Family Medicine Vital Signs

By Hanna Raber, PharmD

Before moving to Utah from the Midwest last year, I had never even heard of dōTERRA essential oils. Needless to say, I have experienced a bit of a learning curve when it comes to the use of natural products in Utah. The patient population I currently work with is noticeably more health conscious and, for the most part, trying to eat right, get regular exercise, and live a seemingly ‘natural’ lifestyle. So, inevitably, I find myself having more frequent conversations with patients regarding natural alternatives to traditional medications, namely dietary supplements.

To be clear, the term ‘dietary supplements’ includes vitamins, minerals, and herbal products (with herbal products as the most frequent category I get asked about). I’ve noticed that discussing these products with patients can often be daunting for providers, and for good reason, as they are not heavily covered in traditional health care curriculums. Not to mention the pressure the provider must feel to maintain the delicate balance between expressing concerns or doubts about the safety and efficacy of these products while still fueling patient autonomy and maintaining a positive patient-provider relationship. So, in traditional “Buzzfeed^” style, I have compiled 3 easy points to consider when discussing dietary supplements with patients.

1. Natural does not always mean safe

My first key point when discussing dietary supplements with patients is that just because a product comes from nature does not mean it can’t be harmful. Case in point: poison ivy. Many dietary supplements have proven to be potentially harmful for certain patients depending on their health conditions and prescription medication use. The list of offending prescription medications and medical conditions for each dietary supplement is impossible for anyone without superpowers to memorize. So, as a general rule of thumb, I think it is helpful to always double check disease and drug interactions on a favorite natural medicines database whenever discovering a dietary supplement on a patient profile. I am especially cautious if a patient is hoping to start a dietary supplement while on anticoagulants or mood-altering medications.

2. Natural does not always mean natural

After a dietary supplement passes the safety step, the next major point to discuss is that not all dietary supplements are created equal. Dietary supplements are not regulated by the FDA the same way that prescription medications are and therefore often the purity standards are left up to the manufacturer to self-regulate. This means that just because the label says the product contains saw palmetto does not necessarily mean it contains only saw palmetto and doesn’t even mean that it contains any saw palmetto. However, we do have a few options that can minimize some of the purity concerns with dietary supplements. If the label contains a ‘USP’ or ‘Consumer Lab’ seal on it, it means that the product has undergone independent testing by United States Pharmacopeia or Consumer Labs respectively to verify the purity of the product. Keep in mind that these companies are not testing products for safety or efficacy, they are only testing that the contents of the product match the label.

3. Natural does not always mean effective

Speaking of efficacy, determining the efficacy of dietary supplements for particular health claims is difficult considering the manufacturing variability (see point 2). While we do have evidence for some dietary supplements, there are various health claims based on either poorly designed trials or no trials at all. This isn’t to say that dietary supplements should never be used but simply that the available evidence needs to be evaluated cautiously and this evidence should be shared with patients. If a patient would like to try a dietary supplement for a particular health concern, I try to make sure we set a ‘revisit date’. This means that after a predetermined amount of time (usually 2-3 months) the patient and I will revisit the use of the dietary supplement. If the patient hasn’t noticed any improvement in their health after that amount of time, it’s a good opportunity to have a discussion about risks versus benefits of continued use.

At the end of the day, our patients are absolutely using dietary supplements. So, it is important for healthcare providers to feel comfortable engaging in conversations about them. Hopefully by discussing safety, purity, and efficacy of dietary supplements, both patient and provider can feel comfortable about their role in individual patient health.

Hanna Raber, PharmD, BCPS, BCACP, TTS is a Clinical pharmacist practicing at the University of Utah Centerville clinic in family medicine.