Americans spend millions of dollars on dietary supplements (DS) annually. According to the Federal Trade Commission (FTC), the supplement industry reported an estimated $25 billion in sales in 2009, which represented a 6% increase over the previous year.1 Over 40% of US adults used DS between 1988–1994, and over one-half in 2003–2006.2 By 2011, 64% to 69% were using these products.3 These numbers are expected to continue rising in the years ahead.4

Two major reasons Americans use DS are to enhance overall health and wellness and to fill nutrient gaps.3 Additionally, the 2008 downturn in the economy led consumers to increase DS use in an attempt to manage their own healthcare and avoid costly medical visits and prescription drugs.1 Many people regard supplements as more “natural,” and therefore more benign than pharmaceuticals. Others have the misconception that these products are safe because they are rigorously overseen by the FDA.4

However, the role of the FDA in regulating supplements is actually considerably less rigorous than its role in regulating pharmaceuticals. In 1994, the Dietary Supplement Health and Education Act (DSHEA) was passed, defining the FDA’s statutory authority to regulate dietary supplements in the United States.5. Although supplements cannot be marketed for the specific treatment or prevention of disease, they are typically taken to address symptoms and/or disease, and to maintain overall health.6 In 1994, there were approximately 4000 available DS products on the US market. In 2014, there were over 85,000 products. The increase may be due to the increasing use of the Internet as a means of advertising and promulgating information.7

The current definition of “dietary supplement” can be found in Table 1