How do I know which supplements to recommend to my patients?

As mentioned previously, the efficacy of supplements is debatable and is the subject of a great deal of investigation. The special classification dietary supplements enjoy under FDA authority is that of neither a food nor a drug. As a result of the particular wording of the DSHEA Act of 1994, which addresses dietary supplements, regulation is not as stringent as it is for food and drugs. Under this Act, dietary supplements are required to meet specific labeling and safety requirements, although the government has not yet implemented an enforcement mechanism to confirm product purity, potency, or quality. There are safeguards, however, to ensure the quality of supplements your patient uses. Under the domain of the FDA, the Center for Food Safety and Applied Nutrition’s Office of Dietary Supplements monitors labeling and some aspects of the production process, but quality control depends mainly on manufacturers’ voluntary compliance with the quality standards of an external organization, the US Pharmacopeia (USP).

The USP is an independent, non-regulatory body that approves the quality, potency, and purity of supplements produced by participating volunteer manufacturers. The acronym "USP" will appear on all those products that have met their stringent good manufacturing, truth in labeling, and marketing standards. It has been suggested by some government officials that USP become the "JCAHO" of the supplement industry – a voluntary compliance organization that creates and enforces standards based on FDA regulations and in the best interests of the public’s health.

Another independent consumer safety group is Consumer Labs (CL). Consumer Labs tests products (herbal products, vitamins, minerals, energy/sport products, and functional foods) to determine if their identity and potency match the product label; if the product is pure (i.e., free from contaminants); if multiple units of the same product are consistent in identity, potency, and purity; and to validate the product’s bioavailability (ability to be used by the body). Consumer Labs performs independent product analysis, and accepts no samples from manufacturers, retailers, or salespeople. Interested parties may, however, request that their products be tested. All products used for analysis are purchased at the retail level to ensure sampling is representative of items that reach consumers. If a product passes Consumer Labs’ scientific- and industry-based testing criteria, it is eligible to receive the "CL Seal of Approval". Approved products are listed on the CL website; manufacturers may include the CL Seal on the label of approved products.

The FDA, in recognition of the demand for dietary supplements and the lack of industry regulation, is expected to unveil a guidance document outlining good manufacturing procedures (GMPs) for the manufacturers of supplements. The phenomenal growth of this industry has provided the impetus for the FDA to devise appropriate and applicable standards to protect the public’s health, and to which all manufacturers must adhere.

Sources:
Consumer Labs
www.consumerlabs.com

US Pharmacopeia
www.usp.org