Are supplements supplemented? Evaluating the composition of complementary and alternative medicines using mass spectrometry and metabolomics

The complementary and alternative medicines (CAM) industry is worth over US$110 billion globally. Products are available to consumers with little medical advice; with many assuming that such products are ‘natural’ and therefore safe. However, with adulterated, contaminated and fraudulent products reported on overseas markets, consumers may be placing their health at risk. Previous studies into product content have reported undeclared plant materials, ingredient substitution, adulteration and contamination. However, no large-scale, independent audit of CAM has been undertaken to demonstrate these problems in Australia. This study aimed to investigate the content and quality of CAM products on the Australian market. 135 products were analysed using a combination of next-generation DNA sequencing and liquid chromatography-mass spectrometry. Nearly 50% of products tested had contamination issues, in terms of DNA, chemical composition or both. 5% of the samples contained undeclared pharmaceuticals. Increasing reports of adulteration with novel drug analogues led to the development of a high-throughput untargeted method for pharmacovigilance. Rapid direct sample analysis coupled to mass spectrometry was used to screen products, this time for hundreds of compounds in minutes with minimal sample preparation. The data correlated well with previous analyses, with the added benefit of detected additional compounds including phytochemicals and vitamins. Finally, metabolomics was used to assess the compositional diversity of finished herbal products on the market and how they compare to standard reference materials. The analysis iii showed that, despite all products stating the same ingredients, there was a clear difference in biochemical profile between products and also the reference materials. The combined techniques and analyses used in this project provide an audit and quality control toolkit which will allow for stronger regulation of CAM products. The data collected has shown that such regulation is needed to improve product quality and to protect consumer safety.