Dietary Supplements: Navigating the Pharmacologic Influences of Nature's Medicine

  • Andrew J. Kubinski, MS, DO University of Pikeville Kentucky College of Osteopathic Medicine/East Tennessee State University Quillen College of Medicine Kingsport Family Medicine Residency PGY1
  • Gregory W. Coppola, DO Lake Erie College of Osteopathic Medicine


The use of dietary supplements occurs in the majority of American adults >20 years old and has been reported to be on the rise by the National Health and Nutrition Examination Survey.  People are not only taking more dietary supplements, but taking them without the advice of a health care provider.  With the lack of education time and focus on this topic, physicians need to know some evidence regarding the most common supplements used, how to understand dietary supplement labels, and where to find reputable information about dietary supplements.  Vitamin D, Omega-3, and Glucosamine/Chondroitin are reviewed here.  Also, a description of the various components of a dietary supplement label is explained.  Finally, a brief description of independent companies ( ®, US Pharmacopedial Convention, Natural Medicine Comprehensive Database, and Natural Standard) as well as the federally run Office of Dietary Supplements are presented.

Author Biography

Gregory W. Coppola, DO, Lake Erie College of Osteopathic Medicine

Lake Erie College of Osteopathic Medicine, Director, Integrative Medicine Fellowship;

Attending Physician, Lake Erie College of Osteopathic Medicine Sports Medicine Fellowship;

Mercyhurst University, Academic Medical Director/Team Physician, Department of Sports Medicine


Dietary Supplement Health and Education Act of 1994. (PL 103-417, Oct 25, 1994).

rd Congress. 21 US Code Chapter 9.

Briefel RR, Johnson CL. Secular trends in dietary intake in the United States. Annu Rev Nutr. 2004; 24: 401-31.

National Center for Health Statistics. Use of dietary supplements in the United States, 1988-94. 1999; 11: 1-9.

Bailey RL, Gahche JJ, Miller PE, Thomas PR, Dwyer JT. Why US adults use dietary supplements. JAMA Intern Med. 2013;173:355-61.

Bailey RL, Gahche JJ, Lentino CV, et al. Dietary supplement use in the United States, 2003-2006. J Nutr. 2011; 141: 261-6.

Wu CH, Wang CC, Kennedy J. The prevalence of herb and dietary supplement use among children and adolescents in the United States: Results from the 2007 National Health Interview Survey. Complement Ther Med. 2013; 21: 358-63.

Barnes PM, Bloom B, Nahin R. Complementary and alternative medicine use among adults and children: United States, 2007. CDC National Health Statistic Report #12. 2008.

De-Regil LM, Fernández-Gaxiola AC, Dowswell T, Peña-Rosas JP. Effects and safety of periconceptional folate supplementation for preventing birth defects. Cochrane Database Syst Rev. 2010; 10:CD007950.

United States Preventive Services Task Force. Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer: U.S. Preventive Services Task Force Recommendation Statement. AHRQ Publication No. 14-05199-EF-2. Accessed April 1, 2014.

Jones G, Strugnell SA, DeLuca HF. Current understanding of the molecular actions of vitamin D. Physiol Rev. 1998; 78: 1193–1231.

Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011; 1:48-54.

Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington, DC: The National Academies Press; 2011.

Jones G. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr. 2008; 88: 582S–6S.

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96:1911–1930.

United States Preventive Services Task Force. Screening for Vitamin D Deficiency: Draft Recommendation Statement. AHRQ Publication No. 13-05183-EF-2. Accessed April 25, 2014.

Kulie T, Groff A, Redmer J, Hounshell J, Schrager S. Vitamin D: An Evidence Review. J Am Board Fam Med. 2009; 22: 698-706.

Riediger ND, Othman RA, Suh M, Moghadasian MH. A systemic review of the roles of n-3 fatty acids in health and disease. J Am Diet Assoc. 2009; 109: 668-79.

Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr. September 1999; 70: 560s-569s.

Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, Chondroitin Sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006; 354:795-808.

Herrero-Beaumont G, Ivorra JA, del Carmen Trabado M, et al. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: A randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator. Arthritis Rheum. 2007; 56: 555-67.

American Academy of Family Physicians. Dietary Supplements: What You Need to Know. Accessed May 12, 2014.

Straub DA. Calcium Supplementation in Clinical Practice: A Review of Forms, Doses, and Indications. Nutr Clin Pract. 2007; 22: 286-296.

National Institute of Health. Office of Dietary Supplements Strategic Plan 2010-2014: Strengthening Knowledge and Understanding of Dietary Supplements. NIH publication number 10-7527. 2010.

Natural Standard. Accessed May 31, 2014. About Accessed June 11, 2014.

Therapeutic Research Faculty. About the Natural Comprehensive Medicines Database. Accessed June 11, 2014.

United States Pharmacopeial Convention. USP Verified Dietary Ingredients. Accessed May 15, 2014.

Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998; 279:1200-5.

Dietary Supplements: What You Need to Know. National Institute of Health Office of Dietary Supplements Website. Updated June 17, 2011. Accessed April 6, 2014.

How to Cite
Kubinski, MS, DO, A. J., and G. W. Coppola, DO. “Dietary Supplements: Navigating the Pharmacologic Influences of Nature’s Medicine”. Osteopathic Family Physician, Vol. 7, no. 1, Jan. 2015,
Review Articles