of employ in "nail" and "hair" supplements, even so it was only in 2017 that the FDA issued a warning about interactions between biotin and sure laboratory tests, including those that test for cardiac function and thyroid function [8]. This warning was based on a study of human volunteers consuming 10,000 mcg of biotin daily for i week. Notably, of the ix biotin supplements in our sample that contained doses more than than x,000 mcg, none warned of this interaction.
Teratogenicity
Electric current labeling laws do not require pregnancy category warnings on any supplements, fifty-fifty for those ingredients that nowadays known teratogenicity risks such every bit high-dose vitamin A or saw palmetto. Every supplement in our sample cautioned meaning women to seek medical communication prior to employ. ("If yous are pregnant, nursing, taking whatsoever medications, or have a medical condition, consult your medico earlier utilize.") However, no supplement included pregnancy category warnings, which are required on prescription teratogenic medications.
Saw palmetto was found in a "hair" supplement. This botanical inhibits 5-alpha-reductase [ix,10]. five-Alpha-reductase inhibitors administered to pregnant animals are associated with aberrant ballocks in male offspring. These drugs are therefore required by the FDA to be labeled every bit pregnancy category X [xi]. No such requirement is in place for supplements.
As well of concern are unknown teratogenicity risks. For many nutrients, risks related to loftier-dose consumption accept not been studied systematically. Many supplements in our sample contained zinc, which warrants further study, as one report noted an association between elevated levels of zinc in umbilical cord blood and adverse neonatal neurobehavioral evolution [12].
High-dose vitamin A is some other concern. In a study of pregnant women who averaged more 10,000 IU per day of vitamin A orally (in the form of retinoid compounds), approximately one in 57 had a fetal malformation owing to the supplement [13]. This risk is considered particularly high before the 7th calendar week of pregnancy, when some women may not know that they are pregnant. In our sample, one product contained 25,000 IU of beta-carotene. Beta-carotene is a precursor to vitamin A. While the teratogenic risk of supplemental beta-carotene is non known, it is considered equivalent to preformed retinoids when computing retinol activity equivalents (RAE) [14]. Therefore, further studies of the teratogenic gamble of high-dose beta-carotene are warranted.
Drowsiness
Seven supplements in our sample contained melatonin, a hormone that may crusade drowsiness. One product did not warn of this side result.
Nutrient "overdosing"
The hazard of nutrient "overdosing" is a significant concern for many vitamins and minerals. In our survey, manufacturers utilized highly variable dosing for many nutrients. Doses of biotin, for example, ranged from 100% DV to 33,333% DV. In fact, multiple products contained vitamins and minerals at doses far exceeding the DV (Table 2).
Consumers may not realize that some vitamins and minerals are harmful if chronically consumed at doses college than that provided past food sources. Chronic high-dose supplementation of certain vitamins and minerals has been linked to neuropathy, gastrointestinal disturbances, vasodilation, and milk-alkali syndrome [15]. These risks led to the development of tolerable ULs. ULs accept been established for 24 vitamins and minerals, and are considered to be the highest "usual intake level" of a nutrient that poses no risk of adverse effects.
ULs encompass nutrient intake from all sources, including foods and supplements. These limits were established because a significant proportion of the population regularly consumes either "large amounts of highly fortified foods, big number of moderately fortified foods, or non-food sources such every bit nutritional supplements, or any combination of the iii" [15].
No products in our sample provided information on ULs or the need to consider food sources of nutrients. Of item concern are supplements containing vitamins and minerals that either exceeded the UL or contained such high doses that boosted nutrient intake would place the user close to the UL.
1 product contained beta-carotene, a vitamin A forerunner, at a dose of 7,500 mcg of RAE. While the Nutrient and Nutrition Board has non established ULs for beta-carotene, the UL for pre-formed vitamin A is 3,000 mcg of RAE per day, and the FNB does not recommend beta-carotene supplements for the full general population except every bit a source to prevent vitamin A deficiency [14]. Beta-carotene supplementation has been linked to an increased cancer risk in male smokers: in one randomized controlled trial (RCT), male smokers taking a beta-carotene supplement had an increased hazard for lung cancer as compared to placebo [16].
Another production independent selenium at a dose of 200 µg. If too consuming selenium-rich foods, consumers could surpass the UL of 400 mcg. A single Brazil nut, for example, contains ninety mcg [17]. Excess selenium intake (with supplement use) has been linked to higher risk of diabetes and even higher overall mortality rates [eighteen,19].
Risks of agin, long-term wellness outcomes exist, even for supplement use non exceeding the UL. High-dose vitamin B6 and B12 supplements have been linked to higher risk of lung cancer in smokers. In one study, male person smokers consuming greater than 20 mg of B6 via supplements over 10 years were 3 times more probable to develop lung cancer. One "pilus loss" supplement in our sample contained 50 mg of B6. In the aforementioned study, male smokers consuming more than than 55 mg of B12 were four times more than likely to develop lung cancer. 1 "pilus loss" supplement contained 850 mcg of B12 [twenty].
The use of other high-dose nutrients has not been studied systematically, so further unknown risks may be. Ane study documented this problem. In this RCT, researchers evaluated a supplement that appeared promising for the reduction of skin cancer. This supplement contained vitamin C, vitamin Eastward, beta-carotene, selenium, and zinc. Unfortunately, afterward median follow-upwards of 7.5 years the incidence of pare cancer was actually higher in women ages 35-60 years consuming this supplement as compared to placebo [21]. Given the lack of FDA regulation, RCTs such as this one are warranted and may reveal farther concerns.
Allergenicity
Among collagen products, 17% indicated sourcing from "fish". Of these, ninety% lacked allergen warnings. Although the allergenicity of collagen products derived from seafood has non been studied systematically, hydrolyzed fish collagen has been reported to cause anaphylaxis [22].
Quality concerns
One potential factor accounting for the pregnant growth of the dietary supplement market is considered to exist the low bulwark to entry. Companies are "expected to adhere to", but practice not have to bear witness, good manufacturing practices [iv].
An FDA spokesperson was quoted in an commodity highlighting the agency's express resource. "…with a staff of less than 24 people to regulate an industry worth an estimated $36.7 billion, the agency has focused its resources on cracking down on unsafe products, said Meyer" [23].
Multiple quality problems with supplements have been reported. Consumer Lab, an independent investigative laboratory, evaluated a full of 15 collagen supplements and found that one production contained unacceptably high levels of cadmium, a heavy metal [24]. Other quality concerns include doses that differ markedly from those indicated on the characterization, dosing inconsistency across products, and bug with disintegration of tablets [25]. Other issues include contamination with microbes or adulteration with heavy metals or prescription medications.
While factories are sometimes inspected past the FDA, the agency is only able to inspect a small fraction. Consumer Lab reported that in fiscal year 2019, the FDA investigated a total of just 560 factories, and issued letters of not-compliance to over 50% of these [26]. The list of manufacturers receiving citations included some that produce collagen powders and hair loss supplements.
Consumers of supplements may exist brash to seek products that have undergone 3rd-party independent quality testing. Per the Office of Dietary Supplements (ODS) of the NIH, "seals of approving" may exist displayed on a supplement, indicating testing past an contained organisation [27]. These seals indicate that the product contains the ingredients listed on the label and does not contain harmful levels of contaminants. Iii such organizations listed by the ODS are USP, NSF, and Consumer Lab.
Just six supplements (3.4%) in our sample displayed such seals. Five displayed the USP seal, all from the same manufacturer, and one displayed the NSF seal. While two other products displayed seals, one simply listed "third-party purity testing", and the other was tested by a manufacturer-funded research lab.
The use of these seals was non related to price of the supplement.
The most common formulations in our survey were tablets, capsules, and gummies. Gummies are particularly apropos: Consumer Lab, a third-political party investigative laboratory, has reported that gummies are the almost probable formulation to experience dosing inconsistencies [28]. None of the gummies in our report independent seals from tertiary-political party laboratories.
Unknowns
Since no studies need be conducted on any of these products prior to apply, we have express information on short-term and long-term risks.
Apart from the unknown risks of substances such as herbals, animal products, and microbes, fifty-fifty vitamins and minerals pose unknown risks. As discussed, some of these risks accept been discovered "accidentally", as with cancer prevention RCTs of vitamins and minerals (at supraphysiologic doses) that were really linked to a higher risk of cancer [16,21].
The unknown aspects of the collagen manufacturing process warrant further consideration. Over half of supplements containing collagen lacked information on source. Consumers should be brash to seek answers from manufacturers on several important questions: What animals and beast parts (or combination thereof) served as the source? What measures were used to protect against contamination or adulteration? If sourced from fish, were depression-mercury fish used? If sourced from cows, what steps were taken to ensure that no brain or nervous system matter was included, in gild to prevent prion illness?
Limitations
As our study was designed to investigate products sold in local retailers, this represents only a limited sample of such products. Farther research should evaluate online products and a wider geographic region.
Futurity directions
We encourage strengthened regulation and oversight of the supplement manufacture, particularly in terms of ensuring quality and safe of ingredients and doses used. Pregnancy category warnings, peculiarly for category X substances, should be required. Every bit many consumers may non recognize the risks of "mega-dose" vitamins and minerals, we encourage labeling stating that such loftier doses should only be taken by those with deficiency. Further enquiry on efficacy, side furnishings, and teratogenicity risk is required.
Consumers at a minimum should seek products that contain third-party "seals of approval" that ensure a product contains the ingredients and doses listed on the label and is free of contamination and cariosity.
Finally, with no required post-marketing surveillance programs, it is imperative that physicians and consumers report any possible supplement reactions. This may be done by contacting the consumer complaint coordinator or filing a rubber report online through the Prophylactic Reporting Portal [29].
Conclusions
Given limited regulation of dietary supplements, information technology is imperative that physicians educate patients on the potential risks. These include risks related to supplement ingredients and dosages, likewise as risks related to the lack of regulatory oversight. Patients must also be educated most the multiple gaps in our noesis of dietary supplements, specially in terms of efficacy and long-term safety.
Notes
The content published in Cureus is the result of clinical experience and/or research past independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not exist deemed a suitable substitute for the communication of a qualified health care professional person. Do not disregard or avoid professional medical advice due to content published inside Cureus.
The authors have declared fiscal relationships, which are detailed in the next section.
Rajani Katta declare(southward) personal fees from Vichy Laboratories. Informational Board. Rajani Katta declare(s) personal fees from Book for public in Diet and Dermatology. Glow: The Dermatologist'south Guide to a Whole Foods Younger Skin Diet
Human Ideals
Consent was obtained by all participants in this written report
Fauna Ideals
Animal subjects: All authors accept confirmed that this study did non involve beast subjects or tissue.
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