If you haven't taken a supplement today, chances are you will in the near future. A 2009 Council for Responsible Nutrition (CRN) survey found that 65 percent of American adults regularly take supplements. And according to Nutrition Business Journal research, U.S. sales of dietary supplements grew 6 percent last year—despite the recession. A mounting body of scientific evidence demonstrating the health benefits of supplements has buoyed those sales. Case in point: vitamin D. No doubt you've heard that supplementing with the vitamin—which a staggering 70 percent of American children are deficient in—can strengthen the immune system and help prevent serious health issues such as osteoporosis, certain types of cancer, and high blood pressure.
Still, some reports may leave you feeling that investing in supplements simply isn't worth the cash layout—or worse, the potential health risks. What's more, although supplements are regulated by the U.S. government, some critics contend that current regulation does not do enough to protect consumers (see "U.S. Supplement Regulation," below). "A number of recent episodes have called the quality of dietary supplements into question, such as weight loss supplements containing prescription medications," says John Atwater, PhD, director of verification programs for the United States Pharmacopeia (USP), a Rockville, Maryland-based nonprofit scientific organization that certifies the quality of dietary supplements. In other instances, certain supplements have been found to not contain the amount of nutrients listed on their labels. "These episodes do not represent the industry as a whole," Atwater says. "However, they illustrate the importance of being an informed consumer, and [of] making the right choices for you and your family." Here are five steps to finding the right supplements and trustworthy brands.
Naturopathic physicians undergo years of training in pharmacology and botanical medicine, so they are particularly well versed in explaining what supplements will best support a person's specific health needs and goals. Discuss possible supplement-drug interactions, and ask which product brands they trust and why, says Lise Alschuler, ND, president of the American Association of Naturopathic Physicians. "Most people can benefit from some nutrient supplementation, but what is needed varies from person to person," Alschuler adds. An ND or other health practitioner will ask detailed questions and can do blood tests to help determine the optimal supplementation regimen for you.
Natural products stores also can provide a wealth of information. Many retailers train their staff on specific products and brands. Ask the salesperson which brands the store has carried the longest and why and how it decides which products to sell. Many stores will only carry supplements that are manufactured using the FDA or NPA (Natural Products Association) good manufacturing practices (GMPs) and that are supported by clinical research.
Steer clear of supplements that do not include the following information on their labels: a statement of identity, including the product brand and a description of what it is; a supplement facts panel, which lists all ingredients (including binders, fillers, colors, and flavors) and, when applicable, the ingredients' percent daily values; units per container, serving size, and dose instructions; allergen warnings and other precautions; expiration date (make sure you'll have enough time to use the product before it expires); a DSHEA disclaimer (see "U.S. Supplement Regulation," below), which explains that the FDA has not evaluated the claims published on the label; and a lot number and company contact information, which can be used to report any adverse events associated with the product.
Finding the NSF International or USP seal on a supplement can be a good indication of quality because both confirm that the product or its manufacturing facility was inspected by an independent certification organization. According to USP's Atwater, the USP Verified mark indicates that the product contains the ingredients listed on the label in the declared amounts; does not contain harmful levels of specified contaminants; will break down and release into the body within a specified amount of time; and has been made according to GMPs. Only a small number of dietary supplements sold in the United States contain a quality seal from third-party organizations such as USP, NSF, or NPA. Even so, Andrew Shao, PhD, vice president of scientific and regulatory affairs at CRN, contends that products without such seals can be high-quality and safe. That said, third-party seals make it easy to quickly distinguish quality brands.
If a product claims to mitigate, prevent, treat, or cure any disease—ranging from the common cold to cancer—it is illegally labeled. "If it's advertised as a magic bullet or a cure for disease, that should be a red flag for consumers," Shao says. DSHEA allows supplement companies to make only what are called "structure/function" claims, which might include statements such as "helps maintain a healthy cholesterol level." Under DSHEA, it is legal to say a supplement "supports a healthy immune system," but the statement "prevents H1N1 infection" or "prevents colds" is not. Pay attention to such labeling distinctions because a company that willingly and knowingly mislabels a product is more likely to cut corners on ingredient and manufacturing quality, Alschuler says.
Contrary to some recent news reports, dietary supplements are regulated by the U.S. government—but supplement regulations are different from drug regulations. Signed into law in 1994, the Dietary Supplement Health and Education Act (DSHEA) created the legal and regulatory framework for dietary supplements, which the FDA defines as products taken orally that contain ingredients—such as vitamins, minerals, or botanicals—intended to supplement a person's diet. Unlike drug companies, dietary supplement companies do not need to go through an FDA premarket approval process before putting a product on store shelves. However, DSHEA does require companies to submit a new dietary ingredient notification 75 days prior to going to market, which acts as a form of premarket approval by including an ingredient safety review by the FDA.
DSHEA also requires manufacturers to register with the FDA and adhere to the agency's supplement good manufacturing practices (GMPs), a set of quality-control guidelines. Unveiled in 2007, supplement GMPs were rolled out to the largest manufacturers in 2008 and will go into effect for all supplement makers in June of this year. The FDA inspects every supplement maker annually to make sure they are following GMPs and, under the Obama administration, the agency is already stepping up efforts to enforce GMPs and other aspects of DSHEA.
Through its mandatory adverse-event reporting requirements, which went into effect in December 2007 for all companies selling supplements in the United States, the FDA keeps tabs on whether specific products are connected to negative health incidents. The rules require companies to notify the FDA of any serious adverse-event reports they receive from consumers about their products within 15 days. Companies must keep records of all adverse-event reports for six years. Iovate Health Sciences' May 2009 recall of its Hydroxycut weight loss supplements was triggered after the company notified the FDA of 23 reports of serious health problems—including jaundice, liver damage, and one death—in people who had taken the popular weight loss pills. This is evidence that dietary supplement regulations work to protect consumers, says Andrew Shao, PhD, vice president of scientific and regulatory affairs at the Council for Responsible Nutrition (CRN), a Washington, DC-based supplement trade association.