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nutrients. Regrettably, these studies just don't seem to get their fair share of the media spotlight.

Fact #3: FDA Provides Poor Oversight of Dietary Supplements

Supplements fall under the jurisdic-

tion of a severely budget-challenged and thus understaffed FDA that's unable to audit but a fraction of nutritional supple- ment manufacturers. This is further com- plicated by the fact that, unlike pharma- ceutical drugs, dietary supplements are not tested for safety and efficacy before they're sold; essentially deemed innocent until proven guilty.

What's more, the government strong- ly relies on manufacturers to self-comply with established CFR part lll supplement manufacturing regulations. Fortunately, most dietary supplement companies do comply and reliably produce quality prod- ucts.

The list of dietary supplement manu- facturers and product lines is vast and sales are growing exponentially, making over- sight even more difficult for chronically overstretched FDA inspectors. None of this should reassure already confused consum- ers trying to confidently make intelligent purchasing decisions.

Fact #4: Fringe Hucksters and Quacks Abound Though most dietary supplement companies do comply and reliably pro- duce quality products, there are a handful of unscrupulous manufacturers who, sadly, will continue to skirt legal require-


ments and market inferior products as long as they're able to avoid the scrutiny of the FDA.

We know that the FDA cannot possi-

bly test every dietary supplement (literally tens of thousands) or audit every manufac- turer, but, thankfully, scores of dodgy manufacturers have been reported to the agency since the Dietary Supplement Health and Education Act (DSHEA) went into effect in 1994. These unprincipled manufacturers produce dubious products. They may bring items to market that contain botanicals, mostly coming from China and often com- prising high levels of pesticides. Other supplements have been found to be con- taminated with feces and urine due to poor quality manufacturing standards. Also, there have been instances of performance- enhancing powders and supplements testing positive for anabolic steroids and other pharmaceutical agents and even dozens of additional products shown not to include the ingredients or amount of ingredients claimed on the label. Finally, a decade ago researchers tested several Ayurvedic remedies in a health food store in Boston finding that 20 percent con- tained potentially dangerous levels of mercury, arsenic and lead. Then there's a whole different body of concerns pertaining to the serious problem presented by some herb/drug combina- tions and contraindications caused by several natural agents. However, while there are plenty of reasons to be highly concerned about dietary supplements, it's critically important to keep this all in con-

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text. While the fringe elements and bad players should not be tolerated, we should keep in mind that the volume of adverse effects reported for natural products is miniscule compared to pharmaceuticals, purported to take over 100,000 American lives each year.

Fact #5: Responsible and Quality-Direct- ed Manufacturers Clearly, the reputation of an entire industry has been tainted by some bad players manufacturing and marketing in- ferior and sometimes dangerous products. However, there are many companies sell- ing carefully sourced products containing high-quality ingredients. These trustworthy companies meet sound manufacturing processes and include third party certifi- cates of cGMP compliance on their labels.

Top Quality Manufacturers Companies including Ayush Herbs,

Bio-Tech, BioClinic Naturals, Carlson, Designs For Health, Gaia Herbs, Genestra, Heel, Innate Response, Jarrow, Douglas, Klarie Labs, Metagenics, Integrative Thera- peutics, Life Extension, Nordic Naturals, Thorne Research, Perque, Protcol for Life, NOW, Pure Encapsulations, Xymogen, Vital Nutrients, Kirkman Labs, and New Chapter are among a growing group of natural product enterprises that are manu- facturing and marketing high-quality pharmaceutical grade food-based products meeting stringent content and purity veri- fication processes. Clinics, community and hospital-based systems (including aca- demic medical centers) should be working with these manufacturers to create in- house natural product dispensaries to further strengthen and evolve their integra- tive medicine service lines. Several of these companies also manufacture private label products for select retailers and physician offices. These elite 'quality-first' nutraceutical companies have been in the business for decades, effectively and consistently supporting the health of millions of consumers around the world.

Chain and Big Box Retailers Unfortunately, price trumps quality for most consumers when it comes to dietary supplements. Price-conscious buyers pa- tronizing some retailers or e-tailors may be purchasing brands featuring low poten- cies and/or containing synthetic agents

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