Contamination and adulteration of food supplements: Risk perception and regulatory awareness in recreational athletes

There is growing concern about the toxicological risks resulting from the contamination and adulteration of food supplements (FS), which may pose significant health hazards. Heavy metals, undeclared pharmaceuticals, stimulants, and other contaminants have been identified in FS. This study evaluated recreational athletes' perceptions and awareness of FS safety, including contamination risk and potential health consequences. A cross-sectional study was conducted among 303 gym-goers, using structured face-to-face interviews. Approximately 72% of participants reported FS use, predominantly men. Most respondents perceived themselves as informed, yet 95% were unable to identify the regulatory definition of FS correctly. Nearly half demonstrated limited awareness of market control and regulatory oversight. Differences emerged between FS users and non-users. As such, non-users showed greater awareness of potential interactions with medicines and were more likely to attribute broader functional roles to FS and expressed greater concern regarding overdose risk. In turn, users recognised the possibility of undeclared or prohibited substances more frequently. Contaminated FS were most often associated with cardiovascular, hepatic, and hormonal concerns. Overall, recreational athletes demonstrated substantial knowledge gaps regarding FS safety and regulation. These findings highlight the need for targeted education and risk communication strategies aligned with toxicological evidence to support safer supplementation practices.