5 Questions to Ponder Before Recommending Supplements

Pharmacists should ponder the reasons why patients are pursuing supplements before recommending the purchase.

According to the National Institutes of Health (NIH), more than 50% of Americans take 1 or more dietary supplements daily or on occasion. These products are extremely accessible and do not require a prescription. Many supplements are also available in several forms, including pill, liquid, and powder.

Patients should always consult a pharmacists or another health care provider before beginning a supplement regimen. Here are some questions that pharmacists can ponder before recommending supplements to patients:

1. Can the patient get his or her desired nutrients from food?

Taking a supplement to get more of a specific nutrient to ward off chronic diseases may not be effective, as there is no evidence supporting the claim that supplements can effectively fight chronic diseases.

In fact, FDA regulations do not allow supplement manufacturers to claim that their product can cure, treat, or prevent a disease.

On the other hand, following government recommendations with respect to food—including those detailed in the recently published 2015-2020 Dietary Guidelines for Americans— can help prevent chronic diseases linked with poor eating habits.

“It’s possible to get all of the nutrients you need by eating a variety of healthy foods, so you don’t have to take one,” said Carol Haggans, a registered dietician and consultant to NIH, in an NIH “News in Health” feature. “But supplements can be useful for filling in gaps in your diet.”

Patients with certain dietary constrictions or habits may choose to use supplements in place of certain foods. Vegans, for instance, may want to rely on vitamin B12 supplements to help support their nerve and blood cell health, as vitamin B12 is found in meat, fish, and dairy foods that they avoid.

2. Is the patient pregnant?

There is a strong body of evidence suggesting that women who take prenatal vitamins and supplements such as folic acid, iron, calcium, and omega-3s have healthier pregnancies and ultimately healthier children.

Taking folic acid supplements during pregnancy has several benefits, including the potential to significantly reduce the risk of offspring being small for gestational age at birth, as well as the potential to significantly lower the risk of having a child with severe autism.

In addition, studies have suggested that vitamin C supplements for pregnant smokers may help the baby breathe and also strengthen the baby’s bones.

3. Is the patient using the supplement to be better, faster, and stronger?

The ever-increasing number and availability of sports supplements makes it challenging for both consumers and health care professionals to keep up with the validity of claims and scientific evidence.

Creatine, the most popular ergogenic aid, has been shown to be effective in short bursts of high-intensity athletic activity by using energy from the ATP-PC energy system. However, creatine is not as useful for longer, endurance-based activities such as distance running.

Caffeine is another popular energy supplement, but the substance’s potential ergogenic effects are more likely attributable to its role as a central nervous system stimulant and the related decreased perception of energy expenditure.

Meanwhile, research analyzing men’s use of legal, OTC performance-enhancing drugs like whey protein, creatine, and glutamine found that some men may be overusing these products because of a lack of self-confidence. This, the researchers posited, may signal a male eating disorder.

In 2014, Sports Illustrated interviewed a cohort of elite Olympic athletes, asking, “If you were given a performance-enhance substance, you would not be caught, and you would win, would you take it?” About 98% of athletes answered yes.

The interviewers then changed the question to, “If you were given a performance-enhancing substance, and you would not be caught, win all competitions for 5 years, then die, would you take it?” More than half still said yes.

The bottom line is that pharmacists should keep an eye out for men who buy excessive amounts of bodybuilding supplements.

4. Is the supplement safe?

Most vitamins and supplements can be safe when used properly, according to Paul M. Coates, PhD, director of the NIH’s Office on Dietary Supplements.

“Products sold nationally in stores and online where you usually shop should be fine,” he noted in a NIH news release.

Every supplement label should contain a caution and warning section describing who should avoid the product, who should take precaution while using it, and what the potential side effects are. Patients taking prescription drugs, pregnant or lactating women, those with serious medical conditions, and patients with allergies should be particularly aware of written warnings.

Beyond these warnings, supplements are sometimes found to be dangerous after they’ve already hit the market.

“According to the FDA, supplement products most likely to be contaminated with pharmaceutical ingredients are herbal remedies promoted for weight loss and for sexual or athletic performance enhancement,” Dr. Coates explained.

The FDA regularly issues warnings about products that may pose a threat to public health. One FDA sweep of potentially unsafe or tainted supplements in November 2015 left more than 100 dietary supplement manufacturers and distributors facing civil injunctions and criminals actions.

5. Will the supplement interact with the patient’s prescription medications?

Supplements can interfere with the proper metabolization of some prescription drugs, and vice versa.

Many researchers believe that drug-supplement interactions are not as easily recognized or managed, which could be a contributing factor to ineffective therapy, adverse effects, and increased risk for deficiencies or toxicities that can negatively affect a patient’s well-being.

Examples of potential drug-supplement interactions include:

· Vitamin A, vitamin E, and vitamin K with warfarin

· Iron with tetracyclines and fluoroquinolones

· Calcium with corticosteroids

· Ginseng with antidiabetic agents

· Melatonin with monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and tricyclic antidepressants

Pharmacists are well placed to answer any questions about potential supplement-medication interactions.