According to an October 2016 article in the Journal of the American Medical Association, more than half of all Americans regularly take a nutritional supplement. Some, such as fish oils and probiotics, have had especially significant increases in use in recent years.
Unfortunately, research also shows that consumers are often confused about supplement choices and that patient-physician communication on the topic leaves room for improvement.
Many patients don’t recognize that supplements can be quite potent and may interact with other drugs. And physicians often have difficulty finding credible information in this area, which may make optimal patient discussion and guidance less likely.
To help guide this conversation, here are some thoughts from Robert Bonakdar, M.D., of the Scripps Center for Integrative Medicine.
Q: Do people need nutritional supplements?
A: There is no one-size-fits-all solution. For example, vitamin B-12 absorption declines as we age and deficiency may accelerate cognitive decline. This is one reason the Institute of Medicine recommends supplemental B-12 for people older than 50. Many can get the extra B-12 through fortified foods, but some will need supplementation based on their diet and medical history.
Supplements should be prescribed based on need and scientific evidence. Many incorporate supplements on an ad hoc basis. They get a recommendation from a friend or see an article and decide it can help them. This is an opportunity for physicians. Why does the patient feel they need a supplement? What is missing from their care that makes them reach for the bottle?
Q: Are supplements safe and well regulated?
A: If a supplement has any activity at all, its potential positive and negative effects should be taken seriously. There are wide variations in potency, purity and processing. People need to ask critical questions: Has it been tested, and found beneficial, in humans? How long has it been on the market?
There have been supplements found to be illegally adulterated with prescription medication. There have also been a number of cases where large chain stores were found to have certain supplements which may not have contained the stated amount of key ingredients. This should give all stakeholders pause as they consider supplements and point to ways to make supplement choice safe and optimal.
We should select our supplements with far greater scrutiny than other consumables, such as shampoo or socks. It’s important to become aware of verification and certification seals on bottles from independent organizations such as the NSF International and the U.S. Pharmacopeial Convention (USP), which can help to ensure higher levels of safety and regulation. This takes time and energy, but should be similar to the effort we place on making other important choices about our health care and treatments.
We should carefully reflect on why we are considering the supplement, discuss it with a provider and come up with a formulation that has proof of safety and benefit.
Another consideration is drug interactions. Although not a widespread phenomenon, certain combinations need to be kept in mind and minimized. St. John’s Wort can help with depression but can also interfere with antidepressants, as well as oral contraceptives. Other supplements interact with blood thinners. Careful consideration can be the difference between finding a supplement that causes problems and one that is helpful.
Q: How can we foster smart supplement usage?
A: Patients must fully disclose their supplements, and physicians need to approach the topic without rancor. A patient who has been “supplement-shamed” may never mention it to any physician, damaging trust and diminishing care. It’s vital for physicians to open the discussion and provide important information to clarify a supplement’s pros and cons.
From Feb. 8-12, Scripps will provide a unique opportunity for interested consumers and health care providers to learn more about the evidence, safety and effectiveness of supplements, at its 14th annual conference, Natural Supplements: An Evidence Based Update. As supplement use continues to evolve and increase, it becomes more imperative to have educational opportunities for all stakeholders to stay updated. This year’s conference will look at emerging topics such as the role of the microbiome, and the role of diet and supplementation in common condition including pain and heart health.
Q: Besides supplements, how can people boost their health?
A: Supplements are just that – supplements to our diet and lifestyle. There are many simple ways to improve health. First, sit less. The average American sits 13 hours a day, which generates inflammation and reduces lifespan by as much as three years. Simply getting up every 30 minutes can make a difference.
The gold standard for exercise is 30 minutes a day, but new research is showing people can get similar benefits from five to 10 minutes of active exercise, such as running in place or brisk walking.
Eat berries. Three or more servings of blueberries or strawberries per week reduce heart disease risk in women by one-third. And they don’t have to be fresh berries, frozen or dried provide the same benefits.
In addition, stress management should be core to our approach. We are finding out more about how stress can negatively shift our gut microbiome and immune system. Taking a pause each day for reflection and mindfulness should be as important as the time we devout to activity and dietary choices.
“To Your Health” is brought to you by the physicians and staff of Scripps. For more information, please visit www.scripps.org/SNS or call (858) 914-2297.
