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Where do you stand on supplementation?
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Nutrition. We all understand its importance. We learn about it as kids - from parents, pediatricians, teachers, even television. And the lesson learned? Eat a well-balanced diet and you'll be just fine, right? Apparently not.
More and more, our conventional wisdom regarding diet is increasingly challenged. Indeed, one needs to look no further than a magazine, television or web page to learn of the virtues of nutritional supplementation. And for good reason. Patients are increasingly interested in supplementation as a means by which to maintain youth and promote health. Health care providers are turning to supplementation to augment traditional medical therapies in the prevention and management of disease. And, of course, industry sees a tremendous profit opportunity in supplementation. Yes, nutritional supplementation has become big business. Big, controversial business.
So, how could anything so well intended be so controversial? The answer seems to lie in deeply rooted philosophical differences. Many health care providers place merit in only those treatment modalities that have passed the rigors of controlled, prospective clinical trials - trials that are lengthy and costly and have generally not been applied to supplements. They are also quick to point out that we know even less about doses, and that supplements - particularly when taken excessively - are not without consequence.
From a consumer's perspective, critics are leery of the multilevel marketing networks through which certain supplements are proffered. They feel supplements appeal to our obsession for youth as well as to the sick and vulnerable, and actually offer limited health benefits.
On the other hand, many of us live a very hectic, stressful existence, one not conducive to a consistently well balanced diet. Further more, considering the oft times "overfarmed" nature of our soil, foods are not always nutritionally rich. Given these trends it seems reasonable to suggest nutritional supplementation. And, perhaps most importantly, there is a substantial body of literature supporting the contention that certain supplements are beneficial - ocularly and systemically.
So, what do we tell the 75-year-old patient with age-related macular degeneration (AMD) or the 55-year-old who inquires about cataract prevention? As I see it, there are three questions we must ask ourselves prior to advising patients:
- Do I know my supplements? Whether you're discussing the potential benefits of zinc and carotenoids for AMD or vitamins C and E for cataracts, know your supplements! Understand their solubility and absorption, when they are taken, proper doses, contraindications and potential side effects. Perhaps, most importantly, first counsel patients on food sources as an alternative.
- Do I know this patient? Is this individual conceptually competent - someone who understands the benefits, risks and responsibility of supplementation - and likely to comply? Or, are this individual's motivations and expectations unreasonable? Certainly, those who supplement irrationally increase risk rather than therapeusis.
- What are my motives? At the heart of any professional recommendation - supplements or otherwise - is our patient's well being. If we elect to dispense supplements (for profit), we must be prepared to support that decision. This support should include maintaining a "supplement-smart" staff, providing patient education and communicating with other health care providers. To do so addresses a patient's total ocular supplementation needs and assures compliance and safety. Anything less and your intentions could be misconstrued as pushing pills for profit.
In the final analysis, the greatest danger involves doing nothing at all. To leave patients to "figure out" supplementation on their own results in confusion, frustration and, perhaps, the missed opportunity of a lifetime.