Report: Inquiries to Tox Info Suisse con-cerning food supplements, slimming foods and foods for athletes, 2014–2019

The Swiss poison control centre Tox Info Suisse provides advice in cases of possible acute poisoning, including reports concerning food supplements, slimming foods and foods for athletes. To obtain an overview of reported cases, the Federal Food Safety and Veterinary Office (FSVO) asked Tox Info Suisse to evaluate the inquiries it had received over the past six years.

The number of inquiries to Tox Info Suisse has increased significantly in recent years. From 2014 to 2019, approximately 1200 reports were received. Around two thirds of these concerned the acute, unintentional intake by young children, leading to mild symptoms at worst. In cases of acute, intentional intake by adults, caffeine was the leading substance in terms of frequency and severity of symptoms (17 of the 22 moderate to severe cases involved caffeine). Two cases led to hospitalisation.

Acute caffeine intoxication

Caffeine was often consumed in sports or fitness products. The caffeine levels involved were significantly higher than the single oral dose of 200 mg per person or the dose of 400 mg per person per day from all sources, considered safe by the European Food Safety Authority (EFSA). The Swiss limits for caffeine in food supplements, sports nutrition and beverages such as energy drinks relate to the safe intake levels and are intended to protect the consumers’ health. At higher caffeine doses, particularly in combination with sports activities, the risks are uncertain. However, the current Tox Info Suisse report shows that adverse effects may occur. The maximum levels should not be exceeded. Consumers should follow the recommended doses stated on the products.

Significance of the report

The report presents an overview of cases reported to Tox Info Suisse over the past six years potentially due to acute poisoning and suspected to be connected with substance intake. However, health problems or diseases for which a possible connection with the intake of a particular substance was not recognized, e.g. due to the intake of low doses over an extended time period or the delayed onset of symptoms after a single intake, lead to hardly any reports to Tox Info Suisse. The number of reports analysed here can therefore not be viewed as representative of the actual number of cases in this area.  

Legal framework for food supplements

According to the national nutrition survey MenuCH data, around 50% of the Swiss population regularly consumes food supplements.

Food supplements are foods which, on account of their concentrated dose of ingredients as capsule, tablet or powder form, and their packaging, are presented in similar ways to medicinal products. In some cases they are advertised to improve health and quality of life, bordering on medicinal products, or are perceived as such by consumers.
Unlike medicinal products, food supplements do not undergo an official authorisation procedure, which requires that they are shown to be safe before placing them on the market. An exception applies to novel foods.

As foods, they must be safe and not pharmacologically active. In addition, their presentation, labelling and packaging must not be misleading. Safety is primarily the responsibility of manufacturers and distributors as part of their self-supervision.
Vitamins, minerals and some other substances are subject to maximum levels or other restrictions. There are also lists of plants, herbal preparations and individual substances which are banned in food due to their risks (Legal basis, in German). The cantonal enforcement authorities conduct inspections on a random basis to ensure the legal compliance of products.

Risks associated with the use of food supplements

Some countries have nutrivigilance systems that systematically record and evaluate reports from consumers, physicians, hospitals and poison control centres on adverse effects of food supplements. Switzerland has no such reporting system.

The scientific literature, nutrivigilance systems and official warnings have described adverse effects extending as far as severe kidney or liver damage, the latter e.g. in the case of certain green tea extracts. In addition, supplements may interact with medicines taken concurrently. This can be attributed, among other things, to the long-term intake of problematic substances, where effects are often not immediately perceived. A possible causal relationship with the consumption of a prob-lematic food supplement may therefore go unnoticed.

Consumers may not be sufficiently aware of potentially problematic aspects, which include:

  • substance overdosing;
  • medicinal products mislabelled as food supplements;
  • addition of undeclared, unauthorised ingredients;
  • addition of unapproved novel foods;
  • presence of contaminants;
  • acquisition from untrustworthy distributors; and
  • sales channels that are difficult to trace, e.g. the Internet.

More information

Last modification 30.06.2023

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