Active Voice: Dietary Supplements – From the Outside In (Part I)

Active Voice: Dietary Supplements – From the Outside In (Part I)

By Jacqueline R. Berning, Ph.D., RD, CSSD and Craig A. Horswill, Ph.D.

Craig A. Horswill, Ph.D.

Jacqueline R. Berning, Ph.D.,

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Jacqueline Berning is a professor and chair of the Health Science Department at the University of Colorado-Colorado Springs (UCCS). Currently, she is the sport dietitian for the UCCS Athletic Department. She also is a member of U.S. Lacrosse Sports Science and Safety Committee. Dr. Berning has won numerous teaching awards at the university and is the recipient of the Academy of Nutrition and Dietetics 2014 Mary Abbott Hess Award for an innovative culinary event where she took University of Colorado-Boulder football players grocery shopping and cooking.

Craig Horswill is a clinical associate professor in the Department of Kinesiology and Nutrition at the University of Illinois Chicago. He has long been interested in acute weight manipulation in athletes, having conducted research on the topic while on the faculties of Ball State University and the Ohio State University. He served on the writing committee for the 2011 NATA position statement on safe weight loss in sport.

This two-part commentary presents Drs. Berning’s and Horswill’s viewpoint on the issues and concerns surrounding dietary supplements. Sport, health, fitness and wellness facilities are among the settings where interest in supplements is especially keen. Part I presents a definitional framework and the limited legislation and regulation that is in place related to the manufacture and distribution of supplements. Part II addresses concerns about product quality control and safety in the supplement industry, identifies helpful online consumer resources, and closes with suggestions for exercise and sports medicine professionals who want to promote consumer understanding in their communities.

The allure of dietary supplements to those seeking improved health, fitness or performance lacks no luster. Recent projections indicate that there will be a doubling in size of this $30 billion-plus industry before the decade ends (see related article in Forbes.) Our purpose in writing this commentary is to offer ACSM colleagues and affiliates our viewpoint on the issues of concern and to suggest resources by which all of us might help potential consumers in the sport and health and fitness fields to make educated decisions for their wellbeing.

Is It a Nutrient or Supplement?

If you ask most consumers what a nutrient is they will tell you it is something you find in food. A strict definition of nutrient is a substance that provides nourishment and is essential for growth and maintenance of life. By definition, an essential nutrient must provide a specific biological function. Removing it from the diet causes a decline in biological function while reintroducing it to the diet restores the body back to normal.

Many Americans believe that they are not getting enough essential nutrients in their food or diet and, therefore, they rely on supplements to fill the gaps. While supplements may contain essential nutrients, they may also contain substances that have no biological function.

The legislation that changed how supplements are regulated was the Dietary Supplement Health Education Act of 1994 (commonly called DSHEA) - Public Law 103:417, 103rd Congress. Existing now for 21 years, DSHEA is still the most important legislation on dietary supplements to date. Under this legislation, the term “dietary supplement” means a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients:
  • a vitamin;
  • a mineral;
  • an herb or other botanical;
  • a dietary substance for use by man to supplement the diet by increasing the total dietary intake;
  • a concentrate, metabolite, constitute, extract or combination of any ingredient described above.
DSHEA assumes that dietary supplements are safe and that consumers have the right of access to supplements. Under the provisions of DSHEA, the U.S. Food and Drug Administration (FDA) regulates the dietary supplement industry and is authorized to implement good manufacturing practice guidelines. However, under DSHEA, supplements do not need to prove efficacy and ingredients used in the supplement prior to 1994 do not need pre-market approval for safety. After 1994, FDA can evaluate pre-market safety for new ingredients, but only limited data is required to prove safety. Much of the burden of proof of safety and efficacy falls on the company manufacturing the dietary supplement.

It is sometimes necessary and legal for consumers and athletes to use vitamin and mineral supplements. The dietary supplement industry is poorly regulated and those who consume dietary supplements should purchase these only from reputable companies who have used a third party to verify their ingredients. One such company is United States Pharmacopeia (USP) that uses their USP certification mark to indicate that a dietary supplement product has been voluntarily submitted to USP and has successfully met the strict USP standards of quality, purity, potency, performance, and consistency, and current FDA good manufacturing practices.

Look for the final installment of this article in next week’s SMB.