Every three months, Monica Wanjiru acquires a dose of calcium supplements. The mother of three has been buying the supplements for her 14-year-old son Benjamin Kariuki for the past one year, under the guidance of a doctor. The supplements, she says, have been vital in improving the bone health of Benjamin who was diagnosed with Stage Three bone cancer in 2016. The disease, which had affected his left leg and weakened his bones left him unable to bear his weight and made it difficult for him to walk. \u201cTaking the supplements, which were prescribed by a doctor as part of his treatment, have significantly improved the strength of his bones,\u201d Monica says. People take supplements to get essential nutrients and improve health. On the flipside, supplements have been widely abused and sold with a false promise of being a silver bullet to all health problems. Some are marketed with exaggerated claims about their impact of treating and preventing diseases. Unlike other drugs in the country, supplements are not tightly regulated, thus it is difficult for consumers to tell apart the legitimate products from the fakes. Supplements come in form of Vitamins, minerals, proteins and amino acids, bodybuilding supplements, essential fatty acids, natural products and probiotics. Regulation gap In Kenya, they are regulated under two guidelines by the Pharmacy and Poisons Board: Guidelines for inspection of imported medical devices, food supplements, medical cosmetics, herbal products and other borderline products and registration for herbal and complimentary products. However, unlike other medicines in the country, supplements are not stringently regulated. \u201cIdeally, before any medicine is registered in the country, it undergoes tests in World Health Organisation (WHO) prequalified laboratories. It\u2019s ingredients are tested and checked for impurities before it achieves market authoritation from Pharmacy and Poisons Board (PPB),\u201d says Dr Daniella Munene, CEO Pharmaceutical Society of Kenya ( PSK) But for supplements, the board checks for expiry date, packaging and details of manufacturing. However, the body does not test and analyse the products to verify that indeed it contains the ingredients declared. This is even worse in the case of herbal products. Plant based products may have multiple compounds some of which are useful and others harmful. Experts now warn it is important to consult a doctor before starting on any supplements or better still, get nutrients from a healthy diet. \u201cIn most cases, taking supplements is unnecessary. All the nutrients and minerals that the body needs to function optimally are contained in whole foods, says Dr Ezra Omollo, general practitioner, AAR Healthcare. Most supplements in the market are considered luxury products, which are good to use, but not essential. There are, however, few supplements that are used as prescription drugs to treat certain illnesses. These types are tightly regulated. \u201cOne example is a combination of vitamins used in treatment of alcoholism and psychiatric disorders,\u201d says Dr Munene. Folic acid and iron are also prescribed during pregnancy while Vitamin A is prescribed in treatment of acne. Supplements like whey protein used by body builders is considered good to use, but not essential. Vegans, Dr Omollo says, may require taking Vitamin B12 supplements to cover up for the deficiency of the nutrients that they cannot acquire from their diet. Supplements are prescribed for people with bone conditions such as osteoporosis, arthritis or rickets. Calcium supplements are necessary in promoting bone strength. Iron supplements are also prescribed for people with anaemia. One of the ways supplements are commonly abused is in fitness and weight loss purposes. \u201cMany of the products sold under the guise of supplements to aid in fitness may be laced with steroids. If taken, the products may affect the blood sugar and affect hormones in the body,\u201d says Dr Omollo. Fitness supplements Edwin Wafula, a personal trainer and body builder says creatine and whey protein are the commonly used supplements in fitness. \u201cThere are different categories of supplements depending on the fitness goals you like to achieve,\u201d he says. Creatine and whey protein are used in losing weight and gaining muscle while Phedra-cut is used in losing weight. For effectiveness, those using supplements for fitness have to stick to a set exercise regimen and follow a diet. \u201cFor clients who wish to use the supplements, we advise them to first visit a doctor for a body check to ensure they are in good state of health,\u201d he adds. In addition to using supplements, Edwin advises his clients to take foods rich in proteins, including chicken and fish and green vegetables, especially for those keen on gaining muscle. He says\u00a0 supplements have the potential to cause adverse health effects including liver damage, irregular heartbeat, dizziness, headaches and digestive problems. A US study of dietary supplements sold between 2007 and 2016 found some contained unlisted pharmaceutical drugs, many of which could interact with other medications. Eighty six per cent of the adulterated supplements were marketed for weight loss and sexual performance, with many containing prescription erectile dysfunction medication. Muscle building supplements were contaminated with anabolic steroids, and multiple products contained antidepressants and antihistamines. Research has also disputed some of the common claims made about what supplements are capable of doing. A 2018 study published in the Journal of the American College of Cardiology found that some supplements have no effect in promoting good health while others may do more harm than good. Negative impacts The study, which reviewed previous research papers (179 in total) on supplements found that vitamin D, calcium and vitamin C have no effect in reducing premature deaths. Folic acid was found to reduce heart disease and stroke. But high levels of folic acid in the blood may increase the risk of prostate cancer. The study concluded that taking supplements cannot undo the damage of poor dietary habits. Also, it cannot replace a balanced diet and eating whole foods. \u201cEven for those prescribed by the doctor, supplements may have negative impact on health. When taken in excess, some supplements including vitamin A and iron can cause liver damage. Others may reduce the effectiveness of prescribed drugs. Vitamin C and Omega 3 supplements have been found to interfere with the effectiveness of chemotherapy while vitamin K reduces the efficacy of blood thinning drugs. Other supplements, particularly vitamins, if taken by a nursing mother may pass to the child through breast milk and cause organ damage to the baby,\u201d the study revealed. But with our busy lifestyles, finding time to get all the required nutrients into each meal isn\u2019t easy, and that\u2019s why people turn to supplements. Additionally, there have been a decline in nutritional value of foods. Several studies of fruits, vegetables and grains have suggested a decline in nutritional value over time owing to soil depletion. But there is considerable evidence that such problems may be related to changes in cultivated varieties with some high-yielding plants being less nutritious than historical varieties. Other factors include changes in farming methods, including the extensive use of chemical fertilizers, as well as food processing and preparation.