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In December 2008, the Centers for Disease Control's National Center for Health Statistics published a report on the use of complementary and alternative medicine in the United States. This report indicates that almost 18% of adults use natural products, defined as nonvitamin and nonmineral supplements derived from plants or enzymes. The five most popular supplements among adults are, in order, fish oil/omega 3, glucosamine, Echinacea, flaxseed oil/pills and ginseng.

Considering the growing popularity of these natural products, consumers should investigate health claims about supplements before using them. The five most popular supplements do appear to show some health benefits.

> Fish Oil/Omega 3 <

The omega-3 fatty acids in fish oils have been linked to numerous health benefits, although the science currently only supports a few of them. Studies strongly support the use of fish oil to reduce the risk of heart attack and sudden death in people with a history of heart attack, as well as to lower blood triglyceride levels.

Some studies also show positive results for reducing inflammation and improving the symptoms of rheumatoid arthritis. Possible benefits requiring more study include prevention of atherosclerosis, cancer and osteoporosis. Fish oil supplements are generally safe, and side effects, usually gastrointestinal issues, disappear with a decreased dose.

> Glucosamine <

Clinical studies indicate beneficial effects of glucosamine sulfate, but not other forms of glucosamine, on mild to moderate knee osteoarthritis. The evidence for treating osteoarthritis of other joints is weaker but promising. Other uses, including treatment of knee injuries or rheumatoid arthritis, are not currently supported.

Glucosamine supplements are generally safe, but because they are often made from shellfish, people with shellfish allergies should be careful about taking them. Some people may experience a temporary increase in blood pressure and heart rate.

> Echinacea <

Of the nine known species of Echinacea, E. purpurea is the one believed to be most potent and the one most commonly used in supplements. Proponents of Echinacea believe it stimulates the immune system to fight infection, and it is a popular supplement to treat and prevent colds and flu. Studies suggest Echinacea is ineffective in preventing upper respiratory infections, but it shows promise in treating them.

Echinacea has few side effects, but it may cause allergic reactions, ranging

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