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

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. "1 Introduction and Background." 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

fied by FDA that their products were considered adulterated as the agency had determined that their ingredients were new dietary ingredients about which FDA had not been notified 75 days in advance of sale, and that failure to cease distribution of the product could result in enforcement action (CFSAN, 2004).

Consumer and health care advisory letters from FDA cautioning use have occasionally led to voluntary product recalls by manufacturers (East Earth Herb, 2000; FDA, 2000; Vital Nutrients, 2001). In addition, warnings about specific dietary supplement ingredients issued in response to a variety of potential health problems identified by FDA as possible concerns have been posted on FDA MedWatch website (FDA, 2004).

Good Manufacturing Practices

As dietary supplements, like foods, can be contaminated with foreign toxic substances, FDA must consider more than the “inherent” safety of specific dietary supplement ingredients to adequately evaluate the potential for public health concerns. Supplement products vary in their quality and composition, which impacts the safety of specific products. Dietary supplement products tainted by improper raw materials, heavy metals, pesticides, or microorganisms, for example, can be unsafe due to these contaminants. DSHEA provides that FDA may define current GMPs for dietary supplement production. Proposed GMPs for the dietary supplement industry were published in early 2003 (FDA, 2003). While GMPs are designed to enhance safety, they are focused on purity and consistency rather than whether a dietary supplement ingredient itself is safe. As requested by FDA, this report focuses on evaluating the inherent safety of a dietary supplement ingredient in the absence of such contamination.

REFERENCES

ADA (American Dietetic Association). 2000. Nutrition and you: Trends 2000. What do Americans think, need, expect? J Am Diet Assoc 100:626–627.


Balluz LS, Kieszak SM, Philen RM, Mulinare J. 2000. Vitamin and mineral supplement use in the United States: Results from the Third National Health and Nutrition Examination Survey. Arch Fam Med 9:258–262.

Barkan ID. 1985. Industry invites regulation: The passage of the Pure Food and Drug Act of 1906. Am J Public Health 75:18–26.

Bender MM, Levy AS, Schucker RE, Yetley EA. 1992. Trends in prevalence and magnitude of vitamin and mineral supplement usage and correlation with health status. J Am Diet Assoc 92:1096–1101.

Blendon RJ, Earaches CM, Benson JM, Brodie M, Altman DE. 2001. Americans’ views on the use and regulation of dietary supplements. Arch Intern Med 161:805–810.

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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)