November 2014 Summary

The following are summaries of this month’s blog responses, followed by recommendations for practice.

The percentage of patients who do not disclose their supplement usage to health care professionals could be as high as 60%. Does this concern you? Is there anything we can do to encourage our clients and patients to be more forthcoming with information about their supplement usage? 

The consensus is that this is a concerning statistic. We all tended to agree that building a rapport with patients is the first step in helping patients feel comfortable disclosing their supplement usage to us. It was also suggested that this might not be a matter of secrecy, but rather a matter of not understanding what a supplement is and how important it is to disclose the usage of something as simple as a multivitamin. Ideas for helping patients know what to disclose include keeping some samples of supplements in the office to show patients, as well as being specific in our questions about supplements (“Did you know vitamins are considered supplements?”). We should make sure patients know why we are asking about supplements, as well.

The supplemental article provided, published in the The American Journal of Medicine in 2008, actually looked at the interactions between dietary supplements and prescription medications to identify potentially dangerous interactions. The researchers' conclusions were pretty straight-forward: the actual potential for harm was low despite a fair number of “potential” interactions between prescriptions and supplement. Zero patients out of nearly 1800 were seriously harmed from an interaction. What is your reaction? Does this change the way you feel about the first article’s findings and conclusions?

While some of you were surprised by the findings and others were not, we were all in agreement that it is still very concerning that 60% of patients are not disclosing their supplement use. Sammy and others pointed out that there are many new supplements on the market since 2008, so we have to be careful in interpreting these findings as a sign of low risk. It is our job to identify any and all potentially harmful interactions because that is the only way to provide the best quality of care to our clients. As Jessica wrote, we have a responsibility to find those interactions that physicians might not be looking for, because we might find that an interaction could be contributing to a lesser quality of life. Susan pointed out that although there may not have been identified harmful reactions, undisclosed supplement use may be contributing to subpar performance of prescription medications. Arthur noted that the public needs to know about and use the FDA’s reporting portal to help identify harmful effects and interactions in an effort to clear dangerous supplements from the market.

A client emails you to ask what you think about adding the following multivitamin to her diet:http://www.vitabase.com/supplements/womens-health/activewoman.aspx. (Note some of the unique advertised benefits of this particular vitamin and related ingredients.) How would you respond? Come up with some tips and educational points for this client to help her make a decision about this vitamin and to help her navigate the supplement market in the future.

As Haley pointed out, and others agreed, we should help clients understand that vitamins should not be viewed as an alternative to a healthy diet. We should recommend food first, whenever we can. Tina and others noted that it might serve us well to talk to clients about some of the marketing tactics and marketing “lingo” that manufacturers use to help them focus on the facts. For this particular case, Caroline suggests that we redirect the client to a simpler multivitamin with more reasonable amounts of vitamins and minerals. Jeanne recommends looking at the supplement to help the client identify what it is they really need from that supplement and to help them learn how to identify potentially unsafe levels or ingredients.

Recommendations for practice:

This month’s research article presents findings suggesting that as many as 60% of patients might be choosing not to disclose their supplement usage to their doctors. With 50% of the US population taking supplements in one form or another and most of them preferring not to disclose their supplement use to their doctors, dietitians have an increasingly important responsibility to stay educated on the supplement market and to understand how to counsel clients about supplement usage. Specifically, dietitians need to look for and understand potential interactions between supplements and medications.

It all starts with building a rapport with patients and ensuring that they trust us enough to disclose personal information to us, such as their supplement usage. It is our responsibility to make sure they know they will not be judged for any information they share. We need to let clients know that having this information allows us to identify potential health risks and provide the highest quality of care. We should not be deterred by one study’s findings that zero of 1800 surveyed persons had a harmful interaction between prescriptions and supplements. It only takes one missed potential interaction to lower quality of life or present a life-threatening situation. We should make sure that we educate patients on the fact that the FDA does not regulate supplements on the market and the fact that they are not necessarily safe just because they are on the shelf. This is especially important if a patient comes to us with a supplement they are interested in taking. We need to be ready to provide a reasoned and researched opinion in those situations. Perhaps most importantly, we need to remember to direct patients and clients to food first whenever possible!