Dietary Supplements, Nutraceuticals, and Functional FoodsFeatured

The Everything Guide to Dietary Supplements: Safety, Truthfulness, Science, Regulation, Litigation

by Juliana Fox
by Juliana Fox

The Everything Guide to Dietary Supplements: Safety, Truthfulness, Science, Regulation, Litigation, etc.

An Overview of Usage, Including Consumer Motivations, Impact on Health, and Government Regulations

**I. Introduction**

A. Definition of Dietary Supplements

Three qualities tend to be consistently considered across countries when defining a substance as a dietary supplement:[1]

  1. The composition of the product.
  2. The claims being made about the product.
  3. The recommended use(s) of the product.

However, worldwide, there is not currently a concise definition of dietary supplements; terms like natural health products, complementary medicines, food supplements, and phytomedicine are often included under the umbrella of dietary supplements within different cultures.[2]

The United States National Institutes of Health Office of Dietary Supplements (NIH ODS) defines a dietary supplement as “[a] product (other than tobacco) that is intended to supplement the diet; contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and other substances) or their components; is intended to be taken by mouth as a pill, capsule, tablet, or liquid; and is identified on the front label of the product as being a dietary supplement.”[3]

According to Health Canada, dietary supplements fall under the umbrella of “natural health products.”[4] Natural health products are “naturally occurring substances that are used to restore or maintain good health.”[5] They can be a product of plants, animals, or microorganisms, and they come in various forms such as tablets, capsules, and creams. Natural health products include vitamins and minerals, herbal remedies, homeopathic medicine, traditional medicines, probiotics, and products like essential fatty acids.

The European Union includes dietary supplements under the terms “traditional herbal medicine” and “food supplements.” Traditional herbal medicines are defined by the Committee on Herbal Medicinal Products as “any medicinal product, exclusively containing as active ingredients one or more herbal substances, one or more herbal preparations, or a combination of the two.”[6] The European Food Safety Authority (EFSA) defines food supplements as “concentrated sources of nutrients (i.e. mineral and vitamins) or other substances with a nutritional or physiological effect that are marketed in ‘dose’ form.”[7]

Australia uses the term “complementary medicine” to describe dietary supplements. Complementary medicines are defined as non-prescription medicines that include vitamins, minerals, plant materials, nutritional substances, essential oils, microorganisms, and animal materials.[8] According to the Therapeutic Goods Administration, complementary medicines are classified as either registered (high risk), assessed listed (low risk), or listed (lowest risk). A comprehensive list of complementary medicines can be found on the Australian Register of Therapeutic Goods.[9]

In Japan, the Ministry of Health, Labour, and Welfare uses the term Foods for Specified Health Uses (FOSHUs) to describe dietary supplements. FOSHUs are defined as “foods containing ingredients with functions for health and officially approved to claim its physiological effects on the human body.”[10] FOSHUs include products that can improve blood sugar, cholesterol, gastrointestinal health, mineral absorption, blood pressure, and dental hygiene.

The Health Sciences Agency (HSA) oversees the regulation of dietary supplements in Singapore. The HSA has a few different categories of dietary supplements: health supplements, traditional medicine, and Chinese proprietary medicines.[11] Health supplements are defined as substances that supplement the normal diet and support or enhance healthy functioning of the body. They include vitamins, minerals, probiotics, and other bioactive compounds, and they can be derived from animal or plant sources or be synthetically composed. Health supplements fall in line with Western definitions of dietary supplements. Traditional medicines are products that contain ingredients historically used in Malay and Indian traditional medicine. Chinese proprietary medicines are products that contain ingredients historically used in traditional Chinese medicine.

Global agencies have synthesized definitions of dietary supplements that take into account the existing definitions from various countries. The International Alliance of Dietary/Food Supplement Associations (IADSA) compiled existing definitions into a set of characteristics consistent among dietary supplements globally:[12]

  • Dietary supplements have high concentrations of specific, bioactive nutrients.
  • Dietary supplements are consumed in “dose” form (tablets, capsules, etc.) rather than in a conventional food form.
  • Dietary supplements are taken in a specified dosage.
  • Dietary supplements are meant to provide specific health benefits for the consumer.

The IADSA also defines qualities that dietary supplements cannot have, including:[13]

  • Dietary supplements are not cosmetic products; they are intended to be ingested.
  • Dietary supplements are not medicinal products.
  • Dietary supplements are not conventional or dietetic foods, like chewing gum or candies.

The World Health Organization (WHO) has also specifically delineated Traditional and Complementary Medicine (TCM) to encompass products that have been historically used in traditional medicine practices and are distinct from more modern dietary supplements.[14] The WHO defines traditional medicines as the knowledge, skills, and products historically used by cultures to treat and prevent illness and maintain optimal health. Complementary medicines are defined as medicinal practices and products that are neither native to the country nor integrated into the country’s healthcare system. TCM is a term that refers to the combination of traditional and complementary medicine products and practices.

B. Importance of Regulation

Originally, the use of dietary supplements was largely restricted to addressing select micronutrient deficiencies.[15] In recent years, however, supplements have become more widely used in a world of increasingly processed and nutrient-deficient foods. This growing dependence on dietary supplements means more emphasis needs to be placed on the safety, efficacy, and quality of the supplements being produced.[16] Additionally, there has been a rising global interest in supplement use, making overarching, worldwide definitions and regulations essential for the continued safety of consumers.[17] Three main concerns stand out with regards to regulation: quality, safety, and efficacy.

Quality refers to whether or not the dietary supplement contains the ingredients that it advertises, which depends on accurately identifying and testing the purity of each ingredient. The quality of dietary supplements has come into question with increased production. Before 2000, only 4,000 products were on the U.S. market as supplements. By 2018, more than 85,000 supplement products were available for purchase in the U.S.,[18] and this increase has been reflected worldwide.[19] This boom in supplement products has been accompanied by issues in quality control; the identification and purity of bioactive compounds in dietary supplements have become considerably more questionable, and increasingly important, as more dietary supplements are produced and consumed every year.[20]

Safety is also important to consider. This refers to whether or not a dietary supplement can cause adverse health effects in consumers. The safety of a dietary supplement includes two facets: it should not exceed the safe upper limits of intake for nutrients, and it should not contain any toxic substances.[21]

Lastly, the efficacy of dietary supplements needs to be evaluated. Efficacy refers to the supplements’ ability to deliver on the claims made on the label and whether it can actually positively impact the health of the consumer. The dietary supplement industry has a history of poorly-demonstrated efficacy; supplements were tested without thorough knowledge of their mechanisms of action, which led to inconsistent results in human trials.[22] Current standards demand that dietary supplements go through more rigorous testing at the mechanistic, animal, and human levels to ensure that the claims being made are supported by robust research.[23] However, more needs to be done to ensure that hard statements can be made about health outcomes from supplements because impacts on specific diseases and physiological processes are areas where dietary supplement research is still lacking.[24]

C. A Brief Global History of Dietary Supplement Regulation

The IADSA emphasizes that regulations and the dietary supplement industry have a symbiotic, mutually beneficial relationship. Regulations have engendered trust amongst consumers, encouraging them to purchase more supplements.[25] In 1994, the U.S. was the first country to introduce legislation regulating dietary supplements in the form of the Dietary Supplement Health and Education Act (DSHEA).[26] At the time, an estimated 4,000 supplement products were on the market in the U.S.[27] The DSHEA established a framework for the Food and Drug Administration (FDA) to regulate supplements.[28]

Throughout the rest of the world, consistent regulation of dietary supplements did not yet exist – supplements were often categorized as foods or pharmaceuticals, and many countries had no regulations at all for supplements.[29] Recommendations for upper dosage limits and general usage were also scarce. The lack of consistent regulation proved to be a stumbling block for the growth and globalization of the supplement industry.[30]

A few years later, in 1998, the International Alliance of Dietary/Food Supplement Associations (IADSA) was established with the aim of facilitating the creation of global regulations and standards surrounding food supplements. That same year, after 10 years of discussion, the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU) adopted the Codex Alimentarius Vitamin and Mineral Food Supplement Guidelines, a set of international guidelines for vitamins and minerals, which:[31]

  • Provided a comprehensive definition for vitamin and mineral food supplements: “Sources in concentrated forms of those nutrients alone or in combinations, marketed in forms such as capsules, tablets, powders, solutions, etc., that are designed to be taken in measured small-unit quantities but are not in a conventional food form and whose purpose is to supplement the intake of vitamins and/or minerals from the normal diet.”
  • Assigned the choice and sources of vitamins and minerals to individual region legislation.
  • Assigned responsibility for establishing recommended daily intake and upper limit to the FAO/WHO for all vitamins and minerals.
  • Established labeling requirements for all vitamin and mineral supplements.

The CCNFSDU also established the Codex General Guidelines on Claims and the Codex Guidelines for Use of Nutrition and Health Claims in 2006. These developments marked the beginning of true globalization of the dietary supplement industry and regulations.

In 2002, the European Union adopted the Food Supplements Directive, Europe’s first supplement legislation. The Food Supplements Directive contained regulations similar to the U.S.’s DSHEA;[32] it dictated a definition for food supplements, regulated the quality and safety of supplement production, and provided guidelines on the labeling of food supplement products.

Regulation in Southeast Asia followed shortly after with the creation of the Alliance of Health Supplement Associations (AHSA) in 2004. AHSA has been involved in standardizing supplement regulations in Southeast Asian countries.

By 2011, Latin America had taken its first steps towards supplement legislation with the creation of the Latin American Alliance for Responsible Nutrition (ALANUR). ALANUR quickly began to collaborate with the IADSA to synchronize existing legislation and create new legislation in countries that had none.

These landmark developments laid the groundwork for the current global dietary supplement industry as we know it today.     

**II. The Dietary Supplement Industry**

A. Global Market Size and Growth

The global market for dietary supplements has grown tremendously in the past two decades. In 1999, it was estimated at $49.1 billion; by 2017, it had grown to $127.8 billion.[33] It has shown a global growth of 5 to 7 percent per year.[34] The U.S. is the largest global supplement market, accounting for 34 percent of worldwide sales as of 2017, and China is the largest Asian contributor to the global market with 14 percent of worldwide sales.[35] Europe accounts for about 19 percent of the global market; other major contributors include Japan and Latin America.

B. Popularity and Consumer Trends

According to the National Health and Nutrition Examination Survey (NHANES), which is conducted annually in the U.S., about half of American adults use dietary supplements.[36],[37],[38],[39],[40] And that number is on the rise, particularly among athletes and those with chronic illnesses.[41],[42],[43] Rates of supplement use also tend to vary based on factors such as income, food security, and participation in food assistance programs (such as SNAP).[44],[45] Based on 2011-2014 NHANES data:

[Dietary supplement (DS)] and [multivitamin-mineral (MVM)] use was significantly higher among those with a household income of ≥ 350% of the poverty level, those who were food secure, and SNAP income-ineligible nonparticipants across all sex, age, and race/ethnic groups. Among women, the prevalence of use significantly differed between SNAP participants (39%) and SNAP income-eligible nonparticipants (54%). Older adults (71+ years) remained the highest consumers of DS, specifically among the highest income group (82%), while younger adults (19–30 years), predominantly in the lowest income group (28%), were the lowest consumers.[46]

A study appearing in JAMA Internal Medicine analyzing three years (2007 to 2010) of NHANES data submitted by nearly 12,000 patients reported that some individuals were able to articulate specific reasons for taking supplements, including the use of calcium products to promote “bone health.”[47] Most individuals surveyed, however, could only explain their use of dietary supplements in general terms, reporting that they used supplements to “improve” or “maintain” overall health.[48] Individuals of all ages use supplements. According to 2017-2018 NHANES data, rates of supplement use tend to increase with age.[49]

According to the C.S. Mott Children’s Hospital Mott Poll Report on Healthy Eating and Use of Dietary Supplements in Children, more than half of parents report that their child regularly takes dietary supplements, which might be partially due to difficulties parents face when trying to get their child to eat a “well-balanced diet.”[50] However, only 43 percent of parents reported discussing supplement use with their child’s primary care provider.[51] “It is unclear if this lack of consultation is the result of providers not asking about the child’s nutrition, parents viewing supplement use as not warranting guidance from providers, or some other reason,” write the authors of the report.[52]

Despite the prevalence of dietary supplements (which are often food extracts), studies have found that most users are not knowledgeable about the active ingredients, possible side effects, or recommended dosages of what they are taking.[53],[54],[55],[56] Patients’ lack of knowledge seems partially attributable to their lack of communication with medical professionals regarding the potential benefits and risks of supplement use.[57],[58],[59] Of those who responded to the NHANES surveys between 2007 and 2010, 77 percent had self-prescribed dietary supplements without consulting a healthcare provider.[60],[61] Many of these individuals further reported that they avoided discussing the use of supplements with their physicians because they felt that their doctors lacked knowledge or were biased against the practice.[62],[63]

Many patients, physicians, and researchers have questioned the safety of taking dietary supplements.[64],[65],[66] As mentioned above, the NIH ODS warns patients about the potential negative effects of supplements’ interaction with other medicines.[67] Some researchers argue that there is little benefit at all to taking supplements and therefore believe it is not worth the potential risk of taking something unknown and potentially harmful.[68],[69] However, an 11-year study from 1999 to 2010, published in Annals of Internal Medicine in 2019, showed that the use of dietary supplements among 30,899 adults was not connected to increased mortality.[70]

The trend of self-prescription also holds among elite athletes, among whom dietary supplement use is significantly more prevalent than it is among average Americans.[71] This heightened frequency of use, however, does not seem to correspond to increased scientific knowledge of how these supplements may impact the body.[72],[73] In multiple studies conducted from 2003 to 2021, athletes have reported taking supplements to achieve a broad range of health goals, including improved performance, enhanced muscle recovery, and disease prevention.[74],[75],[76],[77],[78],[79],[80]

In a 2019 survey of elite athletes in Spain published in the Journal of the International Society of Sports Nutrition, more than 60 percent of respondents stated that they used dietary supplements, including supplements that had little evidence backing their efficacy.[81] Nearly half of the respondents said that they relied primarily on themselves as sources of information, rather than a physician, nutritionist, or other healthcare professional.[82] “This information points towards the necessity of increasing the knowledge of the benefits and risks of supplementation in the elite athlete population,” the authors wrote.[83] In addition, a 2010 study published in JAMA Internal Medicine showed that the majority of athletes surveyed did not know the active ingredients or mechanisms of action of the supplements they were taking, and only half of the athletes knew the recommended supplement dosages.[84] Less than half of these athletes said they consulted their medical providers before starting supplementation.[85]

**III. Global Policy Today**

A. United States

The U.S. was the first country to establish legislation that would regulate dietary supplements.[86] The Dietary Supplement Health and Education Act (DSHEA) was instituted in 1994; at the time, only 4,000 supplement products were on the market.[87] The DSHEA established a framework for the Food and Drug Administration (FDA) to regulate supplements.[88] With the implementation of the DSHEA, the FDA was able to:

  • Establish safety standards for supplements.
  • Control the approval of new ingredients being added to supplements.
  • Create Good Manufacturing Practices (GMP) that ensure quality and safety when producing supplements.
  • Regulate the claims companies use to promote their supplements.

The FDA regulates dietary supplements as foods, but they do have slightly different regulatory frameworks between dietary supplements and foods.[89] A major regulation instituted by the DSHEA in 1994 is that new dietary ingredients must be deemed safe prior to inclusion in dietary supplements. New dietary ingredients are any substances that were not included in dietary supplements prior to 1994. Ingredients included prior to 1994 are presumed safe based on their historic use; ingredients not included prior to 1994 must now go through a vetting process run by the FDA to ensure that they are safe to consume.[90] The manufacturer must prove to the FDA that it has substantial evidence supporting the safety of using the new dietary ingredient.[91]

The FDA also regulates the statements made on dietary supplement labels. Unlike pharmaceutical products, dietary supplements cannot claim to prevent, treat, or cure a disease.[92] There are three types of claims that can be made on the label of a dietary supplement: health claims, nutrient content claims, and structure/function claims.[93] These claims are universal to foods and dietary supplements – one of the many examples of how foods and dietary supplements are regulated similarly in the U.S.[94]

Health claims are statements regarding the relationship between a food or dietary supplement and the risk of particular health conditions. The FDA regulates health claims in three ways:

  1. 1990 Nutrition Labeling and Education Act (NLEA): The 1990 NLEA allows the FDA to regulate health claims for foods and dietary supplements with internal investigations of the existing scientific evidence. This review can occur either in response to a health claim petition or independently.[95] The claim must meet specific FDA standards in order to be used to advertise the food or supplement.
  2. 1997 Food and Drug Administration Modernization Act (FDAMA): The 1997 FDAMA allows labels to include authorized statements from scientific bodies such as the National Academy of Sciences.[96] This allows the label to bypass FDA-specific authorization. The 1997 FDAMA applies only to foods, not to dietary supplements.
  3. Interim Procedures for Qualified Health Claims in the Labeling of Conventional Human Food and Human Dietary Supplements: The FDA is allowed to provide “qualifying language” for claims that do not meet the FDA standards for quality and strength of scientific evidence. These claims will include language specified by the FDA that qualifies the given claims to ensure that consumers are not misled.[97]

Health claims must be approved under one of the above three criteria and contain a specific food/dietary supplement and a specific health condition.

Nutrient content claims describe the level of a specific nutrient in a food; the regulations surrounding these claims were laid out in the 1990 NLEA.[98]  Nutrient content claims must be authorized by the FDA and follow FDA regulations.[99] These claims can use terms like “free,” “high,” “low,” “more,” “reduced,” and “lite” to characterize nutrient levels or make comparisons with other foods. An exact quantitative statement (e.g., “200 mg of sodium”) is allowed if it does not subjectively characterize the nutrient level. However, claims using a qualifier such as “only” (e.g. “only 200 mg of sodium”) imply that the level is low and, therefore, have specific criteria. Nutrient content claims ensure consistent use of terms like “high” or “low” for all food products, making them meaningful to consumers. The term “healthy” is an implied nutrient content claim that signifies specific levels of fats and sodium as defined in the regulations. There are also percentage claims for dietary supplements that describe the percentage of an ingredient within the supplement, even if there is no established Daily Value.[100]

Structure/function claims describe the role of a nutrient or ingredient in affecting the body’s normal structure or function, how it maintains that structure or function, or the general well-being associated with its consumption.[101] The 1994 DSHEA established specific regulations for structure/function claims. These claims are not pre-approved by the FDA, but manufacturers must have evidence that they are truthful and not misleading and must notify the FDA within 30 days of marketing the supplement with the claim. Labels with these claims must include a disclaimer that the FDA has not evaluated the claim and that the product is not intended to diagnose, treat, cure, or prevent any disease.[102] Structure/function claims for conventional foods are based on nutritive value, while those for dietary supplements can include non-nutritive effects.[103] Conventional food manufacturers do not need to notify the FDA or include disclaimers for structure/function claims on their products.[104]

Dietary supplement labeling can include two less common types of claims defined by statute: those related to benefits for classic nutrient deficiency diseases (with a required disclosure of disease prevalence) and general well-being claims from nutrient or dietary ingredient consumption.[105] Claims relating to nutrient deficiency diseases can look something like: “Supports healthy iron levels, even in women over 50 (iron deficiency affects less than 10% of women in this age group in the US);” they need to qualify the prevalence of the disease and tend to be used when the disease is not as common. General well-being claims include statements such as: “Supports cognitive function and mental clarity in healthy adults (as part of a balanced diet and healthy lifestyle)” General well-being claims don’t actually reference specific diseases or benefits, instead making broad statements. These claims are subject to the same regulatory requirements as structure/function claims, including the need for a disclaimer and substantiation to ensure truthfulness and non-misleading information.[106] Additionally, dietary supplements can make other labeling claims not explicitly regulated by statute or regulation, such as claims about taste or ingredient quality, as long as these claims are also truthful and not misleading.[107]

Outside of the claims being made on the label, the FDA also regulates the content of the label for dietary supplements.[108] The FDA mandates that specific information be included on dietary supplement labels.[109] This information comprises general details, such as the product’s name (with the word “supplement” or a supplement statement), the net quantity of contents, and the manufacturer’s information.[110] Additionally, labels must provide directions for use and a “Supplement Facts” panel detailing serving size, dietary ingredients, their amounts per serving, percent of Daily Value if applicable, and the scientific or common name of botanical ingredients.[111] For proprietary blends, the total weight and components must be listed. Other non-dietary ingredients like fillers and flavors should be listed by weight and common name. It is crucial to note that the absence of a cautionary statement on the label does not imply the absence of potential adverse effects associated with the product.

Standardization is a method used by manufacturers to ensure the consistency of their products from batch to batch, often involving the identification of specific chemical markers.[112] While standardization serves as a form of quality control, it is essential to note that dietary supplements in the United States are not required to undergo standardization according to any legal or regulatory definition.[113] This means that the term “standardization” can vary in meaning and usage among supplement manufacturers.[114] Some incorrectly use it to imply uniform manufacturing practices, which does not guarantee product quality.[115] Consequently, the presence of the word “standardized” on a dietary supplement label does not necessarily indicate a higher level of product quality or consistency.[116]

Lastly, the FDA does not regulate the safety or effectiveness of dietary supplements. Instead, when a dietary supplement is marketed, the burden of proof falls on the FDA; the FDA must prove that the product is unsafe in order to remove it from the market.[117] The level of quality control can vary from product to product, depending upon the manufacturer and production process. However, in 2007, the FDA introduced Good Manufacturing Practices (GMPs) for dietary supplements, setting forth stringent requirements for the manufacturing, preparation, and storage of these products to ensure their quality.[118] Manufacturers are now obligated to ensure the identity, purity, strength, and composition of their dietary supplements. GMPs are designed to prevent issues such as incorrect ingredients, improper quantities, contamination (e.g., by pesticides, heavy metals, or bacteria), and incorrect packaging and labeling.[119]

Challenges

According to a 2019 review of labeling impacts on consumer behavior in The Journal of Alternative and Complementary Medicine, “Many consumers did not regularly read product labels, nor understand the information they read on those labels.”[120] This leads to challenges in educating the public, even with the strict regulations surrounding labeling practices.

The lack of regulation has led to the production and sale of supplements that do not always contain the ingredients and quantities that the labels say they do.[121],[122] In fact, a 2022 study in The Journal of Clinical Pharmacology, showed that 1,068 over-the-counter dietary supplement products sold from 2007 through 2021 were tainted with undisclosed pharmaceutical ingredients.[123] Third party groups, such as United States Pharmacopeia (USP) and NSF International,[124],[125] have thus stepped in to test various dietary supplements (including vitamins, minerals, herbal supplements, and others) to verify what exactly is in them.[126],[127] Consumers, therefore, are encouraged to take special caution when choosing to take dietary supplements.[128]

In April 2022, Senators Dick Durbin of Illinois and Mike Braun of Indiana introduced the Dietary Supplement Listing Act of 2022 to the U.S. Senate.[129] The intention of this Act is “[t]o improve transparency and the availability of information regarding dietary supplements by amending the Federal Food, Drug, and Cosmetic Act to require manufacturers of dietary supplements to list dietary supplements with the Food and Drug Administration.”[130]

U.S. policymakers can look to other countries, particularly Japan, when creating legislation to regulate dietary supplements and other non-pharmaceutical treatments taken by consumers. Japan was one of the first governments to regulate functional foods and explore the health benefits of foods through robust research and testing.[131],[132],[133] Developing a more robust regulatory framework will help consumers better understand the effects of supplements on their health while simultaneously promoting the expansion of evidence-based food as medicine practices and programs.[134]

B. European Union

In 2002, the European Union established its first set of legislation surrounding supplements—the Food Supplements Directive (FSD).[135] The FSD covers many of the same bases as the DSHEA in the U.S., and it allows the European Food Safety Authority (EFSA) and the European Commission (EC) to collaborate to regulate the safety of food supplements. The 2002 FSD classified food supplements under the larger umbrella of “food” and applied existing food legislation to food supplements, including:

  • Placing the burden of safety on the manufacturers of the food supplements.[136]
  • Dictating preparation and safety requirements according to the Hazards Analysis and Critical Control Points (HACCP).[137]
  • Regulating the labeling of all dietary supplements and ensuring claims are authorized.[138]
  • Controlling the maximum levels of contaminants and the use of additives to ensure safety of the product.[139]
  • Approving novel food ingredients that had not previously been on the European market before 1997.[140]

Additionally, it allowed the EU and the U.S. to begin interchanging supplements thanks to their aligned standards.[141] It is important to note, however, that the Food Supplements Directive of 2002 only applies to vitamins and minerals; most other substances included in food supplements are subject to Member State-specific regulations.[142] Notable exceptions are food additives and novel food ingredients, both of which are subject to separate EU regulations.[143]

While some components of food supplement regulation are standardized across the EU, there are many components that are left to the discretion of individual nations, including the maximum dosage and uses of specific bioactive ingredients[144] as well as the decision of what substances can and cannot be used in food supplements.[145]

The EFSA and EC jointly regulate the food supplement industry. One way in which they do this is by controlling which ingredients can be included in a food supplement. When a company adds novel nutrient sources to a food supplement, they must first submit an application to the EC. The EFSA then compiles the scientific research surrounding that nutrient source and submits a scientific opinion for the EC to review; based on this scientific opinion, the EC will either approve or disapprove the addition of the novel nutrient source. This is also the case for novel food ingredients (which may not be specifically nutrient sources) that have been introduced since 1997, similar to how U.S. food ingredients used before 1997 are automatically grandfathered in based on a history of safe human consumption. Novel food ingredients must also be approved by the EC based on the scientific opinion of the EFSA.

Another major role of the EFSA in particular is to evaluate the safety of micronutrients and establish recommendations for the dosage of these micronutrients. In 2006, the EFSA—in conjunction with the Scientific Committee on Food (SCF)—established possible adverse effects of micronutrient supplementation and defined tolerable upper intake levels for those micronutrients.[146] These guidelines formed the basis for the EFSA to evaluate the safety of novel nutrient sources today. Additionally, the EFSA verifies claims of positive health effects for all food supplements through independent assessments of the scientific literature.[147] Lastly, the EC is responsible for compiling a list of restricted substances that cannot be added to food or food supplements, and the EFSA provides scientific opinions to the EC to inform these decisions.

The EFSA and EC also monitor the labeling of food supplements. Food supplement labels are required to include: a thorough list of ingredients, daily consumption recommendations, a warning not to exceed the daily consumption recommendations, a statement warning against using food supplements in place of a healthy diet, and a statement instructing the consumer to store the product out of reach of young children.[148] Labels cannot state that food supplements have the power to prevent, treat, or cure diseases.[149]

The EFSA and EC regulate health and nutrition claims on the labels of food supplements. Health claims are statements about the relationship between food and health, and in the EU, these claims must be based on scientific evidence and easily comprehensible to consumers. The EFSA evaluates the scientific evidence supporting these claims. There are different types of health claims, including function health claims, risk reduction claims, and health claims referring to children’s development.

Function health claims are related to body functions, psychological and behavioral functions, and slimming or weight control. The EC has a list of permitted function health claims that can be applied to food supplements, given that the EFSA approves its use.

Risk reduction claims pertain to reducing risk factors for disease development, such as reducing blood cholesterol to lower the risk of coronary heart disease. Health claims referring to children’s development involve nutrients needed for their normal growth and development, like vitamin D for bone health. Both of these types of claims are approved on an individual basis – the manufacturer must submit a request, which will be approved by the joint evaluation of the EFSA and the EC. The EFSA is responsible for assessing the scientific literature and putting together a publicly available opinion on the claim, and the EC then approves or rejects the claim based on the evidence provided by the EFSA.

The term “nutrition claim” pertains to statements implying beneficial nutritional properties in a food due to its energy content, nutrients, or other substances. Nutrition claims can only be used if they are included on the EC’s approved list, provided by the Annex of Regulation (EC) No 1924/2006. Permitted nutrition claims include “low energy” for products containing no more than 40 kcal per 100 g (solids) or 20 kcal per 100 ml (liquids), “energy-reduced” for foods with a 30 percent reduced energy value, “low fat” for products with no more than 3 g of fat per 100 g (solids) or 1.5 g per 100 ml (liquids), and various claims related to sugar, sodium, fiber, protein, vitamins, minerals, and omega-3 fatty acids. These claims must meet specific conditions to be used, ensuring they are meaningful and truthful for consumers. Additionally, “light” or “lite” claims follow the same conditions as “reduced,” and the term “naturally/natural” can be used as a prefix to a claim when the condition is naturally met.

C. Canada

Canada regulates natural health products (NHPs) through a dedicated framework that is distinct from the regulation of pharmaceutical drugs and foods. This framework is administered by Health Canada, the country’s health regulatory agency.[150] NHPs in Canada are defined as products that include vitamins, minerals, herbal remedies, homeopathic medicines, traditional medicines, probiotics, amino acids, and essential fatty acids.[151] They are typically used to maintain or improve health and must be safe to use without a prescription.[152] There are a few key pieces of legislation that dictate how Health Canada is able to regulate natural health products.

The 2004 Natural Health Products Regulations (NHPR) regulates NHPs in a similar way to the EU and U.S. supplement regulations – it lays out the oversight that Health Canada can exercise over NHP production. In particular, the Natural and Non-Prescription Health Products Directorate is the branch of Health Canada that regulates NHPs.[153] The NHPR defines what constitutes a natural health product, regulates the sale of NHPs in Canada, and requires that the product be licensed prior to sale.[154] Licensing of NHPs involves a review of the safety and efficacy of the product.[155] In addition to licensing the product, all sites involved in the production of NHPs (from manufacturing to labeling) must also be licensed; site licensing involves a review of safety and quality of the NHP production.[156] The NHPR dictates Good Manufacturing Practices (GMPs) with which manufacturers must comply when producing NHPs.[157] GMPs ensure that products are high quality, safe, and consistent. The NHPR requires that NHPs are labeled in a specific way. Labels must include: the product name, all ingredients, recommended use, recommended dosage, and information on possible adverse effects. Any health claims must be supported by evidence. The NHPR allows the following claims:

  • Disease risk reduction: a statement that associates a food or one of its components with a decreased risk of developing a diet-related disease or condition.
    • Therapeutic claims: a subset of disease risk reduction claims that specifically pertain to the treatment, mitigation, or improvement of a disease, health condition, or the modification of bodily functions.
  • Functional: a statement that describes the positive impacts of consuming a food or its components on the regular functions or biological activities of the body.
    • Nutrient function claims: a subset of function claims that specifically highlight the established roles of essential nutrients or energy in maintaining good health and normal growth and development.

Health claims are optional, but when they are used they must be truthful and approved by Health Canada. All NHPs must have an associated Product Identification Number (PIN) that indicates the NHP has been approved by Health Canada. Following the production of an NHP, the NHPR gives Health Canada the latitude to continue surveillance of the NHP; this ensures that the NHP is safe and effective.[158] It is important to note that traditional and homeopathic medicines both have slightly different guidelines informed by traditional uses and knowledge of the product.[159]NHPs that do not meet the above criteria can be removed from the market by Health Canada.[160]

In Canada, the Food and Drug Act (F&DA) and the Food and Drug Regulations (F&DR) are two distinct but closely related components of the country’s regulatory framework for food, drugs, and health products. Both were originally established in 1920 and have been gradually altered over the years, with the most recent alteration in 2023. The F&DA provides the legal foundation for the regulation of food, drugs, medical devices, and various health products in Canada.[161] The F&DR provides the actual regulations that can be enforced under the authority of the F&DA. The F&DR lays out the baseline regulations for labeling, packaging, product safety, and quality of all food and drug products, including natural health products.[162]

New amendments are still being made to Canada’s NHP regulations. In 2023, Vanessa’s Law—also known as the Protecting Canadians from Unsafe Drugs Act—was expanded to include NHPs. Vanessa’s Law grants Health Canada increased powers when it comes to removing unsafe products from the market and requesting safety information from manufacturers.[163] This regulation helps maximize the protection of the consumer against unsafe NHPs and other therapeutic goods.

D. Australia

In Australia, the regulation of dietary supplements, which are often referred to as “complementary medicines,” is stringent and is primarily overseen by the Therapeutic Goods Administration (TGA), a division of the Australian Department of Health. Complementary medicines are defined as non-prescription medicines that include vitamins, minerals, plant materials, nutritional substances, essential oils, microorganisms, and animal materials.[164] Australia’s first supplement regulation went into effect in 1989: the Therapeutic Goods Act is the primary legislation governing the regulation of complementary medicines and determines how the TGA is able to regulate therapeutic goods. Therapeutic goods include prescription and non-prescription drugs, complementary medicines, and medical devices, and all therapeutic goods are subject to the same general regulations.[165] The Therapeutic Goods Act of 1989 established that all therapeutic goods must first be approved by the TGA. The depth of evaluation before approval depends upon whether or not the product is deemed to be high or low risk.[166] The TGA ensures that all approved products are safe, effective, and high quality.[167]After approval, therapeutic goods are included on the Australia Register of Therapeutic Goods (ARTG). All therapeutic goods sold in Australia must be on the ARTG.[168] In addition to approval of therapeutic goods, the TGA ensures that manufacturers uphold Good Manufacturing Practices (GMPs).[169] GMPs are a key component in ensuring that products are safe and high quality.

The Therapeutic Goods Act of 1989 included a Therapeutic Goods Advertising Code that regulates the labeling of complementary medicines. Additionally, in 2002, Australia added the Therapeutic Goods (Labeling and Packaging) Regulations to the existing legislation.[170] The TGA’s labeling requirements are designed to ensure that consumers have the information they need to use therapeutic goods safely and effectively. The requirements cover a range of topics, including:[171]

  • The name of the product.
  • The active ingredients in the product.
  • The dosage and how to take the product.
  • Any potential side effects or interactions with other medications.
  • The manufacturer’s contact information.

To ensure that therapeutic goods are labeled correctly, the TGA requires sponsors (the companies that market and sell therapeutic goods in Australia) to submit their labeling for approval before they can start selling the product.[172] The TGA will review the labeling to make sure that it complies with all of the relevant requirements. If the labeling is approved, the sponsor will be issued a Therapeutic Goods Number (TGO).[173] The TGO must be included on the product label. The TGA also conducts regular audits of sponsors to ensure that they are complying with the labeling requirements. If a sponsor is found to be in breach of the requirements, the TGA can take a range of actions, including issuing warnings, fines, or even suspending or canceling the sponsor’s product registration.[174] All claims made on the product label must be based on scientific evidence and cannot be misleading; they must be approved by the TGA prior to inclusion on the label.[175] Additionally, claims cannot be therapeutic in nature – manufacturers cannot claim that complementary medicines can treat, prevent, or cure illness.[176]

After a product has been approved to go on the market, the TGA continues to monitor its safety and efficacy. If any therapeutic goods are found to be unsafe or non-compliant following approval, the product will be removed from the market.[177]

E. China

Dietary supplements in China are regulated as “health food,” defined as food that is intended to supplement the diet and that has a health function.[178] The State Administration for Market Regulation (SAMR) and the National Medical Products Administration (NMPA) are the main government agencies responsible for regulating health foods in China.[179] China has issued a number of laws and regulations governing health foods, including the Food Safety Law, Health Food Regulations, and the Administrative Measures for the Registration and Filing of Health Foods.[180]

The Food Safety Law (FSL) was first established in 2009 and is the comprehensive law governing food safety in China, including health foods.[181] The Food Safety Law establishes that the SAMR is responsible for conducting risk assessments of health foods and ensures that food products are traceable from source to shelf.[182] Additionally, the FSL established Good Hygiene Practices (similar to GMPs) that ensure food products are handled safely and remain high quality throughout the manufacturing process. Hazard Analysis and Critical Control Points (HACCP) is another concept laid out by the FSL that mandates manufacturers to identify and account for food safety hazards. Lastly, the FSL mandates food manufacturers to test their own products to ensure safety. The FSL gave the SAMR the power to issue warnings and fines for manufacturers in violation of these regulations and to suspend or cancel product registrations if the product does not meet the standard laid out by FSL legislation.[183]

The history of the Health Food Regulations (HFRs) can be traced back to the early 1980s, when the Chinese government began to recognize the growing demand for health foods. In 1986, the government adopted the first HFRs, which were relatively basic.[184] The HFRs in China were first established in 1986 but have since been amended multiple times, the most recent occurring in 2016. The HFRs are the main regulations governing the registration, filing, labeling, and advertising of health foods in China. The HFRs divide health foods into two categories: functional health foods and nutrient supplements. Functional health foods are foods that have been shown to have specific health benefits, such as reducing cholesterol or boosting the immune system. Nutrient supplements are foods that contain vitamins, minerals, or other nutrients that are essential for good health. All health foods that are manufactured in or imported into China must be registered or filed with the SAMR. The registration process is more rigorous than the filing process. Registered health foods must undergo a safety and efficacy assessment by the SAMR, while filed health foods do not. Functional health foods must be registered with the SAMR, while nutrient supplements can be either registered or filed with the SAMR.[185]

The HFRs also set out requirements for the labeling and advertising of health foods.[186] All health foods must be labeled in accordance with the HFR Health Food Labeling Regulations. The labeling requirements include the following: the name of the product, the ingredients in the product, the dosage and how to take the product, any potential side effects or interactions with other medications, the manufacturer’s contact information, and the health function of the product (if registered). All health food advertising must be truthful and not misleading. The Health Food Advertising Regulations prohibit advertising that make false or misleading claims, compare the product to other products on the market, or specifically target children.[187]

The Administrative Measures for the Registration and Filing of Health Foods (AMRFHF) is a regulation issued by the SAMR in 2016. The AMRFHF replaced the previous regulation on health food registration, which had been in place since 2003. The AMRFHF introduced a number of changes to the regulation of health foods in China:[188]

  • The establishment of a two-tier system for health food registration and filing: Registered health foods are subject to a more rigorous safety and efficacy assessment than filed health foods.
  • The introduction of a new list of permitted ingredients for health foods: The new list is more restrictive than the previous list, and it eliminates a number of ingredients that were previously allowed.
  • New requirements for the labeling and advertising of health foods: The new requirements are designed to ensure that consumers have accurate and complete information about health food products.

The AMRFHF has had a significant impact on the health food industry in China. The number of new health food products registered with the SAMR has decreased significantly since the AMRFHF was issued. This is because the new registration process is more rigorous and time-consuming. However, the AMRFHF has also led to an improvement in the quality and safety of health food products in China.[189] Companies that want to register their products must now undergo a more rigorous safety and efficacy assessment. This has helped to ensure that only safe and effective health food products are available to consumers.

F. Japan

Japan’s government was one of the first to regulate functional foods and explore the health benefits of foods through robust research and testing.[190],[191] The Japanese Ministry of Health, Labour, and Welfare (MHLW) oversees the approval process for these foods, which are called Food for Specified Health Uses (FOSHU).[192],[193]

The FOSHU system was established in Japan in 1991 by the Ministry of Health, Labour, and Welfare (MHLW).[194] The FOSHU system was created in response to a growing public interest in functional foods, which are foods that have been shown to have health benefits beyond basic nutrition. The system was designed to ensure that consumers had access to safe and effective functional foods.[195] To be approved as a FOSHU product, a food was required to undergo a rigorous safety and efficacy assessment by the MHW.[196] The MHW also called for FOSHU products to be labeled with clear and accurate information about their health benefits. The FOSHU system has been successful in promoting the development and commercialization of functional foods in Japan.[197]

Today, the Food Safety and Consumer Affairs Bureau of the MHLW regulates the FOSHU system.[198] The MHLW is responsible for approving FOSHU products, setting the standards for FOSHU labeling, and monitoring the safety and efficacy of FOSHU products. To be approved as a FOSHU product, a food must meet the following requirements:[199]

  • It must be safe for human consumption.
  • It must have a specific health benefit that has been scientifically proven.
  • It must be labeled with clear and accurate information about its health benefits.

The MHLW has also developed a number of guidelines for the development and commercialization of FOSHU products.[200] These guidelines are designed to ensure that FOSHU products are safe and effective and that they are marketed in a way that is not misleading to consumers.

**X. Consumer Education and Empowerment**

A. Common Myths and Misconceptions about Dietary Supplements

Common misconceptions about dietary supplements can vary across the globe due to cultural, regulatory, and educational differences. Here are some prevalent misconceptions associated with dietary supplements:

  1. “Natural” means safe:[201] Many people believe that if a supplement is labeled as “natural,” it is automatically safe. However, natural ingredients can still have side effects or interact with medications.
  2. Dietary supplements are a substitute for a healthy diet:[202] Some individuals think they can replace a balanced diet with dietary supplements. In reality, supplements are intended to complement a healthy diet, not replace it.
  3. Dietary supplements are not regulated:[203] Most countries, including the U.S., have robust regulations surrounding dietary supplements, including how they are labeled and manufactured. It is important to note that while the U.S. does not ensure the safety and efficacy of dietary supplements, there are still regulations in place to maximize the safety and quality of dietary supplements.
  4. “More is better”:[204] It can be dangerous to assume that taking higher doses of supplements is more beneficial. In some cases, excessive intake can lead to adverse effects, including toxicity.
  5. Supplements are always backed by scientific evidence:[205] Not all dietary supplements have been rigorously tested in clinical trials. Some products on the market lack scientific support for their health claims.

These misconceptions highlight the need for education and awareness about dietary supplements. It is important for consumers to research products, consult healthcare professionals, and approach supplements with caution, keeping in mind that they are intended to support, not replace, a well-rounded diet and a healthy lifestyle.

B. Trusted Resources and Verification Tools

In a world where new supplements go on the shelves every day, it can be hard for consumers to identify which supplements are safe and which ones are not. Here are some reliable resources that may be helpful when considering adding a supplement to your routine:

  1. U.S. Food and Drug Administration (FDA): The FDA’s website provides valuable information on dietary supplements, including regulations, safety alerts, and tips for consumers. They also offer a tool called the “Dietary Supplement Ingredient Advisory List” to check the safety status of specific ingredients.
  2. National Institutes of Health (NIH): The NIH’s Office of Dietary Supplements (ODS) provides evidence-based information on dietary supplements, including safety, health benefits, and recommended dosages. They also offer resources like the Dietary Supplement Label Database and fact sheets on individual dietary ingredients.
  3. MedlinePlus: This resource, maintained by the U.S. National Library of Medicine and the NIH, offers an extensive section on dietary supplements. It provides information on safety, effectiveness, and potential interactions with medications.
  4. ConsumerLab.com: ConsumerLab is an independent organization that conducts quality testing on dietary supplements. While some of their content is behind a paywall, they offer free information on selected products and issues related to dietary supplements.
  5. Examine.com: Examine.com is an independent and evidence-based resource that provides in-depth information on dietary supplements, including safety, efficacy, and interactions. They do not sell supplements or have affiliations with supplement manufacturers.
  6. WebMD: WebMD’s Vitamins and Supplements Center offers consumer-friendly information on dietary supplements, including articles on safety, benefits, and potential side effects.
  7. The National Center for Complementary and Integrative Health (NCCIH): Part of the NIH, NCCIH provides evidence-based information on complementary and alternative health practices, including dietary supplements. They offer resources on safety, efficacy, and research findings.
  8. Academic and Medical Institutions: Websites of respected academic and medical institutions, such as the Mayo Clinic, Harvard Medical School, and the Cleveland Clinic, often provide reliable information on dietary supplements and safety.
  9. Pharmacist and Healthcare Providers: Consulting with a pharmacist or healthcare provider can be invaluable for personalized advice on dietary supplements, especially when considering interactions with specific medications or health conditions.
  10. Official Government Health Websites: In countries outside of the U.S., official government health websites, such as the National Health Service (NHS) or Health Canada, provide information on dietary supplements and safety specific to their regions.

When using these resources, consumers should always exercise caution and critically evaluate the information provided. It is essential to cross-reference information from multiple sources, consult healthcare professionals when necessary, and be aware of potential conflicts of interest in the dietary supplement industry. Additionally, consumers should remain vigilant and stay informed about the latest research and safety alerts related to dietary supplements.

C. Making Informed Choices

The steps below provide useful tips for selecting a dietary supplement. Included are additional agencies that can supply valuable information and supplement ratings.

Consult a Healthcare Professional: Before starting any new dietary supplement, it is essential to consult with a healthcare professional, such as a doctor or registered dietitian.[206] They can assess your specific needs and recommend supplements that are appropriate for your individual health goals.

Identify Your Needs: Determine why you are considering a dietary supplement. Are you looking to fill a specific nutrient gap in your diet, improve your overall health, or address a specific health condition?[207] Identifying your needs will help narrow down your choices.

Research Your Country’s Specific Supplement Regulations: Each country has its own set of specific supplement regulations. Make sure to read up on the regulation of supplements in your country – the level of regulation in your country will impact the general safety and efficacy standards of supplements you can purchase in your country.

Look for Third-Party Testing: To ensure the quality and safety of dietary supplements, it is advisable to choose products that have been tested by independent, third-party organizations. This will be indicated by a Certificate of Analysis (COA).[214] Some reputable third-party testing agencies that evaluate products for quality, purity, and potency include:

  • USP (United States Pharmacopeia)
  • NSF International
  • ConsumerLab.com
  • Informed-Choice
  • Banned Substances Control Group (BSCG)

Check for Quality Certifications: Look for dietary supplements that have quality certifications. For example in the U.S., quality certifications such as the following can be found on products:[215]

  • GMP (Good Manufacturing Practices): Products manufactured in facilities following GMP standards are more likely to be of high quality.
  • Certified Organic: If you prefer organic supplements, look for products with the USDA Organic seal.
  • Non-GMO Project Verified: If you want non-genetically modified supplements, seek products with this certification.

Read Labels Carefully: Examine the supplement’s label to understand its contents. Look for the following information:

  • List of ingredients
  • Serving size
  • Recommended daily dosage
  • Potential allergens or additives
  • Expiration date

Consider the Form: Dietary supplements come in various forms, including capsules, tablets, powders, and liquids. Choose a form that is convenient for you and easy to incorporate into your daily routine.

Research the Brand: Investigate the supplement’s manufacturer or brand. Reputable companies are more likely to produce high-quality products.[216] Check for online reviews and customer feedback to gauge the brand’s reputation.

Avoid Excessive Claims: Be cautious of supplements that make extravagant health claims or promises of quick fixes.[217] Supplements should complement a balanced diet and not replace it.

Be Mindful of Interactions: If you are taking medications or have underlying health conditions, consult your healthcare provider to ensure that the supplement you choose will not interact negatively with your current treatments. Add one supplement into your diet at a time rather than mixing multiple supplements all at once.[218]

Start with a Low Dosage: If you are trying a new supplement, start with a lower dosage and monitor how your body reacts before increasing the dose.[219]

Remember that dietary supplements are not a substitute for a healthy diet, and it is best to get essential nutrients from whole foods whenever possible. Always prioritize your safety and health when choosing and using dietary supplements.

**XI. Future Trends and Developments**

A. Technological Advancements

Technological advancements have significantly impacted the dietary supplement industry in various ways. These advancements have influenced product development, quality control, consumer engagement, and more. The following are some key technological advancements that have had an impact on dietary supplements:

  1. Nutrigenomics and Personalized Nutrition:[220] Advances in genetics and biotechnology have enabled the development of personalized dietary supplements based on an individual’s genetic profile. Nutrigenomic testing can help determine a person’s specific nutritional needs, leading to customized supplement recommendations.
  2. Digital Health Apps and Wearables:[221] Mobile apps and wearable devices allow individuals to track their health and dietary habits. Some apps provide dietary recommendations and suggest suitable supplements based on a person’s health data.
  3. Blockchain for Transparency: Blockchain technology is used to create transparent and traceable supply chains for dietary supplement ingredients. This helps ensure the authenticity and quality of products, particularly in cases of herbal and botanical supplements.
  4. 3D Printing:[222] 3D printing technology is being used to produce personalized supplements with precise dosages and ingredient combinations. This allows for on-demand supplement production tailored to individual needs.
  5. Artificial Intelligence (AI) and Machine Learning:[223] AI and machine learning algorithms can process large datasets to identify patterns related to dietary supplement use, health outcomes, and potential interactions. This information can help guide supplement recommendations and improve product safety.
  6. Nanotechnology:[224] Nanotechnology is used to enhance the bioavailability of dietary supplement ingredients. Nano-sized particles can improve the absorption and efficacy of certain nutrients.
  7. Smart Packaging:[225],[226] Smart packaging technologies include QR codes, sensors, and RFID tags that provide real-time information about a product’s freshness, storage conditions, and authenticity. Consumers can verify the product’s quality using their smartphones.

These technological advancements have improved the development, production, quality control, and accessibility of dietary supplements. However, it is crucial for consumers to be discerning and well-informed when considering dietary supplement products, because marketed technologies or claims may not all be evidence-based or regulated.

B. Sustainability and Ethical Concerns

Sustainability and ethics are important considerations in the dietary supplement industry due to concerns related to environmental impact, responsible sourcing, fair trade, and ethical marketing. Some key concerns include:

  1. Overharvesting and Resource Depletion:[227] Many dietary supplements are derived from plants and natural resources. Overharvesting of these resources can lead to habitat destruction, endangered species, and resource depletion. Sustainable sourcing and cultivation are essential to mitigate these issues.
  2. Wild Harvesting:[228] The practice of wild harvesting, or gathering plants from their natural habitats, can disrupt ecosystems and lead to the depletion of certain species. Ethical sourcing involves regulating wild harvesting and promoting sustainable alternatives.
  3. Agricultural Practices:[229] Practices used for agricultural purposes—including deforestation, habitat destruction, pesticide use, and soil degradation—can have significant detrimental impacts on the environment. Sustainable farming practices are necessary to minimize these negative effects.
  4. Traceability and Transparency:[230] Ensuring the authenticity and quality of ingredients in dietary supplements is critical. Ethical companies invest in traceability systems to verify the source and purity of their ingredients and share this information with consumers.
  5. Conservation and Biodiversity:[231] Ethical sourcing practices should aim to protect biodiversity and promote conservation. Companies can play a role in supporting initiatives that preserve and restore natural habitats.
  6. Sustainable Packaging:[232] Reducing the environmental footprint of packaging materials used for dietary supplements is a sustainability concern. Companies are increasingly adopting eco-friendly packaging options.
  7. Waste Reduction:[233] Reducing waste, including unnecessary packaging and production byproducts, is an ethical and environmental concern. Sustainable practices aim to minimize waste generation and promote recycling.

Consumers can contribute to addressing these concerns by choosing dietary supplement products from companies that prioritize sustainability, ethical practices, and transparency. They can also look for certifications such as Fair Trade, USDA Organic, and third-party sustainability certifications to identify products and brands that meet higher ethical and sustainability standards. Additionally, advocating for responsible and environmentally friendly practices within the dietary supplement industry can promote positive change.

[1] Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients. 2018;10(1):41. Published 2018 Jan 4. doi:10.3390/nu10010041

[2]  Féart C. Dietary Supplements: Which Place between Food and Drugs?. Nutrients. 2020;12(1):204. Published 2020 Jan 13. doi:10.3390/nu12010204

[3] “Background Information: Dietary Supplements,” NIH Office of Dietary Supplements. Updated March 11, 2020. Accessed January 25, 2022. https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/.

[4] “About Natural Health Products.” Health Canada. Updated March 14, 2016. Accessed October 19, 2023. https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation/about-products.html

[5] “About Natural Health Products.” Health Canada. Updated March 14, 2016. Accessed October 19, 2023. https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation/about-products.html

[6] https://health.ec.europa.eu/medicinal-products/herbal-medicinal-products_en

[7] https://www.efsa.europa.eu/en/topics/topic/food-supplements

[8] https://www.tga.gov.au/topics/complementary-medicines

[9] https://www.tga.gov.au/topics/complementary-medicines

[10] https://www.mhlw.go.jp/english/topics/foodsafety/fhc/02.html

[11] https://www.hsa.gov.sg/health-supplements/overview

[12] https://www.iadsa.org/codex-alimentarius-the-international-reference-for-food-supplements

[13] https://www.iadsa.org/codex-alimentarius-the-international-reference-for-food-supplements

[14] https://iris.who.int/bitstream/handle/10665/312342/9789241515436-eng.pdf?sequence=1

[15] Féart C. Dietary Supplements: Which Place between Food and Drugs?. Nutrients. 2020;12(1):204. Published 2020 Jan 13. doi:10.3390/nu12010204

[16] Féart C. Dietary Supplements: Which Place between Food and Drugs?. Nutrients. 2020;12(1):204. Published 2020 Jan 13. doi:10.3390/nu12010204

[17] Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients. 2018;10(1):41. Published 2018 Jan 4. doi:10.3390/nu10010041

[18] Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients. 2018;10(1):41. Published 2018 Jan 4. doi:10.3390/nu10010041

[19] Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients. 2018;10(1):41. Published 2018 Jan 4. doi:10.3390/nu10010041

[20] Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients. 2018;10(1):41. Published 2018 Jan 4. doi:10.3390/nu10010041

[21] Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients. 2018;10(1):41. Published 2018 Jan 4. doi:10.3390/nu10010041

[22] Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients. 2018;10(1):41. Published 2018 Jan 4. doi:10.3390/nu10010041

[23] Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients. 2018;10(1):41. Published 2018 Jan 4. doi:10.3390/nu10010041

[24] Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients. 2018;10(1):41. Published 2018 Jan 4. doi:10.3390/nu10010041

[25] https://www.iadsa.org/the-evolution-of-the-health-supplements-sector

[26] https://www.iadsa.org/the-evolution-of-the-health-supplements-sector

[27] Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients. 2018;10(1):41. Published 2018 Jan 4. doi:10.3390/nu10010041

[28] https://www.iadsa.org/the-evolution-of-the-health-supplements-sector

[29] https://www.iadsa.org/the-evolution-of-the-health-supplements-sector

[30] https://www.iadsa.org/the-evolution-of-the-health-supplements-sector

[31] https://www.iadsa.org/resources/34

[32] https://eur-lex.europa.eu/eli/dir/2002/46/oj

[33] https://www.iadsa.org/the-evolution-of-the-health-supplements-sector

[34] https://www.iadsa.org/the-evolution-of-the-health-supplements-sector

[35] https://www.iadsa.org/the-evolution-of-the-health-supplements-sector

[36] Bailey, Regan L., Jaime J. Gahche, Paige E. Miller, Paul R. Thomas, and Johanna T. Dwyer. 2013. “Why US Adults Use Dietary Supplements.” JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2013.2299.

[37] Rock, Cheryl L. 2007. “Multivitamin-Multimineral Supplements: Who Uses Them?” The American Journal of Clinical Nutrition. Oxford University Press (OUP). https://doi.org/10.1093/ajcn/85.1.277s.

[38] “Data Brief 399: Dietary Supplement Use Among Adults: United States, 2017–2018.” 2021. National Center for Health Statistics. https://doi.org/10.15620/cdc:101131.

[39] “Data Brief 399: Dietary Supplement Use Among Adults: United States, 2017–2018.” 2021. National Center for Health Statistics. https://doi.org/10.15620/cdc:101131.

[40] Bailey, Regan L, Kevin W Dodd, Jaime J Gahche, Johanna T Dwyer, Alexandra E Cowan, Shinyoung Jun, Heather A Eicher-Miller, et al. 2019. “Best Practices for Dietary Supplement Assessment and Estimation of Total Usual Nutrient Intakes in Population-Level Research and Monitoring.” The Journal of Nutrition. Oxford University Press (OUP). https://doi.org/10.1093/jn/nxy264.

[41] Radimer, K. 2004. “Dietary Supplement Use by US Adults: Data from the National Health and Nutrition Examination Survey, 1999-2000.” American Journal of Epidemiology. Oxford University Press (OUP). https://doi.org/10.1093/aje/kwh207.

[42] Rock, Cheryl L. 2007. “Multivitamin-Multimineral Supplements: Who Uses Them?” The American Journal of Clinical Nutrition. Oxford University Press (OUP). https://doi.org/10.1093/ajcn/85.1.277s.

[43] Dascombe, B.J., M. Karunaratna, J. Cartoon, B. Fergie, and C. Goodman. 2010. “Nutritional Supplementation Habits and Perceptions of Elite Athletes within a State-Based Sporting Institute.” Journal of Science and Medicine in Sport. Elsevier BV. https://doi.org/10.1016/j.jsams.2009.03.005.

[44] Cowan, Alexandra, Shinyoung Jun, Jaime Gahche, Janet Tooze, Johanna Dwyer, Heather Eicher-Miller, Anindya Bhadra, et al. 2018. “Dietary Supplement Use Differs by Socioeconomic and Health-Related Characteristics among U.S. Adults, NHANES 2011–2014.” Nutrients. MDPI AG. https://doi.org/10.3390/nu10081114.

[45] Jun, Shinyoung, Alexandra Cowan, Janet Tooze, Jaime Gahche, Johanna Dwyer, Heather Eicher-Miller, Anindya Bhadra, et al. 2018. “Dietary Supplement Use among U.S. Children by Family Income, Food Security Level, and Nutrition Assistance Program Participation Status in 2011–2014.” Nutrients. MDPI AG. https://doi.org/10.3390/nu10091212.

[46] Cowan, Alexandra, Shinyoung Jun, Jaime Gahche, Janet Tooze, Johanna Dwyer, Heather Eicher-Miller, Anindya Bhadra, et al. 2018. “Dietary Supplement Use Differs by Socioeconomic and Health-Related Characteristics among U.S. Adults, NHANES 2011–2014.” Nutrients. MDPI AG. https://doi.org/10.3390/nu10081114.

[47] Bailey, Regan L., Jaime J. Gahche, Paige E. Miller, Paul R. Thomas, and Johanna T. Dwyer. 2013. “Why US Adults Use Dietary Supplements.” JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2013.2299.

[48] Bailey, Regan L., Jaime J. Gahche, Paige E. Miller, Paul R. Thomas, and Johanna T. Dwyer. 2013. “Why US Adults Use Dietary Supplements.” JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2013.2299.

[49] “Data Brief 399: Dietary Supplement Use Among Adults: United States, 2017–2018.” 2021. National Center for Health Statistics. https://doi.org/10.15620/cdc:101131.

[50] “Healthy Eating and Use of Dietary Supplements in Children.” National Poll on Children’s Health. C.S. Mott Children’s Hospital, April 18, 2022. https://mottpoll.org/reports/healthy-eating-and-use-dietary-supplements-children.

[51] “Healthy Eating and Use of Dietary Supplements in Children.” National Poll on Children’s Health. C.S. Mott Children’s Hospital, April 18, 2022. https://mottpoll.org/reports/healthy-eating-and-use-dietary-supplements-children.

[52] “Healthy Eating and Use of Dietary Supplements in Children.” National Poll on Children’s Health. C.S. Mott Children’s Hospital, April 18, 2022. https://mottpoll.org/reports/healthy-eating-and-use-dietary-supplements-children.

[53] Dascombe, B.J., M. Karunaratna, J. Cartoon, B. Fergie, and C. Goodman. 2010. “Nutritional Supplementation Habits and Perceptions of Elite Athletes within a State-Based Sporting Institute.” Journal of Science and Medicine in Sport. Elsevier BV. https://doi.org/10.1016/j.jsams.2009.03.005.

[54] Bailey, Regan L., Jaime J. Gahche, Paige E. Miller, Paul R. Thomas, and Johanna T. Dwyer. 2013. “Why US Adults Use Dietary Supplements.” JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2013.2299.

[55] Turfus, S.C., J.O.L. Smith, A. Mansingh, R.L. Alexander-Lindo, and S. Roopchand-Martin. 2019. “Supplementation Practices, Perceptions and Knowledge about Anti-Doping among Jamaican High School Athletes.” Performance Enhancement & Health. Elsevier BV. https://doi.org/10.1016/j.peh.2019.07.001.

[56] Garthe, Ina, and Ronald J. Maughan. 2018. “Athletes and Supplements: Prevalence and Perspectives.” International Journal of Sport Nutrition and Exercise Metabolism. Human Kinetics. https://doi.org/10.1123/ijsnem.2017-0429.

[57] Bailey, Regan L., Jaime J. Gahche, Paige E. Miller, Paul R. Thomas, and Johanna T. Dwyer. 2013. “Why US Adults Use Dietary Supplements.” JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2013.2299.

[58] Burns, Robert D., M.Rosita Schiller, Mark A. Merrick, and Kay N. Wolf. 2004. “Intercollegiate Student Athlete Use of Nutritional Supplements and the Role of Athletic Trainers and Dietitians in Nutrition Counseling.” Journal of the American Dietetic Association. Elsevier BV. https://doi.org/10.1016/j.jada.2003.11.013.

[59] Maughan, Ronald J., Susan M. Shirreffs, and Alan Vernec. 2018. “Making Decisions About Supplement Use.” International Journal of Sport Nutrition and Exercise Metabolism. Human Kinetics. https://doi.org/10.1123/ijsnem.2018-0009.

[60] Bailey, Regan L., Jaime J. Gahche, Paige E. Miller, Paul R. Thomas, and Johanna T. Dwyer. 2013. “Why US Adults Use Dietary Supplements.” JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2013.2299.

[61] Burns, Robert D., M.Rosita Schiller, Mark A. Merrick, and Kay N. Wolf. 2004. “Intercollegiate Student Athlete Use of Nutritional Supplements and the Role of Athletic Trainers and Dietitians in Nutrition Counseling.” Journal of the American Dietetic Association. Elsevier BV. https://doi.org/10.1016/j.jada.2003.11.013.

[62] Bailey, Regan L., Jaime J. Gahche, Paige E. Miller, Paul R. Thomas, and Johanna T. Dwyer. 2013. “Why US Adults Use Dietary Supplements.” JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2013.2299.

[63] Rock, Cheryl L. 2007. “Multivitamin-Multimineral Supplements: Who Uses Them?” The American Journal of Clinical Nutrition. Oxford University Press (OUP). https://doi.org/10.1093/ajcn/85.1.277s.

[64] “What You Need to Know: Dietary Supplements,” NIH Office of Dietary Supplements. Updated September 3, 2020. Accessed October 26, 2021. https://ods.od.nih.gov/factsheets/WYNTK-Consumer/.

[65] Ronis, Martin J.J., Kim B. Pedersen, and James Watt. 2018. “Adverse Effects of Nutraceuticals and Dietary Supplements.” Annual Review of Pharmacology and Toxicology. Annual Reviews. https://doi.org/10.1146/annurev-pharmtox-010617-052844.

[66] Shipkowski, Kelly A., Joseph M. Betz, Linda S. Birnbaum, John R. Bucher, Paul M. Coates, D. Craig Hopp, Duffy MacKay, et al. 2018. “Naturally Complex: Perspectives and Challenges Associated with Botanical Dietary Supplement Safety Assessment.” Food and Chemical Toxicology. Elsevier BV. https://doi.org/10.1016/j.fct.2018.04.007.

[67] “What You Need to Know: Dietary Supplements,” NIH Office of Dietary Supplements. Updated September 3, 2020. Accessed October 26, 2021. https://ods.od.nih.gov/factsheets/WYNTK-Consumer/.

[68] Marcus, Donald M. 2015. “Dietary Supplements: What’s in a Name? What’s in the Bottle?” Drug Testing and Analysis. Wiley. https://doi.org/10.1002/dta.1855.

[69] Zhang, Fang Fang, Susan I Barr, Helene McNulty, Duo Li, and Jeffrey B Blumberg. 2020. “Health Effects of Vitamin and Mineral Supplements.” BMJ. BMJ. https://doi.org/10.1136/bmj.m2511.

[70] Chen, Fan, Mengxi Du, Jeffrey B. Blumberg, Kenneth Kwan Ho Chui, Mengyuan Ruan, Gail Rogers, Zhilei Shan, Luxian Zeng, and Fang Fang Zhang. 2019. “Association Among Dietary Supplement Use, Nutrient Intake, and Mortality Among U.S. Adults.” Annals of Internal Medicine. American College of Physicians. https://doi.org/10.7326/m18-2478.

[71] Dascombe, B.J., M. Karunaratna, J. Cartoon, B. Fergie, and C. Goodman. 2010. “Nutritional Supplementation Habits and Perceptions of Elite Athletes within a State-Based Sporting Institute.” Journal of Science and Medicine in Sport. Elsevier BV. https://doi.org/10.1016/j.jsams.2009.03.005.

[72] Dascombe, B.J., M. Karunaratna, J. Cartoon, B. Fergie, and C. Goodman. 2010. “Nutritional Supplementation Habits and Perceptions of Elite Athletes within a State-Based Sporting Institute.” Journal of Science and Medicine in Sport. Elsevier BV. https://doi.org/10.1016/j.jsams.2009.03.005.

[73] Baltazar-Martins, Gabriel, Diego Brito de Souza, Millán Aguilar-Navarro, Jesús Muñoz-Guerra, María del Mar Plata, and Juan Del Coso. 2019. “Prevalence and Patterns of Dietary Supplement Use in Elite Spanish Athletes.” Journal of the International Society of Sports Nutrition. Informa UK Limited. https://doi.org/10.1186/s12970-019-0296-5.

[74] Juhn, Mark S. 2003. “Popular Sports Supplements and Ergogenic Aids.” Sports Medicine. Springer Science and Business Media LLC. https://doi.org/10.2165/00007256-200333120-00004.

[75] Maughan, Ron J, Doug S King, and Trevor Lea. 2004. “Dietary Supplements.” Journal of Sports Sciences. Informa UK Limited. https://doi.org/10.1080/0264041031000140581.

[76] Baltazar-Martins, Gabriel, Diego Brito de Souza, Millán Aguilar-Navarro, Jesús Muñoz-Guerra, María del Mar Plata, and Juan Del Coso. 2019. “Prevalence and Patterns of Dietary Supplement Use in Elite Spanish Athletes.” Journal of the International Society of Sports Nutrition. Informa UK Limited. https://doi.org/10.1186/s12970-019-0296-5.

[77] Kakutani, Yuya, Akane Kiowa, Saori Kamiya, Miho Ono, Ikuko Sasahara, and Naomi Omi. 2019. “Why Do Athletes Choose Dietary Supplements? Reliability and Validity of the Dietary Supplement Choice Questionnaire (DSCQ) among Japanese College Athletes.” Journal of Nutritional Science and Vitaminology. Center for Academic Publications Japan. https://doi.org/10.3177/jnsv.65.343.

[78] Madden, Robyn, Jane Shearer, David Legg, and Jill Parnell. 2018. “Evaluation of Dietary Supplement Use in Wheelchair Rugby Athletes.” Nutrients. MDPI AG. https://doi.org/10.3390/nu10121958.

[79] Aguilar-Navarro, Millán, Gabriel Baltazar-Martins, Diego Brito de Souza, Jesús Muñoz-Guerra, María del Mar Plata, and Juan Del Coso. 2020. “Gender Differences in Prevalence and Patterns of Dietary Supplement Use in Elite Athletes.” Research Quarterly for Exercise and Sport. Informa UK Limited. https://doi.org/10.1080/02701367.2020.1764469.

[80] Sánchez-Oliver, Antonio Jesús, Raúl Domínguez, Paola López-Tapia, Francisco Miguel Tobal, Pablo Jodra, Juan José Montoya, Eduardo J. Guerra-Hernández, and Juan José Ramos-Álvarez. 2020. “A Survey on Dietary Supplement Consumption in Amateur and Professional Rugby Players.” Foods. MDPI AG. https://doi.org/10.3390/foods10010007.

[81] Baltazar-Martins, Gabriel, Diego Brito de Souza, Millán Aguilar-Navarro, Jesús Muñoz-Guerra, María del Mar Plata, and Juan Del Coso. 2019. “Prevalence and Patterns of Dietary Supplement Use in Elite Spanish Athletes.” Journal of the International Society of Sports Nutrition. Informa UK Limited. https://doi.org/10.1186/s12970-019-0296-5.

[82] Baltazar-Martins, Gabriel, Diego Brito de Souza, Millán Aguilar-Navarro, Jesús Muñoz-Guerra, María del Mar Plata, and Juan Del Coso. 2019. “Prevalence and Patterns of Dietary Supplement Use in Elite Spanish Athletes.” Journal of the International Society of Sports Nutrition. Informa UK Limited. https://doi.org/10.1186/s12970-019-0296-5.

[83] Baltazar-Martins, Gabriel, Diego Brito de Souza, Millán Aguilar-Navarro, Jesús Muñoz-Guerra, María del Mar Plata, and Juan Del Coso. 2019. “Prevalence and Patterns of Dietary Supplement Use in Elite Spanish Athletes.” Journal of the International Society of Sports Nutrition. Informa UK Limited. https://doi.org/10.1186/s12970-019-0296-5.

[84] Dascombe, B.J., M. Karunaratna, J. Cartoon, B. Fergie, and C. Goodman. 2010. “Nutritional Supplementation Habits and Perceptions of Elite Athletes within a State-Based Sporting Institute.” Journal of Science and Medicine in Sport. Elsevier BV. https://doi.org/10.1016/j.jsams.2009.03.005.

[85] Dascombe, B.J., M. Karunaratna, J. Cartoon, B. Fergie, and C. Goodman. 2010. “Nutritional Supplementation Habits and Perceptions of Elite Athletes within a State-Based Sporting Institute.” Journal of Science and Medicine in Sport. Elsevier BV. https://doi.org/10.1016/j.jsams.2009.03.005.

[86] https://www.iadsa.org/the-evolution-of-the-health-supplements-sector

[87] Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients. 2018;10(1):41. Published 2018 Jan 4. doi:10.3390/nu10010041

[88] https://www.iadsa.org/the-evolution-of-the-health-supplements-sector

[89] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[90] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[91] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[92] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[93] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[94]https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements

[95] https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements

[96] https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements

[97] https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements

[98] https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements

[99] https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements

[100] https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements

[101] https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements

[102] https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements

[103] https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements

[104] https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements

[105] https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements#:~:text=Among%20the%20claims%20that%20can,%2Drelated%20condition)%2C%20structure%2F

[106] https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements#:~:text=Among%20the%20claims%20that%20can,%2Drelated%20condition)%2C%20structure%2F

[107] https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements#:~:text=Among%20the%20claims%20that%20can,%2Drelated%20condition)%2C%20structure%2F

[108] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[109] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[110] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[111] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[112] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[113] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[114] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[115] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[116] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[117] https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements

[118] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[119] https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/

[120] Boon, Heather, and Natalie Bozinovski. 2019. “A Systematic Narrative Review of the Evidence for Labeling of Natural Health Products and Dietary Supplements.” The Journal of Alternative and Complementary Medicine. Mary Ann Liebert Inc. https://doi.org/10.1089/acm.2018.0533.

[121] Marcus, Donald M. 2015. “Dietary Supplements: What’s in a Name? What’s in the Bottle?” Drug Testing and Analysis. Wiley. https://doi.org/10.1002/dta.1855.

[122] “Testing Supplements,” The New York Times. November 4, 2013. https://archive.nytimes.com/www.nytimes.com/interactive/2013/11/05/health/Testing-Supplements.html?searchResultPosition=11.

[123] White, C. Michael. 2022. “Continued Risk of Dietary Supplements Adulterated With Approved and Unapproved Drugs: Assessment of the US Food and Drug Administration’s Tainted Supplements Database 2007 Through 2021.” The Journal of Clinical Pharmacology. Wiley. https://doi.org/10.1002/jcph.2046.

[124] “USP Quality Supplements,” Accessed February 4, 2022. https://www.quality-supplements.org/.

[125] “NSF International,” Accessed February 4, 2022. https://www.nsf.org/

[126] Kevin Loria, “How to Choose Supplements Wisely,” Consumer Reports. October 30, 2019. https://www.consumerreports.org/supplements/how-to-choose-supplements-wisely/.

[127] “Tested to be Trusted,” CVS. Accessed October 20, 2021. https://www.cvs.com/content/tested-trusted.

[128] “What You Need to Know about Dietary Supplements,” FDA. Accessed October 20, 2021. https://www.fda.gov/food/buy-store-serve-safe-food/what-you-need-know-about-dietary-supplements.

[129] 117th Congress. S.4090 – Dietary Supplement Listing Act of 2022. https://www.congress.gov/bill/117th-congress/senate-bill/4090/actions

[130] 117th Congress. S.4090 – Dietary Supplement Listing Act of 2022. https://www.congress.gov/bill/117th-congress/senate-bill/4090/actions

[131] Swinbanks, David, and John O’Brien. 1993. “Japan Explores the Boundary between Food and Medicine.” Nature. Springer Science and Business Media LLC. https://doi.org/10.1038/364180a0.

[132] Henry, C J. 2010. “Functional Foods.” European Journal of Clinical Nutrition. Springer Science and Business Media LLC. https://doi.org/10.1038/ejcn.2010.101.

[133] Arai, Soichi. 1996. “Studies on Functional Foods in Japan—State of the Art.” Bioscience, Biotechnology, and Biochemistry. Oxford University Press (OUP). https://doi.org/10.1271/bbb.60.9.

[134] Santini, Antonello, Silvia Miriam Cammarata, Giacomo Capone, Angela Ianaro, Gian Carlo Tenore, Luca Pani, and Ettore Novellino. 2018. “Nutraceuticals: Opening the Debate for a Regulatory Framework.” British Journal of Clinical Pharmacology. Wiley. https://doi.org/10.1111/bcp.13496.

[135] https://www.iadsa.org/the-evolution-of-the-health-supplements-sector

[136] https://www.raps.org/News-and-Articles/News-Articles/2018/7/Food-Supplements-in-the-European-Union-the-Diffic

[137] https://www.raps.org/News-and-Articles/News-Articles/2018/7/Food-Supplements-in-the-European-Union-the-Diffic

[138] https://www.raps.org/News-and-Articles/News-Articles/2018/7/Food-Supplements-in-the-European-Union-the-Diffic

[139] https://www.raps.org/News-and-Articles/News-Articles/2018/7/Food-Supplements-in-the-European-Union-the-Diffic

[140] https://www.raps.org/News-and-Articles/News-Articles/2018/7/Food-Supplements-in-the-European-Union-the-Diffic

[141] https://www.iadsa.org/the-evolution-of-the-health-supplements-sector

[142] https://food.ec.europa.eu/safety/labelling-and-nutrition/food-supplements_en

[143] https://www.efsa.europa.eu/en/topics/topic/food-supplements

[144] https://www.raps.org/News-and-Articles/News-Articles/2018/7/Food-Supplements-in-the-European-Union-the-Diffic

[145] https://www.raps.org/News-and-Articles/News-Articles/2018/7/Food-Supplements-in-the-European-Union-the-Diffic

[146] https://www.efsa.europa.eu/en/topics/topic/food-supplements

[147] https://www.efsa.europa.eu/en/topics/topic/food-supplements

[148] https://www.efsa.europa.eu/en/topics/topic/food-supplements

[149] https://www.efsa.europa.eu/en/topics/topic/food-supplements

[150]  “About Natural Health Products.” Health Canada. Updated March 14, 2016. Accessed October 19, 2023. https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation/about-products.html

[151]  “About Natural Health Products.” Health Canada. Updated March 14, 2016. Accessed October 19, 2023. https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation/about-products.html

[152]  “About Natural Health Products.” Health Canada. Updated March 14, 2016. Accessed October 19, 2023. https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation/about-products.html

[153] “Natural and Non-Prescription Health Products Directorate.” Health Canada. Updated 21 July 2022. Accessed 3 Nov 2023. https://www.canada.ca/en/health-canada/corporate/about-health-canada/branches-agencies/health-products-food-branch/natural-non-prescription-health-products-directorate.html

[154] Natural Health Products Regulations. Government of Canada Justice Laws Website. Updated 15 Feb 2023. https://laws-lois.justice.gc.ca/eng/regulations/sor-2003-196/

[155] Natural Health Products Regulations. Government of Canada Justice Laws Website. Updated 15 Feb 2023. https://laws-lois.justice.gc.ca/eng/regulations/sor-2003-196/

[156] Natural Health Products Regulations. Government of Canada Justice Laws Website. Updated 15 Feb 2023. https://laws-lois.justice.gc.ca/eng/regulations/sor-2003-196/

[157] Natural Health Products Regulations. Government of Canada Justice Laws Website. Updated 15 Feb 2023. https://laws-lois.justice.gc.ca/eng/regulations/sor-2003-196/

[158] Natural Health Products Regulations. Government of Canada Justice Laws Website. Updated 15 Feb 2023. https://laws-lois.justice.gc.ca/eng/regulations/sor-2003-196/

[159] Natural Health Products Regulations. Government of Canada Justice Laws Website. Updated 15 Feb 2023. https://laws-lois.justice.gc.ca/eng/regulations/sor-2003-196/

[160] Natural Health Products Regulations. Government of Canada Justice Laws Website. Updated 15 Feb 2023. https://laws-lois.justice.gc.ca/eng/regulations/sor-2003-196/

[161] Food and Drug Act. Government of Canada Justice Laws Website. Updated 22 June 2023. https://laws-lois.justice.gc.ca/eng/acts/f-27/index.html

[162] Food and Drug Act. Government of Canada Justice Laws Website. Updated 22 June 2023. https://laws-lois.justice.gc.ca/eng/acts/f-27/index.html

[163] “Overview of Vanessa’s Law.” Health Canada. Updated 4 July 2023. https://www.canada.ca/en/health-canada/services/drugs-health-products/legislation-guidelines/overview-vannessa-law-protecting-canadians-unsafe-drugs-act-vanessa-law-amendments-food-drugs-act.html

[164] “Complementary Medicines.” Therapeutic Goods Administration. https://www.tga.gov.au/topics/complementary-medicines

[165] “Therapeutic Goods: a quick guide.” Parliament of Australia. Updated 4 May 2022. https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/pubs/rp/rp2122/Quick_Guides/TherapeuticGoods

[166] “Therapeutic Goods: a quick guide.” Parliament of Australia. Updated 4 May 2022. https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/pubs/rp/rp2122/Quick_Guides/TherapeuticGoods

[167] “Therapeutic Goods: a quick guide.” Parliament of Australia. Updated 4 May 2022. https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/pubs/rp/rp2122/Quick_Guides/TherapeuticGoods

[168] “Therapeutic Goods: a quick guide.” Parliament of Australia. Updated 4 May 2022. https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/pubs/rp/rp2122/Quick_Guides/TherapeuticGoods

[169] “Therapeutic Goods Act of 1989.” Australian Government Federal Register of Legislation. https://www.legislation.gov.au/Series/C2004A03952

[170] “Therapeutic Goods Advertising Code.” Therapeutic Goods Administration. Updated 1 July 2022. https://www.tga.gov.au/about-tga/legislation/legislation-and-legislative-instruments/therapeutic-goods-advertising-code

[171]  “Therapeutic Goods Advertising Code.” Therapeutic Goods Administration. Updated 1 July 2022. https://www.tga.gov.au/about-tga/legislation/legislation-and-legislative-instruments/therapeutic-goods-advertising-code

[172]  “Therapeutic Goods Advertising Code.” Therapeutic Goods Administration. Updated 1 July 2022. https://www.tga.gov.au/about-tga/legislation/legislation-and-legislative-instruments/therapeutic-goods-advertising-code

[173]  “Therapeutic Goods Advertising Code.” Therapeutic Goods Administration. Updated 1 July 2022. https://www.tga.gov.au/about-tga/legislation/legislation-and-legislative-instruments/therapeutic-goods-advertising-code

[174]  “Therapeutic Goods Advertising Code.” Therapeutic Goods Administration. Updated 1 July 2022. https://www.tga.gov.au/about-tga/legislation/legislation-and-legislative-instruments/therapeutic-goods-advertising-code

[175]  “Therapeutic Goods Advertising Code.” Therapeutic Goods Administration. Updated 1 July 2022. https://www.tga.gov.au/about-tga/legislation/legislation-and-legislative-instruments/therapeutic-goods-advertising-code

[176]  “Therapeutic Goods Advertising Code.” Therapeutic Goods Administration. Updated 1 July 2022. https://www.tga.gov.au/about-tga/legislation/legislation-and-legislative-instruments/therapeutic-goods-advertising-code

[177]  “Therapeutic Goods Advertising Code.” Therapeutic Goods Administration. Updated 1 July 2022. https://www.tga.gov.au/about-tga/legislation/legislation-and-legislative-instruments/therapeutic-goods-advertising-code

[178] Ashley Roberts, Rebecca Rogerson. Chapter 19 – Chinese Approach on Regulating Food Additives, Novel Foods. Functional Foods and Dietary Supplements. Nutraceutical and Functional Food Regulations in the United States and Around the World. Academic Press. 2008: 291-303. https://doi.org/10.1016/B978-012373901-8.00019-6.

[179]  Ashley Roberts, Rebecca Rogerson. Chapter 19 – Chinese Approach on Regulating Food Additives, Novel Foods. Functional Foods and Dietary Supplements. Nutraceutical and Functional Food Regulations in the United States and Around the World. Academic Press. 2008: 291-303. https://doi.org/10.1016/B978-012373901-8.00019-6.

[180]  Ashley Roberts, Rebecca Rogerson. Chapter 19 – Chinese Approach on Regulating Food Additives, Novel Foods. Functional Foods and Dietary Supplements. Nutraceutical and Functional Food Regulations in the United States and Around the World. Academic Press. 2008: 291-303. https://doi.org/10.1016/B978-012373901-8.00019-6.

[181] Shraddha Thakkar, Elke Anklam, Alex Xu, Franz Ulberth, Jing Li, Bo Li, Marta Hugas, Nandakumara Sarma, Scott Crerar, Sibyl Swift, Takashi Hakamatsuka, Valeriu Curtui, William Yan, Xingchao Geng, William Slikker, Weida Tong. Regulatory landscape of dietary supplements and herbal medicines from a global perspective. Regulatory Toxicology and Pharmacology. 2020;114. https://doi.org/10.1016/j.yrtph.2020.104647.

[182]  Shraddha Thakkar, Elke Anklam, Alex Xu, Franz Ulberth, Jing Li, Bo Li, Marta Hugas, Nandakumara Sarma, Scott Crerar, Sibyl Swift, Takashi Hakamatsuka, Valeriu Curtui, William Yan, Xingchao Geng, William Slikker, Weida Tong. Regulatory landscape of dietary supplements and herbal medicines from a global perspective. Regulatory Toxicology and Pharmacology. 2020;114. https://doi.org/10.1016/j.yrtph.2020.104647.

[183]  Shraddha Thakkar, Elke Anklam, Alex Xu, Franz Ulberth, Jing Li, Bo Li, Marta Hugas, Nandakumara Sarma, Scott Crerar, Sibyl Swift, Takashi Hakamatsuka, Valeriu Curtui, William Yan, Xingchao Geng, William Slikker, Weida Tong. Regulatory landscape of dietary supplements and herbal medicines from a global perspective. Regulatory Toxicology and Pharmacology. 2020;114. https://doi.org/10.1016/j.yrtph.2020.104647.

[184]   Ashley Roberts, Rebecca Rogerson. Chapter 19 – Chinese Approach on Regulating Food Additives, Novel Foods. Functional Foods and Dietary Supplements. Nutraceutical and Functional Food Regulations in the United States and Around the World. Academic Press. 2008: 291-303. https://doi.org/10.1016/B978-012373901-8.00019-6.

[185]   Ashley Roberts, Rebecca Rogerson. Chapter 19 – Chinese Approach on Regulating Food Additives, Novel Foods. Functional Foods and Dietary Supplements. Nutraceutical and Functional Food Regulations in the United States and Around the World. Academic Press. 2008: 291-303. https://doi.org/10.1016/B978-012373901-8.00019-6.

[186]   Ashley Roberts, Rebecca Rogerson. Chapter 19 – Chinese Approach on Regulating Food Additives, Novel Foods. Functional Foods and Dietary Supplements. Nutraceutical and Functional Food Regulations in the United States and Around the World. Academic Press. 2008: 291-303. https://doi.org/10.1016/B978-012373901-8.00019-6.

[187]   Ashley Roberts, Rebecca Rogerson. Chapter 19 – Chinese Approach on Regulating Food Additives, Novel Foods. Functional Foods and Dietary Supplements. Nutraceutical and Functional Food Regulations in the United States and Around the World. Academic Press. 2008: 291-303. https://doi.org/10.1016/B978-012373901-8.00019-6.

[188]   Ashley Roberts, Rebecca Rogerson. Chapter 19 – Chinese Approach on Regulating Food Additives, Novel Foods. Functional Foods and Dietary Supplements. Nutraceutical and Functional Food Regulations in the United States and Around the World. Academic Press. 2008: 291-303. https://doi.org/10.1016/B978-012373901-8.00019-6.

[189] Shraddha Thakkar, Elke Anklam, Alex Xu, Franz Ulberth, Jing Li, Bo Li, Marta Hugas, Nandakumara Sarma, Scott Crerar, Sibyl Swift, Takashi Hakamatsuka, Valeriu Curtui, William Yan, Xingchao Geng, William Slikker, Weida Tong. Regulatory landscape of dietary supplements and herbal medicines from a global perspective. Regulatory Toxicology and Pharmacology. 2020;114. https://doi.org/10.1016/j.yrtph.2020.104647.

[190] Swinbanks, David, and John O’Brien. 1993. “Japan Explores the Boundary between Food and Medicine.” Nature. Springer Science and Business Media LLC. https://doi.org/10.1038/364180a0.

[191] Arai, Soichi. 1996. “Studies on Functional Foods in Japan—State of the Art.” Bioscience, Biotechnology, and Biochemistry. Oxford University Press (OUP). https://doi.org/10.1271/bbb.60.9.

[192] “Food for Specified Health Uses,” Japanese Ministry of Health, Labour and Welfare. Accessed October 27, 2021. https://www.mhlw.go.jp/english/topics/foodsafety/fhc/02.html.

[193] Farid, Mohamed, Kota Kodama, Teruyo Arato, Takashi Okazaki, Tetsuaki Oda, Hideko Ikeda, and Shintaro Sengoku. 2019. “Comparative Study of Functional Food Regulations in Japan and Globally.” Global Journal of Health Science. Canadian Center of Science and Education. https://doi.org/10.5539/gjhs.v11n6p132.

[194]  “Food for Specified Health Uses,” Japanese Ministry of Health, Labour and Welfare. Accessed October 27, 2021. https://www.mhlw.go.jp/english/topics/foodsafety/fhc/02.html.

[195]  “Food for Specified Health Uses,” Japanese Ministry of Health, Labour and Welfare. Accessed October 27, 2021. https://www.mhlw.go.jp/english/topics/foodsafety/fhc/02.html.

[196]  “Food for Specified Health Uses,” Japanese Ministry of Health, Labour and Welfare. Accessed October 27, 2021. https://www.mhlw.go.jp/english/topics/foodsafety/fhc/02.html.

[197]  “Food for Specified Health Uses,” Japanese Ministry of Health, Labour and Welfare. Accessed October 27, 2021. https://www.mhlw.go.jp/english/topics/foodsafety/fhc/02.html.

[198]  “Food for Specified Health Uses,” Japanese Ministry of Health, Labour and Welfare. Accessed October 27, 2021. https://www.mhlw.go.jp/english/topics/foodsafety/fhc/02.html.

[199]  “Food for Specified Health Uses,” Japanese Ministry of Health, Labour and Welfare. Accessed October 27, 2021. https://www.mhlw.go.jp/english/topics/foodsafety/fhc/02.html.

[200]  “Food for Specified Health Uses,” Japanese Ministry of Health, Labour and Welfare. Accessed October 27, 2021. https://www.mhlw.go.jp/english/topics/foodsafety/fhc/02.html.

[201]  “Medical Myths: Vitamins and supplements.” MedicalNewsToday. Updated 9 Aug 2021. https://www.medicalnewstoday.com/articles/medical-myths-vitamins-and-supplements#1.-More-is-always-better

[202]   “Medical Myths: Vitamins and supplements.” MedicalNewsToday. Updated 9 Aug 2021. https://www.medicalnewstoday.com/articles/medical-myths-vitamins-and-supplements#1.-More-is-always-better

[203] Israelsen L, Lampe F. Three Myths About Dietary Supplements … and How Knowing the Right Answers Is Good for Your Integrative Medicine Practice. Integr Med (Encinitas). 2016;15(3):20-24.

[204] “Medical Myths: Vitamins and supplements.” MedicalNewsToday. Updated 9 Aug 2021. https://www.medicalnewstoday.com/articles/medical-myths-vitamins-and-supplements#1.-More-is-always-better

[205]  Israelsen L, Lampe F. Three Myths About Dietary Supplements … and How Knowing the Right Answers Is Good for Your Integrative Medicine Practice. Integr Med (Encinitas). 2016;15(3):20-24.

[206]   Dietary Supplements: What You Need to Know. National Institutes of Health. Updated 4 Jan 2023. Accessed 2 Nov 2023.

[207]  Dietary Supplements: What You Need to Know. National Institutes of Health. Updated 4 Jan 2023. Accessed 2 Nov 2023.

[208] Questions and Answers Dietary Supplements. Food and Drug Administration. Updated 26 Nov 2022. Accessed 2 Nov 2023.

[209] Natural Health Products Regulations. Government of Canada Justice Laws Website. Updated 15 Feb 2023. Accessed 2 Nov 2023.

[210] About Food Supplements. European Commission. Accessed 2 Nov 2023.

[211] Complementary Medicines Overview. Therapeutic Goods Administration. Updated 20 June 2019. Accessed 2 Nov 2023.

[212] Junshi Chen. An update of China’s Food Safety Regulatory Framework. Regulatory Focus. Updated 30 June 2022. Accessed 2 Nov 2023.

[213] Foods for Specific Health Uses (FOSHU). Ministry of Health, Labor, and Welfare. Accessed 2 Nov 2023.

[214] How to Choose High Quality Vitamins and Supplements. Healthline. Updated 15 July 2020. Accessed 2 Nov 2023.

[215] How to Choose High Quality Vitamins and Supplements. Healthline. Updated 15 July 2020. Accessed 2 Nov 2023.

[216] Choosing and Using Dietary Supplements Wisely. American Cancer Society. Updated 30 Aug 2021. Accessed 2 Nov 2023.

[217]  Choosing and Using Dietary Supplements Wisely. American Cancer Society. Updated 30 Aug 2021. Accessed 2 Nov 2023.

[218]  Choosing and Using Dietary Supplements Wisely. American Cancer Society. Updated 30 Aug 2021. Accessed 2 Nov 2023.

[219] How to Choose High Quality Vitamins and Supplements. Healthline. Updated 15 July 2020. Accessed 2 Nov 2023.

[220] Neeha, V.S., Kinth, P. Nutrigenomics research: a review. J Food Sci Technol 50, 415–428 (2013). https://doi.org/10.1007/s13197-012-0775-z

[221] Chelsea L. Ratcliff, Melinda Krakow, Alexandra Greenberg-Worisek, and Bradford W. Hesse. Digital Health Engagement in the US Population: Insights From the 2018 Health Information National Trends Survey. American Journal of Public Health. 2021;111: 1348-1351. https://doi.org/10.2105/AJPH.2021.306282

[222] Melocchi, A., Parietti, F., Maccagnan, S. et al. Industrial Development of a 3D-Printed Nutraceutical Delivery Platform in the Form of a Multicompartment HPC Capsule. AAPS PharmSciTech 19, 3343–3354 (2018). https://doi.org/10.1208/s12249-018-1029-9

[223] Lee H-A, Huang T-T, Yen L-H, Wu P-H, Chen K-W, Kung H-H, Liu C-Y, Hsu C-Y. Precision Nutrient Management Using Artificial Intelligence Based on Digital Data Collection Framework. Applied Sciences. 2022; 12(9):4167. https://doi.org/10.3390/app12094167

[224] Mian Kamran Sharif, Faiz-ul-Hassan Shah, Masood Sadiq Butt, Hafiz Rizwan Sharif. 15 – Role of nanotechnology in enhancing bioavailability and delivery of dietary factors. Editor(s): Alexandru Mihai Grumezescu. In Nanotechnology in the Agri-Food Industry. Nutrient Delivery Academic Press. 2017: 587-618. https://doi.org/10.1016/B978-0-12-804304-2.00015-9.

[225] Phalgun Madhusudan, Nagendra Chellukuri, Neeta Shivakumar. Smart packaging of food for the 21st century – A review with futuristic trends, their feasibility and economics. Materials Today: Proceedings. 2018;5(10):21018-21022. https://doi.org/10.1016/j.matpr.2018.06.494.

[226] Vipul Prajapati, Salona Roy. Chapter 14 – Smart packaging for medicinal food supplements. Green Sustainable Process for Chemical and Environmental Engineering and Science. Elsevier. 2023: 229-266. https://doi.org/10.1016/B978-0-323-95644-4.00007-3.

[227] Anne Sibbel. The sustainability of functional foods. Social Science & Medicine. 2007;64(3):554-561. https://doi.org/10.1016/j.socscimed.2006.08.042.

[228]  Anne Sibbel. The sustainability of functional foods. Social Science & Medicine. 2007;64(3):554-561. https://doi.org/10.1016/j.socscimed.2006.08.042.

[229]  Anne Sibbel. The sustainability of functional foods. Social Science & Medicine. 2007;64(3):554-561. https://doi.org/10.1016/j.socscimed.2006.08.042.

[230] Durazzo Alessandra, Sorkin Barbara C., Lucarini Massimo, Gusev Pavel A., Kuszak Adam J., Crawford Cindy, Boyd Courtney, Deuster Patricia A., Saldanha Leila G., Gurley Bill J., Pehrsson Pamela R., Harnly James M., Turrini Aida, Andrews Karen W., Lindsey Andrea T., Heinrich Michael, Dwyer Johanna T. Analytical Challenges and Metrological Approaches to Ensuring Dietary Supplement Quality: International Perspectives. Frontiers in Pharmacology. 2022:12. doi:10.3389/fphar.2021.714434    

[231]  Anne Sibbel. The sustainability of functional foods. Social Science & Medicine. 2007;64(3):554-561. https://doi.org/10.1016/j.socscimed.2006.08.042.

[232] Fuguo Liu, Moting Li, Qiankun Wang, Jun Yan, Shuang Han, Cuicui Ma, Peihua Ma, Xuebo Liu & David Julian McClements(2023) Future foods: Alternative proteins, food architecture, sustainable packaging, and precision nutrition, Critical Reviews in Food Science and Nutrition, 63:23, 6423-6444, DOI: 10.1080/10408398.2022.2033683

[233] Fuguo Liu, Moting Li, Qiankun Wang, Jun Yan, Shuang Han, Cuicui Ma, Peihua Ma, Xuebo Liu & David Julian McClements(2023) Future foods: Alternative proteins, food architecture, sustainable packaging, and precision nutrition, Critical Reviews in Food Science and Nutrition, 63:23, 6423-6444, DOI: 10.1080/10408398.2022.2033683

Rate this post

Juliana Fox is a passionate researcher and science communicator. In 2022, she received her B.S. in molecular and cell biology from UCSD, and in 2023, she received her M.S. in Biology from UCSD. She also currently works as Research Assistant II in the Asahina lab at Salk, where she studies the neurological basis of social hierarchies in eusocial sweat bee species. She currently runs a science education account on Instagram (@shrewdscience) that aims to share biology with the public in an accessible way! In the future, she plans to progress to a neuroscience Ph.D. program and pursue a career in research and science communication!

You may also like

Plant-based Meat Alternatives Study Spotlight Take-Away with Chef...

What are the Health Benefits of Matcha?

Timing is Everything: Study Spotlight Take-Away with Chef...

Is Breakfast Still “The Most Important Meal of...

Breathing Life into Food As Medicine: COPD Study...

Which Foods Can Protect Against Dementia?

Why are Acai Berries Healthier than Other Berries?

Additive (Danger?) Study Spotlight Take-Away with Chef Dr....

Is Agave Nectar Healthier than Other Sweeteners?

Diet, Genes, and Choices Study Spotlight Take-Away with...

Copyright 2022-23 Center For Food As Medicine |
Center For Food As Medicine, Inc., a non-profit organization.
Subscribe To The Weekly Food & Nutrition News and Research Digest
The Center for Food As Medicine's weekly email news and research digest is everything you need to know about food, nutrition, fitness and health.
No Thanks
Thanks for signing up. You must confirm your email address before we can send you. Please check your email and follow the instructions.
We respect your privacy. Your information is safe and will NEVER be shared.
Don't miss out. Subscribe today.
×
×