2.5: Dietary Supplements

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Learning Objectives

Understand what dietary supplements are and when they are needed.
Explain the safety and regulations of dietary supplements.

Understanding Dietary Supplements

To supplement literally means to add to complete a thing, supply a deficiency, or reinforce or extend a whole.¹ When referring to dietary supplements, the US Food and Drug Administration defines them as any substance, such as a vitamin or mineral, taken as a supplement to food to replace nutrients that would otherwise be missing in a person’s diet.² Simply stated, the main purpose of dietary supplements is to treat and prevent nutrient deficiencies if inadequate levels of nutrients are not obtained from the diet.

Because the global supplement market is worth nearly $124 billion, it is easy to assume that most adults take some sort of dietary supplement for one reason or another.³ Although many can justify their consumption, dietary supplements are not always used for the purpose intended: to enhance or supplement one’s diet.

Typically speaking, nutrients from foods are best absorbed and are complimented by additional nutrients in the foods themselves. However, a dietary supplement can be a great addition to filling in the gaps if someone is not able to consume an adequate amount of a nutrient straight from their diet. For example, if a person is allergic to milk, they might not be able to get in a sufficient amount of calcium needed to maintain bone health. Another instance in which a dietary supplement can be necessary is the extra need for folate during pregnancy, since the need for folate is so high during pregnancy.

Regulation of Dietary Supplements

When taking supplements, it is important to understand how they are regulated and how to know if they are safe. The Dietary Supplement Health and Education Act (DSHEA) of 1994 defines dietary supplements as food and not drugs. This is critical to maintaining access to high quality, natural food-supplements.⁴ It is within this act in which the US Food and Drug Administration (FDA) regulates dietary supplements. Under the directive of the FDA, it is the obligation of the manufacturers and distributors of the dietary supplements to ensure safety and proper labeling of their products put on the market. Should a claim of harm or falsification of one or more ingredients be made against a supplement, it is the FDA’s responsibility to take action in removing the product from the marketplace.

Here are some safety points for a consumer when purchasing or even considering the inclusion of a dietary supplement:

Discuss possible supplement needs with a medical provider. This helps make sure there is even a need for a supplement and to check if there is a contraindication with any already used supplements or medications. A supplement can interfere with a medication’s efficacy or can cause complications. As an example, the medication, Warfarin, is taken as a blood thinner. Vitamin K helps your blood to clot. So, taking a vitamin K supplement will have an impact on Warfarin’s action.
Manufacturers can obtain voluntary seals of approval. Independent organizations such as ConsumerLab.com, NSF International, and United States Pharmacopeia (USP) (Figure $\PageIndex{1}$) offer voluntary seals of approval if a product passes the organization's quality tests for potency and the product is free of harmful contaminants. The seals do not ensure safety or effectiveness of the product.

Figure $\PageIndex{1}$: ConsumerLab.com, NSF International, and USP Verified seals. (ConsumerLab.com; nsf.org; usp.org)

Select brands that are established. It should have been around for a while, not a “pop-up” brand. The longer it has been in the market, the more likely it has not had a claim made against it.
“Natural” on the label may not mean it is harmless. Natural substances such as arsenic, mercury, lead and others have proven to be harmful in different capacities.
Be wary of testimonials used to market supplements. A company of a dependable product can rely on the science behind its formula to “speak” on its behalf.
Consider whether the supplement's health claim is "too good to be true". A supplement is not meant to cure a disease or cause weight loss without the effort of proper diet and physical activity.
Never hesitate to contact the supplement company to ask any questions. Trustworthy companies will be forthcoming with any answers about the product.

Key Takeaways

Dietary supplements are beneficial for preventing and treating nutrient deficiencies.
The impact of a dietary supplement on currently used medications and/or supplements should be considered prior to new supplement use.
The FDA is the regulatory agency that oversees the safety and efficacy of dietary supplements in the marketplace.

References

Dictionary.com. Supplement. https://www.dictionary.com/browse/supplement?s=t. Accessed October 17, 2020.
U.S. Food & Drug Administration. Dietary Supplements. https://www.fda.gov/food/dietary-supplements. Accessed October 17, 2020.
Grand View Research. Dietary Supplements Market Size, Share & Trends Analysis Report by Ingredient (Vitamins, Minerals), By Form, By Application, By End User, By Distribution Channel, By Region, and Segment Forecasts, 2020 – 2027. https://www.grandviewresearch.com/industry-analysis/dietary-supplements-market. Accessed October 17, 2020.
Council for Responsible Nutrition. Dietary Supplement Health & Education Act (DSHEA). https://www.crnusa.org/regulation-legislation/fda-ftc-regulations/dietary-supplement-health-education-act-dshea. Accessed October 17, 2020.

Contributors

Metropolitan State University of Denver Nutrition Department: Marci Steiner