The American College of Physicians Proposes Modernizing DSHEA Framework

Editor’s Note: This article has been updated on July 14, 2026 at 7:10pm ET to include additional industry commentary.

The American College of Physicians (ACP) published a position paper on July 14, 2026, in Annals of Internal Medicine titled "Modernizing the Regulatory Framework for Dietary Supplements."¹ ACP's central argument is that the Dietary Supplement Health and Education Act of 1994 (DSHEA), in treating supplements as a subcategory of food rather than requiring FDA premarket safety review, relies too heavily on postmarket surveillance to catch adulterated or mislabeled products. The paper puts forward ten recommendations, with the first recommendation that Congress amend DSHEA to require dietary supplements — including those already on the market — to undergo evidence-based review, registration, and approval by the FDA, and to meet quality standards set by the United States Pharmacopeia.

Additional recommendations include increased FDA funding, stronger mandatory recall authority and adverse-event reporting, expanded FTC resources to monitor and marketing claims and take action on violations, a public national database of supplements with unique identifiers, standardized international terminology, manufacturer adherence to Good Manufacturing Practices and full ingredient labeling, integration of supplement data into electronic health records, improved patient-provider communication about supplement use, and increased funding for the NIH Office of Dietary Supplements.

The paper notes that 57.6% of U.S. adults over age 20 report using a dietary supplement in the past 30 days, with multivitamins, vitamin D, and omega-3 fatty acids the most common, yet only about a quarter of users take supplements recommended by a health care professional. It also stated that as many as 100,000 dietary supplements are on the market, part of a global industry valued at $209.52 billion in 2025.

“A robust approach to premarket registration and postmarket surveillance of dietary supplements is needed to prevent the marketing of harmful products and protect the health of the public,” the paper concludes.

How Has the Industry Responded to the Paper?

The Natural Products Association (NPA) called ACP's proposals an attempt to dismantle DSHEA “under the guise of protecting public health.”²

“The dietary supplement industry is more than adequately regulated, and it has a long-established track record of safety,” stated Daniel Fabricant, Ph.D., president and CEO of NPA. “Congress has delegated authority to FDA to routinely inspect manufacturing facilities, assess the safety of new dietary ingredients, and review serious adverse event reports, which could trigger FDA actions to protect the public, including mandatory recalls, seizure of products, injunctions and criminal prosecutions. ACP’s proposals would eviscerate the regulatory distinctions between pharmaceuticals and dietary supplements, undermining congressional intent in DSHEA (Dietary Supplement Health and Education Act of 1994) and depriving American consumers of unfettered access to safe, beneficial nutritional products.”

He also noted the actions would contradict the administration's push for nutrition-focused medical education, referencing the recent announcement from the US Department of Health and Human Services (HHS) and the US Department of Education that 8 major medical accrediting, assessment, and board organizations committed to increasing nutrition education in physician training and residency programs.³

The Council for Responsible Nutrition (CRN), a supplement industry trade association, issued a statement acknowledging shared goals with ACP, including removing adulterated products, strengthening FDA oversight, improving communication between patients and their provider, and expanding research on nutrition.⁴ The organization rejected the paper's core proposal, however, arguing that the harms the ACP discusses, such as adulteration and illegal disease claims, are already prohibited under existing law and reflect a need for stronger enforcement rather than evidence that DSHEA itself has failed.

The organization also contends that requiring FDA premarket approval for every supplement, as ACP recommends, would create substantial regulatory burden, limit access to products, slow innovation, and divert FDA resources from bad actors. Instead, CRN points to measures it already supports, including the 2006 adverse-event reporting law, increased FDA funding, and a mandatory product listing system.

“Ultimately, the choice is not between today's regulatory framework and pharmaceutical regulation,” CRN stated. “It is between targeted modernization that strengthens FDA's ability to enforce the law and a sweeping overhaul that would burden responsible companies while doing little to deter those already operating outside the law.”

Where Does the Dietary Supplement Listing Act of 2026 Fit In?

Legislation forming a supplement product registry is the focus of the Dietary Supplement Listing Act of 2026, introduced in the House by Rep. Maxine Dexter, MD, in April with a Senate companion from Majority Whip Dick Durbin introduced earlier this year.⁵

The bill would require manufacturers to submit labels and ingredient information to FDA. CRN president and CEO Steve Mister has called it "a commonsense solution" to give FDA and retailers better visibility into the marketplace. The Natural Products Association (NPA) opposes the bill, arguing FDA already has sufficient authority and warning the registry could become a "litigation trap." The American Herbal Products Association (AHPA) supports the concept of listing but has withheld support for the bill as written, citing concerns over a proposed label-number requirement.

References

1. Cline K, Beachy MW, Carr PW; Health and Public Policy Committee of the American College of Physicians. Modernizing the regulatory framework for dietary supplements: a position paper from the American College of Physicians. Ann Intern Med. Published online July 14, 2026. doi: 10.7326/ANNALS-26-01119
2. Natural Products Association. Natural Products Association Slams Physician Group Reforms as Attempt to Dismantle DSHEA. July 14, 2026. Accessed July 14, 2026. https://www.npanational.org/news/natural-products-association-slams-physician-group-reforms-as-attempt-to-dismantle-dshea/
3. Saraceno N. Nutrition Requirements in Medical Training Are Expanding: Here's What the Industry Should Know. June 9, 2026. Nutritional Outlook. Accessed July 14, 2026. https://www.nutritionaloutlook.com/view/nutrition-requirements-medical-training-what-industry-should-know
4. Council for Responsible Nutrition. Statement from the Council for Responsible Nutrition on the American College of Physicians' position paper on dietary supplement regulation. Published 2026. Accessed July 14, 2026. https://www.crnusa.org/newsroom/statement-council-responsible-nutrition-american-college-physicians-position-paper-dietary
5. Saraceno N. House dietary supplement listing bill sparks industry debate on transparency and regulatory burden. Nutritional Outlook. Published April 23, 2026. Accessed July 14, 2026. https://www.nutritionaloutlook.com/view/house-dietary-supplement-listing-bill-sparks-industry-debate-transparency-regulatory-burden