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Part of the book series: Nutrition and Health ((NH))

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Abstract

Hope springs eternal in the human breast

A. Pope, Essay on man, Epistle i.

Dietary supplements refer to any substance taken in addition to regular food. Supplements include vitamins, minerals, amino acids, herbs, enzymes, and various substances extracted from plants and animals. They are sold as liquids, tablets, capsules, and powders. By definition these products are not conventional foods but are intended to supplement the diet, generally with the intent of improving health and body functioning, and of preventing or treating disease.

There has been a rapid increase in recent years in the sales of dietary supplements in the USA. Much of this can be traced to the passing of the Dietary Supplement and Health Education Act (DSHEA) in 1994, a law that gave the supplement industry much wider freedom. Sales of dietary supplements in the United States doubled after the passing of this law to almost $18 billion in 2000 (Nutr Bus J, 2002) and have been steadily increasing since. Sales in the USA now total roughly $32 billion per year. Surveys reveal that around half of adults in the USA take supplements regularly (JAMA Intern Med 173:355–361, 2013; Nutritional health: strategies for disease prevention, New York, 435–449, 2012). Canadian surveys are broadly similar (Can J Public Health 93:426–430, 2002). The profiles of people most likely to use dietary supplements are female, older, white, nonsmokers, regular exercisers, and better educated (JAMA Intern Med 173:355–361, 2013; Nutritional health: strategies for disease prevention, New York, 435–449, 2012).

Physicians and other health professionals need to be aware of issues related to supplements. Patients may seek advice from their physician concerning supplements. Ideally, physicians should be able to give reliable information. This does not mean that physicians should have a detailed knowledge of all supplements, but rather that they should have a good basic knowledge while also knowing where to obtain additional information. Unfortunately, most physicians receive very little training in this area.

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References

  1. Nutrition Business Journal’s annual industry overview VII. Nutr Bus J. 2002;7(5/6):1–30.

    Google Scholar 

  2. Bailey RL, Gahche JJ, Miller PE, Thomas PR, Dwyer JT. Why US adults use dietary supplements. JAMA Intern Med. 2013;173:355–61.

    Article  CAS  PubMed  Google Scholar 

  3. Temple NJ. The marketing of dietary supplements: profit before health. In: Temple NJ, Wilson T, Jacobs DR, editors. Nutritional health: strategies for disease prevention. 3rd ed. New York: Humana Press; 2012. p. 435–49.

    Chapter  Google Scholar 

  4. Troppmann L, Johns T, Gray-Donald K. Natural health product use in Canada. Can J Public Health. 2002;93:426–30.

    PubMed  Google Scholar 

  5. Scragg R. Vitamin D and public health: an overview of recent research on common diseases and mortality in adulthood. Public Health Nutr. 2011;14:1515–32.

    Article  PubMed  Google Scholar 

  6. Chowdhury R, Kunutsor S, Vitezova A, et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014;348:g1903.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JP. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ. 2014;348:g2035.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bischoff-Ferrari HA, Willett WC, Orav EJ, et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med. 2012;367:40–9.

    Article  CAS  PubMed  Google Scholar 

  9. Watkins ML, Erickson JD, Thun MJ, et al. Multivitamin use and mortality in a large prospective study. Am J Epidemiol. 2000;152:149–62.

    Article  CAS  PubMed  Google Scholar 

  10. Neuhouser ML, Wassertheil-Smoller S, Thomson C, et al. Multivitamin use and risk of cancer and cardiovascular disease in the Women’s Health Initiative cohorts. Arch Intern Med. 2009;169:294–304.

    Article  PubMed  Google Scholar 

  11. Park SY, Murphy SP, Wilkens LR, et al. Multivitamin use and the risk of mortality and cancer incidence: the multiethnic cohort study. Am J Epidemiol. 2011;173:906–14.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Guallar E, Stranges S, Mulrow C, et al. Enough is enough: stop wasting money on vitamin and mineral supplements. Ann Intern Med. 2013;159:850–1.

    Article  PubMed  Google Scholar 

  13. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev. 2012;3:CD007176.

    Google Scholar 

  14. Newmaster SG, Grguric M, Shanmughanandhan D, Ramalingam S, Ragupathy S. DNA barcoding detects contamination and substitution in North American herbal products. BMC Med. 2013;11:222.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Karsch-Völk M, Barrett B, Linde K. Echinacea for preventing and treating the common cold. JAMA. 2015;313:618–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sarris J, Kavanagh DJ. Kava and St. John’s wort: current evidence for use in mood and anxiety disorders. J Altern Complement Med. 2009;15:827–36.

    Article  PubMed  Google Scholar 

  17. Wandel S, Jüni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ. 2010;341:c4675.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Blendon RJ, DesRoches CM, Benson JM, Brodie M, Altman DE. Americans’ views on the use and regulation of dietary supplements. Arch Intern Med. 2001;16:805–10.

    Article  Google Scholar 

  19. Cohen PA. Hazards of hindsight—monitoring the safety of nutritional supplements. N Engl J Med. 2014;370:1277–80.

    Article  CAS  PubMed  Google Scholar 

  20. Geller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, Mozersky RP, Budnitz DS. Emergency department visits for adverse events related to dietary supplements. N Engl J Med. 2015;373:1531–40.

    Article  CAS  PubMed  Google Scholar 

  21. Cohen PA, Venhuis BJ. Adulterated sexual enhancement supplements: more than mojo. JAMA Intern Med. 2013;173:1169–70.

    Article  PubMed  Google Scholar 

  22. Saper RB, Phillips RS, Sehgal A, et al. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA. 2008;300:915–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. O’Connor A. New York Attorney General targets supplements at major retailers. New York Times. 2015. http://well.blogs.nytimes.com/2015/02/03/new-york-attorney-general-targets-supplements-at-major-retailers. Accessed 3 Nov 2015.

  24. Reid IR, Bristow SM, Bolland MJ. Calcium supplements: benefits and risks. J Intern Med. 2015;278:354–68.

    Article  CAS  PubMed  Google Scholar 

  25. Temple NJ. The marketing of dietary supplements: a Canadian perspective. Curr Nutr Rep. 2013;2:167–73.

    Article  Google Scholar 

  26. Temple NJ, Eley D, Nowrouzi B. Advice on dietary supplements: a comparison of health food stores and pharmacies in Canada. J Am Coll Nutr. 2009;28:674–7.

    Article  PubMed  Google Scholar 

  27. Morris CA, Avorn J. Internet marketing of herbal products. JAMA. 2003;290:1505–9.

    Article  CAS  PubMed  Google Scholar 

  28. Nestle M. Food politics: how the food industry influences nutrition and health. Berkeley: University of California Press; 2007.

    Google Scholar 

  29. Fontanarosa PB, Rennie D, DeAngelis CD. The need for regulation of dietary supplements—lessons from ephedra. JAMA. 2003;289:1568–70.

    Article  PubMed  Google Scholar 

  30. Marcus DM, Grollman AP. Botanical medicines—the need for new regulations. N Engl J Med. 2002;347:2073–6.

    Article  PubMed  Google Scholar 

  31. Temple NJ. The regulation of dietary supplements in Canada: many promises but little progress. J Diet Suppl. 2016. [Epub ahead of print].

    Google Scholar 

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Correspondence to Norman J. Temple Ph.D. .

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Temple, N.J. (2017). Dietary Supplements: Navigating a Minefield. In: Temple, N., Wilson, T., Bray, G. (eds) Nutrition Guide for Physicians and Related Healthcare Professionals. Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-319-49929-1_32

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  • DOI: https://doi.org/10.1007/978-3-319-49929-1_32

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