Key suppliers respond to French agency’s warning against joint supplements use

10 Apr 2019 --- Suppliers of joint health solutions have questioned a recent assessment by French authorities which claims that supplements containing glucosamine or chondroitin sulfate may cause adverse reactions among certain groups. The French Agency for Food, Environmental and Occupational Health & Safety’s (ANSES) nutrivigilance scheme is advising that certain populations, such as diabetics, avoid consuming food supplements containing the flagged ingredients. However, key players in the joint health market point to the “limited evidence available” in relation to the claims, and are keen to reassure patients that there are no safety concerns over these ingredients. They do suggest that clear-on pack labeling, as well as EU-wide regulation of certain joint health ingredients, could be useful for this growing market.

The alleged adverse reactions related to the consumption of the supplements in question reported include digestive disorders, abdominal pain, skin rashes, itching, hepatitis or purpura (lesions caused by bleeding beneath the skin). 

Synadiet, a French union for food supplements, has released a statement noting that it was anxious to “reassure the general public about the safety of glucosamine and chondroitin-targeted dietary supplements.” The French market for glucosamine and chondroitin products reaches around 2.2 million items per year, which means that the cases of proven adverse effects amount to about one per 1.8 million items sold, it says.

Glucosamine and chondroitin sulfate are molecules naturally present in the connective and cartilage tissues of the body and ensure, among other things, the structure and elasticity of cartilage, tendons and skin. These two compounds are marketed in most European countries as medications and food supplements. In France, many food supplements containing glucosamine and/or chondroitin sulfate claiming to contribute to joint comfort are available on the market. Seven out of ten consumers in Germany, France and Italy would consider purchasing a joint health product, according to Lonza.

This market is also increasingly popular as consumers see dietary supplements as a convenient and effective way to support joint health. A survey of supplement users commissioned by Swiss multinational Lonza and conducted by the Natural Marketing Institute (NMI) found that seven out of ten consumers in Germany, France and Italy would consider purchasing a joint health product. 

Joan Gispert, Bioiberica R&D Director, tells NutritionInsight that, “both glucosamine and chondroitin sulfate have been on the market for more than 20 years. They have been widely available and used both with and without medical supervision, the exposure has been huge and no significant safety signals have been apparent.”

Adverse effects and “at risk” groups
The assessment identified specific populations at risk and advised that they should not consume such products.

One such group is diabetic or pre-diabetic individuals, as well as those who are asthmatic or are treated with vitamin K antagonists (VKA). Gispert, however, says that the available evidence on this topic is extremely limited and there appears to be no reason to restrict use for these individuals. 

People with a food allergy to crustaceans or insects are also advised in the assessment to avoid glucosamine-based food supplements. As glucosamine is an ingredient extracted from shellfish, patients with an allergy must consult a physician before use, Gispert adds.

People on sodium, potassium or calcium-restricted diets should avoid the supplements as they can be an important source of these elements, notes the assessment. In response, Gispert notes, “It is not possible to generalize on this statement since there is a wide range of producers of both chondroitin and glucosamine in the market as an ingredient or marketers of food supplements. As per a company perspective, Bioiberica recommends to limit the intake of chondroitin and glucosamine in sodium-restricted diets when the ingredient is taken in the form of sodium salt.”

Pregnant or breastfeeding women, as well as children, should avoid the supplements due to insufficient data on the safety of these products, says ANSES. This recommendation is embraced by Gispert, who also notes that “both chondroitin and glucosamine would not be intended to these groups, but are aimed for aging population, sport people, elderly and menopause women with joint discomfort.”Dietary supplements should declare the quality and quantity of its ingredients, as well as the specific risk populations, experts note.

EU standardization
ANSES notes that it is necessary to standardize the maximum authorized daily doses of glucosamine and chondroitin sulfate in food supplements at a European level, based on safety data from robust safety studies – which they state are currently lacking – for these two compounds.

Speaking to NutritionInsight, Mandy Osterloh, Senior Regulatory Affairs Manager at Lonza, noted that as the market continues to grow the introduction of EU-wide regulation on certain joint health ingredients may simplify formulation and labeling for companies who are active across several countries. 

Consumers could also benefit from EU standardization, both at a level of the doses used in a specific product as already mentioned and from a quality of the ingredient perspective, adds Gispert.

Moving forward, clear on-pack labeling, alongside ongoing education and transparency on the science, will both be critical in enabling the consumer to have access to safe products that are backed by science, Osterloh adds.

“Dietary supplements should declare the quality and quantity of its ingredients, as well as the specific risk populations. The EU should ensure that they come from reliable companies working under the right quality and traceability standards to avoid health risks issues which would affect negatively the reliable industry,” Gispert concludes.

The ANSES nutrivigilance scheme was set up in 2009 to monitor adverse reactions related to the consumption of food supplements and other food products such as fortified foods and beverages.

Joint health is a major category in the changing consumer health and nutrition landscape and demand for safe and convenient products backed by science remains strong. Innova Market Insights data has shown that seven percent of UK consumers used prescription medication for bone health in the past year, while 21 percent used prescription medication for joint health. The market researcher’s data has further shown that mobility is one of the top concerns for UK and US consumers, while products featuring mobility claims accounted for almost 17 percent of all supplements tracked globally between 2013 and 2017. 

By Laxmi Haigh