Denise Feeley is an avid runner and Registered Dietitian with more than eight years of experience counseling athletes. She is currently an adjunct professor in the Department of Exercise Science at George Washington University. She is available for nutrition counseling. For information or questions contact her at denf44@yahoo.com.

The nutrition supplement industry is a multi-billion dollar industry. About half of American adults take nutrition supplements on a daily basis. The percentage of athletes using supplements is even higher. Unlike over-the-counter and prescription medications, the Food and Drug Administration or any other regulatory agency does not regulate supplements. The "regulation" of dietary supplements falls under the Dietary Supplement Health and Education Act (DSHEA) passed in 1994. This legislation is ambiguous at best and in fact there are entire books written on the interpretation of this act.

In summary, dietary supplements do not need to be proven safe and effective before they are marketed and sold, unlike medications. The manufacturer is responsible for ensuring that its supplements are safe before they are packaged and marketed. The manufacturer is not required to disclose safety or efficacy information to the FDA or to the consumer before a supplement is marketed; each company is responsible for formulating its own policy. However, a consumer can request this information from the manufacturer if desired.

A potential loophole in this legislation is that thorough and scientific clinical trials are not required and thus many of the "studies" done by the companies are not considered scientific nor are the results statistically significant. The companies are also not required to record, investigate, or forward to the FDA any reports of adverse side effects, illnesses, or injuries that may have occurred as a result of the ingestion of the supplement. However, consumers are encouraged to report any side effects, illnesses, or deaths to the FDA. Under DSHEA, the FDA is required to investigate such reports and determine whether the supplement is "unsafe" before it can be removed from the market.

At this time, the dietary supplement ephedra, which is found in certain weight loss supplements, has been associated with several deaths and is under investigation by the FDA. Kava- containing supplements (usually marketed as a treatment for anxiety) are also under investigation due to its association with liver failure in individuals ingesting the supplement.

Nutrition supplement labels are required to display a "supplement facts" label, which contains a list of each dietary ingredient contained in the label. Food products are required to list the serving size whereas nutrition supplements are not. The amount of the "nutrient" contained in the supplement is not restricted either, so there are no consistent amounts of a "nutrient" found between different manufacturers. For example, if you were to examine several different nutrition supplements that contained creatine, none of them would contain the same amount nor would they necessarily contain the same form of creatine.

As a health care professional, I will only make recommendations based on what is reported in the literature. You can probably surmise that I am not an advocate of nutrition supplements unless it has been proven scientifically to exude a benefit with minimal, if any, side effects. If you are regularly taking a supplement with a hypothetical benefit, thoroughly research the supplement to see if there are any published studies on the use of the supplement. If you experience any usual side effects, report them to your physician.