The Need to Educate Doctors About Natural Supplements

The media has made much of a recent study published in the Oct. 10 issue of the Archives of Internal Medicine, which found an association between the use of nutritional supplements and a heightened risk of mortality. Based on its findings, questions have been raised about the safety of a number of commonly used supplements. This has generated a great deal of controversy, and in the ensuing media storm, the most important issue has been overlooked: There is a growing need to educate primary care physicians about natural supplements and their effects on a person’s wellbeing.

The study’s limitations have already been widely reported. For instance, the researchers themselves concede that a cause-and-effect relationship between supplement use and death has not been established. The Los Angeles Times quotes the study’s lead author, Jaakko Mursu, as saying, "We don't have the detailed information why the women were using [supplements].” In fact, a number of women in the study were likely taking supplements as part of a regimen to treat an illness. For example, iron is used to treat anaemia. In cases such as these, it is far more likely that the illness rather than the supplements were the cause of death.

Despite its shortcomings, the study does contain two findings that have not received the analysis they deserve. First, the study reports the growing use of supplements among the women in the study’s sample, from 65% in 1986 to 85% in 2004. Second, it acknowledges a “dose response” relationship, meaning that the stronger the dosage, the more likely one’s health is adversely affected. As the vice president for scientific and regulatory affairs at the Council for Responsible Nutrition noted, "Anything, including water, can be harmful if you overdo it."  

Why are these two findings important? They point to a very real issue that conventional medicine has ignored. Natural supplements represent a trillion dollar industry that doctors have little exposure to and that, as a result, patients take them without the proper professional guidance.

This situation in the medical field is the consequence of the pharmaceutical industry’s monopoly on medical education and postgraduate training. As a result, doctors are prone to prescribe medications developed synthetically in laboratories rather than natural supplements that are present in the foods we eat.  

“The truth is, whether you like it or not, your patients are taking supplements,” Dr. Erika Schwartz, Chief Medical Officer at RestoreMD, told a gathering of primary care physicians recently. “Physicians assume that supplements won’t interfere with treatment, and patients assume they don’t need to tell their doctor what supplements they are taking because, well, they are just supplements. That couldn’t be further from the truth!”

The challenge, as Dr. Schwartz sees it, is educating medical practitioners about nutritional supplement use. For example, doctors who do not ask their patients what supplements they are taking are unaware of possible drug interactions.

“You need to know what supplements your patients are taking and what they do,” said Dr. Schwartz. “Otherwise, you are not delivering the optimal level of care.”

Dr. Charles Clark, professor of medicine at the Indiana University School of Medicine was quoted by ABC News as saying, "People take nutritional supplements for a variety of reasons, both related directly to a health problem or only related to a health belief that a little of something is good and a lot of something must be better. This is not always the case."

In fact, in most cases, supplements should be taken in small doses; there is no need for mega doses most of the time.

To provide guidance in areas such as dosage, Dr. Schwartz advocates that primary care providers first educate themselves about natural supplements and then get actively involved and take charge of the way their patients use them.

“You ought to be involved,” she said. “That way you know what they are taking and you can provide guidance. I would even encourage you to provide supplements to your patients directly through your office.”