Blake Ebersole, president of NaturPro Scientific, noted adulteration of natural products, especially foods and botanical ingredients, has been occurring for thousands of years. He added, “Two main classes of adulteration include economically motivated adulteration—generally the substitution or dilution of expensive ingredients with cheaper ones—and also, unintended cases of accidental adulteration or mistaken botanical identity.”
Standard Operating Procedures (SOP) for Cannabis, CBD and Hemp operations are required for every type of business — even if you are only a distributor or marketer.
Our experts have decades of experience with all types of document requirements, for all types of firms — especially SOP supporting the following:
- Good Manufacturing Practices (GMP’s)
- Good Agricultural and Collection Practices (GACP)
- Good Distribution and Storage Practices
Need help with your SOP’s and GMP’s? Contact us!
Our goal is to help you meet Cannabis, CBD and Hemp regulatory requirements as efficiently as possible.
Cannabis & Hemp Procedures and SOP (Standard Operating Procedures) are the central part of operations of any cultivation, extraction, processing, packaging, marketing, distribution, or testing business.
Cannabis SOP are required by each state where cannabis, marijuana or hemp are regulated.
All cannabis, hemp, medical or adult-use (recreational) marijuana product is subject to a number of regulations and standards from seed to shelf.
NaturPro Scientific has supported a number of clients in the aim of providing safe, effective cannabis and hemp products to support human health.
Startups who invest in solid standard operating procedures (SOP) accelerate their growth from the start.
The worst thing a start-up can do is go in blind to what their processes and procedures — their Good Manufacturing Practices — should be.
But within a patchwork of regulations, processes and procedures depend on the type of product you are making.
So what GMP guidelines should you follow?
Here’s some free advice, that’s common sense: Follow the most applicable regulatory guidelines, that are closest to your type of product.
The following types of products are generally considered dietary supplements, which are products intended to supplement the diet, but not replace food. Supplements in the U.S. are governed by 21 CFR 111, Good Manufacturing Practices (GMP) for Dietary Supplements:
- Capsules and Softgels
- Food products with structure-function claims nutrients without recommended daily values
The following types of products are generally considered foods, governed under 21 CFR 117, that are FDA GMP’s for Food:
- Protein powders
- Ready to drink beverages
- Infused coffee and tea
Need help with your SOP’s and GMP’s? Contact us!
When it comes to other types of products, standards or test methods, we generally recommend to pick the most relevant standards for your type of product.
Here is a basic set of quality management SOP’s for a Food facility:
- Quality Management Systems
- Product Quality Policy/Manual
- Document Control
- Formula Records
- Batch Records
- Certificates of Analysis
- Traceability & Recall
- Risk Analysis
- Hazard Analysis
- Purchasing Criteria & Specifications
- Supplier Qualification
- Intentional Adulteration
- Preventive Controls
- Product Approval & Rejection, Material Inspection
- Complaints & CAPA (Corrective Actions)
We recommend to follow the standards and requirements set by FDA and other standards-setting organizations:
- 21 CFR 111, Good Manufacturing Practices (cGMP) for Dietary Supplements
- 21 CFR 117, Good Manufacturing Practices (cGMP) for Foods
- American Herbal Pharmacopoeia Monograph on Cannabis
- American Herbal Products Association Cannabis Guidelines for Regulators
- AOAC International Official Methods for Cannabinoids
- ASTM International D.37 Group Standards
- USDA Hemp Program
- FDA BAM
- FDA PAM
- U.S. Hemp Authority
- U.S. Pharmaceopoeia Expert Panel on Medical Cannabis
Need help with your SOP’s and GMP’s? Contact us anytime!
Farmers are at the root of high quality product, so here’s some free SOP’s for farmers, followed by a sample guidance proposed for cannabis, hemp and CBD agricultural materials (i.e. “Farm SOP’s”)
CANNABIS, HEMP AND CBD FARM SOP LIST
- Cultivation or Processing
- Applicable Regulations
- Training & Safety
- Sanitation & Cleaning
- Farm or Facility
- Seeds and Propagation Materials
- Agricultural Inputs
- Pre-harvest practices
- Post-harvest practices
- Drying & Milling
- Testing (Potency, purity, cannabinoids, microbiology, heavy metals, pesticides)
- Waste Management
A BASIC EXAMPLE for FARM OPERATIONS
The following information is a partial excerpt from draft from U.S. Hemp Roundtable guidance for CBD products, which NaturPro was fortunate to contribute to.
CBD SOP’s and Cannabis Procedures
U.S. Hemp Guidance Program PHASE 2
1.1 GENERAL TERMS & DEFINITIONS
The following Definitions and Interpretations apply to such terms when used in this U.S. Hemp Guidance Program.
Adulteration refers to a food that may be considered adulterated if it contains “any poisonous or deleterious substance which may render it injurious to health…..or if any valuable constituent has been in whole or in part omitted or abstracted therefrom; or (2) if any substance has been substituted wholly or in part therefor; or (3) if damage or inferiority has been concealed in any manner; or (4) if any substance has been added thereto or mixed or packed therewith so as to increase its bulk or weight, or reduce its quality or strength, or make it appear better or of greater value than it is”.
Batch means a specific quantity of industrial hemp that is uniform, that is intended to meet specifications for identity, purity, strength, and composition, and that is produced during a specified period of time according to a single manufacturing record.
Batch number, or lot number means any distinctive group of letters, or numbers, or any combination of them, from which the complete history of the processing, packaging, labeling, and/or storage of a batch or lot of industrial hemp product can be determined.
Biomass means the amount of living matter in a given habitat, expressed either as the weight of organisms per unit area or as the volume of organisms per unit volume of habitat.
Component means any substance intended for use in the manufacture of industrial hemp, including those that may not appear in the finished batch of the industrial hemp.
Growth Medium means the solid, liquid or semi-solid substance used to support the growth of the plant.
Hemp refers to cannabis varieties and any part of the plant, whether growing or not, containing a delta-9 tetrahydrocannabinol (THC) concentration of no more than three-tenths of one percent (0.3%) on a dry weight basis.
Industrial Hemp is Hemp
Ingredient means any substance that is used in the manufacture of hemp and that is intended to
be present in the finished batch of the hemp product.
In-process material means any material that is compounded, blended, ground, extracted, sifted, sterilized, derived by chemical reaction, or processed in any way for use in the manufacture of the hemp product.
Lot means a batch, or a specific identified portion of a batch, or, in the case of a hemp product produced by continuous process, a specific identified amount produced in a specified unit of time or
U.S. Hemp Guidance Program PHASE 2
quantity in a manner that is uniform and that is intended to meet specifications for identity, purity, strength, and composition.
Microorganisms means yeasts, molds, bacteria, viruses, toxins, and other similar microscopic organisms which may or may not have a health or sanitary concern.
Pest means any objectionable insect or other animal including but not limited to birds, rodents, flies, mites, and larvae.
Physical plant or facility means all or any part of a building or facility used for or in connection with manufacturing, processing packaging, labeling, or storage of industrial hemp products or ingredients.
Processor means making a transformative change to the hemp plant or product following harvest.
Product complaint means any communication that contains any allegation, written, electronic, or oral, expressing concern, which may or may not have be related to the quality of an industrial hemp product.
Quality means that the hemp product meets the established specifications for identity, purity, strength, and composition, and limits on contaminants, and has been manufactured, packaged, labeled, and held under conditions to prevent adulteration.
Quality Management Systems means a planned and systematic operation or procedure for ensuring the quality of a hemp product.
Quality Management Systems personnel means any person, persons, or group, within or outside the organization, designated to be responsible for quality control operations.
Representative sample means a sample with an adequate number of units that are intended to ensure that the sample accurately portrays the material being sampled.
Reserve sample means a representative sample of product that is held for a designated period of time.
Sanitize means to adequately treat cleaned equipment, containers, utensils, etc.by a process that is effective in destroying of microorganisms of public health concerns.
U.S. Hemp Guidance Program PHASE 2
Prior to the Industrial Hemp Grower planting any seed, a license or agreement with the State must be obtained. The following information is required to make the application before a license will be issued: (Each State may have different regulations – refer to application – See Kentucky Hemp Policy Guide as an example)
1.2.1 Registration/Application Guidance
- Name of the person or corporation to whom the license or authorization is to be issued
- Address of the farm or place including county and township or legal description
- The number of acres
- Global Positioning System coordinates
- Intended purpos of industrial hemp
- In the case of a plant breeder, the variety of industrial hemp that may be cultivated; and
o Any conditions that are necessary to minimize security, public health or safety hazards related to the licensed or authorized activities.
o Specify if the hemp is for food or non-food purposes
1.2.2 Notification of Changes to the licensor by the licensee
Every licensee shall notify the State of any changes to the information provided on the application, within 15 days after the change, including:
- Corporate name or ownership, or officers, and the replacement of an officer, or director
- Any change to the address of the licensee
- The replacement of an individual referred to a licensee
- Any change in the mailing address of the licensee
- Any change in the ownership of the land used to cultivate industrial hemp
- Any change to the approved cultivar being sown or, in the case of a plant breeder, to thevariety of industrial hemp being sown;
- Any genetic modification.
Signature: _____________________________ Date: ________________________ Printed Name: __________________________ Company/Location: ________________________
U.S. Hemp Guidance Program PHASE 2
Qualified employees who grow, manufacture, package, or label industrial hemp shall be qualified to do so, and those responsible for quality control or performing any quality control operations, must have the education, training, or experience to perform the assigned functions.
Supervisors shall be qualified by education, training, or experience to supervise.
Contamination Prevention and Hygienic measures shall be taken to exclude from any operations
any person who might be a source of microbial contamination.
Such measures shall include the following:
- Exclude personnel from working in any operations that may have an illness, infection, open lesion, or any other abnormal source of contamination.
- Instructing employees to notify their supervisor if there is a possibility that they have a health condition described above.
- Wearing outer garments in a manner that protects against the contamination.
- Maintaining adequate personal cleanliness.
- Washing hands thoroughly, and sanitizing if necessary, in a hand-washing facility.
- Removing or covering all unsecured jewelry and other objects that might fall into components, industrial hemp, equipment, or packaging.
- Using gloves when appropriate.
- Wearing, where appropriate, hair nets, caps, beard covers, shoes, PPE etc.Personnel and employee safety measures shall include the following:
- Appropriate and Adequate First Aid Equipment
- Adequate bathrooms and changing rooms
- Appropriate OSHA warnings, labels, and training
- Appropriate training and personal protective equipment for pesticide application
U.S. Hemp Guidance Program PHASE 2
1.3.1 U.S. HEMP GUIDANCE – GROWER – PERSONNEL CHECKLIST
Are the supervisors qualified for their responsibilities by training, education or experience?
Do the employees performing the growing, processing, packaging and labeling tasks, have the proper training necessary to perform the tasks?
Are contamination and hygienic measures in place to exclude personnel who might be a source of contamination?
Are personnel excluded from operations if they have, an illness, infection, open lesion, or any other abnormal source of contamination?
Do employees notify their supervisor if there is a possible health condition as described above?
Do personnel wear outer garments in a manner that protects against the contamination?
Do operating personnel maintain adequate personal cleanliness?
Are hand washing facilities available and used?
Do operating personnel remove or cover unsecured jewelry etc. to prevent them from falling into hemp products or causing harm?
Are gloves used when appropriate?
Are caps, shoes and head covering used when appropriate?
Is the appropriate Personal Protective Equipment (PPE) used as needed?
Are there adequate and appropriate first aid equipment available?
Is there adequate bathrooms and changing rooms?
Are the OSHA warnings and signs visible?
Has there been adequate training?
If applicable is the PPE and trains available for the pesticide applicators?
Signature: _____________________________ Date: ________________________ Printed Name: __________________________ Company/Location: ________________________
U.S. Hemp Guidance Program PHASE 2
1.3.2 U.S. HEMP GUIDANCE – GROWER – BEST MANAGEMENT PRACTICES CHECKLIST
Are you using the best soil available?
Have you Soil tested for macro and micro nutrients?
Have you used the appropriate Growth Medium for intended purposes?
Has the licensee determined the concentration of THC in the hemp?
Is seed planted listed on the license?
Is the entire hemp plant used as licensed?
Do you properly use pre- plant weed control?
Do you have a Germination Certificate from the seed supplier
Did you use the proper Certified Seed suitable for location?
Did you use the proper seed treatment?
Do you have a site history?
Do you have a water quality report or history?
Did you use fertilizer to target desired yield per acre according to soil test?
Did you use animal manure for fertilizer or biomass purposes?
Did you plant by optimum seeding date?
Did you plant at the optimum rate of seeds per acre?
Have samples of the industrial hemp been collected in accordance with the Guidance Procedures?
Has the equipment used to sow, harvest and transport the hemp been thoroughly cleaned to prevent contamination?
Are you prepared to harvest when the plant is ready?
Have you complied with the drying procedures
Do you have sufficient and proper storage facilities or adequate transportation equipment available?
Is the biomass sold to a licensed person or entity according the Guidance Procedures?
Is the biomass packaged, labeled, and transported according to the Transportation Guidance Procedures?
Has any loss or theft been reported according to the license requirements?
Are the records being kept according to the Guidance Procedures for Record Retention?
Grower Signature___________________________ Date _________________ Printed Name___________________ Farm location or identifier__________________
U.S. Hemp Guidance Program PHASE 2
1.3.3 U.S. HEMP GUIDANCE – GROWER – FACILITY & BIOSECURITY AWARENESS CHECKLISTA.
Facility Security (physical security of buildings and grounds)
Is the facility using:
Controlled gate access
Off-hours security guard
Electronic motion detectors
Adequate indoor lighting
Alarms linked to an off-site security system
Door hardware is of industrial design
Guards are installed on exterior ladders
Exit doors and gate are electronically/mechanically secured
Entry and discharge points of exterior tanks are padlocked when not in use
All vehicles parked outside are locked
Empty/loaded containers are parked inside
Law enforcement patrol over company premises on regular but unpredictable basis
Employees reporting any suspicious behaviors
Restricted access to computer process control and data systems
Safeguard of data systems using data security program
Backup of all data and processes at an off-site place
Is the facility using:
Company representative for visitor to check in with
Signs informing visitors where to report
Specific area for visitor parking
Records of visitors (include name, company, arrival and departure, and purpose of visit)
Visitor badges/identification cards
Company representative to escort visitor all the time
Restricted access to key manufacturing areas
Is the facility implementing the following:
Bulk containers are inspected prior to loading for foreign and/or suspicious material
U.S. Hemp Guidance Program PHASE 2
Verify that all customer pick-up drivers are representatives of the customer
The product stream is inspected visually
Container access points are secured after loading
Seal numbers are documented on the shipping papers
Shipping documents are used to identify the contents of each compartment
Shipping log is maintained
Bio-sanitation program is implemented
Procedures exist to disinfect vehicles and drivers
√ if Applicable
Is the facility implementing the following:
Written housekeeping program for all areas of the facility
Written pesticide and rodenticide program
Is the facility implementing the following:
Employees are adequately trained to respond to a crisis as calmly and safely as possible
Current inventory of all hazardous and flammable products
A plan to provided MSDS to emergency response teams etc.
A list of emergency contacts is posted
An action plan to deal with suspicious devices or substances
Evacuation plan in case of fire and explosions is published
Establish and maintain an up-to-date employee roster and visitor log to facilitate personnel head count at any time
Disaster Preparedness Plan
A weapons security program
Conduct evacuation and respond drill periodically
Post a site plan depicting escape routes, fire-fighting and rescue equipment
Printed Name: __________________________ Company: ________________________________
Date: ________________________________ Facility Location: ________________________________8
U.S. Hemp Guidance Program PHASE 2
1.4 SAMPLING AND HANDLING HEMP FOR THC & CBD1.4.1 Definitions
delta-9-THC means delta-9-tetrahydrocannabinol concentration.
Authority having jurisdiction usually means the state, but it could be FDA, USDA,
county or city.
Certified seed means seed for which a certificate or any other instrument has been issued, by an agency authorized under the laws of a state, territory, or possession to certify seed and which has standards and procedures approved by the United States Secretary of Agriculture to ensure the genetic purity and identity of the seed certified.
Plot means a contiguous area in a field, greenhouse, or indoor growing structure containing the same variety or strain of hemp throughout the area.
ppm means parts per million.ppb means parts per billion.
Post-Harvest Sample means a sample taken from the harvested hemp materialfrom a particular plot’s harvest. The entire plot’s harvest must be in the same form(e.g., intact-plant, flowers, ground materials, etc.), homogenous, and not mixed with non-hemp materials or hemp materials from another plot.
Pre-Harvest Sample means a composite, representative portion from plants in a hemp plot collected in accordance with the procedures as defined by the state providing authority.
Processing means converting an agricultural commodity into a marketable form.Prohibited Variety means a variety or strain of cannabis excluded from the state
Sample means a sufficient amount of material that is representative of the population from which it is taken. A sample may be a particular plant part, including inflorescence (flower), leaf, stalk or seed, or it may be a processed product (oil, extract, powder. Samples must be dried to a sufficiently low moisture content so as not to harbor growth of microorganisms.
Seed source means the origin of the seed or propagules as determined by the state providing authority.
U.S. Hemp Guidance Program PHASE 2
- 1.4.2 Sampling Timeline and Grower Responsibilities
- The grower shall refer to the jurisdiction having authority to determine a timeline.
- During the sampling, the grower or an authorized representative shall be present at the growing site.
- Floral materials harvested for phytocannabinoid extraction shall not be moved beyond the processor, nor commingled, nor extracted, until test results are complete
- 1.4.3 Pre-Harvest Sampling Procedure
- Adequate personal protective equipment shall be used.
- Proper equipment shall be used to prevent cross contamination.
- The material selected for Pre-Harvest Sampling will be determined by the grower. Cuttings will be collected to make one representative sample.
- Refer to the authority having jurisdiction to determine adequate number of samples and proper locations. In the absence of jurisdictional requirements, the following guidance is given.
- Clip the top 12 inches of hemp plant’s primary stem, including female floralmaterial.
- Take cuttings from at least five (5) hemp plants within the plot.
- Place the complete sample in a paper bag.
- Seal the bag by folding over the top once and staple the bag shut.
- A separate sample must be taken from each non-contiguous plot of a given variety.
- A separate sample must be taken for each variety.
- Samples shall be secured in a paper bag (to allow for air-drying during transport).
- Label the sample container with a sample ID.
- 1.4.4 Handling Procedures of Pre-Harvest Samples
- Samples will be taken for drying and storage.
- Samples should be arranged in a single layer for drying.
- Drying oven will be used when possible.
- Samples in the oven will be left in the labeled sample bag.
- If selected for testing, the entire sample will be sent to a testing lab for analysis.
- 1.4.5 Post-Harvest Sampling Procedures for Floral Material
- Refer to the authority having jurisdiction to determine adequate number of samples and proper locations. In the absence of jurisdictional requirements, the following guidance is given.
- Adequate personal protective equipment shall be used.
- Proper equipment shall be used to prevent cross contamination
- The plot selected for sampling shall be designated by the Pre-Harvest Sampleresults. The material selected for Post-Harvest Sampling from this plot will be
U.S. Hemp Guidance Program PHASE 2
determined by the grower. All Post-Harvest Samples of floral material shall be taken from the designated harvested plot materials in the form (intact-plant, flowers, ground materials, etc.) in which the material will be sent to the processor
e. Grower must inventory the entire harvest to determine the form in which it exists and follow the protocol as appropriate in part a), b), or c) below.
- If, upon inventory, the grower determines that the entire harvest is not in a homogenous form (intact-plant, flowers, ground materials, etc.), it must be determined to take additional samples or other course of action or take the pre-harvest results.
- For intact-plant post-harvest samples:
- Ensure that the entire harvest is accounted for and in the sameform (i.e., intact-plants).
- Clip the top 12 inches) of hemp plant, primary stem, includingfemale floral material.
- Take cuttings from at least five (5) non-adjacent hemp plantswithin the harvest’s storage/drying area.
- Place the complete sample in a paper bag.
- Seal the paper bag by folding over top once and stapling to keep closed.
- Complete sampling procedures in part (d) –(f).
- For ground plant or ground floral material Post-Harvest Samples:
- Ensure that the entire harvest is accounted for and in the sameform (i.e., all harvested material whether whole plant or floral material only must be ground with no intact plants or whole flowers remaining from that harvest).
- Sample material from bag or container.
- Sample from a minimum of four locations within the containers from a given harvest.
- Place the complete sample in a plastic sample container.
- Seal the plastic sample container.
- Complete sampling procedures in part (d) –(f).
- For Post-Harvest Samples in other forms (e.g., trimmed floral material, or floral material and stems, etc.):
- Ensure that the entire harvest is accounted for and in the same form (i.e., all harvested material must be uniform).
- Randomly collect at least one cup of material by volume.
- Place the complete sample in a paper bag or plastic containerand seal the container, as appropriate.
- Complete sampling procedures in part (d) –(f).
- A separate sample must be taken for each plot designated for Post-Harvest Sampling.
- Samples shall be labeled and prepared for transport to the lab.
- Label the sample container with a sample ID.
U.S. Hemp Guidance Program PHASE 2
1.4.6 Handling Procedures of Post-Harvest Samples
- The entire sample will be sent to the testing lab for analysis.
- Industrial hemp crops generated from Certified seed will incur pre-harvest testing of at least five percent (5%) of growing plots per variety, per seed source.
- Industrial hemp crops from planting materials other than Certified seed will incur pre- harvest testing of at least fifty percent (50%) of growing plots per variety, per seed source.
- 100% of post-harvest samples will be tested.
Blake Ebersole, president of NaturPro Scientific, noted adulteration of natural products,
especially foods and botanical ingredients, has been occurring for thousands of years. He added, “Two main classes of adulteration include economically motivated adulteration— generally the substitution or dilution of expensive ingredients with cheaper ones—and also, unintended cases of accidental adulteration or mistaken botanical identity.”
Adulteration of food and agricultural materials has a long history. NaturPro has generated a list of references citing adulteration of food and dietary ingredients in recent times (publications in the past ~30 years).
Historical Food and Supplement Adulterant List
The intent of this list to promote awareness for historical adulterants in natural products. This list is for comprehensive and historical reference only.
[wpforms id=”1985″ title=”false” description=”false”]
The brain is not simple, and neither are any answers. Early risk detection and a combination of supplements and interventions are the focus of today’s research by thousands of scientists and physicians who are likely to bear fruit in the near future.
Scientific Publications on Natural Products, including Food, Medicine and Dietary Supplements: With a focus on Good Manufacturing Practices (GMP) for Natural Products, Quality Management Systems, and Good Agricultural and Collection Practices (GACP)
(Have a suggestion to add? Contact us!)
- A Field Guide to Herbal Dietary Supplements, AHPA-ERB Foundation, http://www.ahpafoundation.org/fieldguide.pdf
- A Harvester’s Handbook to Wild Medicinal Plant Collection in Kosovo (2003). Lonner J. and Thomas M. Source: http://www.gowildconsulting.com/wp-content/uploads/2011/02/harvesters_handbook.pdf
- AHPA-AHP Good Agricultural and Collection Practice for Herbal Raw Materials, December 2006. (Updated draft 2016)
- AHPA Botanical Identity References Compendium, http://www.botanicalauthentication.org/index.php/Main_Page
- AHPA Guidance Policies, http://www.ahpa.org/Portals/0/PDFs/Policies/AHPA_Guidance_Policies.pdf
- Aspects of sustainable wild plant collection (2012) Rodina K, WWF Hungary/TRAFFIC
- Biological Diversity Act 2002 (India)
- BRC’s Global Standard for Food Safety
- Canadian Herb, Spice and Natural Health Product Coalition (CHSNC) Good Agriculture and Collection Practices (GACP). Kehler C. Source: https://www.cotr.bc.ca/webs_media/Creston/_docManager/docs/Good%20Agricultural%20and%20Collection%20Practices(1).pdf
- Canadian Horticultural Council OFFS (CanadaGAP)
- Code of Good Agricultural Practices of Georgia (2007). Ministry of Agriculture of Georgia. Source: http://iwlearn.net/iw-projects/633/reports/aret-code-of-good-agriculture-practices-of-georgia
- Code of hygienic practices for spices and dried aromatic herbs. (2014) Codex Alimentarius Commission, CAC/RCP 42-1995
- Codex Alimentarius Commission Recommended International Code of Practice – General Principles of Food Hygiene CAC/RCP1-1969, Rev. 4 -2003
- Current good manufacturing practice in manufacturing, packaging, labeling or holding operations for dietary supplements (21 CFR 111)
- Current good manufacturing practice, hazard analysis and risk-based preventive controls for human food (21 CFR 117)
- Development of a Good Agricultural Practice Approach. November 5, 2003. Source: http://www.fao.org/prods/GAP/archive/GAPCONCEPT12_en.pdf.
- Development of Good Wildcrafting Practices and Wildcrafter Certification for Medicinal Plants. (2006) Howe A. Source: http://www.bestlibrary.org/best_teachers/files/Wildcraftingfinalreport.pdf
- Dietary Supplement Ingredient Database, https://dietarysupplementdatabase.usda.nih.gov/
- Dietary Supplement Label Database, https://ods.od.nih.gov/factsheets/DietarySupplements-HealthProfessional/
- Dietary supplement laboratory quality assurance program: the first five exercises. Phillips MM, Rimmer CA, Wood LJ, Lippa KA, Sharpless KE, Duewer DL, Sander LC, Betz JM. J AOAC Int 2011;94:803-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173719/
- Dietary Supplement Online Wellness Library (OWL), Council for Responsible Nutrition (CRN), http://www.supplementowl.org/
- EFSIS Safe & Legal: https://www.saiglobal.com/assurance/food-safety/SafeandLegal.htm
- Ensuring the Compliance of Raw Herbal Materials stemmed from China with European Good Agricultural and Collection Practice. Philippe A. et al. Chinese Herbal Medicine, (2011) 3(4): 251-256
- FairWild Standard, Version 2.0 (2010).
- FairWild Standards Map. Source: http://search.standardsmap.org/assets/media/FairWild/English/AtAGlance_EN.pdf
- FDA Food Safety Modernization Act http://www.fda.gov/Food/GuidanceRegulation/FSMA/
- FDA Dietary Supplement Labeling Guide, http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/DietarySupplements/ucm2006823.htm
- Field Techniques Used by Missouri Botanical Garden. Compiled by R. Liesner with suggestions from MO staff and others. Source: http://www.mobot.org/MOBOT/molib/fieldtechbook/pdf/handbook.pdf
- GAP Production of TCM Herbs in China (2010) Zhang B. et al. Planta Med 2010 76:1948-1955
- General guidelines for good agricultural practices: spices. International Organisation of Spice Trade Associations (IOSTA) (2013). Source: http://www.esa-spices.org/download/iosta-gap-final.pdf
- Global GAP, http://www.globalgap.org/uk_en/
- Good Agricultural and Collection Practices – Guidelines for the cultivation and collection of herbal medicines. (2012) Republic of Kenya.
- Good agricultural and collection practices for medicinal plants: Illustrated booklet for farmers and collectors. Source: http://www.dmapr.org.in/Downloads/Illustratedbooklet.pdf
- Good Agricultural and Wild Collection Practice (GACP) of Medicinal Plants in Europe, EUROPAM,( EHGA), c/o Veterinaerplatz, Vienna.
- Good Agricultural Practice (GAP) – Does It Ensure a Perfect Supply of Medicinal Herbs for Research and Drug Development? (2008) Leung PC and Cheng KF. Int J. App. Res. Nat. Prod. 1(2);1-8.
- Good Agricultural Practices and Good Handling Practices: Audit Verification Program. (2011) USDA Source: https://www.ams.usda.gov/sites/default/files/media/GAPGHP_Audit_Program_User%27s_Guide%5B1%5D.pdf
- Good Agricultural Practices and Good Handling Practices: Risk Mitigation in Edible Horticultural Production Systems (2015) Urbanowitz S and Bishop C. Source: https://www.unce.unr.edu/publications/files/ag/2015/cm1501.pdf
- Good agricultural practices for Artemisia (2014) ICAR Directorate of Medicinal and Aromatic Plants Research, Anand, Gujarat, India. Source: http://www.dmapr.org.in/publications/bulletine/artemisia%2016-1-15.pdf
- Good Agricultural Practices for Chinese Crude Drugs (Interim) (2002). Source: http://eng.sfda.gov.cn/WS03/CL0768/61642.html
- Good Agricultural Practices for Medicinal Plants (2009) National Medicinal Plant Board (NMPB), Department of AYUSH, India and World Health Organization Source: http://nmpb.nic.in/WriteReadData/links/8527013542Good%20Agricultural%20Practicies%20(GAPs)%20Booklet%20-%20Part%20-%20I.pdf
- Good Agricultural Practices for Plantago ovate Forsk. National Medicinal Plant Board (NMPB), Department of AYUSH, India and World Health Organization Source:
- Good agricultural practices for senna (2015) ICAR Directorate of Medicinal and Aromatic Plants Research, Anand, Gujarat, India. Source: http://www.dmapr.org.in/publications/bulletine/Good%20Agricultural%20Practices%20for%20Senna.pdf
- Good agricultural practices for small diversified farms, Carolina Farm Stewardship Association. Source: http://www.carolinafarmstewards.org/wp-content/uploads/2013/07/CFSA_GAPS-web.pdf
- Good agricultural practices for sustainable cocoa production: a guide for farmer training. Asare R and Sonii D. (2010) University of Copenhagen
- Good Practices for Plant Identification for the Herbal Industry (2004), Saskatchewan Herb and Spice Association, National Herb and Spice Coalition (Canada)
- Grocery Manufacturers Association (GMA-SAFE)
- Guidance for Implementing the International Standard for Sustainable Wild Collection of Medicinal and Aromatic Plants (ISSC-MAP). (2008) Leaman and Cunningham.
- Guidance for Industry: Botanical Drug Products (2004) FDA.Source: http://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm070491.pdf
- Guidance Manual for Organic Collection of Wild Plants (2005) Swiss Import Promotion Programme (SIPPO).
- Guideline on good agricultural and collection practice (GACP) for starting materials of herbal origin. London, 20 February 2006. Doc. Ref. EMEA/HMPC/246816/2005 Source: http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500003362.pd
- Guidelines for good agricultural and hygiene practices for raw materials used for herbal and fruit infusions (GAHP). [Former EHIA Document], Version 6, 2014 Source: http://www.thie-online.eu/fileadmin/inhalte/Publications/HFI/2_2014-06_PU_GAHP_Version_6.pdf
- Guidelines for good agricultural and wild collection practices for medicinal and aromatic plants (2010). EUROPAM the European Herb Growers Association Brussels, November, 2010; EUROPAM GACP‐MAP 8.0
- Guidelines for identification and collection of medicinal plants in Bhutan. 2008.
- Guidelines for the Sustainable Harvesting of Traditional Medicinal Plants in Zimbabwe ( ). Khumalo SG, Frode A, Sola P. Research and Development Section Southern Alliance for Indigenous Resources (SAFIRE). Source: http://projects.nri.org/adappt/docs/HarvestingGuidelines.pdf
- Hand book of domestic medicine and common Ayurvedic remedies. Source: http://niimh.nic.in/ebooks/ayuhandbook/index.php
- Heavy metals: analysis and limits in herbal dietary supplements, http://www.naturalhealthresearch.org/wp-content/uploads/2013/02/09_1214_AHPA_Heavy-Metals-White-Paper-Revised.pdf
- Herbs of Commerce, American Herbal Products Association, Second Ed. (First Ed., 1992 available here: https://law.resource.org/pub/us/cfr/ibr/001/ahpa.herbs.1992.pdf )
- In search of comprehensive standards for nontimber forest products in the botanicals trade. PIERCE, A.R. and S.A. LAIRD. (2003). International Forestry Review 5(2):138-147.
- International Labour Organization: Labour Principles of the United Nations Global Compact
- International Standard for Sustainable Wild Collection of Medicinal and Aromatic Plants (ISSC-MAP) (2007) Version 1.0 Source: http://www.floraweb.de/map-pro/Standard_Version1_0.pdf
- ISO /TS 22003:2007 Food safety management systems – Requirements for bodies providing audit and certification of food safety management systems
- ISO 22000:2005 Food safety management systems – Requirements for any organization in the food chain
- ISO 9000:2005 Quality management systems – Fundamentals and vocabulary
- ISO 9001:2008 Quality management systems – Requirements
- ISO/IEC 17000:2004 Conformity assessment – Vocabulary and general principles
- ISO/IEC 17011:2004 Conformity assessment – General requirements for accreditation bodies accrediting conformity assessment bodies
- ISO/IEC 17021:2006 Conformity assessment – Requirements for bodies providing audit and certification of management systems
- ISO/IEC Guide 65:1996 General requirements for bodies operating product certification systems
- Legal and regulatory frameworks governing the growing, packing and handling of fresh produce in countries exporting to the U.S. (2010) Produce Safety Project, Pew Charitable Trust, Georgetown University. Source: http://www.pewtrusts.org/~/media/legacy/uploadedfiles/phg/content_level_pages/reports/psprptlegalregexportspdf.pdf
- National Advisory Committee on Microbiological Criteria for Foods Hazard Analysis and Critical Control Point Principles and Application Guidelines, August 1997.
- Office of Dietary Supplements, Background Information on Dietary Supplements, https://ods.od.nih.gov/factsheets/DietarySupplements-HealthProfessional/
- Pesticide Analytical Manual, Vol I, FDA. Source: http://www.fda.gov/downloads/Food/FoodScienceResearch/ucm113702.pdf
- Pesticide Analytical Manual, Vol II, FDA. Source: http://www.fda.gov/downloads/Food/FoodScienceResearch/ucm113721.pdf
- Pesticide chemicals in processed foods (21 CFR 170.19)
- Phytomedicine 101: plant taxonomy for preclinical and clinical medicinal plant researchers. Bennett, BC, Balick MJ. J Soc Integr Oncol 2008;6:150-157. https://www.ncbi.nlm.nih.gov/pubmed/19134447
- Quality assurance of cultivated and gathered medicinal plants. Mathe and Mathe, Source: http://www.mtk.nyme.hu/fileadmin/user_upload/kornyezet/Mathe/Quality_assurance.pdf
- Quality control methods for medicinal plant materials (1998) World Health Organization
- Recommendations for microbial limits in herbal products, American Herbal Products Association, http://www.ahpa.org/Portals/0/PDFs/Policies/14_0206_AHPA_micro_limits_comparisons.pdf
- Research and implementation of good agricultural practice for traditional Chinese medicinal materials in Jilin Province, China. (2014) Li C, Yan Z, Zhang L, Li Y. Ginseng Res. 38;227-232 Source: http://www.ginsengres.com/article/S1226-8453(14)00062-1/pdf
- Safe Quality Food, Edition 7.0. (SQF 2000 Levels 1, 2 & 3)
- Selection and authentication of botanical materials for the development of analytical methods. Applequist WL, Miller JS. Anal Bioanal Chem 2013;405):4419-28. https://www.ncbi.nlm.nih.gov/pubmed/23224664
- Standard operating procedure for the collection and preparation of voucher plant specimens for use in the nutraceutical industry. Hildreth J, Hrabeta-Robinson E, Applequist W, Betz J, Miller J. Anal Bioanal Chem. 2007 Sep;389(1):13-7. Epub 2007 Jun 16.
- Standardization of herbal medicines – A review. Kunle O.F. et al, (2012) Int. J Biodiv and Conserv. 4(3) 101-112. Source: http://www.academicjournals.org/article/article1380017716_Kunle%20et%20al.pdf
- Suggested Good Agricultural and Collection Practices for North Carolina Medicinal Herbs (2016) Davis J. Source: http://content.ces.ncsu.edu/suggested-good-agricultural-and-collection-practices-for-north-carolina-medicinal-herbs
- Suggested guidelines for articles about botanical dietary supplements. Swanson CA. Am J Clin Nutr 2002;75:8-10, https://www.ncbi.nlm.nih.gov/pubmed/11756054
- The Ayurvedic Pharmacopoeia of India, 5 Volumes, Ministry of Health and Family Welfare, Govt. of India, New Delhi, 1989-2005
- The Chinese Approach to Medicinal Plants – Their Utilization and Conservation. Pen-Gen X. (1991) In: Akerle, O., V. Heywood, and H. Synge (eds.). Conservation of Medicinal Plants. Cambridge University Press, Cambridge, UK.
- The Drugs and Cosmetics Act and Rules (as amended up through 30 June 2005. New Delhi: Department of Health. 2005.Schedule T: Good Manufacturing Practices (GMPs) for Ayurveda, Siddha and Unani Medicines.
- The Global Food Safety Initiative: GFSI Guidance Document, 6th Version 6.3
- The Indian Forest Act, India, 1927
- The NIH analytical methods and reference materials program for dietary supplements. Betz JM., Fisher KD., Saldanha LG, Coates PM. Anal Bioanal Chem 2007; 389:19-25. https://www.ncbi.nlm.nih.gov/pubmed/17541565
- The Siddha Pharmacopoeia of India, Part I(1), Ministry of Health and Family Welfare, of India, New Delhi, 2007
- The Unani Pharmacopoeia of India, Part-I, Ministry of Health and Family Welfare, Govt. of India, New Delhi
- Trainer’s manual on good agricultural and collection practices for medicinal plants: Source: http://www.dmapr.org.in/Downloads/Trainersmanual.pdf
- U.S. Customs & Border Protection, (C-TPAT)
- USDA (National Organic Program), https://www.ams.usda.gov/about-ams/programs-offices/national-organic-program
- USP Food Fraud Mitigation Guidance, http://www.usp.org/food/food-fraud-mitigation-guidance
- USP <2750> Manufacturing Practices for Dietary Supplements.
- USP <467> Residual Solvents
- USP <561> Articles of Botanical Origin
- Voluntary Sustainability Standards (Draft), United Nations Forum on Sustainability Standards Source: https://unfss.org/documentation/general-documentation/
- WHO guidelines on good agricultural and collection practices (GACP) for medicinal plants (2003). Source: http://apps.who.int/iris/bitstream/10665/42783/1/9241546271.pdf
- WHO Traditional Medicine Strategy 2002-2005. World Health Organization, Geneva.
- Wild Life (Protection) Act, India, 1972
A message from the Founder and President:
Many of you know me as a “science guy”, a consultant for food and supplements who always tries to go the extra mile and do the right thing for our clients. Many of our clients aren’t aware that the values of NaturPro are essentially the same as the values of the people who have influenced me, in particular, the Black men who have influenced my life.
When I was 14, I went to work for Glenn Ebersole, my dad, at the Country Club of Harrisburg in Pennsylvania. I spent almost every holiday, summer and busy weekend there until I was 22. Although my parents and family, and my education and work experiences are the foundation of NaturPro Scientific, some of the most important lessons of my life came from the Black men who trained and mentored me at the club.
Ron, who is Black, is a banquet legend in Central PA. (I changed his name to protect his privacy). I’ll always remember Ron in a tux uniform, a shining gold-toothed smile, gliding in between the crowd with a giant stacked tray of dirty china hoisted high in the air, so smooth that no one even sees him there. Ron was known to carry 32 entrees at a time, 16 plates tray-stacked, on each hand. Ron could set a formal service for 100 guests in an hour, by himself.
I was the kind of teenager who didn’t like to listen to my dad, if for no other good reason than he was the boss, and I was a teenager. Ron understood that, and he took me under his wing, and called me a brother. My dad set the high standards, but Ron taught them and got me to meet them, all by example. My time with Ron came with valuable lessons on life, that I believe Black men in America are uniquely qualified to share.
Private country clubs in America are places where the disparity between the staff and the members is especially striking. In the 1990’s, there were no Black club members at CCH. But Black people, and people of color made up most of our full-time staff. My dad paid and treated all his staff fairly. He gave second and third chances to his employees, and posted bail and gave out more loans than he can probably remember. As a staff, we were all in it together in the aim to keep guests happy, while bearing daily witness to the engine of inequality in America.
Ron’s driver’s license was suspended for 18 years after being caught joyriding as a teenager. But I don’t remember Ron ever complaining or making excuses about it. He showed up for work every day, often a few minutes late, usually in a taxi or on his bicycle after riding the few miles to work.
When Ron got his driving privilege back, he never went back to get his license. When I asked why, he said he wanted to stay out of trouble. They’re not gonna get me again, I remember him saying with his Carolina country drawl that was often difficult for us PA folk to understand.
Ron taught me my first lessons about quality assurance, in the form of the most effective and efficient technique used to wipe water stains from every piece of silver and glass. Not many restaurants wipe their silverware, which is why there’s always water marks on them.
Wiping silver and glass for formal service requires a certain technique to do correctly and efficiently, using a clean cloth of just the right type (clean, white, 100% cotton hand towel), and with just the right amount of water. If the cloth is too dry, it doesn’t wipe off the water marks. Too wet and it just creates new water marks. The water used for wiping silverware should also be just the right temperature (hot, from the coffee machine, but allowed to cool in the cloth for a few minutes so that it doesn’t burn your hand). That way, the water left from wiping evaporates and doesn’t create new water marks.
This was all Ron’s technique he developed to make sure the silverware looked like new for every guest, without it being an all-day project. Using this technique, one of us could clean and inspect about 1,000 pieces of spotless silverware per hour. Wiping silverware was the only time we got to sit down all day, so we looked forward to wiping silverware, as we listened to old R&B on an old clock radio, and I listened to Ron talk about life.
Ron didn’t bark orders. Most of the time, he simply and quietly did the job better than anyone else. Ron expected everyone else to watch and learn, to try their best, to be helpful and not lazy. But slow-walking and empty hands were the red flags for which Ron would watch everyone closely, and he wasn’t afraid to call you out on it when he needed to.
Ron protected and helped me, covered for my mistakes on the floor without question or judgment, and helped me clean up the china and glasses I broke. Ron put me in the position to look good, when I was 15 and anything but. He did that for everyone else too – it was a team effort, always. Because if one person screws up, then we all screwed up. As I got older, the two of us flawlessly ran 5-course white-cloth meals for 100+ guests, with no other communication needed aside from nods and hand signals.
Ron taught me some of the most important lessons about work, and about life, that a teenager can learn. These were the important lessons we all need to learn when we’re young. Lessons about going the extra mile to make the guests happy. Lessons about taking responsibility and working hard. About picking your battles, holding your tongue and saying the right things at the right time, when the truth matters.
There were numerous lessons about how food should look on a plate. There were many lessons about what real street smarts are, and about the importance of trust and loyalty, that I will always have with me. There were lessons about doing the right thing, even when everyone else thinks is right doesn’t make any sense. There were lessons about staying positive and having a sense of humor during life’s challenges. And lessons about taking the time to enjoy a cold Coors Light at the end of the day.
Ron didn’t talk about white privilege, but he didn’t need to. We saw it in action, every day at work. We had to have thick skin for some of the rude looks and the nasty comments from guests, and meet them with a smile. I learned that what other people think, no matter how rich they are, or the color of skin – it doesn’t matter, as long as you stick to your own values and intuition. Ron rarely talked about how he had been treated unfairly by the system that took away half a lifetime of driving privileges for his harmless joyride. And at the time, I knew I benefited just by the color of my skin, without needing it explained.
Ron is not the only Black mentor I had at the club who did hard time just for being Black. There was Ron’s friend, Curtis. Curtis is quiet, humble, hardworking. The maintenance guy and cleaner who knew how to remove every type of stain. I learned from Curtis that sometimes the cleaning sprays don’t work, and you just have to scrub the shit out of a stain until its gone. Curtis knew how to fix everything with duct tape and still make it look like new.
Curtis’s skin was dark as night. He did time in county jail for threatening a white co-worker who had stolen money from him. He was a big, strong guy, could bench 400 pounds and run five miles without breathing heavy. After scrubbing the locker rooms and shining golf shoes all day, Curtis would don the tux and haul trays at night until exhaustion. Curtis showed up for work every day with a level of loyalty and dedication that is rare for anyone of any skin color.
There are a lot more Ron’s and Curtis’s I’ve known, but they are two of the high-character Black people who have influenced me greatly. I know and trust Ron and Curtis, my dad knows and trusts them, and numerous influential white people in the Harrisburg area know and trust them.
Yet Ron and Curtis had their lives turned upside down for behavior that white people typically get a slap on the wrist for.
Today, I’m aware of white people who would call Ron and Curtis “thugs”, but that couldn’t be further from the truth. Ron and Curtis are Black people, who I would choose to be in my corner, any day. And they deserve better from America.
There’s millions of Ron’s and Curtis’s out there who’s stories are lost in labels of ignorance. That’s why Black Lives Matter to me, and that’s why we are long overdue for real and permanent change in this country.
On behalf of NaturPro Scientific, I am pledging our support to the following:
–Sharing the stories of our experiences with great Black people like Ron and Curtis, and encouraging others to do the same.
–Encouraging all white people in America to understand and reflect on the issues facing Black people, and people of all colors, nationalities, races, genders and sexualities.
–Communicating on issues of diversity within our network in the food and supplement space
–Donating to organizations supporting Black people, such as Black Lives Matter and ACLU
I hope that you will join me.
President and Founder
NaturPro Scientific LLC
Dietary Supplements: Regulatory Challenges and Research Resources
Johanna T. Dwyer, Paul M. Coates, and Michael J. Smith
Nutrients 2018, 10, 41; doi:10.3390/nu10010041 (Open Access)
Abstract: Many of the scientific and regulatory challenges that exist in research on the safety, quality and efficacy of dietary supplements are common to all countries as the marketplace for them becomes increasingly global. This article summarizes some of the challenges in supplement science and provides a case study of research at the Office of Dietary Supplements at the National Institutes of Health, USA, along with some resources it has developed that are available to all scientists. It includes examples of some of the regulatory challenges faced and some resources for those who wish to learn more about them.
Keywords: dietary supplements; food supplements; supplement science; scientific challenges; regulatory challenges; natural health product; complementary medicine; traditional medicines; National Institutes of Health; Office of Dietary Supplements
The fundamental challenge in any discussion about the regulation of dietary supplements is that there is no global consensus on how the category of products known variously as dietary supplements, natural health products (NHPs), complementary medicines or food supplements in different countries is defined. For example, a product considered to be a dietary supplement and regulated as a food in the USA, in another jurisdiction may be considered a food supplement or a therapeutic good (complementary medicine) or a therapeutic good (prescription medicine) or potentially even a controlled substance. The situation is even more complicated when countries like China or India that have an existing regulatory framework for traditional medicine or phytomedicine that includes crude botanicals are considered. To add further to the confusion, many regulatory frameworks are changing.
Another challenge is that while all regulatory scientists want to protect consumers from harm, ensure that consumers have the ability to make informed choices about the products they use, and do the right thing, the scientific challenges and regulatory systems that have arisen to deal with them vary greatly from country to country. Even in countries with similar cultures, legal systems, and levels of economic development, regulations applying to dietary supplements vary considerably. Some of these differences are explored below, using examples from Australia, Canada and the USA, all English-speaking countries with largely similar cultures and legal systems to illustrate this point. The discussion of other countries with similar legal systems such as the United Kingdom, New Zealand and South Africa or other nations in the Americas, Europe, Africa and Asia, often with different cultures, legal systems, and levels of economic development is left for others with greater expertise and experience.
A final challenge is that “dietary supplement” health products are often very emotive and polarizing topics, evoking a diverse range of opinions and viewpoints. While some observers may contend that these products should be considered in a similar fashion to conventional drugs and foods, others believe that a more tailored approach is necessary since there is often a traditional or historical evidence base and products often contain multiple ingredients. Increasingly, this situation has become even more complex because of the lucrative nature of the global dietary supplement sector, increased involvement of a growing industry sector producing them, and the introduction of many new and innovative products onto the market. A detailed discussion of the politics of the subject is outside the scope of this paper. However, it must be recognized that politics may play both a positive and negative role in shaping both regulatory frameworks and research agendas. Irrespective of the reader’s point of view, this context is important in any discussion of dietary supplement products.
1.1. Importance of Research on Dietary Supplements
Until relatively recently, there was limited scientific research on dietary supplements and so little was known about them . However, the prevalence of supplement use has increased dramatically over the past 20 years , and they have become a matter of consumer interest [3,4]. At the same time, the application of state-of-the art scientific methods to explore issues involving dietary supplements has advanced rapidly. The other invited articles in this special issue illustrate progress in our understanding of supplement science as it applies to several nutrients, including vitamin D, iron, omega-3 fatty acids, and iodine. Progress on botanicals and other non-nutrient ingredients (e.g., glucosamine, methylsulfonylmethane (MSM), coenzyme Q10) has been more challenging . There is no global consensus in terminology for the category of products known variously as dietary supplements, NHPs, and food supplements in different countries and while we recognize this limitation, for the purpose of this article the term dietary supplement will be used to refer to such products as nutritional supplements, herbal medicines and traditional medicines. This article summarizes some of the scientific challenges in supplement research and some resources that may be useful in studying them. Most of the scientific challenges in supplement science are ubiquitous and global, so it is vital for scientists to collaborate across nations to help meet them without duplicating effort. A case study is provided by the work of the NIH Office of Dietary Supplements (ODS) which has been pursuing this goal since 2000. Some freely available resources and tools that ODS has developed for advancing health-related scientific knowledge on supplements are presented. The supplement marketplace is increasingly international, making collaboration between regulators essential since national decisions have international implications. Since products are consumed world-wide, calls for global quality standards are emerging. The remainder of the article focuses on regulatory challenges involving dietary supplements, and perspectives on how the regulatory systems in a number of different countries deal with them. Key resources for learning more about these approaches are provided.
1.2. Areas of Scientific Consensus about Supplement Science
Although there is broad consensus on the need for advances in science to make progress, opinions vary on the best paths to take and on priority areas for consideration.
The supply of ingredients used in supplements has outpaced the availability of methods and trained personnel to analyze them . For example, in 1994, when the Dietary Supplement Health and Education Act (DSHEA) first became law in the USA, about 600 U.S. manufacturers of supplements were producing an estimated 4000 products. By 2000, more than 29,000 supplement products were on the US market but few documented analytical methods or reference materials (RM) were available for these products. This growth in the market has also been evident internationally. For example, there are anecdotal reports that over 100,000 product license applications have been approved in Canada since the Natural Health Products Regulations came into force in 2005. The need for improving quality continues today, since now there are estimated to be more than 85,000 supplement products in the US marketplace and concerns about ingredient misidentification, safety concerns, and quality assurance/control problems continue to be important for the industry and the public [7,8].
The first step in characterizing supplement products is generally identifying the ingredients . Plant identification is a particular challenge. Even when easily identified whole plants or plant parts are used, unless the chain of custody is tight, and the exact manufacturing process is known and well characterized, the quality of extracts and blends such as those found in many botanical products is difficult to ascertain. Reliable analytical methods to characterize the bioactive components in supplements are helpful, but even for the nutrients in supplements, specific analytical chemistry methods must be often developed . The bioactives in supplements differ from those in foods in their matrices in that the forms, combinations, and doses in which they are consumed, and the circumstances under which they are used are likely to differ. Analytical techniques for other bioactives in supplements are further complicated because the active compound(s) are often unknown, and even when they are known, validated analytical methods may not exist for determining their content. Reference materials are often unavailable to compare results between different laboratories for research purposes and to monitor data and supplement quality.
Manufacturers are prohibited from marketing supplement products that are unsafe or contain unsafe ingredients. This includes assuring that safe upper levels of intake for nutrients or maximum dosages for other constituents are not exceeded and ensuring that toxic contaminants are absent. Improved accuracy and precision of the nutrient measurements, bioactive marker compounds for other ingredients, natural toxins, toxic elements and/or pesticides in dietary supplement ingredients and finished products will be helpful to regulatory agencies.
Demonstration of efficacy typically depends on a number of research approaches ranging from basic in-vitro research on the mechanisms of action to animal and human studies. For example, in the past, large and expensive clinical trials using poorly characterized herbal supplement products for which the mechanisms of action were not understood were performed, leading to results that were inconclusive and irreproducible [11–13]. These experiences led publishers and funders to demand better product characterization and funders to demand more mechanistic evidence of bioactivity. Once mechanistic plausibility is established, animal and small phase 1 and phase 2 trials should precede the launch of large phase 3 studies of efficacy. More and better clinical studies of the safety and efficacy of dietary supplements on “hard” health outcomes are also sorely needed. Health outcomes such as changes in validated surrogate markers for performance, functions, morbidity, and mortality from diseases or conditions are required rather than changes in biochemical measures in blood with unvalidated surrogate markers. The question of the use of evidence from traditional forms of health and healing such as Traditional Chinese Medicine (TCM) makes the question of efficacy often more complex. This is briefly explored in the regulatory section below.
1.2.4. Translation of the Science
Widespread consensus exists on the need to translate the scientific evidence on supplements into appropriate recommendations, regulations, and policies that ensure the public health. Population-based prevalence estimates of supplement use are needed to estimate total exposures to nutrients or other bioactives that can be related to health outcomes . Monitoring is especially important when supplementation is used as a public health strategy to fill nutrient gaps in deficient populations. It is also needed in other countries such as the USA where use of certain supplements is high, and where substantial proportions of total intakes of nutrients such as vitamin D and calcium come from supplements, especially among older adults .
2. Challenges and Resources: Regulatory Perspectives
As with other categories of regulated goods such as foods and drugs, the development of regulations is a balancing act where many different factors need to be taken into account. Notable among these are ensuring that products are of high quality and safe, that any claims made are truthful and not misleading, and that there is reasonable and appropriate access to the marketplace. All regulatory scientists want to both protect consumers from harm and support them in making informed choices about the products they include—or as importantly do not include—in their healthcare options. Appropriate regulatory oversight of this category is very challenging, and requires that scientists and regulators work together, as the former director general of the World Health Organization, Margaret Chan, MD urged . This section provides a concise overview of how these regulations have been developed, and common themes as well as challenges faced in a global market.
2.1. Definition of “Dietary Supplements”
Although the definition of dietary supplement within a specific jurisdiction such as the USA is quite precise [17,18], a fundamental challenge to any discussion on regulation is that there is no global consensus on either what falls within this category or even what the category is called. Intuitively many equate a dietary supplement in the USA with a NHP in Canada or a traditional herbal medicine in the European Union or a complementary medicine in Australia, but this is not the case. For example, while melatonin is regulated in the USA as a dietary supplement and in Canada as a NHP, in Australia it is considered as a prescription medicine [19–21]. Dehydroepiandrosterone (DHEA) is readily available as a dietary supplement in the US, while in many other jurisdictions it is regulated as a controlled substance and is subject to significant regulatory oversight .
This situation is even more complicated when one considers that in addition to dietary supplements such as vitamins and minerals, many of these products come from traditional systems of health and healing such as TCM in China and Ayurvedic/Unani/Siddha medicine in India. For this reason, we must differentiate between the manner in which nations regulate the practice of medicine and the manner in which they regulate marketed products used in medical practice or as foods. In the U.S., the practice of medicine is regulated by the states, while marketed food and drug products in interstate commerce are regulated by the Federal government. Approaches and regulatory frameworks in many parts of the world, notably in Asia, reflect this fact with terminology and categories developed accordingly .
To assist in development of its Traditional Medicine Strategy 2014–2023, the World Health Organization refers to this category as Traditional and Complementary Medicines (T & CM) . Although this classification does have significant limitations, it recognizes the fact that definitions for this category vary significantly globally. Descriptions of specific national/regional definitions and categories can be found through the list of resources in Table 1.
EU Parliament and Council
European Food Safety Authority (EFSA)
China Food and Drugs Administration (CFDA)
Health Ministry—Chinese Medicine Division
Food Safety and Standards Authority of India (FSSAI)
Ministry of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH)
WHO World Health Organization
World Self Medication Industry
International Alliance of Dietary/Food Supplement Associations (IADSA)
While it would be easy just to consider that the substance itself is the defining factor in determining whether or not a product is a dietary supplement, this is not the case. Two other important factors considered are the claim that the product is making and how the product is supplied or recommended (intended use). In many jurisdictions such as the USA, Canada and Australia, dietary supplements are considered suitable for self-selection without the need for the intervention of a practitioner or prescription. Here the claims that can be made are limited to minor conditions and to the support of health and wellness depending on the jurisdiction [24,25]. In other jurisdictions, notably those where a traditional form of health and healing is recognized, traditional and complementary medicine products are often prescribed, and in some cases supply is limited only to trained practitioners.
2.2. Regulatory Models
As with the definition of the products themselves, there is no consistent global approach to regulation, with many different frameworks developed that largely reflecting national and regional priorities and needs. That being said, there are a number of common themes and approaches that have been taken internationally.
2.2.1. Where Does the Category Fall within Existing Legislation?
With a few exceptions, notably where traditional forms of health and healing exist, most countries do not regulate dietary supplements as a stand-alone category. Rather, they include them as a subset of existing legislation [17,18]. That is, they “hang from the hook” that is set in existing legislation. In the past, this was largely a question of whether these products should be considered a subset of drugs or foods; increasingly though, a third option is to capture them under existing regulations for biologics. It is important to note that overarching legislation is often one of the most important factors impacting the type of claim that can be made and what level of scrutiny and oversight will exist. For example, countries that regulate these products as a subset of drugs or therapeutic goods such as Australia, Canada and the European Union (EU) for traditional herbal medicines allow far more specific clinical claims to be made than in a jurisdiction such as the USA, where dietary supplements are captured in regulations under the existing food legislation, with their advertising regulated by trade regulations [20,25,26].
2.2.2. Should They Be Regulated as a Group?
As noted above in many jurisdictions dietary supplements are simply captured under the existing food or drug regulations and legislation with no specific consideration for these products, in some cases specific regulations have developed to reflect the category. In these cases, two different regulatory models have typically been adopted that reflect their domestic use, national priorities and public health needs. In many jurisdictions, the first model applies. Dietary supplements are simply captured under the existing food or drug regulations and legislation. In that model, a wide range of products (typically herbal medicines, traditional medicines and dietary or nutritional supplements) reside under an umbrella term such as dietary supplements in the USA, complementary medicines in Australia or NHP in Canada [20,24,25]. In the second model, specific regulations are developed to deal with these products. In this case, specific categories are developed with very structured regulatory frameworks for specific types of T&CMs. This is particularly the case in countries with a strong traditional form of health and healing such as Chinese proprietary medicines in China (TCM), Ayurvedic medicines in India and Kampo medicines in Japan .
Irrespective of the approach taken, it is rare that one set of regulations will encompass all products commonly considered to be dietary supplement-like. Typical examples of this are guidelines and legislation related to advertising that apply irrespective of whether or not a product is considered to be a dietary supplement.
2.2.3. Common Elements of Regulatory Frameworks
As with other forms of regulations, independent and irrespective of the approach taken, frameworks that deal with dietary supplements may contain a number of common elements, in this case often specifically developed to reflect the challenges and nature of the products. These common elements include: process for approval of a product to be sold; provisions related to manufacture and Good Manufacturing Practices (GMPs); reporting of adverse events; controls on labeling related to indications, contraindications and warnings; and, where claims are permitted, the type and quality of supporting evidence required. Again, the number and nature of these elements applied are determined by the specific regulations in place.
2.2.4. Risk-Based Approach
Operationally, the regulation of dietary supplements faces a number of issues and challenges not shared with conventional drugs or even food products. Notable amongst these are the sheer number of individual dietary supplements on the domestic markets, often numbering in the tens of thousands, and the fact that the sector contains many different types of products often posing very different risks that are grouped together often by the fact that they do not fit under any other regulatory regime. In particular, considerable challenges are posed especially by herbal and traditional medicine products that contain crude botanicals and a complex milieu of potentially active moieties, unlike conventional allopathic pharmaceuticals.
While a completely pre-market approach, where all products and manufacturing sites are ‘approved’ before the dietary supplement is marketed would be the optimal situation, given the challenges mentioned above, this is often impractical. This has led to the development of regulatory frameworks that increasingly blend elements looking at products and sites both before they come to market as well as once they are available to consumers, or post-market. This regulatory oversight is sometimes referred to as a “life-cycle” approach. Examples of post-market regulatory approaches (i.e., once the dietary supplement is on the market) include target audits where dietary supplements already on the market are analyzed for quality or manufacturers are requested to submit evidence they may hold that supports a specific claim. The determining factor on which approach is applied is largely determined by risk posed to the consumer. Since most dietary supplements when appropriately manufactured are considered to be inherently low risk, increasingly regulatory frameworks are increasingly focused more on post-market review than pre-market licensure.
Even in countries that are in many ways socially, economically and legally similar, different approaches to the definition and regulation of dietary supplement health products are evident although they contain some common elements. Illustrative examples of this are evident in the different regulatory frameworks in place in the United States, Australia and Canada.
In the United States, dietary supplements are regulated under the Dietary Supplements Health Education Act of 1994 (DSHEA) as a subset of foods and limited to those taken orally. This approach is primarily post-market in nature. However, it does contain pre-market elements. For example, manufacturers must hold evidence to support their claims and they cannot make specific disease treatment claims but only claims related to nutritional support (which includes physiological structure and function) . All products must carry a disclaimer on the label stating that claims have not been reviewed by the US Food and Drug Administration (FDA). Provisions also include a post-market site audit process for manufacturing sites for Good Manufacturing Practice compliance and mandatory reporting of serious adverse effects by manufacturers. Companies must notify the Food and Drug Administration before marketing products with new dietary ingredients (NDI) . There is at present no indication that DSHEA will be substantially changed or modified by Congress, in recent years the regulatory authority has given more attention to the notification and classification of NDIs as well as the importance of Good Manufacturing Practices (GMP) .
In Australia, although a small number of these products are captured by a food standard, most are regulated as therapeutic goods under the Australian Therapeutic Goods Act. Products are referred to as complementary medicines and are legally defined as being a listed therapeutic good or a registered therapeutic good. The legislation itself does not define these terms, but a comprehensive set of guidelines describes how they are considered. Most complementary medicines are listed medicines and are managed through an online portal called the Electronic Listing Facility (ELF). Permitted claims are limited to minor, self-limited considerations and those traditional forms of health and healing such as traditional Chinese medicine. Evidence for efficacy is assured through a random and targeted post-market audit system and new listable substances are evaluated pre-market. As with all registered therapeutic goods, registered complementary medicines are evaluated pre-market for safety, quality and efficacy. Manufacturers of either finished listed or registered complementary medicines must undergo an on-site audit to ensure GMP .
In 2014, complementary medicines were included within a comprehensive review of regulations for all therapeutic goods and medical devices to be conducted by an external expert panel . The Commonwealth government accepted the majority of the recommendations from the panel and preliminary draft legislation was made public in September 2017. Although one of the recommendations was to keep complementary medicines as a distinct category, some significant changes are proposed, allowing mid-level claims through a new third regulatory route between the listed and registered therapeutic goods process as well as changes to how advertising is approved and compliance management [25,30].
In Canada, the majority of these dietary supplement products are referred to as natural health products (NHPs) and are considered a subset of drugs under a specific set of regulations—the Natural Health Products Regulations. Products must undergo a premarket assessment for safety, quality and efficacy. This is done in part through an online submission process with permissible claims supported by Health Canada monographs. Producers of NHPs who wish to make novel claims not supported through the monograph process must submit a full dossier of evidence for review. The products can make therapeutic claims, but their use is limited to self-care situations. While manufacturers are required to have a valid site license following approved GMP guidelines, no pre-market site audit is needed; the process being primarily paper based . To address the growing number of NHPs sold in a food-like format, Health Canada has created a new category of food currently defined through regulatory policy called “supplemented foods”. The category does allow for some health claims, but they are limited reflecting the nature of the products .
Unlike Australia, Canada is proposing to take different approach and rather than keeping NHPs as a distinct category, will include them in a self-care health product category together with non-prescription medicines and cosmetics. The intent of this initiative is to support informed consumer choice through a more consistent regulatory approach to these product categories that is based on risk. Key questions being explored deal with topics including evidence needed to support claims, provisions ensuring safety and quality and introduction of cost recovery framework .
2.2.5. Competing Types of Evidence
While it is clear that high quality scientific evidence is always required to support the quality of a dietary supplement, from a regulatory perspective the same may not always be true with regard the type and nature of the evidence required to support a product claim. Given the nature of the dietary supplement sector and the fact that it often encompasses traditional medicines with a long history of use, the question faced by regulators is how to balance the need for robust scientific evidence with a respect for diverse forms of health and healing.
Globally, no consistent approach has been taken in answering this question. In some jurisdictions such as Canada and Australia, the approach has been to link the form of evidence, whether it be traditional or evidence based from scientific research, to the level and type of claim that can be made. In these cases, typically products based on traditional evidence making traditional health care claims are ‘approved’ according to pre-cleared and approved sources of information such as monographs or labeling standards. For products making higher level, clinical claims, in a way similar to that for conventional pharmaceuticals, companies must supply a full dossier with appropriate supporting evidence such as that from randomized controlled trials (RCTs) [24,28]. In many countries such as the United States with no pre-market approval framework system, claims that can be made are more limited [17,18]. In countries with long-established traditional forms of medicines such as in China, India, and Japan, specific regulatory frameworks have been developed for these types of products with the type of claim that can be made and the evidence required to reflect this approach .
As the dietary supplement sector matures and develops and the market for raw ingredients becomes more global, establishing a balance between evidence generated by scientific research and that coming from traditional forms of health and healing is becoming increasingly demanding. This will be discussed later.
2.3. Evolving Regulatory Landscape—Challenging Issues
International regulatory frameworks are still considered by many to be a new and novel sector, although many of them are now more than two decades old. They were developed to reflect a time when the sector and nature of the market, not to mention the needs and demands of the consumer, were very different. This has meant that some decisions made in the past around policies and regulatory decisions may need to be revisited. These include the need to evaluate evidence of the “grandfathering” of dietary supplements already on the market when new regulations were implemented, the need to ensure that approaches are sustainable through cost-recovery mechanisms and the more global nature of the market place. Table 1 provides links to some of the regulatory frameworks of different countries that provide insights into the ways issues are dealt with in them.
2.3.1. Evaluating Evidence for Product Claims
As the market for dietary supplements has increased, so has the amount and diversity of scientific evidence and research to support, or not support, their use. This market is made more complex when there are conflicting evidence bases and conflicting ways for evaluating them. For example, how, or should, traditional evidence be evaluated within the framework of traditional healing theories or those of allopathic evidence based medicine; what should be done when evidence from traditional forms of health and healing are not supported by more conventional evaluation mechanisms such as randomized clinical trials; and how can consumers, often wanting to explore both conventional and traditional medicine, be supported in making informed choices about including, or not including, these products in their health care options.
The original concept of Evidence Based Medicine is based on three basic premises—individual clinical expertise, the best external evidence and patients’ values and expectations . The challenge faced by the regulator is to ensure that these are in play and to support consumers in making informed choices that are often made in a self-care setting.
2.3.2. Questions at the Regulatory Interface
It has never been easy to distinguish between a dietary supplement and other categories such as conventional foods, drugs and biologics. As all these sectors have evolved, this question of product classification has become even more complex. Two of the main questions at the regulatory interface are: what are the boundaries are between dietary supplements and conventional foods and between dietary supplements and over-the-counter drugs?.
As the popularity of dietary supplements available in a food-like format such as a pre-prepared drink or bar has increased, the line between what a consumer would understand to be a food as compared to a dietary supplement has become increasingly blurred. In essence, how does the regulator provide for appropriate regulatory oversight? This has been particularly challenging for those jurisdictions that consider these products as a sub-set of drugs with regulation and often legislation governing them that is very different from that for foods. In these cases, the regulatory frameworks are more specific to such dosage forms as capsules, tablets and tinctures. The challenge is one primarily of balance in providing a regulatory approach that is appropriate and not unnecessarily restrictive with the need to ensure that consumers are aware that these food-like dietary supplements that they are considering are not typical foods. This lack of clarity is also challenging for the private sector in determining what regulatory framework applies to a product, either food or drug, that they wish to develop and bring to market. In Canada, this concern required the government to create a new category called “supplemented foods” distinct from NHPs where products in a food like format are considered as a subset of foods and not as natural health products . In other jurisdictions such as Australia, authority has been given to the respective regulators to deem something to be either a therapeutic good or a food based a specific set of criteria .
The challenge at the over-the-counter (OTC)/dietary supplement interface is even more pronounced. A number of herbal medicines with a long history of use within the conventional health care model, such as senna and cascara, are regulated in most countries as OTC drugs rather than dietary supplements. As described above, Health Canada is proposing to address this issue in part by considering both NHPs and OTC drugs within a single regulatory approach for self-care products .
2.3.3. Working on the Global Stage
Although science and research may be global, regulations are still made primarily to reflect domestic needs and pressures. This poses a challenge regarding dietary supplements and dietary supplement ingredients that are now often sourced and/or manufactured outside of the country where they are sold. In spite of calls for regulatory harmonization, examples of true harmonization are limited to regions such as countries in the Association of South East Asian Nations (ASEAN) with the lack of a coherent and consistent regulatory approach prohibiting this globally . Even if regulatory harmonization is not possible, regulatory cooperation is often a viable option, taking into account inputs from stakeholder groups such as industry and not just governments. For example, to support cooperation between regulators, in 2005 in Ottawa, the World Health Organization supported the creation of the International Cooperation on Herbal Medicine (IRCH). IRCH now has over twenty members and provides a forum and mechanism for regulators to share information on safety issues and common challenges they all face . Increasingly governments are working together as well as with other stakeholders such as industry and consumers to address common problems and in some cases to provide regulatory decisions in one jurisdiction that can be used as a basis for action in another.
2.3.4. Strengthening Product Quality
As the dietary supplement market has become more global and lucrative, so have the importance of ensuring product quality and the challenges in doing so. There are increasing numbers of cases of adverse reactions and some fatalities due to contaminants or adulterants in the product rather than in the dietary supplement ingredients themselves. In some cases this has been due to intentional fraud by producers of these poor quality products who have developed sophisticated methods for overcoming existing regulations and oversight. This situation is explored in greater depth elsewhere in this paper.
2.4. Need for Continued Science in Support of Regulation
Irrespective of whether the goal is to support production of high quality products or to develop, apply or modify methods for evaluation of evidence in support of claims, the need for robust and relevant science and research on dietary supplements has never been more necessary. As regulatory frameworks evolve, many of the questions posed above will need to be addressed, balancing the need for robust science with a respect for traditional forms of health and healing.
3. Challenges: Scientific Perspectives
3.1. Issues Involving Human Requirements
Scientists often disagree about definitions of human requirements for bioactives and the implications for supplements. They differ on whether some non-nutrient bioactives are required for certain population subgroups and also on the health effects associated with the use of non-nutrient bioactives. It has been known for over 100 years that inborn errors of nutrient metabolism exist that can be remediated by supplying the lacking nutrient that has become conditionally essential. However, it is not clear that such a model based on single gene defects is useful for the amelioration of multigenic complex diseases. It is unclear that there are large numbers of individuals with common diseases and conditions such as type 2 diabetes or depression whose unique genetic characteristics cause them to have special nutritional requirements requiring supplements or medical foods .
Discoveries of genetic polymorphisms and the advent of inexpensive genetic tests that are widely available to consumers have nutritional implications. They have led to the rise of personalized or “precision nutrition”  and to the proliferation of boutique “personalized” eating plans and “precision” dietary supplements supposedly tailored to an individual’s genetic profile. The extent to which such supplements are efficacious in reducing chronic degenerative disease remains to be determined.
3.2. Supplement Quality, Safety and Efficacy
Challenges remain on the appropriate means for assuring supplement quality, safety and efficacy.
Regulators, health professionals and manufacturers often disagree on how much quality testing is necessary for supplements. This is echoed by the World Health Organization’s Strategy on Traditional Medicines 2014–2023  where quality is seen as a cornerstone of the sector. Botanical extracts and blends present particular challenges for detecting misidentification and contamination. The presence of adulterants and contaminants of both a biological and chemical nature in supplements is also challenging. Certain categories of supplements, such as athletic performance, sexual performance, and weight loss products, are particularly prone to the deliberate “spiking” with unlabeled extraneous or synthetic substances to confuse analytical techniques and even occasionally the addition of active synthetic drugs. Purity is a special problem for individuals with inborn errors of metabolism for specific nutrients such as vitamin B-6 or choline who require reliable, high quality sources of the nutrient. In countries that do not require that added nutrients be pharmaceutical grade or provide nutrients free to such patients, afflicted individuals must buy products that vary greatly in their quality on the open market.
The scientific challenges involved in all of the problems cited above depend in part on the adequacy and application of analytical methods. Analytical methods and reference standards are lacking for many of the thousands of different bioactive ingredients in dietary supplements. There is still disagreement about whether only a single officially endorsed method of analysis is acceptable. Any analytical method that is appropriately calibrated to a recognized reference standard should suffice but the onus is on the user of the method to demonstrate that affirmative requirements are met and that the method is suitable for its intended use and yields results that are accurate and precise. Methods that are suitable for foods may not be so for dietary supplements. Opinions also differ on whether government or the private sector is responsible for developing reference standards and analytical methods, and, if the private sector develops them, how they can be both kept independent and objective and made publicly available to avoid duplication of effort while preserving the marketing advantage of the developer. Tension also exists between researchers who desire ever more precise analytical methods for ingredients in dietary supplements and manufacturers who are concerned about the expertise and monetary costs required to apply some of the methods. A balance needs to be struck between the two.
Apart from concerns related to product quality, the safety of dietary supplements depends largely on dose. High doses of some nutrients are more likely to pose problems than others, although there is disagreement about the levels at which problems arise. For example, some dialysis patients who are receiving very large doses of calcium and the active form of vitamin D on a chronic basis may exceed the Tolerable Upper Level (UL) and incur adverse effects on health, including calcification of the soft tissues . Very high doses of vitamin D may also cause adverse effects in people with normal kidney function . There is little evidence that usual doses and forms of these nutrients give rise to health problems . The possibilities of excessive intakes of nutrients from dietary supplements are greater in countries with programs to fortify their food supplies than in others, and therefore they must also be evaluated [43–46].
Dose-response data for establishing safe levels of intakes of non-nutrient bioactives in supplements is frequently lacking [47,48]. Some dietary supplements containing non-target herbs added intentionally (like germander as an adulterant for skullcap), or others such as black cohosh, kava extract, green tea and others have been associated with liver injures of various types even after taking into account concomitant use with acetaminophen and alcohol and consumption while fasting . Extracts that are used in bodybuilding and weight loss have also been linked to liver injury. This has led to studies of the composition of different supplements [50,51]. Causes of liver toxicity from supplements appear to be due to insufficient regulatory authority, inaccurate product labeling, adulterants and inconsistent sourcing of ingredients . There is controversy about whether evidence of causality is sufficient for regulators to take action against supplements that seem to pose a hepatotoxic risk . Some possible actions include requirements for warning labels with usage instructions as is done for drugs, or/and removal of products from the market. Adulterated or fraudulent tainted products sold as dietary supplements are already illegal and subject to recall .
Interactions of some ingredients in supplements with other dietary supplements, nutrients, prescription or over-the-counter drugs are well documented. Of particular concern are adverse reactions occurring with commonly used medications, such as anti-hypertensive and cardiovascular preparations . In addition, much interest focuses around concomitant use of herbal medicines such as St. John’s Wort which has been shown to alter drug metabolism of a number of drugs notably those used in the treatment of HIV/AIDS, warfarin, insulin, aspirin and digoxin .
Among the most hotly debated issues in supplement research is the type and amount of evidence needed to demonstrate the efficacy of dietary supplements. Many of the issues involving efficacy include those common in testing of all medications such as study designs, significance testing, appropriate outcomes, effect sizes, acceptable biomarkers of effect, and the differences between statistical and clinical significance. In order to be efficacious, dietary supplements must be bioavailable, and yet in some countries regulations do not require testing of supplements for disintegration and dissolution and some products on the market fail such tests. This is a matter of concern both to researchers and regulators since such results have a negative impact on studies of dietary supplement efficacy. In-vitro methods are available for testing disintegration and dissolution of drugs, and these are adaptable for use with dietary supplement products. Regulators in some countries insist on changes in health outcomes or in validated surrogate biochemical markers of effect on the causal pathway to a health or performance outcome. Others accept changes in intermediary biochemical markers that may or may not be surrogates of health outcomes. These considerations have come to the fore because supplements on the market in some countries apparently have little or no demonstrated efficacy. For example, one recent review of 63 randomized, placebo-controlled clinical trials of dietary supplements in Western adults found that in 45 of them no benefits were found, 10 showed a trend toward harm and 2 showed a trend toward benefit, while 4 reported actual harm, and 2 both harms and benefits; only vitamin D and omega 3 fatty acids had strong enough benefits and lack of harm to suggest possible efficacy . This is an area of controversy that is highly polarized with questions being raised that depend on the type of dietary supplement being used, notably herbal medicines, the quality of the studies included in the review, and additional factors such as product quality of the supplement being evaluated that need to be taken into account .
3.2.4. Standards of Efficacy for Traditional Natural Products
The traditional use of Chinese medicines, Ayurvedic medicines and other remedies is embedded in larger healing systems and cultural or metaphysical beliefs that are part of users’ larger and more holistic world views. Should usual standards for efficacy should apply to them when they are used in the traditional manner? Clearly such uses are quite different than the use of a single product or ingredient at much higher traditional doses and without such a cultural context.
Although policy issues arise with all types of dietary supplements, the examples below will focus on nutrient-containing dietary supplements since these are particularly germane to discussions of nutritional status.
3.3.1. Nutrient Supplements Are Only One of Many Strategies for Improving Nutrient Intakes
There are many strategies for filling nutrient gaps in dietary intakes. They include nutrition education on appropriate food choices, fortification and enrichment that add nutrients to staple foods, genetic engineering that increases the nutrient content of a commodity itself either by genetic engineering/biotechnology, biofortification involving conventional breeding, and the use of nutrient containing dietary supplements. Dietary supplements provide concentrated sources of bioactives that are low or lacking in some individuals’ ordinary dietary intakes. The supplements can be used selectively by those whose diets have gaps in them. However, supplements have disadvantages. Their use depends upon individual motivations. Because they provide concentrated sources of bioactives at relatively high levels, they may increase the risks that some individuals will ingest excessive quantities and suffer health risks. Moreover, since dietary supplements can contain ingredients that lack a history of safe use, their long-term health effects may be unknown. The advantages and disadvantages of dietary supplements as a strategy to improve dietary intakes therefore must be carefully considered.
3.3.2. Supplementation as a Strategy to Achieve Nutritional Adequacy
The cost-effectiveness of using supplements to fill gaps in nutrient intakes as opposed to other means such as fortification or nutrition education varies from one nutrient to another and by country, and so each situation is unique and must be evaluated independently. There are also questions about what the supplement should be, if supplementation is chosen. In countries where nutrient containing dietary supplements are common, the use of multivitamin-multi-mineral (MVM) supplements is often associated with a greater proportion of the population reaching the estimated average requirement (EAR) for nutrients . However, for some of these nutrients, intakes are already adequate, so that the increased intakes may do little good, and in some cases supplements may increase the risk of exceeding the upper safe level (UL) of intakes.
3.3.3. Monitoring of Supplement Use
Monitoring of supplement use is particularly important in countries where premarket approval is not required to detect potential adverse reactions. Dietary indicators are known to be imprecise and estimates of usual intake are lacking for many nutrients . Biochemical indicators of deficiency are often not well linked with adverse health outcomes, underscoring the need for more attention to be paid to the development of agreed on measures of deficiency and excess . Recent work on key nutrient biomarkers is now available, facilitating the monitoring of high risk groups, such as pregnant women for folate status [61,62].
3.3.4. Authoritative Recommendations for Dietary Supplements
Health and nutrition experts differ on whether it is appropriate to include recommendations for nutrient containing dietary supplements in national health promotion and disease prevention recommendations. Many countries opt to recommend that adequate nutrient intake for the general public be achieved solely from foods, and reserve recommendations of specific nutrient supplements for specific subgroups in the population. Others recommend only food alone with no recommendations for special populations.
3.3.5. Inclusion of Dietary Supplements in Food Programs to Reduce Malnutrition
There is pressure by industry to include MVM or other dietary supplements in food programs. However, there is little evidence that the target groups are deficient in the ingredients in the supplements, nor has it been demonstrated that provision of a supplement leads to better health outcomes.
3.3.6. Stimulating Innovation
The development of new and more highly bioavailable forms of the nutrients, timed release, dosage forms, novel bioactive constituents and the appropriate application of new technologies such as nanotechnology are all important, but some pose new scientific and regulatory challenges.
4. Case Study: Office of Dietary Supplements (ODS), National Institutes of Health (NIH), USA
This case study highlights some examples of dietary supplement research supported by or conducted at the ODS, and provides some research tools it has developed that may be useful resources for scientists both there and abroad.
Since its establishment in 1995 as part of the implementation of the Dietary Supplement and Health Education Act [17,18] of 1994, the ODS is the lead federal agency devoted to the scientific exploration of dietary supplements. Its mission is to support, conduct and coordinate scientific research and provide intellectual leadership to strengthen the knowledge and understanding of dietary supplements in order to enhance the US population’s health and quality of life. ODS’s four goals are to: expand the scientific knowledge base on dietary supplements by stimulating and supporting a full range of biomedical research and by developing and contributing to collaborative initiatives, workshops, meetings and conferences; enhance the dietary supplement research workforce through training and career development; foster development and dissemination of research resources and tools to enhance the quality of dietary supplement research; and translate dietary supplement research findings into useful information for consumers, health professionals, researchers, and policymakers.
Several of its major initiatives that have expanded the scientific knowledge base on dietary supplements are described elsewhere in this special issue of NUTRIENTS. They include studies to clarify the implications for public health of omega-3 fatty acids , iodine , vitamin D , and iron .
4.2. Research Resources and Tools
This section provides the details on freely available research resources developed by ODS that are available for scientists to use to enhance the quality of dietary supplement research and meet public health priorities, with a focus on those that may be useful to scientists in other countries.
4.3. Analytical Methods for Dietary Supplements
The rigorous assessment of dietary supplement ingredients requires accurate, precise and reliable analytical methods and matching reference materials. The ODS Analytical Methods and Reference Materials program accelerates the creation and dissemination of validated methods and reference materials. It provides resources for characterization and verification of supplement product content that enhance the reliability and reproducibility of research using these products and supports product quality .
The genesis of the program was the paucity of publicly available methods for the analysis of supplement ingredients [68,69]. In 2000, the US dietary supplement community tended to use proprietary or compendial methods for quality control operations, and scientists and laboratories often kept their proprietary methods to themselves. Negative publicity about discrepancies between label claims and the results of product testing performed by third parties led to some unsuccessful efforts on the part of the industry to pay a laboratory to develop and validate methods through the Association of Official Analytical Chemists International (AOACI). The program was not successful for several reasons, including lack of expert technical guidance and conflicting sponsor priorities. However, this early effort led to a collaboration between trade associations, ODS, the AOACI, the United States Pharmacopoeia (USP), NSF International, and others in an attempt to establish standard methods for dietary supplement analysis. The ODS became involved because explicit wording in DSHEA required the Government to use “publicly available” analytical methods for enforcement actions involving dietary supplements. In response to the need for such publicly available methods and to support efforts to validate methods used in biomedical research on dietary supplement ingredients, ODS established the Analytical Methods and Reference Materials (AMRM) program in 2002.
ODS has been involved in sponsoring the creation of AOAC Official Methods of Analysis for dietary supplements and in the development and dissemination of numerous analytical methods and reference materials for 15 ingredients in dietary supplements in the USA, 32 botanical identification and documentation projects, and 45 studies determining contamination and adulterants. It has also helped to develop guidance on the validation of identity methods for botanical ingredients  and the conduct of single-laboratory validation studies for dietary supplements, Appendix K, AOAC Official Methods of Analysis, and provided guidance to evaluation of the literature on botanical supplements [71,72]. The portion of the ODS website includes a searchable database of analytical methods; these can be accessed at: https://ods.od.nih.gov/Research/AMRMProgramWebsite.aspx.
ODS also supports the Dietary Supplement Laboratory Quality Assurance Program in which participants measure concentrations of active and/or marker compounds and nutritional and toxic elements in practice and test materials. Exercises have included water and fat-soluble vitamins, nutritional and toxic elements, fatty acids, contaminants (e.g., aflatoxins, polyaromatic hydrocarbons (PAH’s)) and botanical markers (e.g., phytosterols and flavonoids).
4.4. Reference Materials
ODS supports the development of certified reference materials for dietary supplement ingredients with assigned values for concentrations of active and/or marker compounds, pesticides, and toxic metals to assist in the verification of product label claims and in quality control during the manufacturing process. A reference material is a material that is sufficiently homogeneous and stable with respect to one or more specified properties, which have been established to be fit for its intended use in a measurement process. A certified reference material (CRM) is a reference material characterized by a metrologically valid procedure for one or more specified properties, accompanied by a certificate that provides the value of the specified property, its associated uncertainty, and a statement of metrological traceability. Certified reference materials can be used for laboratory proficiency studies, methods development, method verification, and method validation studies. Calibration standards are the single chemical entities necessary for construction of calibration curves for quantitative analysis and for confirming analyte identity. Several processes are used to produce calibration standards. ODS provided funding to the U.S. Department of Commerce’s National Institute of Standards and Technology (NIST) for the development and distribution of calibration standard solutions and matrix standard reference materials (SRM®; a NIST-trademarked type of CRM). The materials fall into one of the following categories: (1) pure chemical entities or their mixtures, including many nutrients and other ingredients in dietary supplements for use in establishing analyte identity and for calibrating instruments; (2) natural matrix materials that represent the supply chain of a particular dietary supplement, e.g., biomass (ginkgo leaves and powder), processed botanical ingredient (ginkgo extract), finished product; (3) natural matrix materials that cover a range of analytes including nutritional compounds, botanical marker compounds, and compounds with known health concerns (heavy metals, pesticides, plant toxins); and (4) Clinical materials that can be used to assist clinical laboratories assess nutrient status or exposure, such as the measure of measure of vitamin D status commonly used around the world, serum 25-hydroxyvitamin D [73–75]. ODS is now expanding efforts to develop biomarkers of nutrient exposure and status in blood and other biological specimens in relation to chronic disease risk in individuals and populations. ODS has worked with NIST to produce and make available reference materials for calibration of various laboratory methods. Supplementary Table S1 shows NIST Standard Reference Materials (SRM®) now available. Supplementary Table S2 shows dietary supplement and nutritional assessment SRMs that are currently in progress.
4.5. Dietary Supplement Databases
Two databases have been developed by ODS that are described elsewhere in detail [76–80]. The goal of the Dietary Supplement Label Database (DSLD) is to include labels for virtually all dietary supplements sold in the USA. This provides all the information on the product label including composition, claims, and manufacturer contact information. It now contains over 72,000 dietary supplement labels, with new labels added at the rate of 1000 per month. Used together with food composition databases it is possible to estimate total daily intakes of nutrients and other bioactive ingredients from both foods and dietary supplements. A mobile version of DSLD is now available for use on smartphones to enhance consumer access to it [78,80]. It is primarily aimed at researchers and so contains information about products that are currently on the market, as well as those that have been removed from the market.
The Dietary Supplement Ingredient Database (DSID) provides analytically derived information on the amount of labeled ingredients of a representative sample of commonly used categories of supplement products sold in the USA, including adult, child and prenatal MVM supplements and omega-3 fatty acids. DSID is now being expanded to examine botanicals and other ingredients in supplements that are of public health interest, such as green tea products. Calculators included with the DSID permit a consumer to examine how closely the labeled contents of a nutrient in a product compare to chemical analyses of all products in the category .
4.6. Nutrition Research Methods and Review Methodology
Systematic reviews of dietary supplements require special techniques. ODS has sponsored a series of technical reports on the application of review methodology to the field of nutrition and dietary supplements [81–86]. Staff have also collaborated in performing systematic reviews with other groups [87,88].
4.7. Population-Based Monitoring of Dietary Supplement Use
In collaboration with the National Health and Nutrition Examination Survey (NHANES) of the National Center for Health Statistics, ODS investigates patterns of dietary supplement use using national and other large cohorts, and assesses supplements’ effects on total nutrient intakes. Several studies have focused on adults , children [90,91], and others in the population and their supplement use. Other studies have focused on the contributions to total intakes of nutrients made by dietary supplements. Investigators at ODS have been active in funding monitoring efforts on the links between intakes of folic acid and health . They have devoted particular attention to blood levels of folic acid and dietary intake patterns that are associated with very low and very high intakes of the nutrient [93–95]. The survey methods used are well documented and they may be useful for those in other countries planning similar population-based surveys to consult .
The motivations for use of dietary supplements are also documented; they often differ from those specified in regulations. NHANES contains several items that are consumer tested and available for use in other surveys on motivations. Knowledge of motivations can improve understanding of how people use these products and may provide clues for encouraging appropriate supplement use.
4.8. Translation of Supplement Science for Health Professionals and the Public
ODS has produced and periodically updates a library of more than two dozen fact sheets on the ingredients in supplements such as vitamin D, magnesium, and special products such as MVM supplements and products marketed for weight loss. There is a detailed version for professionals that is complete with detailed references, as well as easy-to-read versions for consumers in both English and Spanish. ODS also works with the National Library of Medicine (NLM) to produce and update a Dietary Supplement Subset of NLM’s PubMed. The National Center for Complementary and Integrative Health (NCCIH) at NIH produces a series of fact sheets on many botanicals and other non-nutrient bioactives in supplements that are also useful. They can be accessed at https:
//www.nccih.nih.gov. ODS also hosts an intensive, free 3-day course on issues in dietary supplement research annually for researchers. Further information about these and other projects is accessible at:https://www.ods.od.nih.gov.
4.9. Other Resources
In order to foster the development of appropriate study methods for dietary supplement research, ODS sponsors workshops on the latest knowledge and emerging approaches to the study of dietary supplements. It also supports the development of cutting–edge approaches to elucidate the mechanisms of action of complex botanical dietary supplements. It co-funds the Centers for Advancing Research on Natural Products (CARBON) with the NCCIM, including its program to develop high content high throughput methods to rapidly generate hypotheses on active compounds and the cellular targets. These and other resources are announced as they become available on the ODS website.
4.10. Fostering Use of Systematic Evidence Reviews in Policy Making and Clinical Practice
ODS has strengthened the scientific framework for developing dietary recommendations by encouraging the incorporation of systematic reviews into the development of the DRI. It has sponsored 18 systematic reviews on topics related to dietary supplements. These include ephedra, B vitamins, MVM supplements, omega-3 fatty acids, soy, probiotics, and vitamin D. The ephedra systematic review was helpful to the US government in banning ephedra products from the US market. The systematic reviews of omega-3 fatty acids funded over a decade ago and more recent updates on their associations with cardiovascular disease and infant health outcomes have been useful for planning intervention programs as well as for regulatory purposes. Current AHRQ reviews are available on the AHRQ website (https://www.ahrq.gov).
5. Future Needs
Attitudes toward safety, efficacy, and values about what is important in food and life will be important in determining future needs involving supplement science in the countries we have discussed and perhaps elsewhere in the world. Safety is critical, and requires better chains of custody and product characterization that exists at present for these products, particularly those involving global markets. Efficacy, that is that the health promotion claims for the product are true and not misleading is also critical. Demonstrating efficacy requires clinical studies with well defined products and rigorous experimental designs, and the studies must be replicable. To that end, many publishers now require that submitted manuscripts comply with established guidelines for the reporting of clinical trial results (e.g., CONSORT guidelines), while funders require demonstration of product integrity by applicants [97,98]. Finally there are issues of personal choice and values, sometimes involving the efficacy of supplements as complementary and alternative therapies that are part of a larger philosophical or religious world views and systems. These must be accommodated without abandoning safety.
Both basic and more applied challenges will continue well into the future. Much remains to be learned about the effects of bioactive constituents such as flavonoids in foods and dietary supplements on health outcomes, as many recent papers in Nutrients and elsewhere indicate [99–101]. More and better biomarkers need to be developed and their associations with health outcomes clarified . Supplements intended to enhance sports performance  botanicals used for disease treatment  and those ingredients thought to slow aging  all require identification of valid biomarkers of efficacy as well as of exposure. The role of supplements and the gut microbiome also must be explored for its associations with common diseases and conditions . The associations between supplement ingredients and health outcomes in chronic degenerative disease must be clarified [47,105,107–109]. High risk groups need more attention Certain subgroups within the population such as athletes consume very high amounts of some supplements and it is important to monitor them to prevent adverse outcomes and study the effects, if any, on athletic performance . Others use supplements in the hope that they will improve cognitive performance . Those who practice polypharmacy with prescription, non-prescription drugs and dietary supplements represent another high-risk group, and interventions to limit the potential for adverse events are needed [111,112]. Collaborations among scientists in many countries are needed to drive supplement science forward.
Irrespective of the type of health product, high quality science is fundamental to the success of any regulatory framework. Assessments of the safety, quality and efficacy of nutrients and other bioactives are needed to provide the scientific information that regulators need . As mentioned earlier, the nature and diversity of the sector means that regulators face a number of very specific challenges for these low risk products. These include evaluating traditional evidence, dealing with products that contain multiple bio-actives and addressing the growing challenges of ensuring product quality. It is critical that scientists and regulators work together and learn from each other in both identifying issues and developing ways in which they can be addressed. Although regulatory challenges must be met at the national level, there must be due regard paid to the fact that national regulatory decisions about supplements have global implications.
Science is vital in regulatory settings, and there is no reason that science and regulation should be incompatible . The challenges in supplement science and its regulation provide new opportunities for scientists and regulators to work together both nationally and internationally, to learn from each other, and to cooperate and when appropriate harmonize approaches to improve the public health.
Supplementary Materials: The following are available online at www.mdpi.com/2072-6643/10/1/41/s1, Tables S1 and S2 Table S1 Standard Reference Materials (SRM®) available from the National Institute of Science and Technology, US Department of Commerce. Table S2 Dietary supplement and nutritional assessment Standard Reference Materials (SRM®) currently under development at the National Institute of Science and Technology, US Department of Commerce (as of December 2016).
Acknowledgments: Funded by the National Institutes of Health, Bethesda, MD, USA. We thank Joseph M. Betz, Leila Saldanha, Cara Welsh, for their thoughtful and critical reviews of the manuscript, and Joyce Merkel, for technical editing and support.
Author Contributions: J.T.D. and P.M.C. developed the concept for the manuscript. J.T.D., P.M.C. and M.J.S. wrote the manuscript.
Conflicts of Interest: Johanna T. Dwyer holds stock in several food and drug companies, and serves on the scientific advisory boards of Conagra Foods, McCormick Spices, and as a consultant for Gerber/Nestle. She accepted partial travel and per diem expenses to speak at a symposium on dietary supplements sponsored by the International Association of Dietary/Food Supplement Associations at the International Congress of Nutrition in Buenos Aires, Argentina in October 2017. Michael J. Smith holds stock in several food and drug companies as well as acting as a consultant with clients in both the private and public sector including companies in dietary supplement and natural health products sector. He sits on the scientific advisory board of ISURA and the advisory board of the American Botanical Council. Paul M. Coates reports no conflicts of interest.
1. White, A. Growth-inhibition produced in rats by the oral administration of sodium benzoate: Effects of various dietary supplements. Yale J. Biol. Med. 1941, 13, 759–768. [PubMed]
- Kantor, E.D.; Rehm, C.D.; Du, M.; White, E.; Giovannucci, E.L. Trends in dietary supplement use among US adults from 1999–2012. JAMA Intern. Med. 2016, 316, 1464–1474. [CrossRef] [PubMed]
- Marik, P.E.; Flemmer, M. Do dietary supplements have beneficial health effects in industrialized nations: What is the evidence? JPEN J. Parenter. Enter. Nutr. 2012, 36, 159–168. [CrossRef] [PubMed]
- Manson, J.E.; Brannon, P.M.; Rosen, C.J.; Taylor, C.L. Vitamin D deficiency—Is there really a pandemic?N. Engl. J. Med. 2016, 375, 1817–1820. [CrossRef] [PubMed]
- Balentine, D.A.; Dwyer, J.T.; Erdman, J.W., Jr.; Ferruzzi, M.G.; Gaine, P.C.; Harnly, J.M.; Kwik-Uribe, C.L. Recommendations on reporting requirements for flavonoids in research. Am. J. Clin. Nutr. 2015, 101, 1113–1125. [CrossRef] [PubMed]
- Betz, J.M.; (NIH Office of Dietary Supplements, Bethesda, MD, USA). Personal communication, 2017.
- Mudge, E.M.; Betz, J.M.; Brown, P.N. The importance of method selection in determining product integrityfor nutrition research. Adv. Nutr. 2016, 7, 390–398. [CrossRef] [PubMed]
- Orhan, I.E.; Senol, F.S.; Skalicka-Wozniak, K.; Georgiev, M.; Sener, B. Adulteration and safety issues in nutraceuticals and dietary supplements: Innocent or risky? In Nutraceuticals, Nanotechnology in the Agri-Food Industry; Grumezescu, A.M., Ed.; Academic Press: Amsterdam, The Netherlands, 2016; Volume 4, pp. 153–182.
- AOAC International. AOAC International guidelines for validation of botanical identification methods.J. AOAC Int. 2012, 95, 268–272.
- Dwyer, J.T.; Holden, J.; Andrews, K.; Roseland, J.; Zhao, C.; Schweitzer, A.; Perry, C.R.; Harnly, J.; Wolf, W.R.; Picciano, M.F.; et al. Measuring vitamins and minerals in dietary supplements for nutrition studies in the USA. Anal. Bioanal. Chem. 2007, 389, 37–46. [CrossRef] [PubMed]
- Swanson, C.A. Suggested guidelines for articles about botanical dietary supplements. Am. J. Clin. Nutr.2002, 75, 8–10. [PubMed]
- Wolsko, P.M.; Solondz, D.K.; Phillips, R.S.; Schachter, S.C.; Eisenberg, D.M. Lack of herbal supplement characterization in published randomized controlled trials. Am. J. Med. 2005, 118, 1087–1093. [CrossRef] [PubMed]
- Gagnier, J.J.; DeMelo, J.; Boon, H.; Rochon, P.; Bombardier, C. Quality of reporting of randomized controlled trials of herbal medicine interventions. Am. J. Med. 2006, 119, 800.e1–800.e11. [CrossRef] [PubMed]
- Dwyer, J.; Costello, R.B.; Merkel, J. Assessment of dietary supplements. In Nutrition in the Prevention and Treatment of Disease, 4th ed.; Coulston, A.M., Boushey, C.J., Rerruzai, M.G., Delahaty, L.M., Eds.; Academic Press: London, UK, 2017; pp. 49–70.
- Ahluwalia, N.; Dwyer, J.; Terry, A.; Moshfegh, A.; Johnson, C. Update on NHANES dietary data: Focus on collection, release, analytical considerations, and uses to inform public policy. Adv. Nutr. 2016, 7, 121–134. [CrossRef] [PubMed]
- Chan, M. Forward. In WHO Traditional Medicine Strategy: 2014–2023; WHO: Hong Kong, China, 2013; pp. 7–8.
- Dickinson, A. History and overview of DSHEA. Fitoterapia 2011, 82, 5–10. [CrossRef] [PubMed]
- Taylor, C.L. Regulatory frameworks for functional foods and dietary supplements. Nutr. Rev. 2004, 62, 55–59.
- Australian Government Department of Health Therapeutic Goods Administration. The Poisons Standard(the SUSMP). Available online: https://www.tga.gov.au/publication/poisons-standard-susmp (accessed on17 September 2017).
- U.S. Food and Drug Administration. Dietary Supplements. Available online: https://www.fda.gov/food/dietarysupplements/ (accessed on 17 September 2017).
- Health Canada. Monograph: Melatonin—Oral. Available online: http://webprod.hc-sc.gc.ca/nhpid-bdipsn/monoReq.do?id=136 (accessed on 17 September 2017).
- Ventola, C.L. Current issues regarding complementary and alternative medicine (CAM) in the United States:Part 2: Regulatory and safety concerns and proposed governmental policy changes with respect to dietarysupplements. P T 2010, 35, 514–522. [PubMed]
- World Health Organization. National Policy on Traditional Medicine and Regulation of Herbal Medicines—Reportof a WHO Global Survey. Available online: http://apps.who.int/medicinedocs/en/d/Js7916e/ (accessed on 6 November 2017).
- Health Canada Natural and Non-prescription Health Products Directorate (NNHPD) About Natural Health Product Regulation in Canada. Available online: https://www.canada.ca/en/health-canada/services/ drugs-health-products/natural-non-prescription/regulation.html (accessed on 5 September 2017).
- Australian Government Department of Health Therapeutic Goods Administration. Exposure Drafts: Therapeutic Goods Amendment (2017 Measures No. 1) Bill 2017 and Therapeutic Goods (Charges) Amendment Bill 2017. Available online: https://www.tga.gov.au/consultation/consultation-exposure-drafts-2017 (accessed on 17 September 2017).
- European Commission Directorate-General for Health and Food Safety. Herbal Medicinal Products. Available online: https://ec.europa.eu/health/human-use/herbal-medicines_en (accessed on 17 September 2017).
- U.S. Food and Drug Administration. New Dietary Ingredients (NDI) Notification Process. Available online: https://www.fda.gov/food/dietarysupplements/newdietaryingredientsnotificationprocess/default.htm (accessed on 17 September 2017).
- Australian Government Department of Health Therapeutic Goods Administration. Australian Regulatory Guidelines for Complementary Medicines (ARGCM). Available online: https://www.tga.gov.au/publication/australian-regulatory-guidelines-complementary-medicines-argcm (accessed on 17 September 2017).
- Australian Government Department of Health Therapeutic Goods Administration. Medicines and Medical Devices Regulation Review. Available online: https://www.tga.gov.au/mmdr (accessed on 17 September 2017).
- Australian Government Department of Health Therapeutic Goods Administration. Australian Government Response to the Review of Medicines and Medical Devices Regulation. Available online: https://www.tga. gov.au/australian-government-response-review-medicines-and-medical-devices-regulation (accessed on 17 September 2017).
- Government of Canada. Category Specific Guidance for Temporary Marketing Authorization: Supplemented Food. Available online: https://www.canada.ca/en/health-canada/services/food-nutrition/legislation- guidelines/guidance-documents/category-specific-guidance-temporary-marketing-authorization- supplemented-food.html (accessed on 17 September 2017).
- Government of Canada Health Canada. Consulting Canadians on the Regulation of Self-Care Products in Canada. Available online: https://www.canada.ca/en/health-canada/programs/consultation-regulation-self- care-products/consulting-canadians-regulation-self-care-products-canada.html (accessed on 17 September 2017).
- Physiopedia. Evidence Based Practice (EBP). Available online: https://www.physio-pedia.com/Evidence_ Based_Practice_(EBP) (accessed on 17 September 2017).
- Australian Government Department of Health Therapeutic Goods Administration. Complementary Medicine Interface Issues. Available online: https://www.tga.gov.au/complementary-medicine-interface- issues (accessed on 17 September 2017).
- Singapore Government Health Science Authority. ASEAN Harmonization of Traditional Medicines and Health Supplements. Available online: http://www.hsa.gov.sg/content/hsa/en/Health_Products_Regulation/ Complementary_Health_Products/Overview/ASEAN_Harmonization_of_Traditional_Medicines_and_ Health_Supplements.html (accessed on 17 September 2017).
- World Health Organization. International Regulatory Cooperation for Herbal Medicines (IRCH). Available online: http://www.who.int/medicines/areas/traditional/irch/en/ (accessed on 17 September 2017).
- Gorman, U.; Mathers, J.C.; Grimaldi, K.A.; Ahlgren, J.; Nordstrom, K. Do we know enough? A scientific and ethical analysis of the basis for genetic-based personalized nutrition. Genes Nutr. 2013, 8, 373–381. [CrossRef] [PubMed]
- De Toro-Martin, J.; Arsenault, B.J.; Despres, J.P.; Vohl, M.C. Precision nutrition: A review of personalized nutritional approaches for the prevention and management of metabolic syndrome. Nutrients 2017, 9, 913. [CrossRef] [PubMed]
- World Health Organization. WHO Traditional Medicine Strategy: 2014–2023. Available online: http://www. who.int/medicines/publications/traditional/trm_strategy14_23/en/ (accessed on 17 September 2017).
- Drueke, T.B.; Massy, Z.A. Role of vitamin D in vascular calcification: Bad guy or good guy? Nephrol. Dial. Transplant.2012, 27, 1704–1707. [CrossRef] [PubMed]
- Rooney, M.R.; Harnack, L.; Michos, E.D.; Ogilvie, R.P.; Sempos, C.T.; Lutsey, P.L. Trends in use of high-dose vitamin D supplements exceeding 1000 or 4000 international units daily, 1999–2014. JAMA Intern. Med. 2017, 317, 2448–2450. [CrossRef] [PubMed]
- Prentice, R.L.; Pettinger, M.B.; Jackson, R.D.; Wactawski-Wende, J.; Lacroix, A.Z.; Anderson, G.L.; Chlebowski, R.T.; Manson, J.E.; Van Horn, L.; Vitolins, M.Z.; et al. Health risks and benefits from calcium and vitamin D supplementation: Women’s Health Initiative clinical trial and cohort study. Osteoporos. Int.2013, 24, 567–580. [CrossRef] [PubMed]
- Fulgoni, V.L., 3rd; Keast, D.R.; Bailey, R.L.; Dwyer, J. Foods, fortificants, and supplements: Where do Americans get their nutrients? J. Nutr. 2011, 141, 1847–1854. [CrossRef] [PubMed]
- Boyles, A.L.; Yetley, E.A.; Thayer, K.A.; Coates, P.M. Safe use of high intakes of folic acid: Research challenges and paths forward. Nutr. Rev. 2016, 74, 469–474. [CrossRef] [PubMed]
- Dwyer, J.T.; Wiemer, K.L.; Dary, O.; Keen, C.L.; King, J.C.; Miller, K.B.; Philbert, M.A.; Tarasuk, V.; Taylor, C.L.; Gaine, P.C.; et al. Fortification and health: Challenges and opportunities. Adv. Nutr. 2015, 6, 124–131. [CrossRef] [PubMed]
- Dwyer, J.T.; Woteki, C.; Bailey, R.; Britten, P.; Carriquiry, A.; Gaine, P.C.; Miller, D.; Moshfegh, A.; Murphy, M.M.; Smith Edge, M. Fortification: New findings and implications. Nutr. Rev. 2014, 72, 127–141. [CrossRef] [PubMed]
- Yetley, E.A.; MacFarlane, A.J.; Greene-Finestone, L.S.; Garza, C.; Ard, J.D.; Atkinson, S.A.; Bier, D.M.; Carriquiry, A.L.; Harlan, W.R.; Hattis, D.; et al. Options for basing Dietary Reference Intakes (DRIs) on chronic disease endpoints: Report from a joint US-/Canadian-sponsored working group. Am. J. Clin. Nutr. 2017, 105, 249s–285s. [CrossRef] [PubMed]
- Gaine, P.C.; Balentine, D.A.; Erdman, J.W., Jr.; Dwyer, J.T.; Ellwood, K.C.; Hu, F.B.; Russell, R.M. Are dietary bioactives ready for recommended intakes? Adv. Nutr. 2013, 4, 539–541. [CrossRef] [PubMed]
- Brown, A.C. Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series. Food Chem. Toxicol. 2017, 107, 472–501. [CrossRef] [PubMed]
- Saldanha, L.; Dwyer, J.; Andrews, K.; Betz, J.; Harnly, J.; Pehrsson, P.; Rimmer, C.; Savarala, S. Feasibility of including green tea products for an analytically verified dietary supplement database. J. Food Sci. 2015, 80, H883–H888. [CrossRef] [PubMed]
- Sander, L.C.; Bedner, M.; Tims, M.C.; Yen, J.H.; Duewer, D.L.; Porter, B.; Christopher, S.J.; Day, R.D.; Long, S.E.; Molloy, J.L.; et al. Development and certification of green tea-containing standard reference materials. Anal. Bioanal. Chem. 2012, 402, 473–487. [CrossRef] [PubMed]
- De Boer, Y.S.; Sherker, A.H. Herbal and dietary supplement-induced liver injury. Clin. Liver Dis. 2017, 21, 135–149. [CrossRef] [PubMed]
- Avigan, M.I.; Mozersky, R.P.; Seeff, L.B. Scientific and regulatory perspectives in herbal and dietary supplement associated hepatotoxicity in the United States. Int. J. Mol. Sci. 2016, 17, 331. [CrossRef] [PubMed]
- Brown, A.C. An overview of herb and dietary supplement efficacy, safety and government regulations in the United States with suggested improvements. Part 1 of 5 series. Food Chem. Toxicol. 2017, 107, 449–471.
- Gardiner, P.; Phillips, R.; Shaughnessy, A.F. Herbal and dietary supplement-drug interactions in patients with chronic illnesses. Am. Fam. Physician 2008, 77, 73–78. [PubMed]
- Tsai, H.H.; Lin, H.W.; Simon Pickard, A.; Tsai, H.Y.; Mahady, G.B. Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: A systematic literature review. Int. J. Clin. Pract. 2012, 66, 1056–1078.
- Gagnier, J.J.; Boon, H.; Rochon, P.; Moher, D.; Barnes, J.; Bombardier, C.; Group, C. Reporting randomized, controlled trials of herbal interventions: An elaborated CONSORT statement. Ann. Intern. Med. 2006, 144, 364–367.
- Blumberg, J.B.; Frei, B.B.; Fulgoni, V.L.; Weaver, C.M.; Zeisel, S.H. Impact of frequency of multi-vitamin/ multi-mineral supplement intake on nutritional adequacy and nutrient deficiencies in U.S. adults. Nutrients 2017, 9, 849. [CrossRef] [PubMed]
- Raghavan, R.; Ashour, F.S.; Bailey, R. A review of cutoffs for nutritional biomarkers. Adv. Nutr. 2016, 7, 112–120. [CrossRef] [PubMed]
- Centers for Disease Control and Prevention National Center for Environmental Health Division of Laboratory Sciences. Second National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population; Centers for Disease Control and Prevention: Atlanta, GA, USA, 2012.
- Bailey, L.B.; Stover, P.J.; McNulty, H.; Fenech, M.F.; Gregory, J.F., 3rd; Mills, J.L.; Pfeiffer, C.M.; Fazili, Z.; Zhang, M.; Ueland, P.M.; et al. Biomarkers of nutrition for development-folate review. J. Nutr. 2015, 145, 1636s–1680s. [CrossRef] [PubMed]
- Branum, A.M.; Bailey, R.; Singer, B.J. Dietary supplement use and folate status during pregnancy in the United States. J. Nutr. 2013, 143, 486–492. [CrossRef] [PubMed]
- Balk, E.M.; Lichtenstein, A.H. Omega-3 fatty acids and cardiovascular disease: Summary of the 2016 Agency of Healthcare Research and Quality evidence review. Nutrients 2017, 9, 865. [CrossRef] [PubMed]
- Ershow, A.G.; Skaeff, S.; Merkel, J.; Pehrsson, P. Development of databases on iodine in foods and dietary supplements. Nutrients 2018, in press.
- Taylor, C.L.; Sempos, C.T.; Davis, C.D.; Brannon, P.M. Vitamin D: Moving forward to address emerging science. Nutrients 2017, 9, 1308. [CrossRef] [PubMed]
- Brannon, P.M.; Taylor, C.L. Iron supplementation during pregnancy and infancy: Uncertainties and implications for research and policy. Nutrients 2017, 9, 1327. [CrossRef] [PubMed]
- Kuszak, A.J.; Hopp, D.C.; Williamson, J.S.; Betz, J.M.; Sorkin, B.C. Approaches by the U.S. National Institutes of Health to support rigorous scientific research on dietary supplements and natural products. Drug Test. Anal.2016, 8, 413–417. [CrossRef] [PubMed]
- Betz, J.M.; Fisher, K.D.; Saldanha, L.G.; Coates, P.M. The NIH analytical methods and reference materials program for dietary supplements. Anal. Bioanal. Chem. 2007, 389, 19–25. [CrossRef] [PubMed]
- Betz, J.M.; Brown, P.N.; Roman, M.C. Accuracy, precision, and reliability of chemical measurements in natural products research. Fitoterapia 2011, 82, 44–52. [CrossRef] [PubMed]
- LaBudde, R.A.; Harnly, J.M. Probability of identification: A statistical model for the validation of qualitative botanical identification methods. J. AOAC Int. 2012, 95, 273–285. [CrossRef] [PubMed]
- Betz, J.M.; Hardy, M.L. Evaluating the botanic dietary supplement literature. In The HERBAL Guide: Dietary Supplement Resources for the Clinician; Bonakdar, R.A., Ed.; Lippincott Williams and Wilkins: Philadelphia, PA, USA, 2010; pp. 175–184.
- Betz, J.M.; Hardy, M.L. Evaluating the botanical dietary supplement literature: How healthcare providers can better understand the scientific and clinical literature on herbs and phytomedicines. HerbalGram 2014, 101, 58–67.
- Brooks, S.P.J.; Sempos, C.T. The importance of 25-hydroxyvitamin D assay standardization and the Vitamin D Standardization Program. J. AOAC Int. 2017, 100, 1223–1224. [CrossRef] [PubMed]
- Phinney, K.W.; Tai, S.S.; Bedner, M.; Camara, J.E.; Chia, R.R.C.; Sander, L.C.; Sharpless, K.E.; Wise, S.A.; Yen, J.H.; Schleicher, R.L.; et al. Development of an improved standard reference material for vitamin D metabolites in human serum. Anal. Chem. 2017, 89, 4907–4913. [CrossRef] [PubMed]
- Phinney, K.W.; Bedner, M.; Tai, S.S.; Vamathevan, V.V.; Sander, L.C.; Sharpless, K.E.; Wise, S.A.; Yen, J.H.; Schleicher, R.L.; Chaudhary-Webb, M.; et al. Development and certification of a standard reference material for vitamin D metabolites in human serum. Anal. Chem. 2012, 84, 956–962. [CrossRef] [PubMed]
- Dwyer, J.T.; Picciano, M.F.; Betz, J.M.; Fisher, K.D.; Saldanha, L.G.; Yetley, E.A.; Coates, P.M.; Milner, J.A.; Whitted, J.; Burt, V.; et al. Progress in developing analytical and label-based dietary supplement databases at the NIH Office of Dietary Supplements. J. Food Compost. Anal. 2008, 21, S83–S93. [CrossRef] [PubMed]
- Dwyer, J.T.; Saldanha, L.G.; Bailen, R.A.; Bailey, R.L.; Costello, R.B.; Betz, J.M.; Chang, F.F.; Goshorn, J.; Andrews, K.W.; Pehrsson, P.R.; et al. A free new dietary supplement label database for registered dietitian nutritionists. J. Acad. Nutr. Diet. 2014, 114, 1512–1517. [CrossRef] [PubMed]
- Dwyer, J.T.; (NIH Office of Dietary Supplements, Bethesda, MD, USA). Personal communication, 2017.
- Andrews, K.W.; (USDA-ARS Beltsville Human Nutrition Research Center, Beltsville, MD, USA). Personal communication, 2017.
- Saldanha, L.G.; (NIH Office of Dietary Supplements, Bethesda, MD, USA). Personal communication, 2017.
- Lichtenstein, A.H.; Yetley, E.A.; Lau, J. Application of Systematic Review Methodology to the Field of Nutrition: Nutritional Research Series; Agency for Healthcare Research and Quality: Rockville, MD, USA, 2009; Volume 1.
- Helfand, M.; Balshem, H. AHRQ series paper 2: Principles for developing guidance: AHRQ and the effective health-care program. J. Clin. Epidemiol. 2010, 63, 484–490. [CrossRef] [PubMed]
- Trikalinos, T.A.; Lee, J.; Moorthy, D.; Yu, W.W.; Lau, J.; Lichtenstein, A.H.; Chung, M. Effects of Eicosapentanoic Acid and Docosahexanoic Acid on Mortality across Diverse Settings: Systematic Review and Meta-Analysis of Randomized Trials and Prospective Cohorts: Nutritional Research Series; Agency for Healthcare Research and Quality: Rockville, MD, USA, 2012; Volume 4.
- Trikalinos, T.A.; Moorthy, D.; Chung, M.; Yu, W.W.; Lee, J.H.; Lichtenstein, A.H.; Lau, J. Comparison of Translational Patterns in Two Nutrient-Disease Associations; Agency for Healthcare Research and Quality: Rockville, MD, USA, 2011.
- Moorthy, D.; Chung, M.; Lee, J.; Yu, W.W.; Lau, J.; Trikalinos, T.A. Concordance between the Findings of Epidemiological Studies and Randomized Trials in Nutrition: An Empirical Evaluation and Citation Analysis; Agency for Healthcare Research and Quality: Rockville, MD, USA, 2013.
- Brannon, P.M.; Taylor, C.L.; Coates, P.M. Use and applications of systematic reviews in public health nutrition.Annu. Rev. Nutr. 2014, 34, 401–419. [CrossRef] [PubMed]
- Ko, R.; Low Dog, T.; Gorecki, D.K.; Cantilena, L.R.; Costello, R.B.; Evans, W.J.; Hardy, M.L.; Jordan, S.A.; Maughan, R.J.; Rankin, J.W.; et al. Evidence-based evaluation of potential benefits and safety of beta-alanine supplementation for military personnel. Nutr. Rev. 2014, 72, 217–225. [CrossRef] [PubMed]
- Brooks, J.R.; Oketch-Rabah, H.; Low Dog, T.; Gorecki, D.K.; Barrett, M.L.; Cantilena, L.; Chung, M.; Costello, R.B.; Dwyer, J.; Hardy, M.L.; et al. Safety and performance benefits of arginine supplements for military personnel: A systematic review. Nutr. Rev. 2016, 74, 708–721. [CrossRef] [PubMed]
- Bailey, R.L.; Gahche, J.J.; Miller, P.E.; Thomas, P.R.; Dwyer, J.T. Why US adults use dietary supplements.JAMA Intern. Med. 2013, 173, 355–361. [CrossRef] [PubMed]
- Bailey, R.L.; Gahche, J.J.; Thomas, P.R.; Dwyer, J.T. Why US children use dietary supplements. Pediatr. Res.2013, 74, 737–741. [CrossRef] [PubMed]
- Berner, L.A.; Keast, D.R.; Bailey, R.L.; Dwyer, J.T. Fortified foods are major contributors to nutrient intakes in diets of US children and adolescents. J. Acad. Nutr. Diet. 2014, 114, 1009–1022.e8. [CrossRef] [PubMed]
- Taylor, C.L.; Bailey, R.L.; Carriquiry, A.L. Use of folate-based and other fortification scenarios illustrates different shifts for tails of the distribution of serum 25-hydroxyvitamin D concentrations. J. Nutr. 2015, 145, 1623–1629. [CrossRef] [PubMed]
- Pfeiffer, C.M.; Hughes, J.P.; Lacher, D.A.; Bailey, R.L.; Berry, R.J.; Zhang, M.; Yetley, E.A.; Rader, J.I.; Sempos, C.T.; Johnson, C.L. Estimation of trends in serum and RBC folate in the U.S. population from pre- to postfortification using assay-adjusted data from the NHANES 1988–2010. J. Nutr. 2012, 142, 886–893. [CrossRef] [PubMed]
- Pfeiffer, C.M.; Sternberg, M.R.; Hamner, H.C.; Crider, K.S.; Lacher, D.A.; Rogers, L.M.; Bailey, R.L.; Yetley, E.A. Applying inappropriate cutoffs leads to misinterpretation of folate status in the US population. Am. J. Clin. Nutr.2016, 104, 1607–1615. [CrossRef] [PubMed]
- Pfeiffer, C.M.; Lacher, D.A.; Schleicher, R.L.; Johnson, C.L.; Yetley, E.A. Challenges and lessons learned in generating and interpreting NHANES nutritional biomarker data. Adv. Nutr. 2017, 8, 290–307. [CrossRef] [PubMed]
- Gahche, J.J.; (NIH Office of Dietary Supplements, Bethesda, MD, USA). Personal communication, 2017.
- NIH National Center for Complementary and Integrative Health. NCCIH Policy: Natural Product Integrity. Available online: https://nccih.nih.gov/research/policies/naturalproduct.htm (accessed on 7 November 2017).
- NIH Office of Extramural Research. Grants & Funcing—Rigor and Reproducibility. Available online: https://grants.nih.gov/reproducibility/index.htm#guidance (accessed on 7 November 2017).
- Sebastian, R.S.; Wilkinson Enns, C.; Goldman, J.D.; Moshfegh, A.J. Dietary flavonoid intake is inversely associated with cardiovascular disease risk as assessed by body mass index and waist circumference among adults in the United States. Nutrients 2017, 9, 827. [CrossRef] [PubMed]© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Dietary Supplement Label Review Checklist
⊗ PACKAGING REQUIREMENTS
Five general requirements for labels include: 1) the statement of identity (name of the dietary supplement), 2) the net quantity of contents statement (amount of the dietary supplement), 3) the nutrition labeling (Supplement Facts Panel), 4) the ingredient list, and 5) the name and place of business of the manufacturer, packer, or distributor.
⊗ LABEL STATEMENTS
You must place all required label statements either on the front label panel (the principal display panel) or on the information panel (usually the label panel immediately to the right of the principal display panel, as seen by theconsumer when facing the product), unless otherwise specified by regulation(i.e., exemptions).
⊗ SUPPLEMENT FACTS PANEL
Total calories, calories from fat, total fat, saturated fat, cholesterol, sodium, totalcarbohydrate, dietary fiber, sugars, protein, vitamin A, vitamin C, calcium, andiron must be listed when they are present in measurable amounts. Calories from saturated fat and the amount of polyunsaturated fat, monounsaturated fat, soluble fiber, insoluble fiber, sugar alcohol, and other carbohydrate may be declared, but they must be declared when a claim is made about them.
⊗ INGREDIENT LIST
When present, you must place the ingredient list on dietary supplementsimmediately below the nutrition label, or if there is insufficient space belowthe nutrition label, immediately contiguous and to the right of the
⊗ WARNING STATEMENT
FDA requires warning statements related to safety and special precautions that, if not followed, could make the product unsafe.
⊗ UNITS OF MEASUREMENT
Proper units of measurement must be used, for example milligrams (mg), micrograms (mcg) or other appropriate units
⊗ PERCENTAGE DAILY VALUE (DV)
The % DV must be declared for all dietary ingredients for which FDA has established Daily Values, except that 1) the percent for protein may be omitted, and 2) on the labels of dietary supplements to be used by infants, children less than 4 years of age, or pregnant or lactating women, you must not list any percent for total fat, saturated fat, cholesterol, total carbohydrate,dietary fiber, vitamin K, selenium, manganese, chromium, molybdenum,chloride, sodium, or potassium.
⊗ DOMESTIC ADDRESS OR PHONE NUMBER
The label of a dietary supplement being marketed in the United States must include a domestic address or domestic phone number through which the responsible person may receive a report of a serious adverse event with such dietary supplement. If the label does not include the required domestic address or phone number, the dietary supplement is misbranded.
⊗ UPC BAR CODE
The UPC bar code may be obtained from the Uniform Code Council (www.uc-council.org)
⊗ NATURAL AND ARTIFICIAL FLAVORS
You must declare these ingredients in ingredient lists by using either specific common or usual names or by using the declarations “natural flavor” or “artificial flavor,” or any combination thereof.
⊗ CHEMICAL PRESERVATIVES
You must list the common or usual name of the preservative, which may be followed by a description that explains its function e.g., “preservative,” “to retard spoilage,”“a mold inhibitor,” “to help protect flavor,” or “to promote color retention.”
⊗ OTHER DIETARY INGREDIENTS
You must list “other dietary ingredients” by common or usual name in acolumn or linear display. FDA has not specified an order that you must follow. You must list the quantitative amount by weight per serving immediately following the name of the dietary ingredient or in a separate column. You must place a symbol in the column for “% Daily Value” that refers to the footnote “Daily Value Not Established,” except that the symbol must follow the weight when you do not use the column format.
⊗ LIQUID EXTRACTS
You must list liquid extracts using the volume or weight of the total extract and the condition of the starting material prior to extraction when it was fresh. You may include information on the concentration of the dietary ingredient and the solvent used. The solvent must be identified in either the nutrition label or ingredient list.
⊗ DRIED EXTRACTS
For dietary ingredients that are extracts from which the solvent has been removed, you must list the weights of the dried extracts.
You may list constituents of a dietary ingredient indented under the dietary ingredient and followed by their quantitative amounts by weight per serving. You may declare the constituents in a column or in a linear display.
⊗ PROPRIETARY BLENDS
You must identify proprietary blends by use of the term “Proprietary Blend” or an appropriately descriptive term or fanciful name. On the same line, you must list the total weight of all “other dietary ingredients” contained in the blend. Indented underneath the name of the blend, you must list the “other dietary ingredients” in the blend, either in a column or linear fashion, in descending order of predominance by weight. These ingredients should be followed by a symbol referring to the footnote “Daily Value Not Established.”Dietary ingredients having RDIs or DRVs must be listed separately and the individual weights declared.
⊗ PRODUCT CLAIMS
Claims come in four basic varieties:
- structure/function claims
- disease claims
- health claims and qualified health claims
- content claims
Basically, dietary supplements cannot make “disease” claims (for example: “treats cancer”). Dietary supplements that make disease claims are considered by FDA as drugs.
Dietary supplements can make “structure/function” claims (for example, “calcium builds strong bones”). A structure/function claim describes the product’s role in maintaining the “structure or function of the body,” or “general well-being.”
The Federal Trade Commission (“FTC”) has overlapping jurisdiction with the federal Food and Drug Administration (“FDA”), and focuses more on whether advertising is truthful, or false and misleading. Thus, it is important to respect nuanced labeling rules, including those regarding the statement of the identity.
The regulation states that the term “high potency” may be used in a claim on the label or in labeling to describe individual vitamins or minerals thatare present at 100 percent or more of the Reference Daily Intakes (RDI) per reference amount customarily consumed (21 CFR 101.54(f)(1)(i)). This means a supplement may be labeled as “high potency” for each nutrient(s) that is present at 100% of the RDI per serving.
⊗ ANTIOXIDANT NUTRIENT CONTENT CLAIMS
A claim that describes the level of antioxidant nutrients present in a food is a nutrient content claim and may be used on the label or in the labeling of a food when the conditions of use in the regulation are met (21 CFR 101.54(g)).
The antioxidant nutrient must meet the requirements for nutrient content claims in 21 CFR 101.54.
A dietary supplement may include claims in labeling such as “sugar free,” “no sugar,” or other claims provided it meets all of the eligibility criteria set forth in the regulation.
Among other requirements, a food must be labeled as “low calorie” or “reduced calorie” or bear a relative claim of special dietary usefulness. However, a dietary supplement that is prohibited from bearing a “low calorie”or “reduced calorie” claim can still use a sugar-free claim provided it meets the “low calorie” requirement in 21 CFR 101.60.
⊗HIGH OR GOOD SOURCE CLAIMS
You may make a “high” claim when your dietary supplement contains atleast 20% of the Daily Value (DV) (i.e. the Reference Daily Intake (RDI) or Daily Reference Value (DRV)) of the nutrient that is the subject of the claim perreference amount customarily consumed. You may make a “good source”claim when your dietary supplement contains 10 to 19% of DV.
⊗ LOW OR FREE-FROM CLAIMS
If a similar dietary supplement is normally expected to contain a nutrient and your dietary supplement is specially processed, altered, formulated, or reformulated as to lower the amount of the nutrient in the food, remove the nutrient in the food, or not include the nutrient, then you are permitted to make a “low” or “free” claim as applicable.
⊗ LOW CALORIE CLAIMS
A “low calorie” claim may not be made on dietary supplements, except when an equivalent amount of a dietary supplement that the labeled dietary supplement resembles and for which it substitutes (e.g., another protein supplement), normally exceeds the definition for “low calorie.”
⊗ QUALIFIED HEALTH CLAIMS
FDA will permit the use of a qualified health claim provided that 1) FDA hasissued a letter stating the conditions under which we will consider exercisingenforcement discretion for the specific health claim, 2) the qualified claim is accompanied by an agency-approved disclaimer, and 3) the claim meets all the general requirements for health claims in 21 CFR 101.14, except forthe requirement that the evidence for the claim meet the validity standard for authorizing a claim, and the requirement that the claim be made in accordance with an authorizing regulation.
This guidance was prepared by the Office of Nutritional Products, Labeling and Dietary Supplements (ONPLDS) in the Center for Food Safety and Applied Nutrition (CFSAN) at the U.S. Food and Drug Administration.