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"Food supplement" redirects here. For food additions that alter the flavor, color or longevity of food, see Food additive. Flight through a CT image stack of a multivitamin tablet "A-Z" by German company Abtei.

A dietary supplement is intended to provide nutrients that may otherwise not be consumed in sufficient quantities.

Supplements as generally understood include vitamins, minerals, fiber, fatty acids, or amino acids, among other substances. U.S. authorities define dietary supplements as foods, while elsewhere they may be classified as drugs or other products.

There are more than 50,000 dietary supplements available. More than half of the U.S. adult population (53% - 55%) consume dietary supplements with most common ones being multivitamins.[1][2]

These products are not intended to prevent or treat any disease and in some circumstances are dangerous, according to the U.S. National Institutes of Health. For those who fail to consume a balanced diet, the agency says that certain supplements "may have value."[3]

Most supplements should be avoided, and usually people should not eat micronutrients except people with clearly shown deficiency.[4] Those people should first consult a doctor.[5] An exception is vitamin D, which is recommended in Nordic countries[6] due to weak sunlight.

According to the United States Food and Drug Administration (FDA), dietary supplements are products which are not pharmaceutical drugs, food additives like spices or preservatives, or conventional food, and which also meet any of these criteria:[7]

In the United States, the FDA has different monitoring procedures for substances depending on whether they are presented as drugs, food additives, food, or dietary supplements.[7] Dietary supplements are eaten or taken by mouth, and are regulated in United States law as a type of food rather than a type of drug.[8] Like food and unlike drugs, no government approval is required to make or sell dietary supplements; the manufacturer checks the safety of dietary supplements but the government does not; and rather than requiring riskbenefit analysis to prove that the product can be sold like a drug, riskbenefit analysis is only used to petition that food or a dietary supplement is unsafe and should be removed from market.[7]

The intended use of dietary supplements is to ensure that a person gets enough essential nutrients.[9]

Dietary supplements should not be used to treat any disease or as preventive healthcare.[10] An exception to this recommendation is the appropriate use of vitamins.[10]

Dietary supplements are unnecessary if one eats a balanced diet.[11]

Supplements may create harm in several ways, including over-consumption, particularly of minerals and fat-soluble vitamins which can build up in the body.[12] The products may also cause harm related to their rapid absorption in a short period of time, quality issues such as contamination, or by adverse interactions with other foods and medications.[13]

There are many types of dietary supplements.

Vitamin is an organic compound required by an organism as a vital nutrient in limited amounts.[14] An organic chemical compound (or related set of compounds) is called a vitamin when it cannot be synthesized in sufficient quantities by an organism, and must be obtained from the diet. Thus, the term is conditional both on the circumstances and on the particular organism. For example, ascorbic acid (vitamin C) is a vitamin for humans, but not for most other animals. Supplementation is important for the treatment of certain health problems but there is little evidence of benefit when used by those who are otherwise healthy.[15]

Dietary elements, commonly called "dietary minerals" or "minerals", are the chemical elements required by living organisms, other than the four elements carbon, hydrogen, nitrogen, and oxygen present in common organic molecules. The term "dietary mineral" is archaic, as the substances it refers are chemical elements rather than actual minerals.

Herbal medicine is the use of plants for medicinal purposes. Plants have been the basis for medical treatments through much of human history, and such traditional medicine is still widely practiced today. Modern medicine recognizes herbalism as a form of alternative medicine, as the practice of herbalism is not strictly based on evidence gathered using the scientific method. Modern medicine, does, however, make use of many plant-derived compounds as the basis for evidence-tested pharmaceutical drugs, and phytotherapy works to apply modern standards of effectiveness testing to herbs and medicines that are derived from natural sources. The scope of herbal medicine is sometimes extended to include fungal and bee products, as well as minerals, shells and certain animal parts.

Amino acids are biologically important organic compounds composed of amine (-NH2) and carboxylic acid (-COOH) functional groups, along with a side-chain specific to each amino acid. The key elements of an amino acid are carbon, hydrogen, oxygen, and nitrogen, though other elements are found in the side-chains of certain amino acids.

Amino acids can be divided into three categories: essential amino acids, non-essential amino acids, and conditional amino acids. Essential amino acids cannot be made by the body, and must be supplied by food. Non-essential amino acids are made by the body from essential amino acids or in the normal breakdown of proteins. Conditional amino acids are usually not essential, except in times of illness, stress, or for someone challenged with a lifelong medical condition[citation needed].

Essential fatty acids, or EFAs, are fatty acids that humans and other animals must ingest because the body requires them for good health but cannot synthesize them.[16] The term "essential fatty acid" refers to fatty acids required for biological processes but does not include the fats that only act as fuel.

Bodybuilding supplements are dietary supplements commonly used by those involved in bodybuilding and athletics. Bodybuilding supplements may be used to replace meals, enhance weight gain, promote weight loss or improve athletic performance. Among the most widely used are vitamin supplements, protein drinks, branched-chain amino acids (BCAA), glutamine, essential fatty acids, meal replacement products, creatine, weight loss products and testosterone boosters. Supplements are sold either as single ingredient preparations or in the form of "stacks" - proprietary blends of various supplements marketed as offering synergistic advantages. While many bodybuilding supplements are also consumed by the general public their salience and frequency of use may differ when used specifically by bodybuilders.

According to University of Helsinki food safety professor Marina Heinonen, more than 90% of dietary supplement health claims are incorrect.[17] In addition, ingredients listed have been found to be different from the contents. For example, Consumer Reports reported unsafe levels of arsenic, cadmium, lead and mercury in several of the protein powders that were tested.[18] Also, the CBC found that protein spiking (the addition of amino acid filler to manipulate analysis) was not uncommon,[19] however many of the companies involved challenged their claim.[19]

The number of incidents of liver damage from dietary supplements has tripled in a decade. Most of the products causing that effect were bodybuilding supplements. Some of the victims required liver transplants and some died. A third of the supplements involved contained unlisted steroids.[20]

Mild to severe toxicity has occurred on many occasions due to dietary supplements, even when the active ingredients were essential nutrients such as vitamins, minerals or amino acids. This has been a result of adulteration of the product, excessive usage on the part of the consumer, or use by persons at risk for the development of adverse effects. In addition, a number of supplements contain psychoactive drugs, whether of natural or synthetic origin.[21][22]

BMC Medicine published a study on herbal supplements in 2013. Most of the supplements studied were of low quality, one third did not contain the active ingredient(s) claimed, and one third contained unlisted substances.[23][24]

An investigation by the New York Attorney Generals office analyzed 78 bottles of herbal supplements from Walmart, Target, Walgreens and GNC stores in New York State using DNA barcoding. a method used to detect labeling fraud in the seafood industry. Only about 20% contained the ingredient on the label.[25][26]

Some supplements were contamined by rodent feces and urine.[27]

Only 0.3% of the 55,000 U.S. market dietary supplements have been studied regarding their common side effects.[20]

In early 20th century there were great hopes for supplements, but later research has shown these hopes were unfounded.[28]

"Antioxidant paradox" means the fact that even though fruits and vegetables are related to decreases in mortality, cardiovascular diseases and cancers, antioxidant nutrients do not really seem to help. According to one theory, this is because some other nutrients would be the important ones.[29][30] Multivitamin pills have neither proved useful[4] but may even increase mortality.[31]

Omega-3 fatty acids and fish oils from food are very healthy, but fish oil supplements are recommended only for those suffering from coronary artery diseases and not eating fish. Latest research has made the benefits of the supplements questionable even for them. Contrary to claims, fish oils do not decrease cholesterol but may even raise the "bad" LDL cholesterol and cause other harms. Also the use of cod liver oil is criticized by scientists.[32]

Alice Lichtenstein, DSc, chairwoman of the American Heart Association (AHA) says that even though omega-3 fatty acids from foods are healthy, the same is not shown in studies on omega-3 supplements. Therefore, one should not eat fish oil supplements unless one suffers from heart diseases.[33]

The regulation of food and dietary supplements by the U.S. Food and Drug Administration is governed by various statutes enacted by the United States Congress and interpreted by the U.S. Food and Drug Administration ("FDA"). Pursuant to the Federal Food, Drug, and Cosmetic Act ("the Act") and accompanying legislation, the FDA has authority to oversee the quality of substances sold as food in the United States, and to monitor claims made in the labeling about both the composition and the health benefits of foods.

Substances which the FDA regulates as food are subdivided into various categories, including foods, food additives, added substances (man-made substances which are not intentionally introduced into food, but nevertheless end up in it), and dietary supplements. The specific standards which the FDA exercises differ from one category to the next. Furthermore, the FDA has been granted a variety of means by which it can address violations of the standards for a given category of substances.

The European Union's Food Supplements Directive of 2002 requires that supplements be demonstrated to be safe, both in dosages and in purity.[34] Only those supplements that have been proven to be safe may be sold in the bloc without prescription. As a category of food, food supplements cannot be labeled with drug claims but can bear health claims and nutrition claims.[35]

The dietary supplements industry in the United Kingdom (UK), one of the 28 countries in the bloc, strongly opposed the Directive. In addition, a large number of consumers throughout Europe, including over one million in the UK, and various doctors and scientists, had signed petitions by 2005 against what are viewed by the petitioners as unjustified restrictions of consumer choice.[36]

In 2004, along with two British trade associations, the Alliance for Natural Health (ANH) had a legal challenge to the Food Supplements Directive[37] referred to the European Court of Justice by the High Court in London.[38]

Although the European Court of Justice's Advocate General subsequently said that the bloc's plan to tighten rules on the sale of vitamins and food supplements should be scrapped,[39] he was eventually overruled by the European Court, which decided that the measures in question were necessary and appropriate for the purpose of protecting public health. ANH, however, interpreted the ban as applying only to synthetically produced supplementsand not to vitamins and minerals normally found in or consumed as part of the diet.[40]

Nevertheless, the European judges acknowledged the Advocate General's concerns, stating that there must be clear procedures to allow substances to be added to the permitted list based on scientific evidence. They also said that any refusal to add the product to the list must be open to challenge in the courts.[41]

Effects of most dietary supplements have not been determined in randomized clinical trials and manufacturing is lightly regulated; randomized clinical trials of certain vitamins and antioxidants have found increased mortality rates.[42][43]

Excerpt from:

Dietary supplement - Wikipedia, the free encyclopedia

Food fortification or enrichment is the process of adding micronutrients (essential trace elements and vitamins) to food. It may be a purely commercial choice to provide extra nutrients in a food, while other times it is a public health policy which aims to reduce the number of people with dietary deficiencies within a population.

Diets that lack variety can be deficient in certain nutrients. Sometimes the staple foods of a region can lack particular nutrients, due to the soil of the region or because of the inherent inadequacy of the normal diet. Addition of micronutrients to staples and condiments can prevent large-scale deficiency diseases in these cases.[citation needed]

While it is true that both fortification and enrichment refer to the addition of nutrients to food, the true definitions do slightly vary. As defined by the World Health Organization (WHO) and the Food and Agricultural Organization of the United Nations (FAO), fortification refers to "the practice of deliberately increasing the content of an essential micronutrient, ie. vitamins and minerals (including trace elements) in a food irrespective of whether the nutrients were originally in the food before processing or not, so as to improve the nutritional quality of the food supply and to provide a public health benefit with minimal risk to health," whereas enrichment is defined as "synonymous with fortification and refers to the addition of micronutrients to a food which are lost during processing."[1]

Food fortification was identified as the second strategy of four by the WHO and FAO to begin decreasing the incidence of nutrient deficiencies at the global level.[1]

As outlined by the FAO, the most common fortified foods are:

The four main methods of food fortification (named as to indicate the procedure that is used in order to fortify the food):

The WHO and FAO, among many other nationally recognized organizations, have recognized that there are over 2 billion people worldwide who suffer from a variety of micronutrient deficiencies. In 1992, 159 countries pledged at the FAO/WHO International Conference on Nutrition to make efforts to help combat these issues of micronutrient deficiencies, highlighting the importance of decreasing the number of those with iodine, vitamin A, and iron deficiencies.[1] A significant statistic that led to these efforts was the discovery that approximately 1 in 3 people worldwide were at risk for either an iodine, vitamin A, or iron deficiency.[4] Although it is recognized that food fortification alone will not combat this deficiency, it is a step towards reducing the prevalence of these deficiencies and their associated health conditions.[5]

In Canada, The Food and Drug Regulations have outlined specific criterion which justifies food fortification:

There are also several advantages to approaching nutrient deficiencies among populations via food fortification as opposed to other methods. These may include, but are not limited to: treating a population without specific dietary interventions therefore not requiring a change in dietary patterns, continuous delivery of the nutrient, does not require individual compliance, and potential to maintain nutrient stores more efficiently if consumed on a regular basis.[3]

Several organizations such as the WHO, FAO, Health Canada, and the Nestl Research Center acknowledge that there are limitations to food fortification. Within the discussion of nutrient deficiencies the topic of nutrient toxicities can also be immediately questioned. Fortification of nutrients in foods may deliver toxic amounts of nutrients to an individual and also cause its associated side effects. As seen with the case of fluoride toxicity below, the result can be irreversible staining to the teeth. Although this may be a minor toxic effect to health, there are several that are more severe.[7]

The WHO states that limitations to food fortification may include: human rights issues indicating that consumers have the right to choose if they want fortified products or not, the potential for insufficient demand of the fortified product, increased production costs leading to increased retail costs, the potential that the fortified products will still not be a solution to nutrient deficiencies amongst low income populations who may not be able to afford the new product, and children who may not be able to consume adequate amounts thereof.[1]

Food safety worries led to legislation in Denmark in 2004 restricting foods fortified with extra vitamins or minerals. Products banned include: Rice Crispies, Shreddies, Horlicks, Ovaltine and Marmite.[8]

Danes said [Kelloggs] Corn Flakes, Rice Krispies and Special K wanted to include "toxic" doses which, if eaten regularly, could damage children's livers and kidneys and harm fetuses in pregnant women.[9]

One factor that limits the benefits of food fortification is that isolated nutrients added back into a processed food that has had many of its nutrients removed, does not always result in the added nutrients being as bioavailable as they would be in the original, whole food. An example is skim milk that has had the fat removed, and then had vitamin A and vitamin D added back. Vitamins A and D are both fat-soluble and non-water-soluble, so a person consuming skim milk in the absence of fats may not be able to absorb as much of these vitamins as one would be able to absorb from drinking whole milk.

Phytochemicals such as polyphenols can also impact nutrient absorption.

Ecological studies have shown that increased B vitamin fortification is correlated with the prevalence of obesity and diabetes.[10] Daily consumption of iron per capita in the United States has dramatically surged since World War II and nearly doubled over the past century due to increases in iron fortification and increased consumption of meat.[11] Existing evidence suggests that excess iron intake may play a role in the development of obesity, cardiovascular disease, diabetes and cancer.[12]

Fortification of foods with folic acid has been mandated in many countries solely to improve the folate status of pregnant women to prevent Neural Tube Defectsa relatively rare birth defect which affected 0.5% of US births before fortification began.[13][14] However, when fortification is introduced, several hundred thousand people are exposed to an increased intake of folic acid for each neural tube defect pregnancy that is prevented.[15] In humans, increased folic acid intake leads to elevated blood concentrations of naturally occurring folates and of unmetabolized folic acid. High blood concentrations of folic acid may decrease natural killer cell cytotoxicity, and high folate status may reduce the response to drugs used to treat malaria, rheumatoid arthritis, psoriasis, and cancer.[15] A combination of high folate levels and low vitamin B-12 status may be associated with an increased risk of cognitive impairment and anemia in the elderly and, in pregnant women, with an increased risk of insulin resistance and obesity in their children.[15] Folate has a dual effect on cancer, protecting against cancer initiation but facilitating progression and growth of preneoplastic cells and subclinical cancers.[15] Furthermore, intake of folic acid from fortification have turned out to be significantly greater than originally modeled in pre mandate predictions.[16] Therefore, a high folic acid intake due to fortification may be harmful for more people than the policy is designed to help.[14][15][17][18]

There is a concern that micronutrients are legally defined in such a way that does not distinguish between different forms, and that fortified foods often have nutrients in a balance that would not occur naturally. For example, in the U.S., food is fortified with folic acid, which is one of the many naturally-occurring forms of folate, and which only contributes a minor amount to the folates occurring in natural foods.[19] In many cases, such as with folate, it is an open question of whether or not there are any benefits or risks to consuming folic acid in this form.

In many cases, the micronutrients added to foods in fortification are synthetic.

In some cases, certain forms of micronutrients can be actively toxic in a sufficiently high dose, even if other forms are safe at the same or much higher doses. There are examples of such toxicity in both synthetic and naturally-occurring forms of vitamins. Retinol, the active form of Vitamin A, is toxic in a much lower dose than other forms, such as beta carotene. Menadione, a phased-out synthetic form of Vitamin K, is also known to be toxic.[20]

There are several main groups of food supplements like:

Many foods and beverages worldwide have been fortified, whether a voluntary action by the product developers or by law. Although some may view these additions as strategic marketing schemes to sell their product, there is a lot of work that must go into a product before simply fortifying it. In order to fortify a product, it must first be proven that the addition of this vitamin or mineral is beneficial to health, safe, and an effective method of delivery. The addition must also abide by all food and labeling regulations and support nutritional rationale. From a food developer's point of view, they also need to consider the costs associated with this new product and whether or not there will be a market to support the change.[21]

Examples of foods and beverages that have been fortified and shown to have positive health effects:

"Iodine deficiency disorder (IDD) is the single greatest cause of preventable mental retardation. Severe deficiencies cause cretinism, stillbirth and miscarriage. But even mild deficiency can significantly affect the learning ability of populations........ Today over 1 billion people in the world suffer from iodine deficiency, and 38 million babies born every year are not protected from brain damage due to IDD."Kul Gautam, Deputy Executive Director, UNICEF, October 2007[22]

Iodised salt has been used in the United States since before World War II. It was discovered in 1821 that goiters could be treated by the use of iodized salts. However, it was not until 1916 that the use of iodized salts could be tested in a research trial as a preventative measure against goiters. By 1924, it became readily available in the US.[23]

Currently in Canada and the US, the RDA for iodine is as low as 90g/day for children (48 years) and as high as 290g/day for breast-feeding mothers.[24]

Diseases that are associated with an iodine deficiency include: mental retardation, hypothyroidism, and goiter. There is also a risk of various other growth and developmental abnormalities.[24]

Folic acid (also known as folate) functions in reducing blood homocysteine levels, forming red blood cells, proper growth and division of cells, and preventing neural tube defects (NTDs).[25]

In many industrialized countries, the addition of folic acid to flour has prevented a significant number of NTDs in infants. Two common types of NTDs, spina bifida and anencephaly, affect approximately 2500-3000 infants born in the US annually. Research trials have shown the ability to reduce the incidence of NTDs by supplementing pregnant mothers with folic acid by 72%.[26]

The RDA for folic acid ranges from as low as 150g/day for children aged 13 years old, to 400g/day for males and females over the age of 19, and 600g/day during pregnancy.[27]

Diseases associated with folic acid deficiency include: megaloblastic or macrocytic anemia, cardiovascular disease, certain types of cancer, and NTDs in infants.[28]

Niacin has been added to bread in the USA since 1938 (when voluntary addition started), a programme which substantially reduced the incidence of pellagra.[29] As early as 1755, pellagra was recognized by doctors as being a niacin deficiency disease. Although not officially receiving its name of pellagra until 1771.[30]Pellagra was seen amongst poor families who used corn as their main dietary staple. Although corn itself does contain niacin, it is not a bioavailable form unless it undergoes Nixtamalization (treatment with alkali, traditional in Native American cultures) and therefore was not contributing to the overall intake of niacin.[31] Although pellagra can still be seen in developing countries, fortification of food with niacin played a huge role in eliminating the prevalence of the disease.[30]

The RDA for niacin is 2mg NE(niacin equivalents)/day (AI) for infants aged 06 months, 16mg NE/day for males, and 14mg NE/day for females who are over the age of 19.[31]

Diseases associated with niacin deficiency include: Pellagra which consisted of signs and symptoms called the 3D's-"Dermatitis, dementia, and diarrhea. Others may include vascular or gastrointestinal diseases.[30]

Common diseases which present a high frequency of niacin deficiency: alcoholism, anorexia nervosa, HIV infection, gastrectomy, malabsorptive disorders, certain cancers and their associated treatments.[30]

Since Vitamin D is a fat-soluble vitamin, it cannot be added to a wide variety of foods. Foods that it is commonly added to are margarine, vegetable oils and dairy products.[32] During the late 1800s, after the discovery of curing conditions of scurvy and beriberi had occurred, researchers were aiming to see if the disease, later known as rickets, could also be cured by food. Their results showed that sunlight exposure and cod liver oil were the cure. It was not until the 1930s that vitamin D was actually linked to curing rickets.[33] This discovery led to the fortification of common foods such as milk, margarine, and breakfast cereals. This took the astonishing statistics of approximately 8090% of children showing varying degrees of bone deformations due to vitamin D deficiency to being a very rare condition.[34]

Risk factors for vitamin D deficiencies include:

The current RDA for infants aged 06 months is 10g (400 International Units (IU))/day and for adults over 19 years of age it is 15g (600 IU)/day.[35]

Diseases associated with a vitamin D deficiency include rickets, osteoporosis, and certain types of cancer (breast, prostate, colon and ovaries). It has also been associated with increased risks for fractures, heart disease, type 2 diabetes, autoimmune and infectious diseases, asthma and other wheezing disorders, myocardial infarction, hypertension, congestive heart failure, and peripheral vascular disease.[34]

Although fluoride is not considered an essential mineral, it is seen as crucial in prevention of tooth decay and maintaining adequate dental health.[36] In the mid-1900s it was discovered that towns with a high level of fluoride in their water supply was causing the residents' teeth to have both brown spotting and a strange resistance to dental caries. This led to the fortification of water supplies with fluoride with safe amounts to retain the properties of resistance to dental caries but avoid the staining cause by fluorosis (a condition caused by a fluoride toxicity).[37] The tolerable upper intake level (UL) set for fluoride ranges from 0.7mg/day for infants aged 06 months and 10mg/day for adults over the age of 19.

Conditions commonly associated with fluoride deficiency are dental caries and osteoporosis.[36]

Some other examples of fortified foods:

Despite having some scientific basis, but with controversial ethics, is the science of using foods and food supplements to achieve a defined health goal. A common example of this use of food supplements is the extent to which body builders will use amino acid mixtures, vitamins and phytochemicals to enhance natural hormone production, increase muscle and reduce fat. The literature is not concrete on an appropriate method for use of fortification for body builders and therefore may not be recommended due to safety concerns.[42]

There is interest in the use of food supplements in established medical conditions. This nutritional supplementation using foods as medicine (nutraceuticals) has been effectively used in treating disorders affecting the immune system up to and including cancers.[43] This goes beyond the definition of "food supplement", but should be included for the sake of completeness.

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Food fortification - Wikipedia, the free encyclopedia