Appropriate supplement use begins with patient-provider discussions

A recent survey showed that 76% of American adults take at least one supplement, and 29% said they take more supplements today than before the COVID-19 pandemic.

Of the 2,053 survey respondents, only 47% said they sought advice from their health care provider before doing so, 35% did not think their health care provider would be interested in knowing if they were taking supplements , 32% thought their health care provider was not doing this know enough about supplements to advise them, and 87% feel “confident” that the supplements they are taking are safe.

Wayne Jonas, MD, The executive director of integrative health programs at the Samueli Foundation, which sponsored the survey, said the use of supplements provides doctors and patients with an opportunity to discuss alternative and integrative approaches to “health and The healing “.

“The key is for the doctor to be proactive about this,” he said.

In an interview with Healio Primary Care, Jonas discussed the use of supplements, including those used to protect against COVID-19, treat mental health issues, and improve sleep. He also spoke about adverse events related to the combined use of supplements and prescription drugs, barriers to discussions between patients and caregivers, etc.

Healio primary care: Many survey respondents said they use supplements to improve protection against COVID-19. However, the NIH said there is not enough evidence to support recommendations for or against the use of supplements for this reason. What should PCPs tell their patients about the role of supplements in COVID-19?

Jonah: There are no supplements that can completely protect someone from COVID-19. It is essential. If patients think that taking vitamin D removes them from the list of those who should be vaccinated and wear a mask, they are wrong.

Wayne Jonas

That said, low vitamin D is a risk factor for COVID-19, and vitamin D supplements could help protect against COVID-19. The jury is still out on this second part. We don’t yet know if the vitamin D we get from sun exposure provides this level of protection. Zinc is another supplement that offers protection, but not immunity against COVID-19. So if a patient’s zinc or vitamin D levels are low, it doesn’t hurt for them to have more.

Healio primary care: Improved sleep and mental health were other common reasons for the increase in supplement use. What supplements, if any, can improve sleep and mental health?

Jonah: For mental health, there are some very good supplements that can be used in tandem with cognitive behavioral therapy and prescription medication. For anxiety, I recommend my patients to consider gingko biloba or lavender supplements, which are probably both safe and effective. For depression, I recommend that patients take folic acid and lavender with conventional antidepressants. I also recommend St. John’s Wort, although I am careful what else patients take because St. John’s Wort can interact with many common medications like birth control pills, for example.

Supplements for sleep – melatonin, magnesium, certain aromatherapies, valerian, L-threonine, B-12 or a combination of these – can be used for short periods and in conjunction with sleep hygiene and body methods. -mind such as body imagery, sleep hygiene, cognitive behavioral therapy, etc.

Healio primary care: Some respondents said they didn’t think their provider could properly advise them on the supplements. What resources can healthcare professionals use to keep abreast of the latest research?

Jonah: Here at the Samueli Foundation, we’ve put together some basic information about supplement use that patients and providers should know about and posted it on our website. The Natural Medicines Research Coalition also has a great site for information on this topic, as does the FDA Advisory List for Supplement Warnings and the NIH’s National Center for Complementary and Integrative Health.

Healio primary care: What are your main concerns about using supplements? What side effects of supplement use have you seen in practice?

Jonah: The main concern is quality because supplements are not regulated before they hit the market, and not all of them contain what the packaging says they contain. If the supplements are imported from overseas, these products can also be contaminated with toxic metals. High doses of supplements like gingko and garlic can create a blood thinning effect, which can be a problem for people on blood thinners. There are also products like St. John’s Wort that alter the metabolism of many different drugs. NSF International, Consumer Lab and the US Pharmacopeia assess the quality of supplements and will certify their quality from companies. Look for their seal.

The second area of ​​concern I have is the dosage and the interaction that some supplements have with prescription drugs, and vice versa. A third is that supplements are not covered by health insurance, which means they add to the medical debt that many people have.

Healio primary care: How often should PCPs ask their patients about supplement use?

Jonah: There are three times they should do it. If a doctor has never asked about it, he or she should start at the very next visit. Be thorough and direct. Another time would be after the patient has had a major health problem like cancer or heart attack as they will often start taking supplements at that time. A third time, it would be during an integrative health visit where the doctor asks about any supplements and prescription drugs he is taking.

Healio primary care: The poll too revealed barriers to patient-provider discussions. What tips can you share with PCPs to start conversations about supplement use?

Jonah: Ask them explicitly about supplement use without being judgmental. I often talk to patients about non-pharmaceutical care approaches, sometimes during an integrative health visit. Our website contains a questionnaire that doctors can use to ask patients about their behavior and lifestyle, social, emotional and mental issues, and supplement consumption.

Another key to these discussions is not to judge your patient. We saw in the survey that some of the respondents feared being judged for the supplements they were taking. Make sure the patient understands that you are there to help and guide them.

Reference:

Three in ten Americans have increased their supplement consumption since the start of the pandemic. https://www.eurekalert.org/news-releases/807544. Posted July 21, 2021. Accessed September 14, 2021.

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