Dietary Supplements:
Exploring the Frontiers

Here’s a Top 10 list that won’t make the Letterman show, but it’s getting a hefty measure of attention anyway. Just note the expanding shelf space in your pharmacy dedicated to vitamins, minerals, herbs, amino acids and botanicals that claim to help prevent, heal, and cure medical complaints. And the Top 10 dietary supplements for 2001 are:

1. multi-vitamins, 2. combination herbs, 3. calcium, 4. vitamin E, 5. the B vitamins, 6. vitamin C, 7. glucosamine/chon-droitin, 8. homeopathic remedies, 9. EFAs (fish oils and plant oils) and 10. vitamin A/beta carotene.

If you’re among the growing group of American consumers—and their physicians—using one or more of the Top 10 supplements, you’re "buying in" to their beneficial effects to the tune of approximately $17.7 billion yearly. In 2001, $5.8 billion was spent in the U.S. on vitamins, $1.2 billion on minerals, $4.1 billion on herbs/botanicals, $1.5 billion on sports nutrition, and $3.8 billion on other supplements. Is there sufficient research to support your trust in these nonprescription therapies?

On September 25, Rebecca Costello, PhD, executive director of the NIH Office of Dietary Supplements (ODS), helped to sort out fact from fiction, known from unknown, for her UMDNJ audience as part of the Distinguished Lecture Series sponsored by the University’s Institute for Complementary and Alternative Medicine (ICAM). Claims for these products often outrun the research, since science is a relative newcomer to the field of dietary supplements. Medical practitioner and consumer alike are hungry for scientifically-derived information.

Supporting, promoting and reviewing research into the health benefits and risks of dietary supplements, and disseminating that information, are the chief missions of the ODS. The importance of the work is underlined by "its trajectory of growth in response to the demand for more information and quality research," says Costello. Funding rose from $ 1 million when the Office was founded in 1995 to $17 million this year.

Chief among the current and upcoming projects discussed by Costello were:

• fact sheets on the Web. Go to the home page of the ODS and you’ll find 10 fact sheets, updated yearly by expert advisors. Topics include vitamins A, B6, B12, D and E, and folate, iron, magnesium, selenium and zinc.

• the Annual Bibliography of Significant Advances in Dietary Supplement Research. Available on the Web and in hard copy, this is a compilation of the 25 premier articles of the year, gleaned from 250 nominations by 40 journal editors.

• the International Bibliographic Information on Dietary Supplements (IBIDS) database. This is a database of published, scientific literature on dietary supplements. Interested in credible information about garlic? Kava? Poppy seeds? Choose from the list of hundreds of supplements and click to search. Titles, dates and authors of the top articles spanning decades appear for your perusing.

• a major systematic review of the scientific literature on the efficacy and safety of ephedra for weight management, athletic performance enhancement and energy enhancement. The purpose of the project is to assist the NIH to develop a research agenda that will answer the question: Does ephedra work? Next on the list is omega-3 fatty acids.

• jump-starting research into "botanicals" by supporting the development of major botanical research centers. Some current projects focus on herbal supplements for menopause, health effects of echinacea and St. John’s Wort, polyphenols and chronic disease, and studies of green tea and Chinese red yeast rice.

• supporting advances in the field through research grants, conferences, workshops and training and travel awards for students.

Costello has a particular interest—based on clinical research completed for her graduate studies at Georgetown University—in looking at dietary supplements in the cardiovascular arena. "There’s very little information on nutrition and heart failure. Can we provide adjunctive therapies to this growing group of people? We have drug therapies, but this doesn’t seem to be the answer," she says.

The roles of dietary supplements to promote health, ward off disease and as therapies, alone or in combination with prescription drugs, is an area that touches all of our lives. But unlike other areas of science, the frontiers are still largely unexplored.

"Inviting Dr. Costello to present is another step in forwarding the Institute’s mission to provide evidence-based information on complementary and alternative medicine (CAM) to the UMDNJ community. It is my hope that the Distinguished Lecture Series will be a stimulus for collaborative research in the area of CAM at the University," says Adam Perlman, MD, MPH, Executive Director of ICAM.

For further information, please call 973-972-8592.

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