The regulatory aspects of the food additives industry offer a backdrop to several areas of public health concern, including consumer behaviors regarding usage, safety, and effectiveness, as well as studies that address health effects from regular use of supplements. The U.S. dietary supplement industry has grown from about 4,000 products in 1994 to about 50,000 to 80,000 products in fiscal year 2021, and approximately 80 percent of U.S. adults reported taking dietary supplements, according to a consumer survey conducted in 2021. These increases in the number of products and in consumers usage highlight the importance of physicians understanding of potential concerns regarding the quality of products presented as dietary supplements, given that the U.S. Food and Drug Administration (FDA) does not rigorously regulate supplements as drugs. The Food and Drug Administration regulates dietary supplement quality, safety, and labeling, while the Federal Trade Commission oversees advertising and marketing; however, there are large enforcement challenges remaining, and optimum government oversight has yet to be achieved. The Food and Drug Administration regulates dietary supplements for safety, production, and labeling, and our partners at the Federal Trade Commission are responsible for overseeing the advertising of these products first.
In addition, manufacturers are not required to submit proof of the products safety to the Food and Drug Administration prior to marketing dietary supplements, except when supplements contain a novel dietary ingredient (a dietary ingredient not sold in this country before Oct. 15, 1994) that has not been presented in the food supply as a food-use article in a form where the food has not been chemically altered. Further, there is no requirement for manufacturers to provide evidence of product safety to Food and Drug Administration prior to marketing a dietary supplement, unless the supplement contains a new dietary ingredient (a dietary ingredient that was not marketed in this country before October 15, 1994) that has not been present in the food supply as an article used for food in a form in which the food has not been chemically altered. The underlying framework of DSHEA allows any products marketed as food additives at the time of enactment of DSHEA, except for products in the context of new ingredients–this is what is known as a grandfathered)–that they are safe. Manufacturers are required to inform FDA prior to marketing of any new ingredients. Instead, the FDA indicates, any chemical not marketed as a food before new dietary supplements laws were passed in 1994 should be considered a new ingredient, and a company would have to submit to FDA, under law, notice that it was being sold as a dietary supplement. Products that contain drugs, such as sildenafil (the active ingredient in some erectile dysfunction drugs) or drug analogs, which are compounds that have structures and functions that are similar to the active pharmaceutical ingredients, may also be sold unlawfully as dietary supplements.
Loop diuretics may increase calcium excretion, and medications that interfere with vitamin D (which facilitates calcium absorption), such as phenytoin, phenobarbital, and orlistat, can reduce calcium absorption from diet. Patients taking these medications might benefit from taking a calcium supplement, particularly if it contains vitamin D. Pharmacists are in a critical position to talk to patients taking these medications and to suggest appropriate calcium consumption. Loop diuretics increase the excretion of calcium, while drugs that affect vitamin D (which promotes of calcium absorption ), such as phenytoin, phenobarbital, and orlistat vitamin D (which promotes of calcium absorption ), such as phenytoin, phenobarbital, and orlistat, may decrease the amount of calcium absorbed from the diet. Patients taking these medications could benefit from a calcium supplement, especially one containing vitamin D. Pharmacists are in a key position to speak with patients taking these medications and to recommend adequate calcium intake and supplementation, particularly for patients with other risk factors for osteoporosis.22,25, methyl-formulin, methyl-formulin, methyl-formulin, methyl-formulin, methyl-formulin, methyl-formulin, and methyl-formulin. Monitor vitamin B 12 status (methylmalonic acid accumulation) and consider vitamin B 12 supplementation when taking the medication for a prolonged period. Vitamin D Through interfering with the absorption of bile acids and fats, cholestyramine may reduce the absorption of vitamin D. Space drug and vitamin D supplementation at least 4 hours apart.
Medication Interactions
Separate taking psyllium supplements from drugs by at least 2 hours to avoid possible interactions. Separate taking antibiotics 2 hours before or 6 hours after taking calcium in foods (including foods with added calcium) and supplements, or in medications that contain calcium (e.g., antacids). Multivitamin/mineral supplements can help to provide adequate amounts; separation of medication and supplementation of nutrients by at least 4 hours will prevent any interactions. If affected medications are expected to be taken for chronic use, and if supplements are considered needed, pharmacists should work with patients and prescribing physicians to recommend alternatives that will limit exposure to a potentially harmful drug interaction.
In addition, pharmacists should encourage software vendors and employers to include fields in their profiles systems for OTC medications and supplements, as these products may impact care and result in easily avoided drug interactions that may place a patient at risk of adverse outcomes or effects. It is important for physicians to be aware of what supplements a patient is taking, and educate patients about any known effectiveness data, as well as any potential medication interactions and adverse effects from the specific supplements. Patients frequently take supplements without consulting clinicians, and they frequently fail to report supplement intake unless specifically asked. Asking about supplement use is critical when patients are taking prescribed medications, as detrimental drug-supplement interactions can occur. In addition, it is important for physicians to know the quality of supplements in order to deliver appropriate care and to recognize adverse events. Finding a good deal is important, but make sure that your health care provider (or pharmacist) knows your health history, including all medications you take–both prescription and nonprescription (over-the-counter) medications, and dietary supplements and herbal products–even if you are not getting them from this specific pharmacy.
Low dietary vitamin K intake may lead to unstable INR, and very high dietary intake (>150 Ug/day) or supplementation with vitamin K can impair warfarins anticoagulant effects. Vitamins and minerals have critical functions in nearly every body process, and they must be obtained through foods or supplements because our bodies are not capable of producing them. Vitamin B 12 Chloramphenicol can reduce the absorption of dietary, but not supplemented, vitamin B 12 into your gut, and it can possibly hinder the effectiveness of vitamin B 12 supplements for treating anemia.
Now, this is complicated further by the fact that the FDA has many sitting bureaucrats that detest dietary supplements and who would like to see dietary supplements approved before they hit the market, thus driving out of the picture the costs of vitamins, minerals, even herbal products. Safety Monitoring The main mechanism to keep an eye on the safety of supplements is the voluntary reporting system established by Food and Drug Administrations Center for Food Safety and Applied Nutrition called the Center for Food Safety and Applied Nutritions (CAERS) E-Reporting System.