Monday, 29 November, 2021

Regulating Dietary Supplements

Dr. Shyam P Lohani

Our body needs a variety of nutrients each day to stay healthy. Those nutrients include calcium that supports bone health, and vitamin D helps the body absorb calcium, thus keeping our bones strong, folic acid to produce and maintain new cells, and vitamin A to help maintain a healthy immune system and vision. Vitamins C and E are antioxidants that prevent cell damage and help to maintain good health. Thus, there is evidence that suggests some supplements may help in enhancing health in different ways.

Women’s need of iron is increased during pregnancy, and breastfed infants need vitamin D supplement. Folic acid, whether from supplements or fortified food, is important for all women of childbearing age. Vitamin B12 is essential to keep nerve and blood cells healthy. The sources of Vitamin B12 are meat, fish, and dairy foods, therefore vegans may consider taking a supplement to be sure to get enough of it. The source of these nutrients is important. Usually, it is suggested to get these vitamins, minerals, and nutrients from food as opposed to supplements.

Booming industry
The dietary supplement industry is booming. Millions of people throughout the world take one or more dietary supplements daily or on occasion. Dietary supplements are available without a prescription and usually available in the form of pill, powder, or liquid. Commonly used supplements include vitamins, minerals, and herbal products, also known as botanicals. It is estimated that the global Dietary Supplements Market size was US$ 167.8 billion in 2019 and will grow to US$ 306.8 billion by 2026. The market is expected to grow at an annual CAGR (compound annual growth rate) of 9 per cent during the forecast period.

People usually take supplements to make sure they get enough essential nutrients and to maintain or improve their health. But not everyone needs to take supplements. Well-balanced diets usually contain most of the essential nutrients needed. Most of the nutrients are relatively safe, however, some of the supplements may have side effects, especially if taken prior to surgery or with other medicines. Supplements can also cause health problems if we have pre-existing illnesses. It is here important to reiterate that the effects of many supplements have not been tested in children, pregnant women, and other vulnerable groups, therefore, not suggested to give to such a population.

Over the past several years, dietary nutrients have attracted considerable interest due to their potential nutritional, safety, and therapeutic effects. These products could have a role in different biological processes, including antioxidant defenses, cell proliferation, gene expression, and the safeguarding of mitochondrial integrity. Therefore, the dietary supplements are used to improve health, prevent chronic diseases, slow down the aging process, and in turn increase life expectancy, or just support the functions and integrity of the body. These products are often promoted to be healthy sources for the prevention of life-threatening diseases such as diabetes, renal and gastrointestinal disorders, as well as different infections.

Moreover, fruits, vegetables, fish, and other healthy foods contain nutrients and other substances not found in a pill, which work together to keep us healthy. The synergistic effects from those natural sources cannot be obtained from a supplement. There have been reports of interference of nutrition absorption or cause side effects when a person takes vitamins or minerals in higher-than-recommended doses.

The philosophy behind the use of dietary supplements is to focus on prevention. Greek physician Hippocrates says: “Let food be your medicine”. Their role in human nutrition is one of the most important areas that need extensive investigation as they have tremendous implications for consumers, healthcare providers, regulators, food producers, and distributors. Dietary supplements are often considered non-specific biological therapies used to promote general well-being, control symptoms, and prevent malignant processes.

The regulation of dietary supplements differs from that which is involved in drugs and other food products. Many of those exciting supplement studies are observational as they do not test a particular supplement against a placebo in a controlled setting. The results of more stringent randomised controlled trials have not yielded the same results as observational studies. Because observational studies may not take into account dietary factors, exercise habits, and other variables, therefore, they may not prove whether the treatment is responsible for the health benefits.

Regulatory policies
Despite the proven risks, the market is flooded with supplement companies and vitamin pushers who argue that supplements from multivitamins to herbal cures for everything from the common cold to obesity are natural and thus safe. They aggressively advocate for keeping access to dietary supplements unrestrained by government regulation, claiming that further regulation would unfairly deprive the public of access to these potentially beneficial substances. Oftentimes, manufacturers and distributers cite theory and inappropriate data to support their claims and dismiss any evidence to the contrary.

Proper randomised studies that are mandatorily performed to establish the safety and efficacy of prescription medications are needed to establish the safety and efficacy of supplements. Although, such studies require large numbers of patients and are extremely costly. Without regulatory policies, there is little motivation for the industry to do such studies, even as supplements bring in large profits from sales to the public. The uses of supplements have also increased substantially during COVID-19 pandemic. Thus, it is urgent to promulgate regulatory policies to monitor dietary supplements in terms of quality and efficacy.

(Prof. Lohani is the founder and academic director at Nobel College.