Clinical Briefs: Evaluating Supplements
With Comments from John La Puma, MD, FACPSource: Petersen A. New Seals of Approval Certify Unregulated Herbs, Vitamins. Wall Street Journal July 10, 2002, D1.
"At one branch of the national chain Vitamin Shoppe, there are 83 different types of calcium, 77 kinds of vitamin C and 22 distinct bottles of ginkgo biloba. Choosing between them could drive the savviest consumer to skip the herbs and go right for the Tylenol.
"Several new seals of approval’ are vying to cut through the clutter of competing products in the largely unregulated $17 billion dietary-supplement industry. At least four outfits, from a nonprofit foundation to the venerable Good Housekeeping Institute, have begun or ramped up issuing official-looking stamps to herbs, vitamins and other supplements that meet certain standards.
"Generally, the programs test and certify that the ingredients listed on the label accurately reflect the makeup of the pills inside the bottle.
"Most also purport to ensure that a substance is free of common contaminants, including heavy metals and pesticides. Two require companies to follow good manufacturing practices.
"But while the seals give consumers some reassurance, they don’t conclusively answer the most important questions on shoppers’ minds: Is the product safe and does it work?"
Comment
What should we tell patients to look for when purchasing vitamins, minerals, and herbal supplements?
The best program is from the United States Pharmacopeia (USP)—I tell my patients to look for it on the label of all vitamins and minerals. Although it doesn’t verify efficacy and safety—no group does, or can—its seal of approval does reflect tested contents; a lack of contaminants, including heavy metals and pesticides; and actual dissolution. Its Dietary Supplement Verification Program (DSVP) seal should be every bit as good. See www.usp-dsvp.org for more information on the DSVP program.
If the bottle says "NSF," on approximately 60 products by year’s end, it’s been manufactured using good manufacturing practices, contains what it says it does, and is free of "common contaminants." Dissolution apparently is not tested. See www.NSF.org for its certification list.
Consumerlab.com tests claimed ingredient profiles, and posts some results on its site.
Good Housekeeping says its label reflects the amount of active ingredient on the bottle, requiring clinical studies; however, this should be taken with several grains of salt because most active ingredients in herbal supplements are not yet identified. Good Housekeeping requires advertising in its magazine to test its product.
All of these groups charge manufacturers for testing, though Consumer-lab.com tests some products for free, and charges all who want to use their seal. Interestingly, getting information about the products that Consumerlab.com tests for free requires a paid subscription from the consumer; the products posted are from companies that paid for the tests.
Recommendation
Look for USP on vitamin and mineral supplements, and USP, DSVP, or NSF on supplement bottles. A Consumer-lab.com subscription will get you the longest list of evaluated products. Caveat emptor.
La Puma J. Evaluating supplements. Altern Med Alert 2002;5:100.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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