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Dietary Supplements: A Framework for Evaluating Safety (2005)
Institute of Medicine (IOM)

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. "3 The Framework." Dietary Supplements: A Framework for Evaluating Safety. Washington, DC: The National Academies Press, 2005.

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Dietary Supplements: A Framework for Evaluating Safety

described as a modifying factor, in that whether identifiable subpopulations are particularly susceptible to harm should always be taken into consideration when setting priorities for review.

GENERAL PRINCIPLES AND CONCEPTS WHEN CONSIDERING DATA

The principles for evaluating specific types of information are described above, but some concepts are more global in nature, because they are applicable to all types of data or because they are principles for integrating different types of data that may or may not be consistent.

Concentration of Substances at the Site of Action

A critical factor in determining toxicity of a compound in a dietary supplement is not necessarily the ingested amount, but rather the unbound (free) concentration of an active ingredient at its receptor site. Once absorbed, distribution of the ingredient is via the systemic circulation to its receptor site.

Bioavailability (i.e., the rate and extent, or fraction, of delivery of a compound to the systemic circulation) has a significant effect on the concentration achieved. Bioavailability is greatly affected by the composition of the dosage form, first pass metabolism in the intestines and liver, and physiological factors, such as the rate of gastric emptying. Bioavailability and the rates of metabolism and excretion are the major determinants of serum concentration of a given dose of product.

Knowing the concentration of the unbound fraction of a compound in plasma will assist in assessing the relevance of in vitro data. Also, the plasma concentration can assist in comparing data across animal species (note that the concentration of the parent compound and/or any active metabolite is frequently used when the unbound fraction is unknown). Knowing the concentration of the unbound compound in plasma may be used as a surrogate marker for toxicity potential if a relationship has been established between the concentration and toxicity. For example, studies evaluating barbiturate sleep time illustrate a similar effect for a given plasma concentration across animal species; barbiturate sleep times may vary among species, but each species appears to awaken at approximately the same barbiturate plasma concentration (Gillette, 1976).

When judging whether the concentration will reach levels of concern in humans in the absence of information relating dose to systemic concentration, conservative assumptions should be used. In the absence of specific data about an ingredient in humans, one should assume rapid absorption and 100 percent bioavailability and divide the dose administered by the

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Front Matter (R1-R20)
Executive Summary (1-18)
1 Introduction and Background (19-42)
2 Approaches Used by Others and Existing Safety Frameworks (43-84)
3 The Framework (85-125)
4 Categories of Scientific Evidence--Human Information and Data (126-155)
5 Categories of Scientific Evidence--Animal Data (156-174)
6 Categories of Scientific Evidence--Information About Related Substances (175-216)
7 Categories of Scientific Evidence--In Vitro Data (217-234)
8 Interactions (235-246)
9 Vulnerable Groups and Prevalance of Use (247-252)
10 Scientific Principles for Integrating and Evaluating the Available Data (253-268)
11 Applying the Framework: Case Studies Using the Prototype Safety Monographs (269-291)
12 Factors Influencing Use of the Safety Framework (292-296)
13 Findings and Recommendations (297-306)
Appendix A: Existing Frameworks or Systems for Evaluating the Safety of Other Substances (307-315)
Appendix B: Scope of Work and Comments to Initial July 2002 Framework (316-321)
Appendix C: Plant Family Information (322-355)
Appendix D: Chaparral: Prototype Monograph Summary (356-362)
Appendix E: Glucosamine: Prototype Monograph Summary (363-366)
Appendix F: Melatonin: Prototype Monograph Summary (367-371)
Appendix G: Chromium Picolinate: Prototype Monograph Summary (372-375)
Appendix H: Saw Palmetto: Prototype Monograph Summary (376-379)
Appendix I: Shark Cartilage: Prototype Monograph Summary (380-384)
Appendix J: Prototype Focused Monograph: Review of Liver-Related Risks for Chaparral (385-449)
Appendix K: Protoype Focused Monograph: Review of Anti-Androgenic Risks of Saw Palmetto Ingestion by Women (450-477)
Appendix L: Acknowledgements (478-480)
Appendix M: Biographical Sketches of Commitee Members (481-488)
Index (489-506)