Question 3 - November 2014
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.
posted by Brady Jiter @ 9:03 AM
15 comments
15 Comments:
I would kindly inform the client that just because this supplement is "designed" for women, it may not necessarily be designed for her. As they stated, women's needs are different than men's needs but one woman's need is going to be different from another woman's need. The supplement uses exotic fruits and names to make it sound like it's really special when we don't even know what they are, or if they really have the impact that they're claiming to have. I would also have her look at the ingredient label with me. A few of those vitamins and minerals are hundreds if not thousands over the %daily value and it's ridiculous. This just means that they're trying really hard to make you believe more is better and that in reality, these supplements are absorbed as well in your body which is why they have to pack so much into one pill. The manufacturer of this supplement wants women to feel as if this is really catered to them and addresses their needs but really it's just all marketing. It's "much more than a vitamin" and "for total women health" they claim. I would inform her of eating simple fruits and vegetables will also give her a healthy dose of vitamins and minerals in a safe and natural way. I would definitely have her question all the weird ingredients and turn her efforts towards food to be her go to source of health instead.
I would discuss the daily percent values and show the patient how ridiculous some of those numbers are because the body cannot absorb that much at one time. I would also suggest an approved multivitamin if she is concerned about getting all her vitamins and minerals. Educating the patient and explaining that taking a vitamin cannot make up for an unhealthy diet is important. Some people think that a magic supplement can provide them with all the nutrients they need, which is simply not true. If there are concerns about certain micronutrients I could give her food suggestions to try to make up for what she is lacking. Food before supplements! However, occasionally patients do need supplementation due to malabsorption or increased needs and that is perfectly fine.
I would first assess what the client's current intake looks like and identify areas where she may be able to make small improvements. I would ask her about any medications that she might be taking and briefly discuss how we might be worried about possible interactions. I would educate the client on the fact that foods (especially fruits and vegetables) found in their natural form are often rich in vitamins and minerals, and they are typically absorbed better in this form than in a supplement form. I would point out things in this supplement that worry me, such as the high doses of fat-soluble vitamins, which may reach toxic levels in the body, and the issues of supplementing with both zinc and iron in one supplement, as they interfere with each other's absorption.
As Haley mentioned, supplementing with an approved multivitamin may be a good back-up plan for some individuals who have higher needs of some nutrients, but I would always recommend food before supplements. I completely agree that taking a supplement cannot make up for an unhealthy diet.
I agree that we should always try to recommend food first and help our clients understand that they can usually get plenty of vitamins and minerals from food with a well-rounded diet. But Haley you are also right that sometimes we do need to recommend supplements, and it's our job to know which ones are safe and reasonable.
I would probably first ask her what her goal is in taking this supplement, or what she’s hoping to achieve by taking this. I would then offer alternatives that might be safer or more realistic in achieving her goals. I would also discuss vitamin absorption with her and, like others have mentioned, let her know there’s no way her body is going to be absorbing all of that. I would take the food first approach and find out what she’s eating and we could go from there in recommending foods to help her make up what she may be missing. If she really is determined to take a supplement or is concerned, I would recommend just a multivitamin and let her know she only needs one a day.
I think Tina said it perfectly when she said just because it’s designed for women, doesn’t mean it’s designed for you. We all have different needs and it’s important to not get caught up in their marketing gimmicks.
First off, this is a great question. Fantastic thinking, B-man. Anyways, the very first thing I would do is look up some of the more heavily advertised ingredients like black cohosh and dong quai to see if there are actually any proven benefits of such ingredients. Depending on what I found with that, I would then begin to look into the other ingredients and the amount contained. Looking onto the supplement facts label, oh my is there a huge amount of some vitamins and minerals. I understand that vitamins like B6 are water soluble, but 125mg...? That just seems like entirely too much for any human being, but okay Dr. Passero, N.D.
I think the marketing strategy of this particular product is sound, and probably quite effective to the lay consumer. With quotes like "Is scientifically formulated for optimum benefit." and the fact that the marketers advertise the supplement directly towards women, I could see how this would sell pretty well. But the fact that it sells doesn't make it a needed or beneficial product.
So...after discussing the ingredients, and the fact that some of those amounts are particularly egregious and unnecessary, I would talk about what the term "supplement" actually means. Whereby supplement means "in addition to", "not in place of". The patient still needs to have an overall healthy diet and no amount of vitamin B6, black cohosh and dong quai is going to make up for the lack of an overall healthy diet. These "one supplement to make all others obsolete" products may sound great to marketing execs, but I'd have a hard time putting my name and credentials behind one of these products unless there was substantial, well-conducted, literature to back up the use of such a product. If she insisted on a multivitamin supplement, I'd probably just recommend a standard one a day (for females) and tell her to still ensure that her diet is complete with fruits, vegetables, whole grains, dairy and lean meats for a balanced intake of essential vitamins and minerals.
Brady and Haley, you make a great point that clinical judgement does come into play when discussing supplements. We can't just be biased and against all forms of supplementation. There are situations where supplementation may be needed and we have to be open to that idea. Knowing the types of products that are safe, and also reasonable becomes the difficult part because there is so little information available to use to make that judgement.
Third party testing is probably our best bet. According to the Department of Defense's Human Performance Resource Center, the following third party supplement testing companies are the most common and recognized: NSF International, United States Pharmacopeia (USP), Informed-Choice, ConsumerLab, and Banned Substances Control Group (BSCG).
We should all familiarize ourselves with these third party labels and be sure that any supplements that we do recommend at least, at a very minimum, carry one of the third party seals of approval. It's no guarantee of absolute safety or efficacy, but it's a step in the right direction and basically says that the ingredients on the label are present without contaminants. This is a good website for more information: http://hprc-online.org/dietary-supplements/opss/operation-supplement-safety-OPSS/resources-1. I know it's not perfect but if the government won't regulate the products, we need third parties (who are hopefully unbiased) to do the work for us.
A-dog, I agree that the third party verifications would be a bare minimum standard that we should have for our supplement recommendations. It is probably best for us to just stay away from anything without third-party verification. Plus, I think that is a great educational opportunity for one-on-one’s with clients.
Sammy, Arthur, and others have been hitting on the marketing gimmickry at play here, as well. I think that’s another educational opportunity for this example client and for real ones in the future. Some people really don’t know how to navigate marketing claims, and, unfortunately, might not understand just how much flexibility marketers have with the “truth”. The food industry has so many of those questionable claims out there - what a great opportunity for us to help clear things up for clients.
I would respond to this client by asking her what drew her to this supplement. I would explain to her that the marketing tactics make the product seem too good to be true. I would also tell her to be cautious of exotic ingredients like black cohosh and dong quai. I would research these ingredients with her, and show her how to research ingredients using reliable sources in the future. I would also tell her to consider the cost of this multivitamin. She would be paying a lot of money for extra vitamins and minerals that her body would not even use. I would look at the supplement facts label with her and point out the percent daily values. I would tell her that her body would not absorb such high amounts of vitamins and minerals. For the water-soluble vitamins like the B Vitamins, the extremely high percent daily values like 3000% or 6000% will just be excreted. Therefore, the client will have very expensive urine. Furthermore, the large amounts of the fat-soluble vitamins could buildup in her body and be harmful over time.
I would suggest she eat a balanced diet with fruits, vegetables, whole grains, and lean protein to get the necessary vitamins and minerals she needs. If her diet is lacking, then I would suggest she take a simple multi-vitamin that does not contain excessive amounts of vitamins and minerals. Overall, I think advising clients to be critical of supplements and not to automatically believe all of the marketing claims that they make will help them become more aware consumers.
Arthur,
You brought up a great point about educating clients that supplement means "in addition to", and therefore supplements should not replace a healthy, well-balanced diet. It's funny that many people complain that healthy food costs too much money, but then they are willing to pay for expensive miracle supplements. We need to convince people to choose healthy foods before supplements! Food doesn't have the side effects or potential for seriously harmful interactions that supplements do.
It's kind of scary because my first reaction is 'I have no idea'. I think I would tell my client that personally the add seems a little too good to be true. I would also tell her to look at the percent daily values and discuss any medications she is on. If there was one aspect she was particularly intrigued by, I would tell her some food items that might increase her intake of that specific nutrient.
As Jessica said, this is kind of scary. There are lots of issues involved, as everyone has mentioned; probably enough to teach a 3 hour class and a lot more than we could explain to a client in a few counseling sessions. I agree that "food first" is a concept we need to stress, and I really like Caroline's point about people who complain about the cost of food but are willing to pay for expensive supplements. Teaching patients how to compare the value of supplements may be helpful. I also think it's good to work with the client to determine what they really need (and don't need) in a supplement, so they will know that for future reference. I also think it's important for clients to know how to identify components of a supplement that may be unsafe for them, such as fat soluble vitamins in quantities above the RDA and poorly researched supplements like uvaursi berries. For most patients, third party verifications may be the best way to do this.
I like Susan's idea of looking at their current intake first and really pinpointing where they may be lacking in certain nutrients, then decide what they need to supplement. Haley had a great idea of having a recommended supplement on hand so that we can point them to the right ones and not just suggesting something random. Arthur really builds on Susan's comment about looking at what they're currently taking and supplements should not replace real foods that provide good nutrients.
I agree with everyone who suggested a well-balanced diet vs supplementation, unless the patient has increased mineral/vitamin needs due to certain circumstances and conditions. Supplements can be sketchayyy. Nutrient dense foods provide adequate vitamin/mineral levels necessary to fuel the body.
I agree with Haley that supplements may be of questionable value. If the patient cannot get enough of a specific nutrient or nutrients, they should covering deficiencies with a multivitamin or supplement that carries approval of a third party, as Arthur mentioned.
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