When asked about supplements, health professionals should emphasise the importance of consuming a diet based on healthy eating guidelines. This is a diet rich in starchy, fibrous carbohydrates, including fruit and vegetables,and low in fat, sugar and salt. Dietary supplements do not convert a poor diet into a good one.
Health professionals should be aware of dietary standards and good food sources for nutrients. They should be able to assess an individual’s risk of nutrient deficiency and need for further referral, by asking questions to detect cultural, physical, environmental and social conditions which may predispose to inadequate intakes.
There is a need to be aware of the potential for adverse effects with supplements. Thus, when a client or patient presents with any symptoms, questions should be asked about the use of dietary supplements. Individuals will not always volunteer this information without prompting because they believe that supplements are ‘natural’ and therefore safe. Health professionals should make their clients aware of the existence of badly worded claims and adverts and of the dangers of supplement misuse. Pharmacists have a particular responsibility, simply because they sell these products. When supplying any supplement with perceived health benefits, pharmacists must be careful to avoid giving their professional authority to a product that may lack any health or therapeutic benefit and has risks associated with its use. In accordance with the Code of Ethics of the Royal Pharmaceutical Society of Great Britain, this may involve not stocking or selling the product.
Pharmacists must not give the impression that any dietary supplement is efficacious when there is no evidence for such efficacy. However, providing a product is not harmful for a particular individual, the freedom to use it should be respected. What is important is that consumers are able to make informed and intelligent choices about the products they buy.
Minggu, 22 Februari 2009
Dietary Supplement Classification
Dietary supplements fall into several categories in relation to ingredients. These are:
1 Vitamins and minerals
· Multivitamins and minerals. These normally contain around 100% of the Recommended Daily Allowance (RDA) for vitamins, with varying amounts of minerals and trace elements.
· Single vitamins and minerals. These may contain very large amounts, and when levels exceed ten times the RDA, they are often termed ‘megadoses’.
· Combinations of vitamins and minerals. These may be marketed for specific population groups, e.g. athletes, children, pregnant women, slimmers, teenagers, vegetarians, etc.
· Combinations of vitamins and minerals with other substances, such as evening primrose oil and ginseng.
2 ‘Unofficial’ vitamins and minerals, for which a requirement and a deficiency disorder in humans has not, so far, been recognised, e.g. boron, choline, inositol, silicon.
3 Natural oils containing fatty acids for which there is some evidence of beneficial effects, e.g. evening primrose oil and fish oils.
4 Natural substances containing ‘herbal’ ingredients with recognised pharmacological actions but whose composition and effects have not been fully defined, e.g. echinacea, garlic, ginkgo biloba and ginseng.
5 Natural substances whose composition and effects are not well defined but which are marketed for their ‘health giving properties’, e.g. chlorella, royal jelly and spirulina.
6 Enzymes with known physiological effects, but of doubtful efficacy when taken by mouth, e.g. superoxide dismutase.
7 Amino acids or amino acid derivatives, e.g. N-acetyl cysteine, S-adenosyl methionine.
1 Vitamins and minerals
· Multivitamins and minerals. These normally contain around 100% of the Recommended Daily Allowance (RDA) for vitamins, with varying amounts of minerals and trace elements.
· Single vitamins and minerals. These may contain very large amounts, and when levels exceed ten times the RDA, they are often termed ‘megadoses’.
· Combinations of vitamins and minerals. These may be marketed for specific population groups, e.g. athletes, children, pregnant women, slimmers, teenagers, vegetarians, etc.
· Combinations of vitamins and minerals with other substances, such as evening primrose oil and ginseng.
2 ‘Unofficial’ vitamins and minerals, for which a requirement and a deficiency disorder in humans has not, so far, been recognised, e.g. boron, choline, inositol, silicon.
3 Natural oils containing fatty acids for which there is some evidence of beneficial effects, e.g. evening primrose oil and fish oils.
4 Natural substances containing ‘herbal’ ingredients with recognised pharmacological actions but whose composition and effects have not been fully defined, e.g. echinacea, garlic, ginkgo biloba and ginseng.
5 Natural substances whose composition and effects are not well defined but which are marketed for their ‘health giving properties’, e.g. chlorella, royal jelly and spirulina.
6 Enzymes with known physiological effects, but of doubtful efficacy when taken by mouth, e.g. superoxide dismutase.
7 Amino acids or amino acid derivatives, e.g. N-acetyl cysteine, S-adenosyl methionine.
What are dietary supplements?
Various definitions for dietary supplements exist worldwide. In the UK, the definition developed by the Proprietary Association of Great Britain (PAGB), British Herbal Manufacturers’ Association (BHMA) and the Health Food Manufacturers’ Association (HFMA) is that they are:
Foods in unit dosage form, e.g. tablets, capsules and elixirs, taken to supplement the diet. Most are products containing nutrients normally present in foods which are used by the body to develop cells,bone, muscle etc, to replace co-enzymes depleted by infection and illness, and generally to maintain good health.
In addition to vitamins and minerals, this definition also covers ingredients such as garlic, fish oils,evening primrose oil and ginseng, which can be taken to supplement dietary intake or for their suggested health benefits. For the purposes of the European Union (EU) Directive on food supplements the term ‘food supplements’ means:
Foodstuffs the purpose of which is to supplement the normal diet and which are concentrated sources of nutrients or other substances with a nutritional or physiological effect, alone or in combination, marketed in dose form, namely forms such as capsules, pastilles, tablets, pills and other similar forms, sachets of powder, ampoules of liquids, drop dispensing bottles, and other similar forms of liquids and powders designed to be taken in measured small unit quantities.
In the USA, the Dietary Supplement Health Education Act (DSHEA) 1994 defines a dietary supplement as:
A product (other than tobacco) that is intended to supplement the diet which bears or contains one or more of the following dietary ingredients: a vitamin, a mineral, a herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total daily intake, or a concentrate, metabolite, constituent, extract or combinations of these ingredients. It is intended for ingestion in pill, capsule, tablet or liquid form, is not represented for use as a conventional food or as the sole item of a meal or diet and is labelled as a dietary supplement.
This definition, like that in the UK, also expands the meaning of dietary supplements beyond essential nutrients, to include such substances as ginseng, garlic, psyllium, other plant ingredients, enzymes, fish oils and mixtures of these. The EU definition does not currently include substances apart from vitamins and minerals,but other substances may be included in the future.
One of the key points in these definitions is that dietary supplements are products consumed in unit quantities in addition to normal food intake. This differentiates supplements from other foods, such as fortified foods and functional foods, to which nutrients are added. However, a major difference in the US definition is the explicit inclusion of ‘herbs or other botanicals’ in the list of dietary ingredients. In the UK, herbal products are currently marketed under a variety of arrangements – either as fully licensed medicines, under the Traditional Herbal Medicines Product (THMP)
Directive, ‘medicines exempt from licensing’ under section 12 of the 1968 Medicines Act, or as cosmetics or foods, so they do not fall entirely in the food supplements category. Enteral feeds (e.g. Complan and Ensure) and slimming aids are also classified as dietary supplements by nutritionists and dieticians, but for the purposes of this book, these products will be ignored.
Foods in unit dosage form, e.g. tablets, capsules and elixirs, taken to supplement the diet. Most are products containing nutrients normally present in foods which are used by the body to develop cells,bone, muscle etc, to replace co-enzymes depleted by infection and illness, and generally to maintain good health.
In addition to vitamins and minerals, this definition also covers ingredients such as garlic, fish oils,evening primrose oil and ginseng, which can be taken to supplement dietary intake or for their suggested health benefits. For the purposes of the European Union (EU) Directive on food supplements the term ‘food supplements’ means:
Foodstuffs the purpose of which is to supplement the normal diet and which are concentrated sources of nutrients or other substances with a nutritional or physiological effect, alone or in combination, marketed in dose form, namely forms such as capsules, pastilles, tablets, pills and other similar forms, sachets of powder, ampoules of liquids, drop dispensing bottles, and other similar forms of liquids and powders designed to be taken in measured small unit quantities.
In the USA, the Dietary Supplement Health Education Act (DSHEA) 1994 defines a dietary supplement as:
A product (other than tobacco) that is intended to supplement the diet which bears or contains one or more of the following dietary ingredients: a vitamin, a mineral, a herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total daily intake, or a concentrate, metabolite, constituent, extract or combinations of these ingredients. It is intended for ingestion in pill, capsule, tablet or liquid form, is not represented for use as a conventional food or as the sole item of a meal or diet and is labelled as a dietary supplement.
This definition, like that in the UK, also expands the meaning of dietary supplements beyond essential nutrients, to include such substances as ginseng, garlic, psyllium, other plant ingredients, enzymes, fish oils and mixtures of these. The EU definition does not currently include substances apart from vitamins and minerals,but other substances may be included in the future.
One of the key points in these definitions is that dietary supplements are products consumed in unit quantities in addition to normal food intake. This differentiates supplements from other foods, such as fortified foods and functional foods, to which nutrients are added. However, a major difference in the US definition is the explicit inclusion of ‘herbs or other botanicals’ in the list of dietary ingredients. In the UK, herbal products are currently marketed under a variety of arrangements – either as fully licensed medicines, under the Traditional Herbal Medicines Product (THMP)
Directive, ‘medicines exempt from licensing’ under section 12 of the 1968 Medicines Act, or as cosmetics or foods, so they do not fall entirely in the food supplements category. Enteral feeds (e.g. Complan and Ensure) and slimming aids are also classified as dietary supplements by nutritionists and dieticians, but for the purposes of this book, these products will be ignored.
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