According to the Centers for Disease Control and Prevention (CDC), expenditures for mental and chronic health conditions make up 90% of the United States’s $3.8 trillion in annual health care costs. (17) This statistic highlights the economic cost of disease, but also the essential need to address chronic conditions to improve individual well-being and quality of life.

Chronic diseases are considered largely preventable with appropriate dietary and lifestyle choices. Making certain changes, such as improving sleep, engaging in regular physical activity, and optimizing your nutritional status, can help prevent or manage a number of chronic conditions. (18) Effective integrative healthcare, a foundational approach to preventative medicine, incorporates various lifestyle changes such as the use of health supplements.


Topics covered in this article:

You can skip to any of these sections to learn more!


What is integrative and functional healthcare?

According to the Academic Consortium for Integrative Medicine & Health, “Integrative medicine and health reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals, and disciplines to achieve optimal health and healing.” (1)

Integrative medicine is sometimes described as the combination of complementary and alternative medicine approaches with conventional medicine. (6) In practice, integrative medicine is a broader system of medicine that involves the coordination between the individual, their healthcare provider or healthcare team, and even institutions, such as hospitals and professional credentialing organizations. (6)(40)(53)

Functional medicine, which is closely related to integrative medicine, is a similar system that promotes optimal health and treats illness by addressing the underlying functional imbalances. (5) Both integrative and functional medicine practitioners may incorporate dietary modifications, lifestyle practices, pharmaceutical medications, and health supplements. (5)(24)

 

Infographic showing the different types of medicine
Integrative medicine, which involves healing the whole person rather than a disease or symptoms, may be used in conjunction with other types of medicine.

Health by the numbers: chronic disease and integrative health statistics

The CDC estimates that 60% of American adults have a chronic disease, while approximately 40% have two or more chronic diseases. Chronic refers to conditions lasting at least a year, such as cancer, cardiovascular diseases, and diabetes. (18) It’s widely accepted that many of these chronic conditions can be prevented by healthy dietary and lifestyle choices. (16)(69)

Further, many individuals who are managing chronic diseases turn to integrative and functional medicine for various reasons, such as:

  • Adverse effects associated with conventional treatments (e.g., pharmaceuticals, surgery)
  • Desire for a patient-centered or holistic treatment approach
  • Perceived failure of conventional medicine (e.g., effective for symptom relief but not curative)
  • Supplemental benefits of complementary and alternative medicine (e.g., an emphasis on the cause of illness) (8)

For example, an estimated 70% to 90% of individuals with arthritis and 50% of individuals with irritable bowel syndrome (IBS) use a variety of complementary and alternative medicine approaches. (8)

Integrative medicine in practice

Many research studies have examined the effectiveness of integrative medicine in practice. One trial interviewed individuals with a variety of chronic diseases, such as chronic fatigue syndrome, eczema, multiple sclerosis, and musculoskeletal disorders, with the aim to understand how conventional and complementary/alternative treatments are used in disease management. The study results suggest that individuals find a personalized balance between the two systems of medicine, which can change over time depending on personal beliefs, treatment effectiveness, adverse effects, and treatment costs. (8)

One review study examined the use of integrated healthcare in individuals with chronic diseases such as chronic heart failure, diabetes, chronic obstructive pulmonary disease (COPD), and asthma. Integrated healthcare refers to coordination between and within healthcare organizations, designed to improve patients’ health outcomes and experience of care. (48) In practice, integrated healthcare provides comprehensive healthcare services and standardized care from a collaborative care team. The review found that, in a majority of cases, this type of integration was associated with benefits such as improved adherence to treatments, reduced hospital admissions and readmissions, and improved quality of life. (48)

Supplemental healthcare

Integrative healthcare practitioners commonly recommend dietary supplements as a part of a comprehensive treatment plan for their patients. For instance, when treating an individual with hypertension (high blood pressure), an integrative or functional medicine physician may begin by assessing oxidative stress, inflammation, and vascular immune function. Dysfunctions may be addressed using pharmaceutical medication and lifestyle interventions, including exercise, meditation, nutrition, weight loss, and health supplements such as certain antioxidants. (2)

What is a dietary supplement?

The U.S. Dietary Supplement Health and Education Act (1994) defines a dietary supplement as a product that:

  • Contains one or multiple dietary ingredients or their constituents (e.g., amino acids, vitamins, minerals, herbs, other botanical ingredients)
  • Is labeled as a dietary supplement
  • Is taken orally (e.g., in liquid, capsule, pill, or tablet format)
  • Supplements an individual’s diet (59)

In Canada, dietary supplements are regulated as natural health products (NHPs), defined as substances intended to maintain or restore health. NHPs are produced from naturally-occurring ingredients, such as plants, animals, marine sources, and microorganisms. NHPs are available as capsules, tablets, tinctures, liquid drops, solutions, ointments, and several other formats. (34)

 

Supplements on a spoon
An integrative or functional medicine practitioner can help advise you on a dietary supplement’s safety, efficacy, and quality.

 

Types of dietary supplements

There is a large variety of dietary supplements that can be classified in a number of ways, such as by their delivery format, ingredient source, or health effects. Nutrients, medicinal herbs, and hormones are examples of some of the key types of supplements.

Note that it’s important to consult with an integrative healthcare practitioner before taking a new supplement to ensure it’s safe and recommended for your wellness plan.

Nutrients

Nutrients are the group of compounds on which your body relies to sustain life and maintain health. (73) These are divided into macronutrients, required in relatively larger amounts, and micronutrients, required in relatively smaller amounts. (86) Ideally, a balanced diet should provide you with optimal amounts of essential nutrients. (52)

When additional support is needed, health supplements containing nutrients may be taken, such as:

Medicinal herbs

Another large category of supplements, medicinal herbs are plants used in herbal medicine for their therapeutic properties. Different parts of the plant may be used in a supplement, such as the bark, leaves, and seeds. (19) Research has identified many constituents in medicinal plants that exert therapeutic effects such as:

Hormones

Glands in the endocrine system secrete hormones, which are substances that act as chemical messengers in the body. Your bloodstream circulates these messengers to targeted cells and organs, where they control various functions. (58) Certain health supplements provide hormones and may be recommended to optimize the body’s level of a particular hormone, referred to as hormone replacement therapy. (58) Hormone or hormone-modulating supplements are produced from a variety of sources, including animals, microorganisms, plants, and synthetic manufacturing. (28)(54)

Examples of some common hormones available as dietary supplements include:

  • Dehydroepiandrosterone (DHEA)
  • Melatonin
  • Pregnenolone

Did you know? There are an estimated 80,000 unique dietary supplements on the U.S. market alone. (62)

Want to order?

Get higher-quality supplements from trusted healthcare professionals*

Sign up and order today Learn more

*You’ll be redirected to Dr. Leu, ND’s dispensary. Dr. Leu is testing early access to a new Fullscript catalog program.

Dietary supplement quality assurance

When shopping for supplements, you may wonder which brand or product is the best choice. This decision is often personal and should take into consideration the recommendations from your integrative practitioner. No matter the type of supplement you choose, it’s best to select high-quality products from reputable brands.

How can you determine whether a supplement is high-quality? According to the Food and Drug Administration (FDA), a quality product “consistently meets the established specifications for identity, purity, strength, and composition, and (limits on) contaminants, and has been manufactured, packaged, labeled, and held under conditions to prevent adulteration.” (20)

Purchasing your supplements from a trusted source can help ensure you’re using safe, high-quality products. Outlined below are several quality factors to consider when purchasing supplements.

Dietary supplement regulation

The FDA and Health Canada are the primary government agencies responsible for overseeing dietary supplements and natural health products in the United States and Canada; however, these products are regulated as food products, not as drugs. (36)(60)(63)

The FDA and Health Canada have established baseline quality standard regulations for dietary supplements’ safety, efficacy, and quality. (12)(35) For example, the U.S. FDA and Canadian Health Products and Food Branch Inspectorate (HPFBI) enforce the Current Good Manufacturing Practices (cGMPs), also referred to as GMPs, which is a set of requirements outlining several standards for manufacturing, packaging, labeling, storage, distribution, and recall procedures. GMPs also involve routine testing of products to ensure that they contain the ingredients indicated on the label and are free of contaminants. (11)

Did you know? A 2013 report published by the FDA determined that 70% of supplement manufacturers violated GMPs. (49)

In the United States, supplement regulation is not as strict as the regulation of pharmaceutical medications. This means that supplement manufacturers are not required to meet the same quality and safety standards as pharmaceuticals or undergo routine testing. As a result, some supplements lack transparency for purity, quality, and safety.

Many reputable supplement manufacturers establish their own strict standards and manufacturing processes, often with oversight from third-party certifiers, to provide additional transparency to consumers. Supplements produced without purity, quality, and safety standards are at a greater risk of cross-contamination and other issues affecting consumer health. The product may also include expired ingredients or may display an inaccurate label. (60)

Ingredient sourcing

Do you know what’s in your supplement? You may be surprised to learn that many supplements contain misidentified or adulterated ingredients that could pose a risk to consumers. Without proper identification and validation of ingredients included in a health supplement, it’s difficult to determine the quality, safety, or efficacy of a product.

Products with poor quality standards may contain mislabeled ingredients or unsafe substances, including:

  • Adulterated ingredients
  • Biological contaminants (e.g., mold, bacteria)
  • Illegal substances
  • Ingredients not indicated on the label
  • Heavy metals
  • Herbicide or pesticide residues (71)

To ensure that you’re using the safest and highest quality supplements, select products from distributors that are transparent about their ingredient sources and harvesting methods, especially when selecting products containing plant-derived components (botanicals). (85) For products containing synthetic ingredients, look for brands that provide information on their extraction and purification methods, both of which can significantly alter the bioavailability and efficacy of the product. (81)

 

Scientist holding a supplement
Purchase supplements from reputable resellers to make certain that the product meets strict quality, identify, and safety standards.

 

Ingredient absorption and bioavailability

Another important consideration for all types of supplements is ingredient absorption and bioavailability. (70) A supplement’s bioavailability, or the amount of the active ingredient absorbed by the body, is influenced by several factors.

Delivery form

Supplements may be better suited for specific delivery forms (e.g., table, capsule, enteric-coated, emulsion) to improve user experience and to optimize absorption and bioavailability based on their characteristics, such as stability, and release time (e.g., sustained-release melatonin). (21)

Dose

The dosage of some supplements can influence the rate of absorption. For example, once certain levels of water-soluble vitamins (e.g., vitamin C, B vitamins) reach a maximal level, excess vitamins are excreted via the kidneys. (46) It’s important to note that supplement dosages are recommended by the manufacturer as there are no standard dosages for supplement ingredients. However, many professional brands determine recommended dosages based on results from clinical trials. (79)

Formulations

Some manufacturers have developed patented formulation technologies to enhance absorption and bioavailability of their product, such as trademarked forms of curcumin, Meriva™ and BCM-95™. (37)

Supplement carriers/vehicles

Carriers, or ingredients used to assist supplement delivery, are used to improve bioavailability for some health supplement ingredients. For example, vitamin D supplements and other fat-soluble vitamins are often combined with a carrier ingredient, such as oil or ethanol (alcohol). (31)

Third-party certifications

Many reputable manufacturers demonstrate dietary supplement quality assurance by voluntarily utilizing third-party certifiers. There are dozens of third-party companies that offer certifications to ensure that manufacturers are meeting certain quality standards. Products that have been certified by a third-party company will typically display a certification emblem on the label.

Common third-party certifications include:

  • Certified Gluten-Free (30)
  • Certified Organic (USDA Organic, Canada Organic) (10)(77)
  • Certified Vegan (80)
  • National Sanitation Foundation (NSF) (56)
  • Non-GMO Project Verified (74)
  • U.S. Pharmacopeia (USP) (75)

Product manufacturing

How a product is manufactured, stored, and distributed is equally important as its contents. Choose products from manufacturers that are transparent with their manufacturing processes and use independent third-party certifiers to verify that the manufacturer is meeting specific standards. When purchasing supplements, it’s important to consider products produced by cGMP-compliant manufacturers. Additionally, purchasing from distributors with cGMP-compliant warehouses ensures that supplements are stored at proper temperatures and humidity levels.

Some manufacturers will provide lab reports and Certificates of Analysis (CoA) to confirm that a product meets predetermined standards and specifications. In other words, a CoA ensures that a supplement’s constituents are accurately represented on the label. (44) Manufacturers that provide CoAs often include this information on their website or it can be obtained by contacting the manufacturer directly.

Allergens

The labeling of allergens and claims related to the sourcing of supplement components is an important consideration, particularly for individuals with allergies. In 2004, the FDA introduced the Food Allergen Labeling and Consumer Protection Act (FALCPA) which requires that supplement labels disclose if the product contains any of the top eight allergens, which include milk, eggs, fish, crustacean shellfish, tree nuts, wheat, peanuts, and soy. (13)

Additionally, labels must include information about any added flavoring, coloring, or additives. Unfortunately, the FALCPA doesn’t require companies to include “may contain” statements that can result from cross-contamination through the manufacturing process. (13)

Did you know? Approximately 10% of adults and 8% of children have a food allergy.

Contaminants, banned substances, and excipients in supplements

Excipients, or inactive ingredients, are often added to supplements and pharmaceuticals to improve the manufacturing process or the stability, taste, texture, or physical appearance of a finished product. (15)(29) Excipients in supplements are similar to food additives in food products and can be derived naturally or synthetically. (75) These additives are regulated by the FDA and must comply with a regulation known as “Generally Recognized as Safe” (GRAS). GRAS ingredients are considered safe by experts when used as directed. (14) While a product’s ingredients may be considered safe, they may pose a risk to individuals who are allergic or sensitive to certain ingredients. Other common adverse reactions associated with excipients include gastrointestinal upset and skin reactions. (4)(66)

Examples of common excipients in supplements include:

  • Ascorbic acid
  • Aspartame
  • Carrageenan
  • Lactose
  • Lecithin
  • Magnesium stearate
  • Polyethylene glycol
  • Polysorbate 80
  • Stearic acid (15)

Contaminants, such as mold, bacteria, and heavy metals, can also find their way into dietary supplements, particularly in poor-quality products that are not regularly inspected by third-party certifiers. Search for products that undergo routine inspections and testing to ensure they are free of harmful contaminants.

The United States Anti-Doping Agency (USADA) and the World Anti-Doping Agency (WADA) have established a list of prohibited substances in dietary supplements known to enhance athletic performance. Competitive athletes should use caution when selecting supplements from resellers as they can potentially contain banned ingredients. (49) Look for products that have been analyzed by third-party certifiers, such as NSF Certified for Sport, Informed Choice, and Informed Sport. (45)(55)

The FDA also maintains a Tainted Supplements List, which outlines over 1,000 products known to contain hidden and potentially harmful ingredients. Many of the products included in the FDA’s list are commonly marketed for weight loss, bodybuilding, or sexual enhancement purposes. (78)

Counterfeit supplements

Dietary supplements can be purchased from numerous brick and mortar stores and online retailers; however, some resellers are at increased risk of poor storage practices, illegitimate product labeling, and counterfeit supplements. Additionally, many resellers don’t have formal processes in place for handling quality control, product recalls, or adverse reactions. For these reasons, it’s important to select supplements from reputable sources.

Numerous investigations have uncovered cases of counterfeit supplements sold at major retailers. According to one investigation, four out of five products taken from shelves of GNC, Target, Walgreens, and Walmart did not contain any of the herbs indicated on the product’s label. Instead, the products contained fillers with no therapeutic effects. (57) Another major supplement reseller, Amazon, is particularly vulnerable to counterfeit supplements because they rely on third-party resellers. In 2019, Amazon warned its customers that a particular supplement sold by third-party resellers on their site was likely fake and therefore unsafe to consume. (33)

Want to order?

Get higher-quality supplements from trusted healthcare professionals*

Sign up and order today Learn more

*You’ll be redirected to Dr. Leu, ND’s dispensary. Dr. Leu is testing early access to a new Fullscript catalog program.

What are dietary supplements used for?

Dietary supplements may be recommended for various reasons based on an individual’s needs, such as to ensure an adequate intake of nutrients, promote optimal health and performance, or achieve a desired health outcome. (61) While a balanced diet, which incorporates a variety of nutrient-dense foods, ideally provides all the essential nutrients needed to support body functions and health, there are many factors that may affect individual nutrient status and supplementation needs.

These factors, which are related to food and diet quality as well as the health status of each individual, include:

  • Decreased nutrient levels in foods due to modern agriculture (22)(23)
  • Impaired digestion and absorption (9)
  • Increased requirements during certain periods (e.g., adolescence, pregnancy, lactation) (9)
  • Low dietary intake and/or poor quality diet (32)
  • Nutrient depletions associated with medications (e.g., oral contraceptives, proton pump inhibitors, statins) (51)
  • Nutrient loss occurring as a result of aging or critical illness (9)

Benefits of dietary supplements

Scientific evidence demonstrates the health benefits of dietary supplements in a variety of chronic and acute health conditions, such as the following examples.

Cardiovascular disease

Supplements have been shown to improve risk factors for heart disease, including hypertension as well as dyslipidemia, a condition characterized by irregular blood levels of cholesterol and triglycerides.

For example, omega-3 fatty acid supplements, derived from fish oils, have been found to decrease very-low-density lipoprotein (VLDL) cholesterol and circulating triglyceride levels. (39)(64)

Furthermore, one meta-analysis of trials that examined the effect of garlic supplementation on blood pressure included a total of 970 individuals. The study found that, in individuals with hypertension, garlic was associated with a significant reduction in systolic and diastolic blood pressure. The results also suggest that garlic may stimulate the immune system and help regulate cholesterol levels. (67)

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is estimated to affect 5% to 20% of the population. (27) Certain types of supplements may help alleviate the discomfort and symptoms that occur with IBS, such as constipation, diarrhea, abdominal distension, and pain. A systematic review of probiotic trials in a total of 1,793 individuals with IBS concluded that probiotics (beneficial microbes) reduce pain and symptom severity when compared to placebo. (26)

Soluble fiber, a type of carbohydrate found in health supplements including guar gum and psyllium, may also benefit individuals with IBS by normalizing stool frequency and decreasing symptom severity. (7)(87) In a randomized controlled trial of partially hydrolyzed guar gum, the researchers indicated that the benefits may be attributed to its ability to regulate the intestinal microbiota, which is the community of microbes found in the digestive tract. (87)

Joint pain

As a result of longer life expectancies and increases in body mass index (BMI) seen in recent years, the prevalence of inflammatory joint conditions, such as knee osteoarthritis, has also increased. (83) Individuals with joint pain may seek relief using evidence-based supplements, such as curcumin, an extract of the herb turmeric (Curcuma longa). (72)

Research has found that long-term (four-month) supplementation with curcumin is associated with reduced markers of inflammation and improved pain scores in individuals with knee osteoarthritis. (72) In specific doses, curcumin may be as effective as over-the-counter painkillers such as acetaminophen (25) and ibuprofen, with less adverse effects. (43)

Type 2 diabetes

Various health supplements may help balance blood glucose (sugar) levels in individuals with type 2 diabetes. For example, controlled trials in individuals with type 2 diabetes found that berberine, a constituent found in a group of medicinal herbs, effectively reduces blood glucose levels and addresses dyslipidemia. (39)(88) Similarly, supplementation with the trace mineral chromium, which supports carbohydrate and lipid (fat) metabolism, has been shown to significantly improve markers such as glucose, insulin, and cholesterol levels in individuals with type 2 diabetes. (3)

Upper respiratory tract infections

The benefits of dietary supplements include addressing and preventing acute health conditions such as the common cold. For instance, higher doses of vitamin C have been found to reduce the duration of the common cold in adults and children. (65) When taken soon after the onset of cold symptoms, zinc lozenges may also help reduce the duration of cough, muscle soreness, nasal congestion, and nasal discharge compared to a placebo. (38)

The medicinal herb echinacea (Echinacea purpurea) has been traditionally used to modulate the immune system and help prevent infections. A randomized, placebo-controlled trial with 755 healthy individuals assessed the effects of echinacea supplementation over a four-month period. Echinacea was associated with a reduced incidence of colds, virally-confirmed colds, and was particularly effective for preventing recurrent infections. (41)

Practitioner’s role in integrative healthcare and supplement recommendations

Whether you have a chronic health condition, nagging symptoms, or you’re simply looking to maintain optimal health, an integrative healthcare practitioner can help you reach your ideal health outcome. Depending on the complexity of your condition, your practitioner may work in conjunction with other practitioners to provide effective integrative healthcare. It’s important to speak to your provider and seek medical care not only when health concerns arise but on a regular basis to ensure you’re maintaining good health throughout your life. (6)(68)

Where do supplements fit in? Dietary supplements are often used in integrative medicine practices. Your provider can determine the best protocol to address your concerns. (53)

Health goals and adherence management

If you’ve ever set a health-specific goal, you’re likely familiar with how difficult it can be to find the motivation and maintain consistency to reach your goal. Integrative practitioners can provide the support and guidance you need to reach your desired health outcomes while helping to address any barriers you may encounter.

Patients consulting with a doctor
An integrative healthcare practitioner can guide you on your path to optimal health.

 

This often involves ensuring that you’re adhering to any prescribed wellness protocols. Adherence is defined as the extent to which your behaviors follow an agreed-upon protocol or regimen. (50)(82)(84) Failing to adhere to your treatment plan can derail your health goals and contribute to increased healthcare costs. (47)

To address your treatment adherence barriers and ensure you remain on track with your goals, your practitioner may consider numerous tactics and factors, including:

  • Booking follow-up appointments
  • Considering cost
  • Establishing accountability
  • Establishing your readiness to change
  • Facilitating trust
  • Keeping treatment plans simple
  • Maintaining open communication
  • Using lab testing

How Fullscript practitioners can provide the best care for their patients

Fullscript prioritizes dietary supplements’ safety, efficacy, and quality by thoroughly vetting each manufacturer’s products before adding them to the online catalog. Patients and practitioners alike can rest assured that products purchased from Fullscript meet high safety and quality standards. Fullscript is also transparent about which brands in the catalog are tested by third-party certifiers and works directly with brand partners without third-party certifications to introduce new standards. In addition to an extensive offering of high-quality supplements, Fullscript offers numerous features to patients and practitioners to complement the treatment process.

Refill reminders

Refill reminders are helpful emails or SMS notifications that can improve treatment adherence by reminding you when you may be running low on a product included in your protocol.

Autoship

Save time and effort by using the autoship feature, which automatically ships you your desired supplements at a frequency that works best for you.

Decision support for your healthcare provider

Fullscript provides decision support to practitioners to help them inform their recommendations by reviewing the current scientific literature. Your practitioner may use these educational resources to ensure they are making safe, effective, and appropriate supplement recommendations for you.

The bottom line

Integrative medicine focuses on the importance of treating the whole person and maintaining a strong relationship between patient and practitioner. An important component of effective integrative healthcare is the use of health supplements, such as nutrients, medicinal herbs, and hormones, to address a host of health concerns. Consult your integrative healthcare practitioner, or find a provider in your area, to determine the best supplements and lifestyle modifications for your desired health outcomes.

Want to order?

Get higher-quality supplements from trusted healthcare professionals*

Sign up and order today Learn more

*You’ll be redirected to Dr. Leu, ND’s dispensary. Dr. Leu is testing early access to a new Fullscript catalog program.

  1. Academic Consortium for Integrative Medicine and Health. (n.d.). Mission. https://imconsortium.org/about/mission/
  2. Alexander, W. (2014). Hypertension: Is it time to replace drugs with nutrition and nutraceuticals? Pharmacy and Therapeutics, 39(4), 291–295.
  3. Anderson, R. A., Cheng, N., Bryden, N. A., Polansky, M. M., Cheng, N., Chi, J., & Feng, J. (1997). Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes, 46(11), 1786–1791.
  4. Balbani, A. P. S., Stelzer, L. B., & Montovani, J. C. (2006). Pharmaceutical excipients and the information on drug labels. Brazilian Journal of Otorhinolaryngology, 72(3), 400–406.
  5. Beidelschies, M., Alejandro-Rodriguez, M., Ji, X., Lapin, B., Hanaway, P., & Rothberg, M. B. (2019). Association of the functional medicine model of care with patient-reported health-related quality-of-life outcomes. JAMA Network Open, 2(10), e1914017.
  6. Bell, I. R., Caspi, O., Schwartz, G. E. R., Grant, K. L., Gaudet, T. W., Rychener, D., … & Weil, A. (2002). Integrative medicine and systemic outcomes research: Issues in the emergence of a new model for primary health care. Archives of Internal Medicine, 162(2), 133–140.
  7. Bijkerk, C. J., de Wit, N. J., Muris, J. W. M., Whorwell, P. J., Knottnerus, J. A., & Hoes, A. W. (2009). Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ , 339, b3154.
  8. Brien, S. B., Bishop, F. L., Riggs, K., Stevenson, D., Freire, V., & Lewith, G. (2011). Integrated medicine in the management of chronic illness: A qualitative study. The British Journal of General Practice, 61(583), e89–e96.
  9. Bruins, M. J., Bird, J. K., Aebischer, C. P., & Eggersdorfer, M. (2018). Considerations for secondary prevention of nutritional deficiencies in high-risk groups in high-income countries. Nutrients, 10(1).
  10. Canadian Food Inspection Agency. (2019, January 15). Use of the organic logo on organic products. Government of Canada. https://www.inspection.gc.ca/food-label-requirements/labelling/industry/organic-claims-on-food-labels/eng/1389725994094/1389726052482?chap=5
  11. Center for Drug Evaluation & Research. (2018, June 25). Facts about the Current Good Manufacturing Practices (CGMPs). U.S. Food & Drug Administration. https://www.fda.gov/drugs/pharmaceutical-quality-resources/facts-about-current-good-manufacturing-practices-cgmps
  12. Center for Food Safety and Applied Nutrition. (2005, April). Dietary supplement labeling guide. U.S. Food & Drug Administration. https://www.fda.gov/food/dietary-supplements-guidance-documents-regulatory-information/dietary-supplement-labeling-guide
  13. Center for Food Safety and Applied Nutrition. (2006, November). Guidance on FAQS on food allergens. U.S. Food & Drug Administration. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/guidance-industry-questions-and-answers-regarding-food-allergens-edition-4
  14. Center for Food Safety and Applied Nutrition. (2014). Guidance for industry considerations regarding substances added to foods, including beverages and dietary supplements. U.S. Food & Drug Administration. https://www.fda.gov/food/guidance-regulation-food-and-dietary-supplements/guidance-documents-regulatory-information-topic-food-and-dietary-supplements
  15. Center for Food Safety and Applied Nutrition. (2019, October 24). Food additive status list. U.S. Food & Drug Administration. https://www.fda.gov/food/food-additives-petitions/food-additive-status-list
  16. Centers for Disease Control and Prevention. (2020, September 15). How you can prevent chronic diseases. https://www.cdc.gov/chronicdisease/about/prevent/index.htm
  17. Centers for Disease Control and Prevention. (2021, January 12). Health and economic costs of chronic diseases. https://www.cdc.gov/chronicdisease/about/costs/index.htm
  18. Centers for Disease Control and Prevention. (2021, January 13). About chronic diseases. https://www.cdc.gov/chronicdisease/about/index.htm
  19. Craig, W. J. (1999). Health-promoting properties of common herbs. The American Journal of Clinical Nutrition, 70(3 Suppl), 491S – 499S.
  20. Current Good Manufacturing Practice in Manufacturing, Packaging, Labeling, or Holding Operations for Dietary Supplements; Final Rule, 72 Federal Register. 34751 (June 25, 2007).
  21. Dalapa, D. (2020, August 17). Supplement manufacturing: Delivery forms. https://www.naturalproductsinsider.com/contract-manufacturing/supplement-manufacturing-delivery-forms
  22. Davis, D. R. (2009). Declining fruit and vegetable nutrient composition: What is the evidence? HortScience, 44(1), 15–19.
  23. Davis, D. R., Epp, M. D., & Riordan, H. D. (2004). Changes in USDA food composition data for 43 garden crops, 1950 to 1999. Journal of the American College of Nutrition, 23(6), 669–682.
  24. Deng, G. E., Frenkel, M., Cohen, L., Cassileth, B. R., Abrams, D. I., Capodice, J. L., … & Society for Integrative Oncology. (2009). Evidence-based clinical practice guidelines for integrative oncology: Complementary therapies and botanicals. Journal of the Society for Integrative Oncology, 7(3), 85–120.
  25. Di Pierro, F., Rapacioli, G., Di Maio, E. A., Appendino, G., Franceschi, F., & Togni, S. (2013). Comparative evaluation of the pain-relieving properties of a lecithinized formulation of curcumin (Meriva(®)), nimesulide, and acetaminophen. Journal of Pain Research, 6, 201–205.
  26. Didari, T., Mozaffari, S., Nikfar, S., & Abdollahi, M. (2015). Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis. World Journal of Gastroenterology: WJG, 21(10), 3072–3084.
  27. Ford, A. C., & Vandvik, P. O. (2012). Irritable bowel syndrome. BMJ Clinical Evidence, 2012, 0410.
  28. Fouany, M. R., & Sharara, F. I. (2013). Is there a role for DHEA supplementation in women with diminished ovarian reserve? Journal of Assisted Reproduction and Genetics, 30(9), 1239–1244.
  29. Furrer, P. (2013). The central role of excipients in drug formulation. European Pharmaceutical Review, 2.
  30. Gluten Intolerance Group. (n.d.). About us. Certified Gluten Free. https://gfco.org/about-us/
  31. Grossmann, R. E., & Tangpricha, V. (2010). Evaluation of vehicle substances on vitamin D bioavailability: A systematic review. Molecular Nutrition & Food Research, 54(8), 1055–1061.
  32. Grotto, D., & Zied, E. (2010). The Standard American Diet and its relationship to the health status of Americans. Nutrition in Clinical Practice, 25(6), 603–612.
  33. Hanbury, M. (2019, July 22). Amazon warns customers that Align supplements sold on its site are probably fake. Business Insider. https://www.businessinsider.com/amazon-warns-customers-that-supplements-on-its-site-are-fake-2019-7
  34. Health Canada. (2016a, March 14). About Natural Health Products. Government of Canada. https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation/about-products.html
  35. Health Canada. (2016b, August 11). About Natural Health Product regulation in Canada. Government of Canada. https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation.html
  36. Health Canada. (2020, March 5). Natural and Non-prescription Health Products Directorate. Government of Canada. https://www.canada.ca/en/health-canada/corporate/about-health-canada/branches-agencies/health-products-food-branch/natural-non-prescription-health-products-directorate.html
  37. Helal, N. A., Eassa, H. A., Amer, A. M., Eltokhy, M. A., Edafiogho, I., & Nounou, M. I. (2019). Nutraceuticals’ novel formulations: The good, the bad, the unknown and patents involved. Recent Patents on Drug Delivery & Formulation, 13(2), 105–156.
  38. Hemilä, H., & Chalker, E. (2015). The effectiveness of high dose zinc acetate lozenges on various common cold symptoms: A meta-analysis. BMC Family Practice, 16, 24.
  39. Innes, J. K., & Calder, P. C. (2018). The differential effects of eicosapentaenoic acid and docosahexaenoic acid on cardiometabolic risk factors: A systematic review. International Journal of Molecular Sciences, 19(2).
  40. Institute of Medicine (US) Committee on the Use of Complementary, & Alternative Medicine by the American Public. (2005). Integration of CAM and conventional medicine. In Complementary and Alternative Medicine in the United States. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK83807/
  41. Jawad, M., Schoop, R., Suter, A., Klein, P., & Eccles, R. (2012). Safety and efficacy profile of Echinacea purpurea to prevent common cold episodes: A randomized, double-blind, placebo-controlled trial. Evidence-Based Complementary and Alternative Medicine: eCAM, 2012, 841315.
  42. Kania-Richmond, A., & Metcalfe, A. (2017). Integrative health care – What are the relevant health outcomes from a practice perspective? A survey. BMC Complementary and Alternative Medicine, 17(1), 548.
  43. Kuptniratsaikul, V., Dajpratham, P., Taechaarpornkul, W., Buntragulpoontawee, M., Lukkanapichonchut, P., Chootip, C., … & Laongpech, S. (2014). Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: A multicenter study. Clinical Interventions in Aging, 9, 451–458.
  44. LeDoux, M. A., Appelhans, K. R., Braun, L. A., Dziedziczak, D., Jennings, S., Liu, L., … & Griffiths, J. C. (2015). A quality dietary supplement: Before you start and after it’s marketed–a conference report. European Journal of Nutrition, 54 Suppl 1, S1–S8.
  45. LGC Group. (n.d.). About Informed Choice. Informed Choice. https://choice.wetestyoutrust.com/about-informed-choice
  46. Lykkesfeldt, J., & Tveden-Nyborg, P. (2019). The pharmacokinetics of vitamin C. Nutrients, 11(10), 2412.
  47. Martin, L. R., Williams, S. L., Haskard, K. B., & Dimatteo, M. R. (2005). The challenge of patient adherence. Therapeutics and Clinical Risk Management, 1(3), 189–199.
  48. Martínez-González, N. A., Berchtold, P., Ullman, K., Busato, A., & Egger, M. (2014). Integrated care programmes for adults with chronic conditions: A meta-review. International Journal for Quality in Health Care, 26(5), 561–570.
  49. Mathews, N. M. (2018). Prohibited contaminants in dietary supplements. Sports Health, 10(1), 19–30.
  50. Miller, N. H., Hill, M., Kottke, T., & Ockene, I. S. (1997). The multilevel compliance challenge: Recommendations for a call to action. A statement for healthcare professionals. Circulation, 95(4), 1085–1090.
  51. Mohn, E. S., Kern, H. J., Saltzman, E., Mitmesser, S. H., & McKay, D. L. (2018). Evidence of drug-nutrient interactions with chronic use of commonly prescribed medications: An update. Pharmaceutics, 10(1), 36.
  52. Morris, A. L., & Mohiuddin, S. S. (2020). Biochemistry, nutrients. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554545/
  53. National Center for Complementary and Integrative Health. (2018, July). Complementary, alternative, or integrative health: What’s in a name? National Institutes of Health. https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name
  54. National Center for Complementary and Integrative Health. (2021, January). Melatonin: What you need to know. National Institutes of Health. https://www.nccih.nih.gov/health/melatonin-what-you-need-to-know
  55. NSF Certified Sport. (n.d.). Certified for Sport® frequently asked questions. NSF. https://www.nsfsport.com/news-resources/documents/ds_cert_for_sport_faq.pdf
  56. NSF International. (n.d.). Dietary supplement FAQs. NSF. https://www.nsf.org/knowledge-library/faq-dietary-supplements
  57. O’Connor, A. (2015, February 3). New York Attorney General targets supplements at major retailers. The New York Times. https://well.blogs.nytimes.com/2015/02/03/new-york-attorney-general-targets-supplements-at-major-retailers/
  58. Office of Dietary Supplements. (n.d.). Dictionary of dietary supplement terms. National Institutes of Health. https://ods.od.nih.gov/HealthInformation/dictionary.aspx
  59. Office of Dietary Supplements. (2020a, March 11). Dietary supplements. National Institutes of Health. https://ods.od.nih.gov/factsheets/DietarySupplements-Consumer/
  60. Office of Dietary Supplements. (2020b, September 3). What you need to know. National Institutes of Health. https://ods.od.nih.gov/factsheets/WYNTK-Consumer/
  61. Office of Dietary Supplements. (2021, February 5). Frequently asked questions (FAQ). National Institutes of Health. https://ods.od.nih.gov/HealthInformation/ODS_Frequently_Asked_Questions.aspx
  62. Office of the Commissioner. (2019, November 2). Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency’s new efforts to strengthen regulation of dietary supplements by modernizing and reforming FDA’s oversight. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-agencys-new-efforts-strengthen-regulation-dietary
  63. Office of the Commissioner. (2020, December 18). Dietary supplements. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/dietary-supplements
  64. Oscarsson, J., & Hurt-Camejo, E. (2017). Omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and their mechanisms of action on apolipoprotein B-containing lipoproteins in humans: A review. Lipids in Health and Disease, 16(1), 149.
  65. Ran, L., Zhao, W., Wang, J., Wang, H., Zhao, Y., Tseng, Y., & Bu, H. (2018). Extra dose of vitamin C based on a daily supplementation shortens the common cold: A meta-analysis of 9 randomized controlled trials. BioMed Research International, 2018, 1837634.
  66. Reker, D., Blum, S. M., Steiger, C., Anger, K. E., Sommer, J. M., Fanikos, J., & Traverso, G. (2019). “Inactive” ingredients in oral medications. Science Translational Medicine, 11(483), eaau6753.
  67. Ried, K. (2016). Garlic lowers blood pressure in hypertensive individuals, regulates serum cholesterol, and stimulates immunity: An updated meta-analysis and review. The Journal of Nutrition, 146(2), 389S – 396S.
  68. Ring, M., & Mahadevan, R. (2017). Introduction to integrative medicine in the primary care setting. Primary Care, 44(2), 203–215.
  69. Roy, R. (2010). Integrative medicine to tackle the problem of chronic diseases. Journal of Ayurveda and Integrative Medicine, 1(1), 18–21.
  70. Saldanha, L. G., Dwyer, J. T., Bailen, R. A., Andrews, K. W., Betz, J. W., Chang, H. F., … & Coates, P. M. (2018). Characteristics and challenges of dietary supplement databases derived from label information. The Journal of Nutrition, 148(suppl_2), 1422S – 1427S.
  71. Sanzini, E., Badea, M., Santos, A. D., Restani, P., & Sievers, H. (2011). Quality control of plant food supplements. Food & Function, 2(12), 740–746.
  72. Srivastava, S., Saksena, A. K., Khattri, S., Kumar, S., & Dagur, R. S. (2016). Curcuma longa extract reduces inflammatory and oxidative stress biomarkers in osteoarthritis of knee: A four-month, double-blind, randomized, placebo-controlled trial. Inflammopharmacology, 24(6), 377–388.
  73. Tapsell, L. C., Neale, E. P., Satija, A., & Hu, F. B. (2016). Foods, nutrients, and dietary patterns: Interconnections and implications for dietary guidelines. Advances in Nutrition, 7(3), 445–454.
  74. The Non-GMO Project. (n.d.). Verification FAQs. The Non-GMO Project. https://www.nongmoproject.org/product-verification/verification-faqs/
  75. The United States Pharmacopeial Convention. (n.d.). Verification services. U.S. Pharmacopeia (USP). https://www.usp.org/services/verification-services
  76. The United States Pharmacopeial Convention. (2016, April 29). Submission guidelines. U.S. Pharmacopeia (USP). https://www.usp.org/get-involved/donate/submission-guidelines
  77. U.S. Department of Agriculture. (n.d.). USDA Organic. U.S. Department of Agriculture. https://www.usda.gov/topics/organic
  78. U.S. Food and Drug Administration. (n.d.). Tainted products marketed as dietary supplements [Data set]. https://www.accessdata.fda.gov/scripts/sda/sdnavigation.cfm?sd=tainted_supplements_cder
  79. U.S. Food and Drug Administration. (2019, July 22). Questions and answers on dietary supplements. U.S. Food and Drug Administration. https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements
  80. Vegan Action. (n.d.). Get certified. Vegan.org. https://vegan.org/certification/
  81. Volpi, N. (2009). Quality of different chondroitin sulfate preparations in relation to their therapeutic activity. The Journal of Pharmacy and Pharmacology, 61(10), 1271–1280.
  82. Vrijens, B., De Geest, S., Hughes, D. A., Przemyslaw, K., Demonceau, J., Ruppar, T., … & ABC Project Team. (2012). A new taxonomy for describing and defining adherence to medications. British Journal of Clinical Pharmacology, 73(5), 691–705.
  83. Wallace, I. J., Worthington, S., Felson, D. T., Jurmain, R. D., Wren, K. T., Maijanen, H., … & Lieberman, D. E. (2017). Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proceedings of the National Academy of Sciences of the United States of America, 114(35), 9332–9336.
  84. World Health Organization. (2003a). Adherence to long-term therapies: Evidence for action (E. Sabaté (Ed.)). World Health Organization. https://www.who.int/chp/knowledge/publications/adherence_report/en/
  85. World Health Organization. (2003b). WHO guidelines on good agricultural and collection practices (GACP) for medicinal plants. World Health Organization. https://www.who.int/medicines/publications/traditional/gacp2004/en/
  86. World Health Organization. (2017, December 19). Nutrients. World Health Organization. https://www.who.int/elena/nutrient/en/
  87. Yasukawa, Z., Inoue, R., Ozeki, M., Okubo, T., Takagi, T., Honda, A., & Naito, Y. (2019). Effect of repeated consumption of partially hydrolyzed guar gum on fecal characteristics and gut microbiota: A randomized, double-blind, placebo-controlled, and parallel-group clinical trial. Nutrients, 11(9), 2170.
  88. Zhang, Y., Li, X., Zou, D., Liu, W., Yang, J., Zhu, N., … & Ning, G. (2008). Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine. The Journal of Clinical Endocrinology and Metabolism, 93(7), 2559–2565.