Herbal and other dietary supplements

1
Unit 24

• Herbal and other dietary supplements

2
True or False

• Products classified as dietary supplements
  consist of herbs and vitamins and mineral
  supplements
• False. They also include protein powders, amino
  acid and enzyme pills, fish oils and fatty acids,
  hormone extracts and other products
• Dietary supplements must be tested for safety and
  effectiveness before they can be sold.
• False. They can be sold without proof of safety
  or efficacy.

3
True or False

• Herbal remedies have been used for over a hundred
  years in Germany so they must be safe and
  effective.
• False. Results of clinical trials, and not
  historic use, are the gold standard for
  determining the safety and effectiveness of
  herbal remedies and other dietary supplements.

4
Regulation of dietary supplements

• You can call anything a dietary supplement, even
  something you grow in your back yard. -Donna
  Porter, RD, PhD
• Supplements are loosely regulated by the FDA-
  they do not have to be tested
• Although they are advertised to relieve certain
  ailments, they are not considered to be drugs,
  which are subject to vigorous testing to prove
  safety and effectiveness.

5
FDA regulations

• Supplements are considered safe until
  demonstrated to be hazardous by the FDA
• Few have been adequately tested
• Negative results in studies may not be reported
• 1993-2000- FDA received over 2800 reports of
  adverse effects of supplements, including 105
  deaths
• Must be labeled with listing of ingredients
• Health claims can be made if they meet
  regulations for nutrition labels

6
Health claims

• Improves circulation, supports the immune
  system, helps maintain mental health can be
  used
• prevents heart disease or cures depression
  cannot be used
• If a function claim is made on the label or
  package inserts, it must acknowledge that the FDA
  does not support the claim
• FTC regulates claims made in advertisements
• Neither the FDA or FTC has sufficient resources
  to monitor products

7
Vitamin and Mineral Supplements

• Multivitamin and mineral supplements
• Calcium, Vitamin E, Vitamin C, calcium or
  magnesium the most popular single supplements
• 49 of U.S. adults use them regularly
• Bioavailability uncertain, especially among
  minerals
• Some contain impurities, i.e. lead in calcium

8
USP Designation

• U. S. Pharmacopeia has tested the ingredient
  availablity for absorption, purity, and strength
• USP label does not indicate effectiveness
• USP label also present on some herbal supplements

9
Who benefits from vitamin and mineral supplements

• Vitamins and minerals prevent deficiency symptoms
  
• Fluoride- prevents tooth decay in areas where not
  present in the water
• B12, Vitamin D- Vegans who dont consume
  fortified soy or rice milk
• Iron- pregnant women, blood loss
• Folate- before and during pregnancy to reduce the
  risk of spina bifida
• Vitamin C- may reduce severity of colds
• Vitamin E- may protect lungs against air pollution

10
The Wrong Reasons

• Often used for an insurance policy against poor
  diets
• Supplements cannot make a poor diet good
• goodness of a diet mostly related to caloric,
  fat, cholesterol, fiber, water, protein and
  complex carbohydrate content
• Supplements do not contain phytochemicals
• Used as a health remedy when there is a treatment

11
Guidelines for Vitamin/Mineral supplements

• Purchase USP labeled supplements. Other terms are
  meaningless
• Check expiration date- do not use expired
  supplements
• Choose supplements with 100 DV or less
• Take with meals
• If you need an individual vitamin or mineral,
  take that one only and not a multi
• Store out of reach of children

12
Herbal Remedies

• In 2000, 12 of adults reported daily use of
  herbal supplements
• Approximately 30 of all modern drugs derived
  from plants
• Plant products known to treat disease are
  considered drugs but OTC herbs have not
• Drugs have been tested, herbs have not
• Drugs are highly regulated, herbs are not

13
Effects of herbal remedies

• Herbal remedies have side effects as well as
  proposed effects
• Benefits must outweigh the risks to be valuable
• Available evidence indicates that some herbal
  remedies are safe and effective while others are
  neither safe nor effective

14
Which supplements are potentially beneficial?

• Page 24-7 in the textbook
• Not proven but the bulk of evidence indicates
  they may be beneficial

15
Quality assurance

• U.S. Pharmacopeia- USP
• National Formulary- NP
• Consumer Laboratories- CL
• Look for USP, NP or CL on the label
• Health-related claims on supplements may or may
  not be true

16
Considering use of herbal remedies

• Dont use for self-diagnosed, serious health
  conditions
• Let your physician know what you are taking
• If taking prescriptions meds, discuss use of
  herbs with physician
• Dont use without medical advice if pregnant or
  considering pregnancy
• Check label for possible allergies
• If you have a bad reaction, stop taking
• Look for USP, NP, CL on label
• Investigate herbs before using

17
Functional Foods

• Also called neutraceuticals or designer foods
• Have been modified to enhance their contribution
  to a healthy diet
• Active-culture yogurt has been around for years
• Some have been taken off market or altered due to
  safety concerns
• No regulations but a few have been FDA- approved
  (Benecol, Nutrasweet)

18
Prebiotics and Probiotics

• Prebiotics- support the growth of beneficial
  bacteria in the gut
• Probiotics- beneficial bacteria ingested to limit
  the growth of harmful bacteria
• Much more common in Europe than in U.S.
• Appear to be safe and potentially beneficial