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Originally published September 21, 2011 at 11:35 AM | Page modified September 26, 2011 at 4:24 PM

Battle lines solidify over bid to distinguish food, supplements

Lawmakers are pushing for tighter regulation of vitamins, herbs, weight-loss products and other dietary supplements.

Chicago Tribune

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Lazy Larry dietary supplements look and taste like fudge brownies. They contain some of the same ingredients, including flour, trans fats, sugar and oil. And until recently, they could be found among the snack foods in convenience stores.

But the brown "relaxation" treats contain melatonin, a neurohormone often used as a sleep aid. There is no safety data on its use in conventional foods, but animal studies on melatonin have raised red flags over potential adverse effects, including blood glucose problems and cardiovascular, eye and reproductive issues.

Citing health risks from products that blur the line dividing supplements from food and beverages, lawmakers are pushing for tighter regulation of vitamins, herbs, weight-loss products and other dietary supplements.

The U.S. is also overwhelmed by potentially dangerous imported ingredients from Asia, said Sen. Dick Durbin, D-Ill., whose recently introduced Dietary Supplement Labeling Act of 2011 would increase labeling requirements and require companies to register their products. "The U.S. Food and Drug Administration has neither the power nor the resources to monitor what's going on in the industry," he said in an interview.

The supplement industry, however, is up in arms over the prospect of stronger FDA oversight and additional rules governing the use of new dietary ingredients. The real problem, it contends, is that the agency isn't enforcing regulations already on the books. Additional requirements would raise the cost of supplements, burden manufacturers, limit availability and infringe on a consumer's "personal freedom," representatives say.

"People want to have some modicum of autonomy when it comes to the question of what they can put into their body and what they can do for their own health," said attorney Marc Ullman, chairman of the legal advisory council for the Natural Products Foundation. "They really resent intervention by the nanny state and want to be allowed to make judgments for themselves."

But do consumers have enough reliable information to make smart decisions about the products they buy? Unlike drugs, which need premarket approval, dietary supplements are not approved by the FDA for safety or efficacy before they hit store shelves. Labels must be truthful, but the FDA does not review them in advance.

The FDA can go after a company only if it can prove a supplement is dangerous. Even then, it can be difficult to get the products out of circulation.

When Harvard Medical School researchers surveyed a group of immigrant women, for example, they found that nearly a quarter of them had used Pai You Guo, a weight-loss supplement from China that the FDA recalled in 2009 because it contained a dangerous mix of banned pharmaceutical substances. Many were still using it and had not heard of the ban.

"The FDA is hamstrung by ineffectual laws governing supplements, placing consumers in the line of fire," said study co-author Danny McCormick, an assistant professor of medicine at Harvard Medical School.

Since the Dietary Supplement Health and Education Act, or DSHEA, was passed in 1994, the number of dietary supplements has surged from 4,000 to an estimated 50,000 to 75,000. Because companies don't need to register individual products, the FDA doesn't know exactly how many supplements are being sold.

Durbin's legislation would require companies to register their products with the FDA, disclose all ingredients, including proprietary blends, and list known health hazards on the labels. Companies would need to provide a batch number so the product can be traced in case of a problem, though many companies already do this under quality control standards that went into effect last year.

The bill also targets the murky area of food, beverage and dietary ingredients by requiring the FDA to clarify the difference between a food and a health aid.

A 2009 report by the Government Accountability Office that recommended increasing the FDA's power over supplements found that foods could "be marketed as dietary supplements to circumvent the (more stringent) safety standards required for food additives."

The GAO also found that consumers are woefully uneducated about supplements. More than half of U.S. adults — or at least 114 million people — take dietary supplements, and the majority mistakenly believe that a government agency approves such products, the report said.

"It's impossible for consumers to get information about ingredients in supplements," Durbin said. "If the good players in the industry don't accept reasonable regulation to establish the integrity of their product, they open the door to cheap and dangerous products. They should see it coming."

But critics say DSHEA already spells out the definition of "dietary supplements"; the problem is that the FDA hasn't followed through on its own advice — which it issued in 2000 — to clarify the boundary between conventional foods and dietary supplements. Industry experts also say the Lazy Larry case proves that the FDA can crack down on violators if it wants to do so. In July, the FDA warned the maker, HHB, that the product was a dietary supplement masquerading as a food.

The words "cake" and "brownie" have since vanished from the website and the product's original name, Lazy Cakes, was changed to Lazy Larry squares. The company also changed the packaging, said CEO Terry Harris.

"The energy being put forth in questioning a dietary supplement that is clearly labeled is wasting time and funds that should be directed at other products such as energy drinks, alcohol and tobacco, which have all consumed lives," said Harris.

Perhaps the industry's biggest fear is that additional legislation will lead to expensive, druglike FDA approval requirements for proving the safety of supplements. Durbin said rigorous premarket testing isn't part of his bill. His gripe isn't with vitamins; he likes to point out that he takes a daily multivitamin and fish oil, though he's not entirely sure they work. Rather, his concerns are energy drinks, weight-loss products and other supplements that contain unapproved ingredients.

His legislation does ask the Institute of Medicine to review all supplement ingredients and identify those that have the potential to cause adverse events.

That review is "the most concerning" to attorney Steve Mister, president and CEO of the Council of Responsible Nutrition, an industry trade group. "Supplements have an incredible margin of safety and very few adverse events when compared to over-the-counter drugs."

Under the proposed paradigm, information on product labels "could warn people off a beneficial product based on just a slight risk," said Mister.

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KEY CHANGES IN REGULATION OF SUPPLEMENTS

1990: The Nutrition Labeling and Education Act amends the Federal Food, Drug and Cosmetic Act to require that most foods, including dietary supplements, bear nutrition labeling.

1994: The Dietary Supplement Health and Education Act creates a new regulatory category, safety standards and other rules for dietary supplements. Under DSHEA, ingredients used before 1994 are presumed to be safe based on past use. If a manufacturer introduces an ingredient not used before 1994, it must file a notice with the FDA.

2002: The Bioterrorism Act requires food facilities, including dietary supplement manufacturers, to register their facilities with the FDA. They do not have to register their products.

2004: After a lengthy legal process, the stimulant and weight loss supplement ephedra is banned after thousands of adverse events, including several deaths.

2006: The Dietary Supplement and Non Prescription Drug Consumer Protection Act requires dietary supplement companies that receive a serious adverse event report to submit the information to the FDA.

2007: Good Manufacturing Practice regulations establish quality control standards for dietary supplements. Companies had until 2010 to comply.

2009: FDA issues draft guidance to help clarify the differences between liquid dietary supplements and beverages. Historically, supplements could be packaged like conventional beverages as long as the label said "supplement." The new guidelines, not yet finalized, say the package can't resemble a food or be located in stores' food section.

2011: The FDA issues draft guidance on new dietary ingredients. Companies fear that instead of obtaining blanket clearance for a new ingredient they would have to get approval for every new product that contains it. There's also concern that previously grandfathered ingredients might be reclassified as new. The comment period for the guidance ends Oct. 3.

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