June 3, 2011

Do Your Homework Before Taking Supplements - P2

Now that I have covered manufacturer seals and the lack of significant backing for them, we need to cover the supplements and the cautions put out by the National Institutes of Health.

"Supplement is a broad term that includes vitamins, minerals, herbs and botanicals," says Carol Haggans, a registered dietician and science and health communication consultant for the Office of Dietary Supplements of the National Institutes of Health.
“Herbs and botanicals are derived from plants, while other supplements may include animal sources. Vitamins are essential nutrients made up of organic compounds, while minerals are an imprecise term for certain chemical elements necessary to life, like calcium.”

"They're regulated under the umbrella of foods and are not intended to treat, diagnose, mitigate, cure or prevent disease. If something claims to do that, then it becomes a drug under FDA regulation," Haggans says.

This last statement is where things fall through the cracks of oversight. Too many claims that should bring supplements under FDA regulations go uninvestigated. The manufacturers have learned over time where the line is and don't cross the line. They leave that up to the stores to have leaflets and pamphlets available for customers making these claims. Then if a complaint is filed, they can righteously claim not to have made any such statements.

Haggans adds, "The FDA has instituted 'good manufacturing practices' (GMP) that manufacturers must follow to ensure the identity and quality of supplements and they can take enforcement action if it's unsafe or unfit for human consumption, but they do not routinely test products." Once manufacturers implement these practices, they can display a seal on their packaging, noting their compliance. The problem with this is that the FDA has not issued regulations outlining the GMPs. People think that because congress authorized this, that it must be so.

To be clear about this, the Dietary Supplement Health and Education Act of 1994 (DSHEA) authorized but did not require the FDA to adopt new federal regulations for GMPs for dietary supplements. Under DSHEA, the FDA can issue GMP regulations for dietary supplements that are modeled after food GMPs. To this day, the FDA has not issued any regulations about GMPs.

Like drugs, supplements can combine with other medications in unhealthy ways. "Dietary supplements can interact with both over-the-counter and prescription medication," Haggans says. "That's one reason we tell people to talk with their doctors about all the supplements that they're taking." For example, the anticoagulant medicine warfarin (Coumadin) can interact with gingko biloba and with garlic and cause bleeding. St. John's wort, which is often used to treat depression, can weaken the effects of birth control pills and other medications. Vitamins C and E can also potentially interfere with chemotherapy used to treat cancer.

Doctors might not know about interactions between supplements and prescriptions and since supplement labels don't list warnings, patients need to do their own research: look for guidance from the sites listed in the resource section and talk to a nutritionist or check with reliable sources at "health food" stores or reputable "wellness" centers. This is a situation where watching carefully for side effects is especially important and consumers are mostly on their own to be vigilant.

Some supplements can be monitored by testing blood levels. This can be expensive but it might also reduce problems related to potential toxicity or unusual individual reactions. Check with your doctor to see if blood tests might be suitable for you.

Where can consumers get information? Check with the Office of Dietary Supplements, the National Center for Complementary and Alternative Medicine, and the Memorial Sloan-Kettering Cancer Center. Both keep regularly updated fact sheets on the most commonly used herbs, supplements and vitamins.

Read this article about the supplements.

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