SOURCES: Institute of Medicine Food and Nutrition Board, Dietary Reference Intakes: "Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride." National Academy Press, Washington, D.C., 1999. Journal of Nutrition, October 2005. Position paper of the American Dietetic Association on Food Fortification and Supplementation, Journal of the American Dietetic Association, August 2005. Michael Holick, MD, PhD, professor of medicine, physiology, and biophysics, Boston University Medical Center. Andrew Shoa, PhD, vice president for regulatory affairs, Council for Responsible Nutrition. Alice Lichtenstein, DSc, director and senior scientist, Cardiovascular Nutrition Laboratory, Human Nutrition Research Center on Aging, Tufts University. Dave Grotto, RD, spokesman, American Dietetic Association; author, 101 Foods That Could Save Your Life. Eduardo Baetti, MD, rheumatologist; Kaiser Permanente. Patrick Rea, editorial director, Nutrition Business Journal. Kristine Clark, PhD, RD, director of sports nutrition, Penn State University. Vasilios Frankos, PhD, Division of Dietary Supplement Programs, FDA. Sarubin, A. The Health Professionals Guide to Popular Dietary Supplements, American Dietetic Association, Chicago, IL, 2000. FDA. WebMD Weight Loss Clinic Feature: "Are You Getting Enough Vitamin D?" National Center for Complementary and Alternative Medicine: "Questions and Answers About Homeopathy."
What happened? Over the next 3 months, the number of soda sales dropped by 11.4 percent. Meanwhile, bottled water sales increased by 25.8 percent. Similar adjustments and results were made with food options. Nobody said a word to the visitors who ate at the cafeteria. The researchers simply changed the environment and people naturally followed suit.
As with all dietary supplements, in the United States inappropriate label health claims such as preventing or treating disease are opposed by the FDA and deceptive advertisements by the Federal Trade Commission. Probiotic foods and dietary supplements are allowed to make claims using Structure:Function vocabulary as long as human trial evidence is adequate. In 2005, the FDA issued a Warning Letter to UAS Laboratories for disease treatment claims (colds, flu, ulcers, elevated blood cholesterol, colon cancer...). The company revised label and website content and continued to sell the product. In 2011 the company was found to have resumed the label and website claims, and the FDA seized product and stopped production. In 2010 a FTC action was brought against a probiotic food company for exaggerated health claims, resulting in a multimillion-dollar fine and revisions to future advertising. In the European Union a more restrictive approach has been taken by the EFSA. All proposed health claims were rejected on the grounds that the science was not sufficient, and no health claims are permitted. Foods with live microorganisms (yogurt, kefir) can be sold, but without claims.
"These products provide a subtle, incremental effect. You can't use a sports supplement for a week and expect to gain pounds of muscle, but if used properly, research shows they can provide a slight, not overwhelming, edge," says Andrew Shoa, PhD, vice president for regulatory affairs for the Council for Responsible Nutrition, a trade association for the dietary supplement industry.
Nutrition is particularly important when you are pregnant. Weight gain during pregnancy is normal—and it's not just because of the growing fetus; your body is storing fat for lactation. The National Academy of Sciences/Institute of Medicine (NAS/IOM) has determined that a gain of 25 to 35 pounds is desirable. However, underweight women should gain about 28 to 40 pounds, and overweight women should gain at least 15 pounds. The IOM has not given a recommendation for an upper limit for obese women, but some experts cap it as low as 13 pounds. If you fit into this category, discuss how much weight you should gain with your health care professional. Remember that pregnancy isn't the time to diet. Caloric restriction during pregnancy has been associated with reduced birth weight, which can be dangerous to the baby.
Kris Clark, PhD, RD, sports nutrition director at Penn State University, says she very carefully uses select sports supplements with collegiate athletes: "I rely on the major nutrients in food, timing of meals and fluids to enhance athletic performance, and in general I discourage dietary supplements, other than the use of sport shakes, bars, and gels after practice or events for muscle cell recovery."
To make it easy to find reliable information, NIH has fact sheets on dietary supplements at ods.od.nih.gov/factsheets/list-all/. NIH also recently launched an online Dietary Supplement Label Database at www.dsld.nlm.nih.gov. This free database lets you look up the ingredients of thousands of dietary supplements. It includes information from the label on dosage, health claims and cautions.
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