Dietary supplement

Dietary supplement

Dietary supplement
From Wikipedia, the free encyclopedia
“Food supplement” redirects here. For food additions that alter the flavor, color or longevity of food, see Food additive.
File:CT image stack of a multivitamin tablet by Abtei, Germany.ogvPlay media
Flight through a CT image stack of a multivitamin tablet “A-Z” by German company Abtei.
See also: Bodybuilding supplement

A dietary supplement is intended to provide nutrients that may otherwise not be consumed in sufficient quantities.

Supplements as generally understood include vitamins, minerals, fiber, fatty acids, or amino acids, among other substances. U.S. authorities define dietary supplements as foods, while elsewhere they may be classified as drugs or other products.

There are more than 50,000 dietary supplements available. More than half of the U.S. adult population (53% – 55%) consume dietary supplements with most common ones being multivitamins.[1][2]

These products are not intended to prevent or treat any disease and in some circumstances are dangerous, according to the U.S. National Institutes of Health. For those who fail to consume a balanced diet, the agency says that certain supplements “may have value.”[3]

Most supplements should be avoided, and usually people should not eat micronutrients except people with clearly shown deficiency.[4] Those people should first consult a doctor.[5] An exception is vitamin D, which is recommended in Nordic countries[6] due to weak sunlight.

Contents

1 Definition
2 Medical uses
3 Types of dietary supplements
3.1 Vitamins
3.2 Dietary element
3.3 Herbal medicine
3.4 Amino acids and proteins
3.5 Essential fatty acids
3.6 Bodybuilding supplement
4 Contraindications
5 Adverse effects
6 Physical and chemical properties
6.1 Adulteration
7 Society and culture
7.1 Use as food replacement
7.2 Legal regulation
7.2.1 United States
7.2.2 Regulation in European Union
8 Research
9 See also
10 References
11 Further reading
12 External links

Definition

According to the United States Food and Drug Administration (FDA), dietary supplements are products which are not pharmaceutical drugs, food additives like spices or preservatives, or conventional food, and which also meet any of these criteria:[7]

The product is intended to supplement a person’s diet, despite it not being usable as a meal replacement.[7]
The product is or contains a vitamin, dietary element, herb used for herbalism or botanical used as a medicinal plant, amino acid, any substance which contributes to other food eaten, or any concentrate, metabolite, ingredient, extract, or combination of these things.[7]
The product is labeled as a dietary supplement.[7]

In the United States, the FDA has different monitoring procedures for substances depending on whether they are presented as drugs, food additives, food, or dietary supplements.[7] Dietary supplements are eaten or taken by mouth, and are regulated in United States law as a type of food rather than a type of drug.[8] Like food and unlike drugs, no government approval is required to make or sell dietary supplements; the manufacturer checks the safety of dietary supplements but the government does not; and rather than requiring risk–benefit analysis to prove that the product can be sold like a drug, risk–benefit analysis is only used to petition that food or a dietary supplement is unsafe and should be removed from market.[7]
Medical uses

The intended use of dietary supplements is to ensure that a person gets enough essential nutrients.[9]

Dietary supplements should not be used to treat any disease or as preventive healthcare.[10] An exception to this recommendation is the appropriate use of vitamins.[10]

Dietary supplements are unnecessary if one eats a balanced diet.[11]

Supplements may create harm in several ways, including over-consumption, particularly of minerals and fat-soluble vitamins which can build up in the body.[12] The products may also cause harm related to their rapid absorption in a short period of time, quality issues such as contamination, or by adverse interactions with other foods and medications.[13]
Types of dietary supplements

There are many types of dietary supplements.
Vitamins
Main article: Vitamin

Vitamin is an organic compound required by an organism as a vital nutrient in limited amounts.[14] An organic chemical compound (or related set of compounds) is called a vitamin when it cannot be synthesized in sufficient quantities by an organism, and must be obtained from the diet. Thus, the term is conditional both on the circumstances and on the particular organism. For example, ascorbic acid (vitamin C) is a vitamin for humans, but not for most other animals. Supplementation is important for the treatment of certain health problems but there is little evidence of benefit when used by those who are otherwise healthy.[15]
Dietary element
Main article: Dietary element

Dietary elements, commonly called “dietary minerals” or “minerals”, are the chemical elements required by living organisms, other than the four elements carbon, hydrogen, nitrogen, and oxygen present in common organic molecules. The term “dietary mineral” is archaic, as the substances it refers are chemical elements rather than actual minerals.
Herbal medicine
Main article: Herbalism

Herbal medicine is the use of plants for medicinal purposes. Plants have been the basis for medical treatments through much of human history, and such traditional medicine is still widely practiced today. Modern medicine recognizes herbalism as a form of alternative medicine, as the practice of herbalism is not strictly based on evidence gathered using the scientific method. Modern medicine, does, however, make use of many plant-derived compounds as the basis for evidence-tested pharmaceutical drugs, and phytotherapy works to apply modern standards of effectiveness testing to herbs and medicines that are derived from natural sources. The scope of herbal medicine is sometimes extended to include fungal and bee products, as well as minerals, shells and certain animal parts.
Amino acids and proteins
Main articles: Amino acid and Protein (nutrient)

Amino acids are biologically important organic compounds composed of amine (-NH2) and carboxylic acid (-COOH) functional groups, along with a side-chain specific to each amino acid. The key elements of an amino acid are carbon, hydrogen, oxygen, and nitrogen, though other elements are found in the side-chains of certain amino acids.

Amino acids can be divided into three categories: essential amino acids, non-essential amino acids, and conditional amino acids. Essential amino acids cannot be made by the body, and must be supplied by food. Non-essential amino acids are made by the body from essential amino acids or in the normal breakdown of proteins. Conditional amino acids are usually not essential, except in times of illness, stress, or for someone challenged with a lifelong medical condition[citation needed].
Essential fatty acids
Main article: Essential fatty acids

Essential fatty acids, or EFAs, are fatty acids that humans and other animals must ingest because the body requires them for good health but cannot synthesize them.[16] The term “essential fatty acid” refers to fatty acids required for biological processes but does not include the fats that only act as fuel.
Bodybuilding supplement
Main article: Bodybuilding supplement

Bodybuilding supplements are dietary supplements commonly used by those involved in bodybuilding and athletics. Bodybuilding supplements may be used to replace meals, enhance weight gain, promote weight loss or improve athletic performance. Among the most widely used are vitamin supplements, protein, branched-chain amino acids (BCAA), glutamine, essential fatty acids, meal replacement products, creatine, weight loss products and testosterone boosters. Supplements are sold either as single ingredient preparations or in the form of “stacks” – proprietary blends of various supplements marketed as offering synergistic advantages. While many bodybuilding supplements are also consumed by the general public their salience and frequency of use may differ when used specifically by bodybuilders.
Contraindications

According to University of Helsinki food safety professor Marina Heinonen, more than 90% of dietary supplement health claims are incorrect.[17]
Adverse effects
some products make extraordinary claims and contain active chemicals which may not be tested by science

The number of incidents of liver damage from dietary supplements has tripled in a decade. Most of the supplements were bodybuilding supplements. Some of the patients require liver transplants and some die. In third of the supplements involved contained unlisted steroids.[18]
Physical and chemical properties
Adulteration

BMC Medicine published a study on herbal supplements. Most of the supplements studied were of low quality, a third did not contain the herb claimed at all, e.g., rice power or laxative. A third contained unlisted substances.[19][20]

Some supplements were contamined by rodent feces and urine.[21]

Only 0.3% of the 55,000 U.S. market dietary supplements were studied so that their common side effects are known.[18]
Society and culture
Use as food replacement

In early 20th century there were great hopes for supplements, but later research has shown these hopes were unfounded.[22]

“Antioxidant paradox” means the fact that even though fruits and vegetables are related to decreases in mortality, cardiovascular diseases and cancers, antioxidant nutrients do not really seem to help. According to one theory, this is because some other nutrients would be the important ones.[23][24] Multivitamin pills have neither proved useful[4] but may even increase mortality.[25]

Omega-3 fatty acids and fish oils from food are very healthy, but fish oil supplements are recommended only for those suffering from coronary artery diseases and not eating fish. Latest research has made the benefits of the supplements questionable even for them. Contrary to claims, fish oils do not decrease cholesterol but may even raise the “bad” LDL cholesterol and cause other harms. Also the use of cod liver oil is criticized by scientists.[26]

Alice Lichtenstein, DSc, chairwoman of the American Heart Association (AHA) says that even though omega-3 fatty acids from foods are healthy, the same is not shown in studies on omega-3 supplements. Therefore one should not eat fish oil supplements unless one suffers from heart diseases.[27]
Legal regulation
United States
Main article: Regulation of food and dietary supplements by the U.S. Food and Drug Administration

The regulation of food and dietary supplements by the U.S. Food and Drug Administration is governed by various statutes enacted by the United States Congress and interpreted by the U.S. Food and Drug Administration (“FDA”). Pursuant to the Federal Food, Drug, and Cosmetic Act (“the Act”) and accompanying legislation, the FDA has authority to oversee the quality of substances sold as food in the United States, and to monitor claims made in the labeling about both the composition and the health benefits of foods.

Substances which the FDA regulates as food are subdivided into various categories, including foods, food additives, added substances (man-made substances which are not intentionally introduced into food, but nevertheless end up in it), and dietary supplements. The specific standards which the FDA exercises differ from one category to the next. Furthermore, the FDA has been granted a variety of means by which it can address violations of the standards for a given category of substances.
Regulation in European Union

The European Union’s Food Supplements Directive of 2002 requires that supplements be demonstrated to be safe, both in dosages and in purity.[28] Only those supplements that have been proven to be safe may be sold in the bloc without prescription. As a category of food, food supplements cannot be labeled with drug claims but can bear health claims and nutrition claims.[29]

The dietary supplements industry in the United Kingdom (UK), one of the 28 countries in the bloc, strongly opposed the Directive. In addition, a large number of consumers throughout Europe, including over one million in the UK, and various doctors and scientists, had signed petitions by 2005 against what are viewed by the petitioners as unjustified restrictions of consumer choice.[30]

In 2004, along with two British trade associations, the Alliance for Natural Health (ANH) had a legal challenge to the Food Supplements Directive[31] referred to the European Court of Justice by the High Court in London.[32]

Although the European Court of Justice’s Advocate General subsequently said that the bloc’s plan to tighten rules on the sale of vitamins and food supplements should be scrapped,[33] 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.[34]

Nevertheless, the European judges acknowledged 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 the product to the list must be open to challenge in the courts.[35]
Research

Effects of most dietary supplements have not been determined in randomized clinical trials and manufacturing is lightly regulated; randomized clinical trials of certain vitamins and antioxidants have found increased mortality rates.[36][37]
See also

Bodybuilding supplement
Essential nutrient
Food fortification
Megavitamin therapy
Nutraceutical
Nutritional genomics
Dietary Supplement Act of 1992
Multivitamin
Superfood
Dietary Supplements (database) (PubMed)

References

Park, Madison. “Half of Americans use supplements”. CNN. Retrieved 3 October 2013.
Grace, Emily. “How to choose the best supplement”. Health Beacon. Retrieved 3 October 2013.
Staff, FDA/ FDA FAQ’s on Dietary Supplements
Guallar E, Stranges S, Mulrow C, Appel LJ, Miller ER (December 2013). “Enough is enough: Stop wasting money on vitamin and mineral supplements”. Ann. Intern. Med. (Editorial) 159 (12): 850–1. doi:10.7326/0003-4819-159-12-201312170-00011. PMID 24490268.
Questions To Ask Before Taking Vitamin and Mineral Supplements, Nutrition.gov, accessed 2013-12-22.
New Nordic Nutrition Recommendations: Focus on quality and the whole diet, Norden.org 03.10.2013.
See Dietary Supplement Health and Education Act of 1994, which includes a definition.
Committee on the Framework for Evaluating the Safety of Dietary Supplements, Food and Nutrition Board, Board on Life Sciences, Institute of Medicine and National Research Council of the National Academies (2004). Dietary supplements a framework for evaluating safety. Washington, D.C.: National Academies Press. p. ES-1-ES-3. ISBN 0-309-09206-X.
Food and Drug Administration (20 March 2014). “Q&A on Dietary Supplements”. fda.gov. Retrieved 26 June 2014.
Food and Drug Administration (11 May 2014). “Consumers – Dietary Supplements: What You Need to Know”. fda.gov. Retrieved 26 June 2014.
American College of Medical Toxicology; American Academy of Clinical Toxicology (February 2013), “Five Things Physicians and Patients Should Question”, Choosing Wisely: an initiative of the ABIM Foundation (American College of Medical Toxicology and American Academy of Clinical Toxicology), retrieved 5 December 2013, which cites
Woodward, KN (May 2005). “The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products.”. Human & Experimental Toxicology 24 (5): 219–33. doi:10.1191/0960327105ht529oa. PMID 16004184.
De Smet, PA (Aug 1995). “Health risks of herbal remedies.”. Drug safety : an international journal of medical toxicology and drug experience 13 (2): 81–93. doi:10.2165/00002018-199513020-00003. PMID 7576267.
Farah, MH; Edwards, R; Lindquist, M; Leon, C; Shaw, D (Mar 2000). “International monitoring of adverse health effects associated with herbal medicines.”. Pharmacoepidemiology and drug safety 9 (2): 105–12. doi:10.1002/(SICI)1099-1557(200003/04)9:2<105::AID-PDS486>3.0.CO;2-2. PMID 19025809.
“The Truth Behind the Top 10 Dietary Supplements”. Webmd.com. Retrieved 2012-12-05.
“The Truth Behind the Top 10 Dietary Supplements”. Webmd.com. 2009-06-30. Retrieved 2012-12-05.
Ermak G., “Modern Science & Future Medicine (second edition)”, 164 p., 2013
Lieberman, S and Bruning, N (1990). The Real Vitamin & Mineral Book. NY: Avery Group, 3, ISBN 0-89529-769-8
Fortmann, SP; Burda, BU; Senger, CA; Lin, JS; Whitlock, EP (Nov 12, 2013). “Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force.”. Annals of internal medicine 159 (12): 824–34. doi:10.7326/0003-4819-159-12-201312170-00729. PMID 24217421.
Robert S. Goodhart and Maurice E. Shils (1980). Modern Nutrition in Health and Disease (6th ed.). Philadelphia: Lea and Febinger. pp. 134–138. ISBN 0-8121-0645-8.
Ravintolisissä paljon humpuukia, Yle.fi 17.10.2012.
Spike in Harm to Liver Is Tied to Dietary Aids, The New York Times, December 21, 2013.
O’CONNOR, ANAHAD. “Herbal Supplements Are Often Not What They Seem”. New York Times. Retrieved 12 November 2013.
Newmaster, Steven G; Grguric, Meghan; Shanmughanandhan, Dhivya; Ramalingam, Sathishkumar; Ragupathy, Subramanyam (2013). “DNA barcoding detects contamination and substitution in North American herbal products”. BMC Medicine 11: 222. doi:10.1186/1741-7015-11-222. PMC 3851815. PMID 24120035.
Skip the Supplements, Paul A. Offit, chief of the division of infectious diseases at the Children’s Hospital of Philadelphia, and Sarah Erush, the clinical manager in the pharmacy department of the Children’s Hospital of Philadelphia. The New York Times, December 14, 2013.
Lichtenstein, Alice H.; Russell, Robert M. (2005). “Essential Nutrients: Food or Supplements?”. JAMA 294 (3): 351–8. doi:10.1001/jama.294.3.351. PMID 16030280.
intake of vitamin e and other antioxidant nutrients in early life and the development of advanced ß-cell autoimmunity and clinical type 1 diabetes, Liisa Uusitalo, National institute for health and Welfare, Helsinki, Finland, and Tampere school of public health, University of Tampere, Finland, 2009, page 74.
Halliwell, B (2013). “The antioxidant paradox: Less paradoxical now?”. British Journal of Clinical Pharmacology 75 (3): 637–44. doi:10.1111/j.1365-2125.2012.04272.x. PMC 3575931. PMID 22420826..
Tutkimus: Ravintolisä- ja vitamiinivalmisteista ei juuri hyötyä, Helsingin Sanomat, 10.10.2011.
Kannattaako kalaöljyvalmisteita syödä?, Helsingin Sanomat 3.12.2012.
The Truth Behind the Top 10 Dietary Supplements, Kathleen M. Zelman, MPH, RD, LD, Reviewed by Brunilda Nazario, MD, WebMD, page 5. Accessed 2012-12-22.
“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”. Eur-lex.europa.eu. Retrieved 2012-12-05.
“European Commission website: Food Safety – Labelling & Nutrition – Health & Nutrition Claims”. Ec.europa.eu. Retrieved 2012-12-05.
“Controversial EU vitamins ban to go ahead”. Timesonline.co.uk. 2005-07-012. Retrieved 2012-12-05.
European Food Commission page of Food Supplements
“‘Court victory for vitamin firms’”. BBC News. 2004-01-30. Retrieved 2012-12-05.
“‘EU health foods crackdown ‘wrong””. BBC News. 2005-04-05. Retrieved 2012-12-05.
“‘Vitamin controls backed by Europe’”. BBC News. 2005-07-12. Retrieved 2012-12-05.
“‘EU court backs health supplements ban’”. Guardian. 2005-07-12. Retrieved 2012-12-05.
Staff, National Public Radio. May 30, 2010 GAO Finds Many Claims About Supplements Mislead
Paul Offit for The Atlantic. July 19, 2013 The Vitamin Myth: Why We Think We Need Supplements

Further reading

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.
Dietary Supplement Fact Sheets, NIH Office of Dietary Supplements.

External links

Dietary Supplements Labels Database, from the United States National Library of Medicine
PubMed Dietary Supplement Subset from the U.S. National Institutes of Health Office of Dietary Supplements and United States National Library of Medicine
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
Marcus DM, Grollman AP (December 2002). “Botanical medicines–the need for new regulations”. The New England Journal of Medicine 347 (25): 2073–6.