A dietary supplement is a manufactured product intended to supplement
the diet when taken by mouth as a pill, capsule, tablet, or liquid.
A supplement can provide nutrients either extracted from food sources
or synthetic, individually or in combination, in order to increase the
quantity of their consumption. The class of nutrient compounds
includes vitamins, minerals, fiber, fatty acids and amino acids.
Dietary supplements can also contain substances that have not been
confirmed as being essential to life, but are marketed as having a
beneficial biological effect, such as plant pigments or polyphenols.
Animals can also be a source of supplement ingredients, as for example
collagen from chickens or fish. These are also sold individually and
in combination, and may be combined with nutrient ingredients. In the
United States and Canada, dietary supplements are considered a subset
of foods, and are regulated accordingly. The
European Commission has
also established harmonized rules to help insure that food supplements
are safe and properly labeled. Among other countries, the
definition of dietary supplements may vary as drugs or other classes
of ingredients used in supplement products.
Creating an industry estimated to have a 2015 value of $37 billion,
there are more than 50,000 dietary supplement products marketed just
in the United States, where about 50% of the American adult
population consumes dietary supplements. Multivitamins are the most
commonly used product. For those who fail to consume a balanced
National Institutes of Health
National Institutes of Health states that
certain supplements "may have value."
In the United States, it is against federal regulations for supplement
manufacturers to claim that these products prevent or treat any
disease. Companies are allowed to use what is referred to as
"Structure/Function" wording if there is substantiation of scientific
evidence for a supplement providing a potential health effect. An
example would be "_____ helps maintain healthy joints", but the label
must bear a disclaimer that the
Drug Administration (FDA)
"has not evaluated the claim and that the dietary supplement product
is not intended to "diagnose, treat, cure or prevent any disease,"
because only a drug can legally make such a claim. The FDA enforces
these regulations, and also prohibits the sale of supplements and
supplement ingredients that are dangerous, or supplements not made
according to standardized good manufacturing practices (GMPs).
2.2 Dietary minerals
2.3 Proteins and amino acids
2.5 Essential fatty acids
2.6 Natural products
4.2 Litigation against false health claims
5 Adverse effects
6 Society and culture
6.1 Public health
6.2 Legal regulation
6.2.1 United States
6.2.2 European Union
7.2 Quality and safety
7.3 Population monitoring
7.4 Clinical studies
7.5 Absence of benefit
8 See also
10 Further reading
11 External links
In the United States, the Dietary Supplement
Health and Education Act
of 1994 provides this description: "The Dietary Supplement
Education Act of 1994 (DSHEA) defines the term “dietary
supplement” to mean a product (other than tobacco) intended to
supplement the diet that bears or contains one or more of the
following dietary ingredients: a vitamin, a mineral, an herb or other
botanical, an amino acid, a dietary substance for use by man to
supplement the diet by increasing the total dietary intake, or a
concentrate, metabolite, constituent, extract, or combination of any
of the aforementioned ingredients. Furthermore, a dietary supplement
must be labeled as a dietary supplement and be intended for ingestion
and must not be represented for use as conventional food or as a sole
item of a meal or of the diet. In addition, a dietary supplement
cannot be approved or authorized for investigation as a new drug,
antibiotic, or biologic, unless it was marketed as a food or a dietary
supplement before such approval or authorization. Under DSHEA, dietary
supplements are deemed to be food, except for purposes of the drug
Per DSHEA, dietary supplements are consumed orally, and are mainly
defined by what they are not: conventional foods (including meal
replacements), medical foods, preservatives or pharmaceutical
drugs. Products intended for use as a nasal spray, or topically, as a
lotion applied to the skin, do not qualify. FDA-approved drugs cannot
be ingredients in dietary supplements. Supplement products are or
contain vitamins, nutritionally essential minerals, amino acids,
essential fatty acids and non-nutrient substances extracted from
plants or animals or fungi or bacteria, or in the instance of
probiotics, are live bacteria.
Dietary supplement ingredients may also
be synthetic copies of naturally occurring substances (example:
melatonin). All products with these ingredients are required to be
labeled as dietary supplements. Like foods and unlike drugs, no
government approval is required to make or sell dietary supplements;
the manufacturer confirms 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, such assessment is
only used by the FDA to decide that a dietary supplement is unsafe and
should be removed from market.
Pharmacies and supermarkets in the U.S. sell a large variety of
vitamin dietary supplements
Main article: Vitamin
A vitamin is an organic compound required by an organism as a vital
nutrient in limited amounts. 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. The term is conditional both on the
circumstances and on the particular organism. For example, ascorbic
acid (vitamin C) is a vitamin for anthropoid primates, humans, guinea
pigs and bats, but not for other mammals.
Vitamin D is not an
essential nutrient for people who get sufficient exposure to
ultraviolet light, either from the sun or an artificial source, as
then they synthesize vitamin D in skin. Humans require thirteen
vitamins in their diet, most of which are actually groups of related
molecules, "vitamers", (e.g. vitamin E includes tocopherols and
tocotrienols, vitamin K includes vitamin K1 and K2). The list:
vitamins A, C, D, E, K,
Pantothenic Acid (B5),
Folate (B9) and
Vitamin intake below recommended amounts can result in
signs and symptoms associated with vitamin deficiency. There is little
evidence of benefit when consumed as a dietary supplement by those who
are healthy and consuming a nutritionally adequate diet.
The U.S. Institute of Medicine sets Tolerable upper intake levels
(ULs) for some of the vitamins. This does not prevent dietary
supplement companies from selling products with content per serving
higher than the ULs. For example, the UL for vitamin D is 100 µg
(4,000 IU), but products are available without prescription at
Minerals are the exogenous chemical elements indispensable for life.
Four minerals: carbon, hydrogen, oxygen, and nitrogen, are essential
for life but are so ubiquitous in food and drink that these are not
considered nutrients and there are no recommended intakes for these as
minerals. The need for nitrogen is addressed by requirements set for
protein, which is composed of nitrogen-containing amino acids. Sulfur
is essential, but for humans, not identified as having a recommended
intake per se. Instead, recommended intakes are identified for the
sulfur-containing amino acids methionine and cysteine. There are
dietary supplements which provide sulfur, such as taurine and
The essential nutrient minerals for humans, listed in order by weight
needed to be at the
Recommended Dietary Allowance or Adequate Intake
are potassium, chlorine, sodium, calcium, phosphorus, magnesium, iron,
zinc, manganese, copper, iodine, chromium, molybdenum, selenium and
cobalt (the last as a component of vitamin B12). There are other
minerals which are essential for some plants and animals, but may or
may not be essential for humans, such as boron and silicon. Essential
and purportedly essential minerals are marketed as dietary
supplements, individually and in combination with vitamins and other
Although as a general rule, dietary supplement labeling and marketing
are not allowed to make disease prevention or treatment claims, the
U.S. FDA has for some foods and dietary supplements reviewed the
science, concluded that there is significant scientific agreement, and
published specifically worded allowed health claims. An initial ruling
allowing a health claim for calcium dietary supplements and
osteoporosis was later amended to include calcium supplements with or
without vitamin D, effective January 1, 2010. Examples of allowed
wording are shown below. In order to qualify for the calcium health
claim, a dietary supplement much contain at least 20% of the Reference
Dietary Intake, which for calcium means at least
"Adequate calcium throughout life, as part of a well-balanced diet,
may reduce the risk of osteoporosis."
"Adequate calcium as part of a healthful diet, along with physical
activity, may reduce the risk of osteoporosis in later life."
"Adequate calcium and vitamin D throughout life, as part of a
well-balanced diet, may reduce the risk of osteoporosis."
"Adequate calcium and vitamin D as part of a healthful diet, along
with physical activity, may reduce the risk of osteoporosis in later
In the same year, the
European Food Safety Authority
European Food Safety Authority also approved a
dietary supplement health claim for calcium and vitamin D and the
reduction of the risk of osteoporotic fractures by reducing bone
loss. The U.S. FDA also approved Qualified
Health Claims (QHCs)
for various health conditions for calcium, selenium and chromium
picolinate. QHCs are supported by scientific evidence, but do not
meet the more rigorous “significant scientific agreement” standard
required for an authorized health claim. If dietary supplement
companies choose to make such a claim then the FDA stipulates the
exact wording of the QHC to be used on labels and in marketing
materials. The wording can be onerous: "One study suggests that
selenium intake may reduce the risk of bladder cancer in women.
However, one smaller study showed no reduction in risk. Based on these
studies, FDA concludes that it is highly uncertain that selenium
supplements reduce the risk of bladder cancer in women."
Proteins and amino acids
Protein (nutrient) and Amino acid
Protein-containing supplements, either ready-to-drink or as powders to
be mixed into water, are marketed as aids to people recovering from
illness or injury, those hoping to thwart the sarcopenia of old
age, to athletes who believe that strenuous physical activity
increases protein requirements, to people hoping to lose weight
while minimizing muscle loss, i.e., conducting a protein-sparing
modified fast, and to people who want to increase muscle size for
performance and appearance. Whey protein is a popular
ingredient, but products may also incorporate casein, soy,
pea, hemp or rice protein.
According to US & Canadian
Dietary Reference Intake guidelines,
Recommended Dietary Allowance (RDA) for adults is based on
0.8 grams protein per kilogram body weight. The recommendation is for
sedentary and lightly active people. Scientific reviews
can conclude that a high protein diet, when combined with exercise,
will increase muscle mass and strength, or conclude the
opposite. The International Olympic Committee recommends protein
intake targets for both strength and endurance athletes at about
1.2-1.8 g/kg body mass per day. One review proposed a maximum
daily protein intake of approximately 25% of energy requirements,
i.e., approximately 2.0 to 2.5 g/kg.
The same protein ingredients marketed as dietary supplements can be
incorporated into meal replacement and medical food products, but
those are regulated and labeled differently from supplements. In the
United States, "meal replacement" products are foods and are labeled
as such. These typically contain protein, carbohydrates, fats,
vitamins and minerals. There may be content claims such as "good
source of protein", "low fat" or "lactose free." Medical foods,
also nutritionally complete, are designed to be used while a person is
under the care of a physician or other licensed healthcare
professional. Liquid medical food products - example Ensure -
are available in regular and high protein versions.
Proteins are chains of amino acids. Nine of these proteinogenic amino
acids are considered essential for humans because they cannot be
produced from other compounds by the human body and so must be taken
in as food. Recommended intakes, expressed as milligrams per kilogram
of body weight per day, have been established. Other amino acids
may be conditionally essential for certain ages or medical conditions.
Amino acids, individually and in combinations, are sold as dietary
supplements. The claim for supplementing with the branched chain amino
acids leucine, valine and isoleucine is for stimulating muscle protein
synthesis. A review of the literature concluded this claim was
unwarranted. In elderly people, supplementation with just leucine
resulted in a modest (0.99 kg) increase in lean body mass.
The non-essential amino acid arginine, consumed in sufficient amounts,
is thought to act as a donor for the synthesis of nitric oxide, a
vasodilator. A review confirmed blood pressure lowering. Taurine,
a popular dietary supplement ingredient with claims made for sports
performance, is technically not an amino acid. It is synthesized in
the body from the amino acid cysteine.
This section is transcluded from
Bodybuilding supplements. (edit
Bodybuilding supplements are dietary supplements commonly used by
those involved in bodybuilding, weightlifting, mixed martial arts, and
athletics for the purpose of facilitating an increase in lean body
mass. The intent is to increase muscle, increase body weight, improve
athletic performance, and for some sports, to simultaneously decrease
percent body fat so as to create better muscle definition. Among the
most widely used are high protein drinks, branched-chain amino acids
(BCAA), glutamine, arginine, essential fatty acids, creatine, HMB,
and weight loss products. 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 the frequency of use will differ when used
specifically by bodybuilders. One meta-analysis concluded that for
athletes participating in resistance exercise training and consuming
protein supplements for an average of 13 weeks, total protein
intake up to 1.6 g/kg of body weight per day would result in an
increase in strength and fat-free mass, i.e. muscle, but that higher
intakes would not further contribute. The muscle mass increase was
statistically significant but modest - averaging 0.3 kg for all
trials and 1.0–2.0 kg, for protein intake
As of 2010,[update] annual sales of sport nutrition products in the
United States was over US$2.7 billion according to a publication
by Consumer Reports.
Essential fatty acids
Main article: Essential fatty acids
Fish oil is a commonly used fatty acid supplement because it is a
source of omega-3 fatty acids. Fatty acids are strings of carbon
atoms, having a range of lengths. If links are all single (C-C), then
the fatty acid is called saturated; with one double bond (C=C), it is
called monounsaturated; if there are two or more double bonds (C=C=C),
it is called polyunsaturated. Only two fatty acids, both
polyunsaturated, are considered essential to be obtained from the
diet, as the others are synthesized in the body. The "essential" fatty
acids are alpha-linolenic acid (ALA), an omega-3 fatty acid, and
linoleic acid (LA), an omega-6 fatty acid. ALA can be
elongated in the body to create other omega-3 fatty acids:
eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
Plant oils, particularly seed and nut oils, contain ALA. Food
sources of EPA and DHA are oceanic fish, whereas dietary supplement
sources include fish oil, krill oil and marine algae extracts. The
European Food Safety Authority
European Food Safety Authority (EFSA) identifies 250 mg/day for a
combined total of EPA and DHA as Adequate Intake, with a
recommendation that women pregnant or lactating consume an additional
100 to 200 mg/day of DHA. In the
United States and Canada are
Adequate Intakes for ALA and LA over various stages of life, but there
are no intake levels specified for EPA and/or DHA.
Supplementation with EPA and/or DHA does not appear to affect the risk
of death, cancer or heart disease. Furthermore, studies of
fish oil supplements have failed to support claims of preventing heart
attacks or strokes. In 2017, the American Heart Association issued
a science advisory stating that it could not recommend use of omega-3
fish oil supplements for primary prevention of cardiovascular disease
or stroke, although it reaffirmed supplementation for people who have
a history of coronary heart disease.
Main article: Natural product
See also: Phytochemical, Herbalism, and Traditional Chinese medicine
St. John's wort petals used in natural product supplements
Dietary supplements can be manufactured using intact sources or
extracts from plants, animals, algae, fungi or lichens, including such
examples as ginkgo biloba, curcumin, cranberry, St. John’s wort,
ginseng, resveratrol, glucosamine and collagen. Products
bearing promotional claims of health benefits are sold without
requiring a prescription in pharmacies, supermarkets, specialist
shops, military commissaries, buyers clubs, direct selling
organizations, and the internet. While most of these products have
a long history of use in herbalism and various forms of traditional
medicine, concerns exist about their actual efficacy, safety and
consistency of quality. Canada has published a
manufacturer and consumer guide describing quality, licensing,
standards, identities, and common contaminants of natural
products. In 2016, sales of herbal supplements just in the United
States were $7.5 billion, with the market growing at about 8% per
year. Italy, Germany and Eastern European countries were leading
consumers of botanical supplements in 2016, with
European Union market
growth forecast to be $8.7 billion by 2020.
Main article: Probiotic
In humans, the large intestine is host to more than 1,000 species of
microorganisms, mostly bacteria, numbering in the tens of
trillions. "Probiotic" in the context of dietary supplements is
the theory that by orally consuming specific live bacteria (or yeast)
species, it is possible to influence the large intestine microbiota,
with consequent health benefits. Although there are numerous claimed
benefits of using probiotic supplements, such as maintaining
gastrointestinal health, in part by lowering risk of and severity of
constipation or diarrhea, and improving immune health, including lower
risk of and severity of acute upper respiratory tract infections,
i.e., the common cold, such claims are not all supported by sufficient
clinical evidence. A review based on interviews with
dozens of experts in microbiome research expressed concern about
"...how biomedical research is co-opted by commercial entities that
place profit over health." The concern is timely, as through 2021,
probiotic supplements are expected to be the fastest growing segment
of the dietary supplement market worldwide, while at the same time,
the global health benefits market for probiotic-containing yogurt (a
food, not a dietary supplement) is declining.
As with all dietary supplements, in the
United States inappropriate
label health claims such as preventing or treating disease are opposed
by the FDA and deceptive advertisements by the Federal Trade
Probiotic foods and dietary supplements are allowed to
make claims using Structure:Function vocabulary as long as human trial
evidence is adequate. In 2005, the FDA issued a Warning Letter to UAS
Laboratories for disease treatment claims (colds, flu, ulcers,
elevated blood cholesterol, colon cancer...). The company revised
label and website content and continued to sell the product. In
2011 the company was found to have resumed the label and website
claims, and the FDA seized product and stopped production. In 2010
a FTC action was brought against a probiotic food company for
exaggerated health claims, resulting in a multimillion-dollar fine and
revisions to future advertising. In the
European Union a more
restrictive approach has been taken by the EFSA. All proposed health
claims were rejected on the grounds that the science was not
sufficient, and no health claims are permitted. Foods with live
microorganisms (yogurt, kefir) can be sold, but without
Probiotic supplements are generally regarded as safe. The greatest
concern, evidenced by reviews reporting on case studies, is that for
people with compromised gut wall integrity there may be a risk of
systemic infection. For this reason, probiotic research is expected to
exclude bacteria species that are antibiotic resistant.
In 2015, the American market for dietary supplements was valued at $37
billion, with the economic impact in the
United States for 2016
estimated at $122 billion, including employment wages and taxes.
One 2016 analysis estimated the total market for dietary supplements
could reach $278 billion worldwide by 2024.
Over the period 2008 to 2011, the Government Accountability Office
(GAO) of the
United States received 6,307 reports of health problems
(identified as adverse events) from use of dietary supplements
containing a combination of ingredients in manufactured vitamins,
minerals or other supplement products, with 92% of tested herbal
supplements containing lead and 80% containing other chemical
contaminants. Using undercover staff, the GAO also found that
supplement retailers intentionally engaged in "unequivocal deception"
to sell products advertised with baseless health claims, particularly
to elderly consumers.
Consumer Reports also reported unsafe levels
of arsenic, cadmium, lead and mercury in several protein powder
Canadian Broadcasting Corporation
Canadian Broadcasting Corporation (CBC) reported
that protein spiking, i.e., the addition of amino acids to manipulate
protein content analysis, was common. Many of the companies
involved challenged CBC's claim.
A 2013 study on herbal supplements found that many products were of
low quality, one third did not contain the active ingredient(s)
claimed, and one third contained unlisted substances. In a genetic
analysis of herbal supplements, 78% of samples contained animal DNA
that was not identified as an ingredient on the product labels. In
some botanical products, undeclared ingredients were used to increase
the bulk of the product and reduce its cost of manufacturing, while
potentially violating certain religious and/or cultural limitations on
consuming animal ingredients, such as cow, buffalo or deer. In
2015, the New York
Attorney General identified four major retailers
with dietary supplement products that contained fraudulent and
potentially dangerous ingredients, requiring the companies to remove
the products from retail stores.
Litigation against false health claims
Drug Administration, Office of Inspections,
Compliance, Enforcement, and Criminal Investigations, monitors
supplement products for accuracy in advertising and labeling, and when
finding violations, warns manufacturers of impending enforcement
action, including search and seizure, injunction, and/or financial
penalties, such as for a
Maine supplement company in 2017. The
United States Federal Trade Commission, which litigates against
deceptive advertising, established a consumer center to assist
reports of false health claims in product advertising for dietary
supplements, and, in 2017, successfully sued nine manufacturers
for deceptive advertising of dietary supplements.
In the United States, manufacturers of dietary supplements are
required to demonstrate safety of their products before approval is
granted for commerce. Despite this caution, numerous adverse
effects have been reported, including muscle cramps, hair loss,
joint pain, liver disease, and allergic reactions, with 29% of the
adverse effects resulting in hospitalization, and 20% in serious
injuries or illnesses. By more than five-fold, the highest
incidence of health problems derived from "combination products",
whereas supplements for vitamins and minerals, lipid products, and
herbal products were less likely to cause adverse effects.
Among general reasons for the possible harmful effects of dietary
supplements are: a) absorption in a short time, b) manufacturing
quality and contamination, and c) enhancing both positive and negative
effects at the same time. The incidence of liver injury from
herbal and dietary supplements is about 16–20% of all supplement
products causing injury, with the occurrence growing globally over the
early 21st century. The most common liver injuries from weight
loss and bodybuilding supplements involve hepatocellular damage with
resulting jaundice, and the most common supplement ingredients
attributed to these injuries are green tea catechins, anabolic
steroids, and the herbal extract, aegeline. Weight loss
supplements have also had adverse psychiatric effects.
Society and culture
Work done by scientists in the early 20th century on identifying
individual nutrients in food and developing ways to manufacture them
raised hopes that optimal health could be achieved and diseases
prevented by adding them to food and providing people with dietary
supplements; while there were successes in preventing vitamin
deficiencies, and preventing conditions like neural tube defects by
supplementation and food fortification with folic acid, no targeted
supplementation or fortification strategies to prevent major diseases
like cancer or cardiovascular diseases have proved successful.
For example, while increased consumption of fruits and vegetables are
related to decreases in mortality, cardiovascular diseases and
cancers, supplementation with key factors found in fruits and
vegetable, like antioxidants, vitamins, or minerals, do not help and
some have been found to be harmful in some cases. In general
as of 2016, robust clinical data is lacking, that shows that any kind
of dietary supplementation does more good than harm for people who are
healthy and eating a reasonable diet but there is clear data showing
that dietary pattern and lifestyle choices are associated with health
As a result of the lack of good data for supplementation and the
strong data for dietary pattern, public health recommendations for
healthy eating urge people to eat a plant-based diet of whole foods,
minimizing processed food, salt and sugar and to get exercise daily,
and to abandon Western pattern diets and a sedentary
Main article: Regulation of food and dietary supplements by the U.S.
The regulation of food and dietary supplements by the U.S.
Drug Administration is governed by various statutes enacted by the
United States Congress
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
Dietary supplement manufacture is required to comply with the good
manufacturing practices established in 2007. The FDA can visit
manufacturing facilities, send Warning Letters if not in
compliance with GMPs, stop production, and if there is a health risk,
require that the company conduct a recall.
The European Union's (EU)
Food Supplements Directive of 2002 requires
that supplements be demonstrated to be safe, both in dosages and in
purity. Only those supplements that have been proven to be safe
may be sold in the EU without prescription. As a category of food,
food supplements cannot be labeled with drug claims but can bear
health claims and nutrition claims.
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. In 2004, along with
two British trade associations, the Alliance for Natural
had a legal challenge to the
Food Supplements Directive referred
European Court of Justice
European Court of Justice by the High Court in London.
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, 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. 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.
Examples of ongoing government research organizations to better
understand the potential health properties and safety of dietary
supplements are the European
Food Safety Authority, the Office of
Dietary Supplements of the
United States National Institutes of
Health, the Natural and Non-prescription
Directorate of Canada, and the Therapeutic Goods Administration
of Australia. Together with public and private research groups,
these agencies construct databases on supplement properties, perform
research on quality, safety, and population trends of supplement use,
and evaluate the potential clinical efficacy of supplements for
maintaining health or lowering disease risk.
As continual research on the properties of supplements accumulates,
databases or fact sheets for various supplements are updated
regularly, including the Dietary Supplement Label Database, Dietary
Supplement Ingredient Database, and Dietary Supplement Facts
Sheets of the United States. In Canada where a license is issued
when a supplement product has been proven by the manufacturer and
government to be safe, effective and of sufficient quality for its
recommended use, an eight-digit Natural Product Number is assigned and
recorded in a Licensed Natural
Health Products Database. The
European Food Safety Authority
European Food Safety Authority maintains a compendium of botanical
ingredients used in manufacturing of dietary supplements.
In 2015, the Australian Government's Department of
the results of a review of herbal supplements to determine if any were
suitable for coverage by health insurance. Establishing
guidelines to assess safety and efficacy of botanical supplement
European Medicines Agency
European Medicines Agency provided criteria for
evaluating and grading the quality of clinical research in preparing
monographs about herbal supplements. In the United States, the
National Center for Complementary and Integrative
Health of the
National Institutes of Health
National Institutes of Health provides fact sheets evaluating the
safety, potential effectiveness and side effects of many botanical
Quality and safety
To assure supplements have sufficient quality, standardization, and
safety for public consumption, research efforts have focused on
development of reference materials for supplement manufacturing and
monitoring. High-dose products have received research
attention, especially for emergency situations such as
vitamin A deficiency in malnutrition of children, and for women
taking folate supplements to reduce the risk of breast cancer.
In the United States, the National
Survey (NHANES) has investigated habits of using dietary supplements
in context of total nutrient intakes from the diet in adults and
children. Over the period of 1999 to 2012, use of multivitamins
decreased, and there was wide variability in the use of individual
supplements among subgroups by age, sex, race/ethnicity, and
educational status. Particular attention has been given to use of
folate supplements by young women to reduce the risk of fetal neural
Research initiatives to improve knowledge of the possible health
benefits of supplementing with essential nutrients to lower disease
risk have been extensive. As examples, just in 2017 were reviews on
vitamin D, providing evidence for protection against acute respiratory
iron, to deter maternal iron deficiency anemia and adverse effects on
folate, to lower the risk of stroke and cardiovascular disease
multiple supplements for which there was no evidence of benefit to
lower risk of death, cardiovascular disease or cancer
A 2017 review indicated a rising incidence of liver injury from use of
herbal and dietary supplements, particularly those with steroids,
green tea extract, or multiple ingredients.
Absence of benefit
The potential benefit of using essential nutrient dietary supplements
to lower the risk of diseases has been refuted by findings of no
effect or weak evidence in numerous clinical reviews, such as for
cardiovascular diseases, cancer, HIV, or
Improving public information about use of dietary supplements involves
investments in professional training programs, further studies of
population and nutrient needs, expanding the database information,
enhancing collaborations between governments and universities, and
translating dietary supplement research into useful information for
consumers, health professionals, scientists, and policymakers.
Future demonstration of efficacy from use of dietary supplements
requires high-quality clinical research using rigorously-qualified
products and compliance with established guidelines for reporting of
clinical trial results (e.g., CONSORT guidelines).
Health and Education Act of 1994
Dietary Supplements (database) (PubMed)
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chemical elements ("minerals")
Pantothenic acid (B5)
Folic acid (B9)
Ascorbic acid (
Ergocalciferol and Cholecalciferol (
Other common ingredients
Cod liver oil
Grape seed extract
Red yeast rice
St John's wort
Very low calorie
Gluten-free and casein-free
List of diets
5 A Day
Dairy Council of California
Fruits & Veggies – More Matters
Healthy eating pyramid
Latin American Diet Pyramid
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Health and fitness portal