September 11, 2016

Problems When Patients Hide Supplements – Part 3

Part 3 of 7 parts.

When you read the label of dietary supplements, there is not much to tell you if the quality is good, if there is small amounts of prescription drugs included, or even if the ingredients are correct. The amount of quality control depends on the manufacturer, the supplier of the ingredients, and the workers on the production line.

It is important to know that in 2007, the Food and Drug Administration (FDA) issued the Good Manufacturing Practices (GMPs) for dietary supplements. The GMP is a set of requirements and expectations by which dietary supplements must be manufactured, prepared, and stored to ensure quality. All manufacturers are expected to guarantee the identity, purity, strength, and composition of their dietary supplements.

The goal of the GMP is to prevent the inclusion of the wrong ingredients, the addition of too much or too little of a dietary ingredient, the possibility of contamination (by pesticides, bacteria, heavy metals such as lead, etc.), and the improper packaging and labeling of a product.

The widely inclusive definition of dietary supplements makes assessment of user prevalence difficult. Whereas some authors limit their description of supplement use to multivitamins and minerals, others include herbals and botanicals as well. It is recommended that providers consider all dietary supplements, minerals, vitamins, and herbals that patients might be taking.

The most often quoted rates of supplement use in the United States are from the National Health and Nutrition Examination Survey (NHANES) data. Estimates of supplement use by adults range from 50%-80%. Supplement use is higher in white and Asian populations, in those with high household incomes, and in college-educated persons. Women and older individuals tend to use supplements more often. Other factors related to supplement use include lean or normal body mass index, moderate to vigorous recreational physical activity, no use of tobacco products, and moderate ingestion of distilled spirits and wine.

More than 40% of the population report taking multivitamins, the most common vitamin product used. More than 20% of the population also report use of vitamins C and E, and 10% report use of vitamin B. Vitamin D use has increased in recent years because evidence suggests that it may be essential to health beyond calcium homeostasis.

Calcium is the most commonly used mineral, with up to 50% of the population reporting use when antacid/calcium combinations are considered. The next most commonly used mineral is iron. Herbals used by more than 5% of the population include echinacea, garlic, ginkgo, ginseng, glucosamine, fish oil, flax seed oil, and St. John's wort. Use of all food supplements is increasing in most age groups in the United States.

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