Category — Complimentary and Alternative Medicine (CAM)

National Library of Medicine’s Dietary Supplements Glossary

Active Ingredient - Component that causes the desired action.

AHRQ - The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans. As one of 12 agencies within the Department of Health and Human Services, AHRQ supports health
services research by developing evidence reports and technology assessments based on rigorous, comprehensive syntheses and analyses of the scientific literature on topics relevant to clinical, social science/behavioral, economic, and other health care organization and delivery issues. Direct links have
been provided to AHRQ evidence reports on specific dietary supplements in this database.

Adverse Effects - An adverse health-related reaction to the intake of a dietary supplement ingredient.

Amino Acid - One of the 20 building blocks of protein: alanine, arginine, asparagine, aspartic acid, cysteine, glutamic acid, glutamine, glycine, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine, threonine, tryptophan, tyrosine, and valine.

Amount per Unit - Quantity of a specific active ingredient contained in one pill, capsule, soft gel, teaspoon, etc.

Brand - Trade name given to a product to distinguish it from other products.

CDC - Centers for Disease Control and Prevention. As a component of the Public Health Service, CDC’s mission is to prevent, track and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats.

Clinical Trials - Pre-planned studies of the safety, efficacy, or optimum dosage schedule (if appropriate) of one or more diagnostic, therapeutic, or prophylactic drugs, devices, or techniques selected according to predetermined criteria of eligibility and observed for predefined evidence
of favorable and unfavorable effects.

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ConsumerLab.com - ConsumerLab.com is an independent test laboratory that tests dietary supplement products to determine:

• the amount of ingredient claimed on the container label
• the existence of contaminants such as lead in the product
• the ability of the product to disintegrate properly in order to dissolve and be absorbed in the body.

ConsumerLab.com does not test the efficacy of products.

Daily Value (DV) - Reference values used on labels for dietary supplements and are based on a 2000 Calorie intake for adults and children 4 or more years of age. DV is based on Daily Reference Values (that apply to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and
potassium) and Reference Daily Intakes (of essential vitamins and minerals).

DeLima Associates - A private company located in McLean, Virginia that has provided the data used in the Dietary Supplements Database under a non-exclusive license to the National Library of Medicine for non-commercial use.

Dietary Supplement - The Federal Food, Drug and Cosmetic Act defines a dietary supplement to be a product (other than tobacco) that is intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, a mineral, an herb or other botanical,
an amino acid, a dietary substance for use by man to supplement the diet by increasing the total daily intake, or a concentrate, metabolite, constituent, extract, or combinations of these ingredients.

Dose - Total amount of a dietary supplement administered to, taken or absorbed by a person.

Drug Facts - Names and quantities of active and other ingredients present in an over-the-counter (OTC) drug product. (Supplement Facts are provided only for dietary supplement products).

DSHEA - The Dietary Supplement Health and Education Act of 1994 (DSHEA) signed by President Clinton on October 25, 1994 addresses, amongst other things, the definition, composition, labeling and manufacturers’ claims for dietary supplement products.

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Efficacy - Capacity or power of a dietary supplement ingredient or combination of ingredients to produce a desired effect or to affect a claimed health condition.

Enzyme - A protein that speeds up chemical reactions in the body. Enzymes bind temporarily to one or more of the reactants of the reaction they catalyze. In doing so, they lower the amount of activation energy needed and thus speed up the reaction.

FDA - U.S. Food and Drug Administration. The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, the nation’s food supply, cosmetics, and products that emit
radiation.

Gluten-free - Claim from manufacturer that specific supplement does not contain plant proteins from cereal grains such as wheat (including different varieties such as spelt and kamut), rye, barley, and cross-bred hybrids of these cereal grains (e.g., triticale).

IBIDS - International Bibliographic Information on Dietary Supplements. The IBIDS database provides access to bibliographic citations and abstracts from published, international, and scientific literature on dietary supplements. This database is maintained by the Office of Dietary Supplements
of NIH.

IU - International unit. This is a unit of measurement of vitamin activity determined by biological methods rather than by direct chemical analysis.

Kosher - Claim from manufacturer that specific supplement was prepared in accordance with religious dietary laws.

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Lactose-free - Claim from manufacturer that specific supplement does not contain the disaccharide, lactose.

Manufacturer - Name of a company that produces or distributes a particular dietary supplement product. The name is found on the container’s label.

Market Share - Proportion of industry sales of a dietary supplement category that is controlled by a single manufacturer of dietary supplements.

mcg - Microgram. It is equal to one millionth of a gram.

MedlinePlus® - MedlinePlus brings together authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations. Preformulated MEDLINE® searches are included in MedlinePlus and give easy access
to medical journal articles. MedlinePlus also has extensive information about drugs, an illustrated medical encyclopedia, interactive patient tutorials, and latest health news.

MedWatch - On-line web site of the Food and Drug Administration (FDA) that provides consumers with timely safety information on drugs and other medical products regulated by the FDA (for example,
safety alerts, recalls, withdrawals and important labeling changes on FDA-regulated products) and provides a gateway for consumers to report adverse events associated with the use of FDA-regulated products, including dietary supplements.

MeSH® - MeSH is the National Library of Medicine’s on-line thesaurus used for indexing articles from 4,800 of the world’s leading biomedical journals for the MEDLINE/PubMED; database.

mg - Milligram. It is equal to one thousandth of a gram.

Mineral - Naturally occurring, inorganic substance with a definite chemical composition and a crystalline structure. Minerals are generally classified into the following chemical classes: silicates, carbonates, sulfates, halides, oxides, sulfides, phosphates and metals.

Multivitamins - Dietary supplement that contains many vitamins including thiamin, riboflavin, niacin, and vitamins A and D.

Multivitamins/multiminerals - Dietary supplement that contains many vitamins including thiamin, riboflavin, niacin, and vitamins A, B-12, B-6, C and D and many minerals including calcium and iron.

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National Center for Environmental Health - The National Center for Environmental Health (NCEH) is a component of the Centers for Disease Control and Prevention (CDC) that plans, directs, and coordinates a national program to maintain and improve the health of the American people by promoting
a healthy environment and by preventing premature death and avoidable illness and disability caused by non-infectious, non-occupational environmental and related factors. The Dietary Supplement Database was initiated by NCEH.

NCCAM - The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health was established to exploring complementary and alternative healing practices in the context of rigorous science, training complementary and alternative medicine (CAM) researchers,
and disseminating authoritative information to the public and professionals.

NCI - The National Cancer Institute (NCI) is a component of the National Institutes of Health. NCI coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention,
and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.

NIH - National Institutes of Health. NIH is one of the world’s foremost medical research centers, and the Federal focal point for medical research in the United States. The NIH, comprising 27 separate Institutes and Centers, is one of eight health agencies of the Public Health Service which,
in turn, is part of the U.S. Department of Health and Human Services. The National Library of Medicine is one component of the NIH.

NLM® - The National Library of Medicine® (NLM), of the National Institutes of Health in Bethesda, Maryland, is the world’s largest medical library. The Library collects materials and provides information and research services in all areas of biomedicine and health care. The Dietary Supplements
Database is one of the on-line databases supported by NLM.

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NSF International Certified - NSF International develops standards for testing dietary supplements. NSF tests supplements to verify the identity and quantity of dietary ingredients declared on product label
and to ensure that the product does not contain undeclared ingredients or unacceptable levels of contaminants. In addition, NSF inspects manufacturing facilities for conformance with Good Manufacturing Practices (GMP). Supplements that have received the NSF mark may be found at
http://www.nsf.org/Certified/Dietary/

ODS - Office of Dietary Supplements (ODS) of the National Institutes of Health was established as a result of DSHEA to strengthen knowledge and understanding of dietary supplements by evaluating scientific information, stimulating and supporting research, disseminating research results, and
educating the public to foster an enhanced quality of life and health for the U.S. population.

Other Names - Other commonly used names for a specific active ingredient.

Percent DV - The % DV is the percent of the Daily Value of a dietary ingredient that is in a serving of the brand.

Pharmacokinetic Actions - Study of the action of a dietary supplement ingredient in terms of time required for absorption, the duration of action and distribution in the body and the method of removal from the body.

Pharmacologic Actions - Effect of intake of a dietary supplement ingredient on living tissues and organisms in the body.

Poisoning - A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent.

Product - A dietary supplement available commercially in the United States.

PubMed®/ MEDLINE® - PubMed is a free resource of the National Library of Medicine that lets you search more than 16 million bibliographic citations and abstracts in the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and preclinical
sciences. It provides access to MEDLINE.

Recalls - Action taken by a firm to either remove a product from the market or to conduct a field correction. Recalls may be conducted on a firm’s own initiative or by a request by the Food and Drug Administration (FDA).

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Serving Size - Quantity of the brand used in one serving of a dietary supplement, which is the maximum amount recommended by the manufacturer of the supplement per intake.

Specialty Ingredients - Dietary supplement ingredients that cannot be classified as a vitamin, mineral, herb, amino acid or enzyme.

Supplement Facts - Names and quantities of dietary ingredients present in the dietary supplement container.

Third-Party Test Results - An analytical test result that is completed by a laboratory that is independent of any parties associated with the product being tested.

Use (in humans) - Studies indicating the effectiveness of a specific dietary supplement ingredient.

Uses Claimed by Manufacturer - Manufacturer’s claims for the intended use of a specific brand.

USP Verified - The United States Pharmacopeia (USP) is the official public standards-setting authority for all prescription and over-the-counter medicines, dietary supplements, and other healthcare products
manufactured and sold in the United States. USP tests the purity, potency, and quality of dietary supplement finished products that are voluntarily entered by their manufacturer in the program. Dietary supplements are not required to be tested or to conform to USP standards in order to be marketed in
the US. Only those that meet USP’s criteria are allowed use of the USP Verified Dietary Supplement Mark to display on their product labels and can be found at http://www.usp.org/USPVerified/dietarySupplements/supplements.html

Vitamin - Any organic substance essential in small amounts to sustain growth and activity of the body and obtained from plant or animal sources.

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Source: National Institutes of Health - Dietary Supplements Labels Database

What is Acupuncture?

Acupuncture is among the oldest healing practices in the world. As part of traditional Chinese medicine (TCM), acupuncture aims to restore and maintain health through the stimulation of specific points on the body. In the United States, where practitioners incorporate healing traditions from China, Japan, Korea, and other countries, acupuncture is considered part of complementary and alternative medicine (CAM).

Acupuncture Key Points

• Acupuncture has been practiced in China and other Asian countries for thousands of years.
• Scientists are studying the efficacy of acupuncture for a wide range of conditions.
• Relatively few complications have been reported from the use of acupuncture. However, acupuncture can cause potentially serious side effects if not delivered properly by a qualified practitioner.
• Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

About Acupuncture

The term “acupuncture” describes a family of procedures involving the stimulation of anatomical points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

Practiced in China and other Asian countries for thousands of years, acupuncture is one of the key components of traditional Chinese medicine. In TCM, the body is seen as a delicate balance of two opposing and inseparable forces: yin and yang. Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle. According to TCM, health is achieved by maintaining the body in a “balanced state”; disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qi (vital energy) along pathways known as meridians. Qi can be unblocked, according to TCM, by using acupuncture at certain points on the body that connect with these meridians. Sources vary on the number of meridians, with numbers ranging from 14 to 20.

One commonly cited source describes meridians as 14 main channels “connecting the body in a weblike interconnecting matrix” of at least 2,000 acupuncture points.

Acupuncture became better known in the United States in 1971, when New York Times reporter James Reston wrote about how doctors in China used needles to ease his pain after surgery. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries.

Acupuncture Use in the United States

The report from a Consensus Development Conference on Acupuncture held at the National Institutes of Health (NIH) in 1997 stated that acupuncture is being “widely” practiced—by thousands of physicians, dentists, acupuncturists, and other practitioners—for relief or prevention of pain and for various other health conditions. According to the 2002 National Health Interview Survey—the largest and most comprehensive survey of CAM use by American adults to date—an estimated 8.2 million U.S. adults had ever used acupuncture, and an estimated 2.1 million U.S. adults had used acupuncture in the previous year.

Acupuncture Side Effects and Risks

The U.S. Food and Drug Administration (FDA) regulates acupuncture needles for use by licensed practitioners, requiring that needles be manufactured and labeled according to certain standards. For example, the FDA requires that needles be sterile, nontoxic, and labeled for single use by qualified practitioners only.

Relatively few complications from the use of acupuncture have been reported to the FDA, in light of the millions of people treated each year and the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments. Practitioners should use a new set of disposable needles taken from a sealed package for each patient and should swab treatment sites with alcohol or another disinfectant before inserting needles. When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.

Status of Acupuncture Research

There have been many studies on acupuncture’s potential health benefits for a wide range of conditions. Summarizing earlier research, the 1997 NIH Consensus Statement on Acupuncture found that, overall, results were hard to interpret because of problems with the size and design of the studies.

In the years since the Consensus Statement was issued, the National Center for Complementary and Alternative Medicine (NCCAM) has funded extensive research to advance scientific understanding of acupuncture. Some recent NCCAM-supported studies have looked at:

• Whether acupuncture works for specific health conditions such as chronic low-back pain, headache, and osteoarthritis of the knee
• How acupuncture might work, such as what happens in the brain during acupuncture treatment
• Ways to better identify and understand the potential neurological properties of meridians and acupuncture points
• Methods and instruments for improving the quality of acupuncture research.

Finding a Qualified Acupuncture Practitioner

Health care providers can be a resource for referral to acupuncturists, and some conventional medical practitioners—including physicians and dentists—practice acupuncture. In addition, national acupuncture organizations (which can be found through libraries or Web search engines) may provide referrals to acupuncturists.

• Check a practitioner’s credentials. Most states require a license to practice acupuncture; however, education and training standards and requirements for obtaining a license to practice vary from state to state. Although a license does not ensure quality of care, it does indicate that the practitioner meets certain standards regarding the knowledge and use of acupuncture.
• Do not rely on a diagnosis of disease by an acupuncture practitioner who does not have substantial conventional medical training. If you have received a diagnosis from a doctor, you may wish to ask your doctor whether acupuncture might help.

What To Expect From Acupuncture Visits

During your first office visit, the practitioner may ask you at length about your health condition, lifestyle, and behavior. The practitioner will want to obtain a complete picture of your treatment needs and behaviors that may contribute to your condition. Inform the acupuncturist about all treatments or medications you are taking and all medical conditions you have.

Acupuncture needles are metallic, solid, and hair-thin. People experience acupuncture differently, but most feel no or minimal pain as the needles are inserted. Some people feel energized by treatment, while others feel relaxed. Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment. This is why it is important to seek treatment from a qualified acupuncture practitioner.

Treatment may take place over a period of several weeks or more.

Acupuncture Treatment Costs

Ask the practitioner about the estimated number of treatments needed and how much each treatment will cost. Some insurance companies may cover the costs of acupuncture, while others may not. It is important to check with your insurer before you start treatment to see whether acupuncture is covered for your condition and, if so, to what extent.

Acupuncture Definitions

Complementary and alternative medicine (CAM): A group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine.

Meridian: In traditional Chinese medicine, a channel or pathway through the body along which qi flows. Practitioners use acupuncture points to reach the meridians and affect the flow of qi.

Qi: In traditional Chinese medicine, the vital energy or life force proposed to regulate a person’s spiritual, emotional, mental, and physical health and to be influenced by the opposing forces of yin and yang.

Traditional Chinese medicine (TCM): A whole medical system that originated in China. It is based on the concept that disease results from disruption in the flow of qi and imbalance in the forces of yin and yang. Practices such as herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi.

Yin and yang: The concept of two opposing yet complementary forces described in traditional Chinese medicine. Yin represents cold, slow, or passive aspects of the person, while yang represents hot, excited, or active aspects. A major theory is that health is achieved through balancing yin and yang and disease is caused by an imbalance leading to a blockage in the flow of qi.

References

• Acupuncture. Natural Standard Database Web site. Accessed at http://www.naturalstandard.com on June 28, 2007. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report #343. 2004.
• Berman BM, Lao L, Langenberg P, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Annals of Internal Medicine. 2004;141(12):901-910.
• Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. Annals of Internal Medicine. 2002;137(12):965-973.
• Ernst E. Acupuncture—a critical analysis. Journal of Internal Medicine. 2006;259(2):125-137.
• Kaptchuk, TJ. Acupuncture: theory, efficacy, and practice. Annals of Internal Medicine. 2002;136(5):374-383.
• Lao L. Safety issues in acupuncture. Journal of Alternative and Complementary Medicine. 1996;2(1):27-31.
• MacPherson H, Thomas K. Short-term reactions to acupuncture—a cross-sectional survey of patient reports. Acupuncture in Medicine. 2005;23(3):112-120.
• National Cancer Institute. Acupuncture (PDQ). National Cancer Institute Web site. Accessed at http://www.cancer.gov/cancertopics/pdq/cam/acupuncture on August 16, 2007.
• National Institutes of Health Consensus Panel. Acupuncture: National Institutes of Health Consensus Development Conference Statement. National Institutes of Health Web site. Accessed at http://consensus.nih.gov/1997/1997acupuncture107html.htm on June 22, 2007.
• Reston J. Now, about my operation in Peking; Now, let me tell you about my appendectomy in Peking…. New York Times. July 26, 1971:1.
• U.S. Food and Drug Administration. Acupuncture needles no longer investigational. FDA Consumer. 1996;30(5). Also available at http://www.fda.gov/fdac/departs/596_upd.html.