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A dietary supplement, also known as food supplement or nutritional supplement, is a preparation intended to supply nutrients, such as vitamins, minerals, fatty acids or amino acids, that are missing or are not consumed in sufficient quantity in a person's diet. Some countries define dietary supplements as foods, while in others they are defined as drugs.
In the United States, a dietary supplement is defined under the Dietary Supplement Health and Education Act of 1994 (DSHEA) as a product that is intended to supplement the diet and contains any of the following dietary ingredients:
- a vitamin
- a mineral
- an herb or other botanical (excluding tobacco)
- an amino acid
- a dietary substance for use by people to supplement the diet by increasing the total dietary intake, or
- a concentrate, metabolite, constituent, extract, or combination of any of the above
Furthermore, it must also conform to the following criteria:
- intended for ingestion in pill, capsule, tablet, powder or liquid form
- not represented for use as a conventional food or as the sole item of a meal or diet
- labeled as a "dietary supplement"
Pursuant to the DSHEA, the Food and Drug Administration (FDA) regulates dietary supplements as foods, and not as drugs. While pharmaceutical companies are required to prove the safety or effectiveness of their products, until recently supplement manufacturers were not, and the FDA could take action only after a dietary supplement had been proven harmful. However, new FDA rules will, by June 2010, ensure that all production of dietary supplements must comply with current good manufacturing practices, and be manufactured with "controls that result in a consistent product free of contamination, with accurate labeling." In addition, the industry is now required to report to the FDA "all serious dietary supplement related adverse events."
The DSHEA, passed in 1994, was the subject of lobbying efforts by the manufacturers of dietary supplements. At the time of its passage DSHEA received strong support from consumer grassroots organizations, and Members of Congress. In recognition of this, President Bill Clinton, on signing DSHEA into law, stated that "After several years of intense efforts, manufacturers, experts in nutrition, and legislators, acting in a conscientious alliance with consumers at the grassroots level, have moved successfully to bring common sense to the treatment of dietary supplements under regulation and law." He also noted that the passage of DSHEA "speaks to the diligence with which an unofficial army of nutritionally conscious people worked democratically to change the laws in an area deeply important to them" and that "In an era of greater consciousness among people about the impact of what they eat on how they live, indeed, how long they live, it is appropriate that we have finally reformed the way Government treats consumers and these supplements in a way that encourages good health."
Popular support may have been based on a misunderstanding of the situation after the deregulation of the supplement industry. A large survey by the AARP, for example, found that 77% of respondents (including both users and non-users of supplements) believed that the federal government should review the safety of dietary supplements and approve them before they can be marketed to consumers. In an October 2002 nationwide Harris poll, 59% of respondents believed that supplements had to be approved by a government agency before they could be marketed; 68% believed that supplements had to list potential side effects on their labels; and 55% believed that supplement labels could not make claims of safety without scientific evidence. All of these beliefs were incorrect as a result of provisions of the DSHEA.
A 2001 study, published in Archives of Internal Medicine, found broad public support for greater governmental regulation of dietary supplements than was currently permitted by DSHEA. The researchers found that a majority of Americans supported pre-marketing approval by the FDA, increased oversight of harmful supplements, and greater scrutiny of the truthfulness of supplement label claims.
The claims that a dietary supplement makes are essential to its classification. If a dietary supplement claims to cure, mitigate, or treat a disease, it would be considered to be an unauthorized new drug and in violation of the applicable regulations and statutes. As the FDA states it in a response to this question in a FAQ:
Is it legal to market a dietary supplement product as a treatment or cure for a specific disease or condition?
No, a product sold as a dietary supplement and promoted on its label or in labeling* as a treatment, prevention or cure for a specific disease or condition would be considered an unapproved--and thus illegal--drug. To maintain the product's status as a dietary supplement, the label and labeling must be consistent with the provisions in the Dietary Supplement Health and Education Act (DSHEA) of 1994.
*Labeling refers to the label as well as accompanying material that is used by a manufacturer to promote and market a specific product.
Dietary supplements are permitted to make structure/function claims. These are broad claims that the product can support the structure or function of the body (e.g., "glucosamine helps support healthy joints", "the hormone melatonin helps establish normal sleep patterns"). The FDA must be notified of these claims within 30 days of their first use, and there is a requirement that these claims be substantiated.
Other claims that required approval from FDA include health claims and qualified health claims. Health claims are permitted to be made if they meet the requirements for the claims found in the applicable regulations. Qualified health claims can be made through a petition process, including scientific information, if FDA has not approved a prior petition.
The Food Supplements Directive requires that supplements be demonstrated to be safe, both in quantity and quality. Some vitamins are essential in small quantities but dangerous in large quantities, notably Vitamin A. Consequently, only those supplements that have been proven to be safe may be sold without prescription. In practice, however, there appears to be little risk to supplement users of experiencing adverse side effects due to excessive intakes of micronutrients.
In Europe, it is also an established view that food supplements should not be labeled with drug claims but can bear health claims, although to a degree that differs from one member state to the other.
The dietary supplements industry in the UK, one of the 27 countries in the European Union, strongly opposed the Directive. In addition, a large number of consumers throughout Europe, including over one million in the UK, and many doctors and scientists, have signed petitions against what are viewed by the petitioners as unjustified restrictions of consumer choice. In 2004, along with two British trade associations, the Alliance for Natural Health had a legal challenge to the European Union's Food Supplements Directive referred to the European Court of Justice by the High Court in London. Although the European Court of Justice's Advocate General subsequently said that the EU's plan to tighten rules on the sale of vitamins and food supplements should be scrapped, he was eventually overruled by the European Court, which decided that the measures in question were necessary and appropriate for the purpose of protecting public health. ANH, however, interpreted the ban as applying only to synthetically produced supplements - and not to vitamins and minerals normally found in or consumed as part of the diet. Nevertheless, the European judges did acknowledge the Advocate General's concerns, stating that there must be clear procedures to allow substances to be added to the permitted list based on scientific evidence. They also said that any refusal to add a product to the list must be open to challenge in the courts.
Russian legislation, Ministry of Health's order number 117 dated as of 15 April 1997, under the title "Concerning the procedure for the examination and health certification of Biologically Active Dietary Supplements", provides the usage of the following terminology:
- As a rule, BADSs are foodstuffs with clinically proven effectiveness. BADSs are recommended not only for prophylactics, but can be included into a complex therapy for the prevention of pharmaceutical therapy's side effects and for the achievement of complete remission.
The development of BADSs and their applications has been very fast moving. They were originally considered as dietary supplements for people who had heightened requirements for some normal dietary components (for example, sportsmen). Later, they were employed as preventive medicines against chronic diseases.
- Alternative medicine
- Essential nutrient
- Food additives
- Food preferences
- Medicinal herbs and plants
- Megavitamin therapy
- Nutritional genomics
- Orthomolecular medicine
- Naturopathic medicine
- Codex Guidelines for Vitamin and Mineral Food Supplements Accessed 27 December 2007
- US Dietary Supplement Health and Education Act of 1994
- Over-the-counter DHEA hormonal therapy may be an effective treatment for depression. News-Medical.net. URL accessed on 2008-06-25.
- Sleep Aids And Stimulants. MedicineNet.com. URL accessed on 2008-06-25.
- Goldman P (2001). Herbal medicines today and the roots of modern pharmacology. Ann. Intern. Med. 135 (8 Pt 1): 594–600.
- U.S. Food and Drug Administration (2007-06-22). FDA Issues Dietary Supplements Final Rule. Press release. Retrieved on 2008-09-10.
- Nutritional Supplements: Your Questions Answered. From Consumer Reports magazine, published 14 June 2006. Accessed 2 February 2007.
- "Beyond Ephedra", by Leon Jaroff. Published in Time magazine 10 February 2004. Accessed 2 February 2007.
- The American Presidency Project, University of California, Santa Barbara. William J. Clinton: Statement on Signing the Dietary Supplement Health and Education Act of 1994; October 25th, 1994. From the website of The American Presidency Project, University of California, Santa Barbara. Accessed 9 February 2007.
- Dietary Supplements and Older Consumers From the AARP website. Published December 2001. Accessed 2 February 2007.
- "Dangerous Supplements: Still at Large, from Consumer Reports magazine. Published May 2004, accessed 7 February 2007.
- Blendon RJ, DesRoches CM, Benson JM, Brodie M, Altman DE (2001). Americans' views on the use and regulation of dietary supplements. Arch. Intern. Med. 161 (6): 805–10.
- Directive 2002/46/EC of the European Parliament and of the Council of 10 June 2002 on the approximation of the laws of the Member States relating to food supplements
- The efficacy and safety of nutritional supplement use in a representative sample of adults in the North/South Ireland Food Consumption Survey Public Health Nutrition, Volume 4, Special Issue 5a, October 2001, pp. 1089-1097(9). Published October 2001. Accessed 14 December 2007.
- "Controversial EU vitamins ban to go ahead" (the Times, July 12 2005)
- EU Food Supplements Directive
- 'Court victory for vitamin firms' BBC News Published 30 January 2004. Accessed 29 April 2007.
- 'EU health foods crackdown 'wrong BBC News. Published 5 April 2005. Accessed 29 April 2007.
- 'Vitamin controls backed by Europe' BBC News. Published 12 July 2005. Accessed 29 April 2007.
- 'EU court backs health supplements ban' The Guardian Published 12 July 2005. Accessed 6 October 2007.
- Dietary Supplements: General Resources for Consumers (PDF|131 KB), Food and Nutrition Information Center, National Agricultural Library. List of resources that provides an overview of herbal and dietary supplements, including use, regulation, research, and cautionary information.
- Questions to Ask Before Taking Vitamin and Mineral Supplements, Nutrition.gov.
- International Bibliographic Information on Dietary Supplements database from the U.S. National Institutes of Health Office of Dietary Supplements and USDA National Agricultural Library
- Dietary Supplement Information from the U.S. Food and Drug Administration
- What's in the Bottle? An Introduction to Dietary Supplements, from the U.S. National Center for Complementary and Alternative Medicine
- Safety information on herbal supplements, from the U.S. National Institutes of Health
- Use of Complementary and Alternative Medicine (CAM) by the American Public: A report of the Institute of Medicine
- Botanical Medicines: The Need for New Regulations, from the New England Journal of Medicine
- EPC Evidence Reports on Dietary Supplements
Retinol (Vitamin A) •
B vitamins: Thiamine (B1) •
Pantothenic acid (B5)•
Folic acid (B9) •
Cyanocobalamin (B12) •
Ascorbic acid (Vitamin C) •
Ergocalciferol and Cholecalciferol (Vitamin D) •
Tocopherol (Vitamin E) •
Naphthoquinone (Vitamin K) •
Other Common Ingredients
Chondroitin sulfate •
Cod liver oil •
Copper gluconate •
Dietary fiber •
Elemental calcium •
Fish oil •
Folic acid •
Iron supplements •
Japanese Honeysuckle •
Krill oil •
Linseed oil •
Red yeast rice •
Royal jelly •
Saw Palmetto •
Spirulina (dietary supplement) •
Zinc gluconate •