Dietary supplements are not drugs, and are not intended to prevent, diagnose, treat, mitigate, or cure disease.
A dietary supplement is a product to supplement the diet.
Presently one half of adults report using one or more dietary supplements.
Before the Covid-19 pandemic 58% of Americans used vitamins, minerals, botanicals, live microorganisms, or other dietary supplements to prevent to treat various conditions including viral infections, memory loss, and heart disease.
More than $55 billion spent on dietary supplements in 2020.
The dietary supplement industry spent about $900 million on marketing in 2021.
85,000 different combinations of vitamins, minerals , amino acids, probiotics and other ingredients consumed.
Spending on supplements is approaching 10% of our overall spending on pharmaceuticals.
Prevalence of use is increasing.
Dietary supplements often contain vitamins, but may also include other ingredients, such as minerals, herbs, and botanicals.
Fruits and vegetables contain a mixture of vitamins, phytochemicals, fiber and other nutrients that probably act synergistically to deliver health benefits.
Micro nutrients in isolation may act differently in the body than when naturally packaged with the host of other dietary components.
In the United States, a dietary supplement is defined under the Dietary Supplement Health and Education Act of 1994.
There is no FDA approval process for dietary supplements, and no requirement that manufacturers prove the safety or efficacy of supplements introduced before 1994.
The US Code of Federal Regulations (CFR) Title 21, part III regulates Good Manufacturing Practices (GMPs) in the manufacturing, packaging, labeling, or holding operations for dietary supplements.
Even though product registration is not required, these regulations mandate production and quality control standards (including testing for identity, purity and adulterations) for dietary supplements.
Patients who utilize supplements are older, have a lower body mass index, are more physically active, less likely to smoke, have higher educational levels, and higher socioeconomic status compared with non-users.
Primary reason for using dietary supplements as to improve or maintain overall health.
Typically advertised as safe, despite lacking scientific studies to assess their efficacy or safety.
Most supplements are taken without healthcare oversight, with individuals depending on product information, many times which is misleading.
Studies have shown no benefit and taking multivitamins in reducing overall mortality, deaths from cardiovascular disease, or cancer related deaths.
Multivitamin-mineral products of the most commonly reported type of supplement.
Studies looking at supplementary vitamin E, vitamin D, calcium, vitamin A, beta carotene, folic acid with without vitamin B 12, vitamin B3, vitamin B5, vitamin C, and selenium have not shown benefits in reducing overall mortality.
Dietary supplements users generally use moderate amounts of alcohol, abstain from smoking, have health insurance, have higher intakes of vitamins and minerals from their food choices than non-users.
Up to 49% of older adults take at least one dietary supplement and 52% use concurrent prescribed medications, potentially exposing individuals to an increased risk of adverse drug to drug interactions.
There is insufficient evidence to recommend either for or against the use of multivitamin vitamin/minerals as a dietary supplement to prevent chronic disease.
In addition to the lack of efficacy, complications of renal failure, hepatotoxicity, nephrolithiasis, gynecomastia, acne, and hirsutism along with arrhythmias and death have been reported with certain supplements.
Many supplements often provide no proven benefit, and may not even have what the bottle labels say they contain.
The risks associated with supplements: about 23,000 emergency department visits and more than 2000 hospitalizations each year attributed to adverse effects of dietary supplements.
Thousands of products have been found to not contain advertised ingredients or include toxic ingredients not listed on the label.
The FDA has identified more than 1000 supplements that contain prohibited prescription or experimental drugs.
About 23,000 visits to emergency departments each year are attributed to Adverse Events from dietary supplements.
Supplement producers do not need to establish that their products work before selling them to patients.
Many supplements contain little of what patients think they do and contain ingredients that have been banned for use in people or have never been studied.
Use of dietary supplements is not associated with mortality benefits.
Meta-analysis of the use of B vitamins to lower homocysteine concentrations showed no significant effects in 5 years for cardiovascular events, cancer incidence, or all-cause mortality (Clarke R et al).
Meta-analysis that examined antioxidant dietary supplements of vitamin D or beta-carotene showed that there was no association between vitamin E supplementation and prevention of cardiovascular disease for mortality, while the beta-carotene trial showed small increase in all-cause or cardiovascular related mortality (Vivekananthan DP et al).
Vitamin D supplementation is not associated with a reduction in major cardiovascular events, myocardial infarction, stroke, cardiovascular disease mortality, or all-cause mortality.
Antioxidant dietary supplements have not been shown to improve health.
Antioxidant dietary supplements have not been shown to be effective at preventing disease: beta-carotene, vitamin A, and vitamin E supplements have no positive effect on mortality rate or cancer risk.
Supplementation with selenium or vitamin E does not reduce the risk of cardiovascular disease.
Among adults with type two diabetes vitamin D or omega-3 fatty acids resulted in no significant difference in GFR at five years, compared with placebo.
Meta-analysis of the use of B vitamins to lower homocysteine concentrations showed no significant effects in 5 years for cardiovascular events, cancer incidence, or all-cause mortality (Clarke R et al).
Meta-analysis that examined antioxidant dietary supplements of vitamin D or beta-carotene showed that there was no association between vitamin E supplementation and prevention of cardiovascular disease for mortality, while the beta-carotene trial showed small increase in all-cause or cardiovascular related mortality (Vivekananthan DP et al).
Studies have shown that supplementation with fatty acids has little or no value in preventing the risk of major cardiovascular diseases or all-cause mortality.
Randomized trials of beta-carotene, ascorbic acid, alpha tocopherol, selenium, vitamin D and folic acid failed to show evidence of efficacy for cancer prevention.
There is little evidence that supplements have any benefits with respect to cancer or heart disease.
Older adults are likely to use supplements for site-specific health reasons such as bone, heart disease, or vision reasons.
Younger adults are likely to use dietary supplements to enhance energy, or to boost immune function.
Among couples seeking infertility treatment, the use of folic acid and zinc supplementation by male partners, compared with placebo did not improve semen quality or couples’ live birth rates.
Among adults with type two diabetes vitamin D or omega-3 fatty acids resulted in no significant difference in GFR at five years, compared with placebo.
Folic acid is recommended for individuals who are or may soon become pregnant to prevent neural tube defects, and iron is recommended to prevent preterm birth, low birthweight, as well as to improve fetal brain development.
The USPTF has concluded that current evidence is insufficient to assess the balance of benefits in harms for the use of multivitamin supplements, single supplements, or most paired supplements for the prevention of cardiovascular disease or cancer.
The USPTF specifically recommends against the use of beta carotene supplements for prevention of cardiovascular disease or cancer, because of possible increased risk of mortality, cardiovascular mortality and lung cancer.
The USPTF specifically recommends against the use of vitamin D supplementation for prevention of cardiovascular disease or cancer because it probably has no net benefit in reducing mortality, cardiovascular disease, or cancer.
The supplements fish oil, garlic, cinnamon, turmeric, plant sterols and red yeast rice do not improve LDL cholesterol levels,