ABSTRACT

Dietary (nonpharmaceutical) supplements The role of dietary supplements in health maintenance has become prominent and regarded. They signicantly add to the available methods of treating disease and in maintaining health. Its expanding scope is appreciated by the ever-increasing promotion in media outlets such as television, radio, and the Internet, and by anyone visiting their local pharmacy or vitamin superstore. The available products far outnumber the standard drugs used by clinicians. They are commonly promoted as natural and healthy alternatives to standard drugs. However, for several reasons, they should be regarded with caution. As opposed to standard drugs, they do not have the classication of pharmaceutical agents, and therefore in most countries are not regulated by governmental medical agencies. In the United States, they are not regulated by the Food and Drug Administration, which has rather strict guidelines for standard pharmaceutical products. As such, the quality of these products varies depending on the manufacturer, and often the labeled dose of the active ingredient is inaccurate. More concerning is contamination with toxic substances such as heavy metals. Lead, mercury, and arsenic are commonly found in Ayurvedic medicines1 and various other toxins are well described.2 Unfortunately, dietary supplements do not need to list these toxic components on their labels. Data from NHANES shows elevated levels of lead in those using herbal supplements.3 Dietary supplements are often marketed as natural and therefore safe and healthy products, yet the doses of many extracts are equivalent to several folds, sometimes several thousand folds, the concentration of the product in its raw form. This clearly is not natural. Finally, for many products, the supporting scientic data is limited and often anecdotal. Fortunately, agencies such as the U.S. Pharmacopeial (USP) Verication Program verify the doses and safety of these products and it is advisable to use products under their supervision. They are clearly marked as “USP veried.” Last, dietary supplements should be regarded, as suggested by its name, as supplements only. They are not a replacement to pharmaceutical agents or to healthy lifestyle and dietary measures.