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Major Areas of CAM

Research on effectiveness of herbal remedies and dietary supplements for treating mental health and health conditions.

Summary of research on effectiveness of herbal remedies and dietary supplements for treating mental health and health conditions.

Biologically Based Practices: An Overview

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Introduction

Definition of Scope of Field
The CAM domain of biologically based practices includes, but is not limited to, botanicals, animal-derived extracts, vitamins, minerals, fatty acids, mino acids, proteins, prebiotics and probiotics, whole diets, and functional foods.

Dietary supplements are a subset of this CAM domain. In the Dietary Supplement Health and Education Act (DSHEA) of 1994, Congress defined a dietary supplement as a product taken by mouth that contains a "dietary ingredient" intended to supplement the diet. The "dietary ingredients" in these products may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. Dietary supplements can also be extracts or concentrates, and hey can occur in many forms, such as tablets, capsules, softgels, gelcaps, liquids, or powders.1


 

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The Food and Drug Administration (FDA) regulates dietary supplements differently than drug products (either prescription or over-the-counter). First, drugs are required to follow defined good manufacturing practices (GMPs). The FDA is developing GMPs for dietary supplements. However, until they are issued, companies must follow existing manufacturing requirements for foods. Second, drug products must be approved by the FDA as safe and efficacious prior to marketing. In contrast, manufacturers of dietary supplements are responsible for ensuring that their products are safe. While the FDA monitors adverse effects after dietary supplement products are on the market, newly marketed dietary supplements are not subject to premarket approval or a specific postmarket surveillance period. Third, while DSHEA requires companies to substantiate claims of benefit, citation of existing literature is considered sufficient to validate such claims. Manufacturers are not required, as they are for drugs, to submit such substantiation data to the FDA; instead, it is the Federal Trade Commission that has primary responsibility for monitoring dietary supplements for truth in advertising. A 2004 Institute of Medicine (IOM) report on the safety of dietary supplements recommends a framework for cost-effective and science-based evaluation by the FDA.2

History and Demographic Use of Biologically Based Practices
Dietary supplements reflect some of humankind's first attempts to improve the human condition. The personal effects of the mummified prehistoric "Ice Man" found in the Italian Alps in 1991 included medicinal herbs. By the Middle Ages, thousands of botanical products had been inventoried for their medicinal effects. Many of these, including digitalis and quinine, form the basis of modern drugs.3

Interest in and use of dietary supplements have grown considerably in the past two decades. Consumers state that their primary reason for using herbal supplements is to promote overall health and wellness, but they also report using supplements to improve performance and energy, to treat and prevent illnesses (e.g., colds and flu), and to alleviate depression. According to a 2002 national survey on Americans' use of CAM, use of supplements may be more frequent among Americans who have one or more health problems, who have specific diseases such as breast cancer, who consume high amounts of alcohol, or who are obese.4 Supplement use differs by ethnicity and across income strata. On average, users tend to be women, older, better educated, live in one- or two-person households, have slightly higher incomes, and live in metropolitan areas.

Use of vitamin and mineral supplements, a subset of dietary supplements, by the U.S. population has been a growing trend since the 1970s. National surveys--such as the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994); NHANES, 1999-2000; and the 1987 and 1992 National Health Interview Surveys--indicate that 40 to 46 percent of Americans reported taking at least one vitamin or mineral supplement at some time within the month surveyed.5-8 Data from national surveys collected before the enactment of DSHEA in 1994, however, may not reflect current supplement consumption patterns.

In 2002, sales of dietary supplements increased to an estimated $18.7 billion per year, with herbs/botanical supplements accounting for an estimated $4.3 billion in sales.9 Consumers consider the proposed benefits of herbal supplements less believable than those of vitamins and minerals. From 2001 to 2003, sales of herbs experienced negative growth. This was attributed to consumers' withering confidence and confusion. Within the herbal category, however, formulas led single herbs in sales; products became increasingly condition-specific; and sales of women's products actually increased by approximately 25 percent.10

References

Last Updated: 08 July 2016
Reviewed by Harry Croft, MD

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