based on the most appropriate supplement, at the best dose and formulation for the clinical indication. Avoid supplements that add “window dressing”, or small amounts of an ingredient for marketing purposes but not enough to make a clinical or health impact.
The Gold Standard In addition to, “what individual or spe-
Navigating the Nutritional Supplement Industry
By Eric R. Secor, Jr. PhD, ND
utritional supplements remain one of the most popular integrative medicine treatment modalities used throughout the United States. Adult cancer survivors alone spend approximately $6.7 billion on vitamins/minerals each year, whereas the general public averages $12.8 billion on natural product supplements and $2.7 billion on self-care products. According to the American Botanical Council, “herbal” sales totaled $7.0 billion in 2015, a new record. The industry has a complex history and the medical acceptance of supplements is even more complicated. With supplements being imported, manufactured, marketed and sold in a wide range of products through a variety of media and sales outlets, it’s challenging to keep pace with the potential benefi ts of the tried and true and the dangers of infomercial night-owls. When my patients and colleagues ask me if Nutritional/Dietary Supplements are safe my answer is, “gener- ally yes but…” The goal of the following discussion is to make us all better, wiser and safer consumers of Nutritional Supplements (NS) so we can take full advantage of the health benefi ts while minimizing the poten- tial for unwanted side effects and loss of time and money.
N
What’s in a Name & Government Oversight: The term Nutritional or Dietary Supple-
ment was brought in to the mainstream by the “Dietary Supplement Health Education Act” (DSHEA), which was sponsored by Senator Orin Hatch from Utah in 1994. The key aspects of DSHEA defi ne a nutritional supplement as a product: • Intended to supplement the diet • Containing one or more dietary ingredi- ents (vitamins, minerals, herbs or other
24 Natural Nutmeg - March 2017
botanicals, plant or part of a plant used for its fl avor, scent, or potential therapeu- tic properties and may include fl owers, leaves, bark, fruit, seeds, stems, and roots, amino acids, and certain other substanc- es) or their constituents • Intended to be taken by mouth, in forms such as tablet, capsule, powder or liquid • Labeled as being a supplement.
There is considerable confusion in regards to regulation, industry oversight and the transition between food and highly extracted and concentrated, “drug-like” supplements. Under DSHEA the Food and Drug Administration (FDA) regulates supplements as food and its primary meth- ods of enforcement include inspections of facilities and ensuring that manufacturers follow good manufacturing (GMP) prac- tices. The Federal Trade Commission (FTC) provides oversight of label claims and false advertising. The natural products industry is largely “self-regulated” and its goal is the manufacture and sale of safe products that support health and wellness, not to have unrepeatable companies fi ned for misguid- ed practices.
Both FDA and FTC weigh in on the
validity of label claims which must not be false or misleading, and must be based upon reliable scientifi c evidence and clini- cal studies (when available). It should be noted that both FDA and FTC as well as case law allows and protects “key ingredi- ent claims” which are based on effi cacy testing of key product ingredients as op- posed to requiring testing of the full multi- ingredient fi nished product. So keep this in mind when comparing products and choose
cifi c supplement should I be taking to sup- port or improve my specifi c condition”, the most common question I get from patients is “how can I ensure that the supplements I’m buying are safe and of the best qual- ity?” My ultimate test is to be an educated consumer and ask for verifi cation (a copy of the report results) of the quality control test- ing for the specifi c products or “lot“ you are using and/ or want to purchase. Many of the supplement raw materials are imported from companies that grow and process individual ingredients outside the United States. These companies provide a certifi cate of analysis (COA), or stamp of authenticity that says you can trust me, “We grew, processed and tested the material and it is free of any con- taminants.” The FDA requirements mandate that testing is required for product: authen- ticity, potency, microbiology and stability. Often the only thing separating the fi nished and bottled product is the recipe, dose and the degree of testing completed by the local US companies. You should be assured that products are free of heavy metals, chemical solvents, pesticides, PCBs, afl atoxins, fungi- cides and that oils are not rancid.
All reputable companies and manu- facturers conduct comprehensive qual- ity control (Q/C) testing on the individual ingredients and the fi nished products of each lot they use. If you and/or your health care team ask for the Q/C testing and it shows up, this is a good indication that you have a quality product from a reputable company. If it doesn’t then it’s your choice to trust them. Use a reputable company that provides this information and one that does not conduct “skip lot testing” or merely relies on the ven- dors COA. You want to be assured that the curcumin (Curcuma Longa, Turmeric spice) you’re taking to provide a mild anti-infl am- matory effect indeed is 500mg of rhizome extract and contains 85-90% curcuminoids as opposed to yellow pigmented, processed saw dust.
Categories to Avoid:
A majority of potentially harmful supple- ments fall into 3 categories: weight loss, sexual enhancement and sports/stimulants. So the good news if you avoid these classes you’ll greatly reduce the likelihood of taking an unknown drug (which has been added to
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