Massachusetts Medical Society: Know Your Patients’ Supplements

Know Your Patients’ Supplements

Dr. Zen-Jay Chuang, Claire Branley
Dr. Zen-Jay Chuang (top); Claire Branley (bottom)

According to the US Centers for Disease Control (CDC) report in 2021, at least 57.6 percent of adults in the United States used a dietary supplement in 2017–2018, and the percentage of supplement use, as well as the likelihood of using multiple supplements, increased with age. An online survey by The Harris Poll for the American Osteopathic Association in 2019 found that more than 4 in 5 American adults (86 percent) take supplements.

A dietary supplement is a product other than tobacco that is intended for oral consumption. It may have one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and other substances) or their constituents. Per the 2021 CDC report, multivitamin-mineral supplements are the most common of these products used by adults in all age groups, followed by vitamin D and omega-3 fatty acid products. Other commonly used supplements included vitamin C, botanical or herbal supplements, and calcium.

Although patients may choose to use dietary supplements for a variety of reasons, a 2014 report on a series of surveys suggests that the most common reasons are to support overall health and wellness and to fill nutrient gaps in the diet. Additionally, 84 percent of respondents said they told their physician which supplements they take, suggesting most adults are comfortable discussing their supplement use.

While many of our patients use supplements regularly, US government policy does not offer adequate protection to the public. The US Food and Drug Administration (FDA) regulates the processing and manufacture of supplements in a manner similar to food, unlike its rigorous approach to regulating drugs. The Federal Trade Commission, in coordination with the FDA, does regulate supplement advertising. However, the government does not review or test supplements before they are marketed. Supplement manufacturers are expected to provide their own “quality control” for ensuring the safety of their products and the veracity of their label claims before their products hit the market.

Since the 1994 passage of the Dietary Supplement Health and Education Act, which laid the foundations for the US government’s current role in regulating supplements, the supplement industry has expanded exponentially, with an estimated 75,000 new supplement products having been introduced. The FDA has no way to determine the ingredients in the tens of thousands of products on the market and is able to investigate and act against a marketed supplement only if complaints are filed. When inspections are done, according to a 2020 report by the AMA Council on Science and Public Health, over half of inspected dietary supplement manufacturers are found to be in violation. Consequently, the same AMA council report calls for tighter regulations of dietary supplements as well as better physician and patient education.

To provide optimal care to our patients, we physicians have the responsibility to know:

  1. Is the patient taking dietary supplements? If so, what is the patient taking?
  2. How efficacious and effective is a supplement for its intended use?
  3. Is the supplement of good quality? Does the supplement contain what the seller claims? Does the supplement contain impurities, contaminants, or harmful substances?
  4. Does the supplement interact with other medications or supplements? If so, how?

While many of the answers remain unclear due to limited research, especially regarding supplements’ efficacy and effectiveness for their intended use, we can at least help our patients reach optimal decisions based on currently available scientific information.

Following are useful resources regarding the use and safety of supplements:

Zen-Jay Chuang, MD, chairs the MMS Committee on Nutrition and Physical Activity and medical director at Lakeside Family Practice in Quincy, MA. Claire Branley, a former member of the committee, is a MD/PhD student in the Global Health Pathway in the T.H. Chan School of Medicine and the Clinical and Population Health Research program in the Morningside Graduate School of Biomedical Sciences.

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