Discussing Dietary Supplements with Patients

With countless commercially available pills, powders, gummies and tablets promising a myriad of health benefits, it’s more important than ever to discuss dietary supplements with patients. Since they are not approved by the Food and Drug Administration (FDA), they may be ineffective—or even harmful. Routine appointments are a key opportunity to emphasize that these products should be approached with caution.   

During these interactions, consider mentioning the following points to educate patients on the risks and benefits of supplements:

• Some supplements can support health, while others can be ineffective or pose risks. For example, according to the National Institutes of Health Office of Dietary Supplements, calcium and vitamin D support bone health, while folic acid has been shown to decrease the risk of birth defects. Other supplements, however, can have detrimental impacts for individuals on medications. For instance, vitamin K may reduce the efficacy of warfarin to prevent blood clots and certain antioxidants may interfere with chemotherapy. Excess vitamin A is known to cause headaches.
  
  Other supplements may be simply ineffective. One recent clinical trial performed by the Cleveland Clinic shed further light on this. In the study, which compared the efficacy of statins and supplements for lowering cholesterol, participants were either given a daily dose of the statin rosuvastatin or supplements including fish oil, cinnamon, garlic, turmeric, plant sterols or red yeast rice. The results were clear: “Rosuvastatin lowered LDL cholesterol by almost 38% and that was vastly superior to placebo and any of the six supplements studied in the trial,” study author Luke Laffin, M.D., told NPR.  

• Physicians should be consulted before taking dietary supplements in place of or in combination with prescription medications. For patients undergoing surgical procedures, special attention should also be paid to supplements.
  
• Using this dietary supplement and medicine record from The Office of Dietary supplements may help ensure that both the patient and physician are on the same page about medication and supplement regimens.
  

• Products that are described as “natural” aren’t always safe. For example, some all-natural supplements such as comfrey and kava can be harmful to the liver.
  
• When purchasing supplements, patients must exercise caution. It may be helpful to remind patients that the FDA does not determine whether dietary supplements are effective before they are marketed. However, according to NIH, the FDA has established “good manufacturing practices” that companies must follow to “ensure the identity, purity, strength and composition of their dietary supplements.”

Additionally, if a patient would medically benefit from supplementation, physicians may encourage patients to look for products with quality assurance seals from independent organizations, such as U.S. Pharmacopeia. While these seals do not guarantee a product’s safety or efficacy, they do indicate that “the product was properly manufactured, contains the ingredients listed on the label and does not contain harmful levels of contaminants.”

Finally, if physicians recommend that a patient begins a supplement regimen, it’s important to discuss the potential benefits and risks, the proper dose, how and when it should be taken and for how long.

For more information on supplementation, NIH recommends the following websites:

• NIH Office of Dietary Supplements
• National Center for Complementary and Integrative Health
• National Library of Medicine
• MedlinePlus
• PubMed

MLMIC also has a number of resources available to guide physicians when leading patient conversations. Explore our articles on patient communication here.