Are nutritional supplements good for you? Should you take them? I get these questions all the time from patients in my practice. The answer is: It depends……depends on you, depends on your nutritional status, depends on the quality of the product and it depends if you have specific condition that can be benefited from a nutritional supplement.
The Unregulated Supplements Industry
In the U.S., supplements are an unregulated industry, which means that aside from gross mislabeling infractions, there are no quality control measures imposed upon the the industry. This is a mixed blessing, negative because unlike FDA approved drugs, supplement consumers are not assured of the tight regulations that impose safety, efficacy and quality control requirements on nutritional supplements, positive because it allows natural based nutritional supplements to be available at affordable prices for people who want them.
Let me explain this a little more in depth. If supplements were forced to go through rigorous scientific trials to prove safety and efficacy, this would be a great thing. So why is not done or required by the FDA? The answer is one of financial incentive. Natural supplements with natural ingredients are not patentable. This is the main reason we do not see large scale, 3 phase, multi million dollar trials being performed on natural medicines through the Pharma industry. If they were forced to go through this very process that would ensure their safety, efficacy, and quality control they would not be available to the general public, because nobody would pony up the bill to go through these research trials. If they showed positive results in controlled trials that met FDA criteria they could be sold as a “drug”. But the supplement manufacture could not be rewarded a patent that would ensure that they could profit from the investment in the research trials and exclude other supplement manufacturers from making the same claims on their products.
Multiple attempts have been made through legislation that would make this mandate required of the supplement industry, but they are always killed because the industry and consumers alike recognize that an unregulated industry and natural supplement availability is better than no supplement industry at all. Regulation has been locked in this stalemate for sometime now and we as healthcare consumers will have to live with this ambiguity for the time being.
So, is their any research to support that natural supplements have health benefits? Definitely, there are thousands of international trials and smaller scale human trials that show that specific natural medicines are effective for specific health conditions. Some more prominent examples of well researched natural supplements are fish oil, probiotics, and glucosamine.
The variables that effect the whether these researched benefits will reach the consumer are: the strain or quality of the product used in the trials, the dosage and frequency, the specific diagnosis and symptoms of the patient.
So with supplements, what you see on the label is not always what you get. Do you have the actual condition or symptom that the research was done for? Many people who are self medicating misdiagnose themselves. Are you taking the correct dosage/ frequency, etc.?
Then there are other situations where you might take a supplement for general health or preventative reasons. An example that comes to mind is fish oil for the prevention of heart disease. With fish oil especially, the question of purity is very important. We know that sea life can easily bio-accumulate toxins. Does the company that produces the fish oil voluntarily test their products through a third party lab assessment for purity from contamination? Also essential fatty acids can spoil rather easily. What precautions does the company take to ensure their product is not rancid, which makes it more harmful than good?
What Constitutes a Quality Supplement Product?
As physicians who prescribe natural supplements all the time, we have struggled with these questions for a long time and over the years have devised a number of criteria which we use when deciding what supplement companies to use, when to prescribe to patients and for how long to keep the patients on these natural supplements.
Being in the natural medicine industry, we have been lucky enough to have access to some of the best supplement companies who make professional quality products designed for natural medicine practices. What differentiates these companies from average over-the-counter supplements? Mostly, it is an issue of quality control. All of the supplement companies that we use utilize third-party independent lab testing to ensure that their products are 1) free of contamination, 2) contain the actual ingredients which are stated on the label and 3) contain quantities of active ingredients demonstrated in the research to have efficacy for certain medical conditions. We also try to work with companies who go above and beyond and conduct their own human trials on their products to ensure efficacy (albeit not to the size and scale of FDA requirements) or work in collaboration with educational and research institutions who have research grants.
So essentially, what we have done over the years is vetted various different supplement companies and products, and figured out which ones work for a good percentage of our patients. This has shaped and changed our natural pharmacy dispensary over the years as we have discovered which supplements work in a majority of patients and which ones do not seemingly work. We have strong incentive to do this right because if we prescribe products of inferior quality or get poor results, the patients do not return or are at least are a little annoyed for wasting their money.
We have patients come into our practice who, in our opinion, are on way way too many supplements. Then there are patients on other side of the spectrum, who refuse all any and all supplements and essentially tie our hands in our ability to help them by taking away the very tools that we can use to give them health benefit.
Neither of these extremes are helpful for the patients.
General Health vs. Condition Specific Supplements
We divide supplements into two different classes as to how they work and what they are being prescribed for. The first is general health and the second is condition specific. General health supplementation may have condition specific applications, but they also have a general health promoting effect that may not always be apparent to the person taking them. Good examples of this are high quality multi-vitamins and fish oil for prevention of heart disease.
Condition specific supplementation, for example glucosamine for osteoarthritis, should provide some measure of benefit to the patient for that condition. If it is not working for you, you should seriously consider consulting your natural health practitioner to get advice on accuracy of your condition, quality of your product (is it indicated), is it the correct dosage, might there be a different supplement that would work better for that condition?
Are your Supplements Working for you?
I am always amazed when I ask my patients why they are taking this or that and tell me: “Well, its supposed to be good for xxxxx condition”. Then I ask them if they feel any different on the supplement and they tell me “no”. Then I ask them: “Do you like wasting money”?
After a long time in practice I have really found that sometimes it takes a few rounds of trying different herbs, nutrients, or other types of supplements until the patient and I can find the right supplement or combination of supplements that make a real difference in quality of life for that person. But when we get it right: the positive results typically meet these criteria: a) noticeable improvement in symptoms or overall health b) free of side effects c) affordable and sustainable for the patient to stay on for the duration that they require, whether temporary or ongoing.
Support those that support you
The last issue I would like to address is why you should buy your prescribed supplements from a natural practitioner that devotes long consult times to you. In a truly holistic practice the practitioner requires much more time and attention to detail to your case than in an ordinary medical practice that is disease centered. To give you the quality medical care that holistic minded patients seek, the practitioner often sacrifices the more lucrative and more superficial route of seeing several patients an hour (the numbers game), to see 1-2 patients per hour and perform attention to detail whole person medicine. Most of us practitioners who utilize this model need to supplement our incomes with a natural pharmacy in order to make a living and have a sustainable business model. Yes, you can probably find some of the supplements we prescribe on amazon.com for 20% cheaper. But amazon.com is not providing the quality healthcare you are looking for. So, economics of natural medicine is important, and it can get expensive. But continued access to quality natural healthcare is community process that requires support in both directions. So next time you are feeling great and have had 45 minutes to an hour of undivided, focused attention from your naturopath or functional medicine doc, consider supporting the viability of their practice though loyalty. We certainly appreciate your patronage and allows us do what we love: which is to help you thrive!