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The DSHEA legislation of 1994 made it possible for manufacturers to sell dietary supplements directly to the public without the level of FDA approval or oversight required of pharmaceuticals. Reports of adulteration and contamination have occurred, but the magnitude of this problem remains unknown. However, information is available on many products independently tested for content and purity. Table e4–3 provides an overview of selected dietary supplements commonly used in the United States today.

Table e4–3.Overview of selected dietary supplements (listed in alphabetical order).


Glucosamine and chondroitin have been used in Europe alone and in combination to treat osteoarthritis (OA) since the 1980s. While glucosamine and chondroitin use appears to have decreased in the United States, studies from the United Kingdom and Australia report a 20% use of glucosamine. It is an amino-monosaccharide synthesized by chondrocytes that serves as a substrate for the synthesis of cartilage. It is prepared commercially from crustacean shells. Besides providing structural support, it may also have anti-inflammatory activity. Oral glucosamine is well-tolerated and does not elevate serum glucose levels in humans. There is evidence that a dose of 1200 mg once a day of chondroitin is as effective as 400 mg three times daily. There are case reports of an increased INR in patients taking warfarin who ingest glucosamine. There is also a theoretical risk of allergic ...

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