Q&A: Proper supplement use starts with patient-provider discussions

A recent survey showed that 76% of U.S. adults take at least one supplement, and 29% said they are taking more supplements today than before the COVID-19 pandemic.

Among the 2,053 survey respondents, only 47% said they sought counsel from their health care provider before doing so, 35% did not think their health care provider would be interested in whether they are taking supplements, 32% thought their health care provider did not know enough about supplements to advise them and 87% felt “confident” that the supplements they take are safe.

Wayne Jonas, MD, executive director of integrative health programs at Samueli Foundation, the survey’s sponsor, said supplement use presents an opportunity for physicians and patients to discuss alternative and integrative approaches to “health and healing.”

“The key is the physician being proactive about it,” he said.

In an interview with Healio Primary Care, Jonas discussed the use of supplements, including those being used to protect against COVID-19, treat mental health conditions and improve sleep. He also talked about adverse events tied to the combined use of supplements and prescription drugs, barriers to patient-provider discussions and more.

Healio Primary Care: Many survey respondents said they used supplements to enhance protection against COVID-19. However, the NIH has said there is not enough evidence to support recommendations for or against the use of supplements for this reason. What should PCPs be telling their patients about the role of supplements in COVID-19?

Jonas: There are no supplements that can completely protect someone against COVID-19. That is the bottom line. If patients think taking vitamin D removes them from the list of those who should get a vaccine and wear a mask, they are mistaken.

Wayne Jonas

That said, low vitamin D is a risk factor for COVID-19 and supplements of vitamin D might help protect against COVID-19. The jury is still out on this second part. We do not know yet if the vitamin D that one gets from being in the sun offers that level of protection. Zinc is another supplement that offers protection, but not immunity from COVID-19. So, if a patient’s zinc or vitamin D levels are low, it does not hurt for them to get more of those.

Healio Primary Care: Other common reasons for increasing supplement use were to improve sleep and mental health. What supplements, if any, can improve sleep and mental health?

Jonas: For mental health, there are some pretty good supplements that can be used in tandem with cognitive behavioral therapies and prescription medications. For anxiety, I recommend my patients consider gingko biloba or lavender supplements, both of which are likely safe and effective. For depression, I recommend patients take folic acid and lavender along with conventional antidepressants. I also recommend St. John’s Wort, although I am careful to consider what else patients are taking as St. John’s Wort may interact with many common drugs like oral contraceptives, for example.

Supplements for sleep — melatonin, magnesium, some aroma therapies, valerian, L-threonine, B-12 or some combination of these — can be used for short periods and in conjunction with sleep hygiene and mind-body methods such as body imagery, sleep hygiene, cognitive behavioral therapy, etc.

Healio Primary Care: Some respondents said they did not think that their provider could properly advise them about supplements. What resources can medical professionals use to stay up to date on the latest research?

Jonas: Here at the Samueli Foundation, we have pulled together basic information about supplement use patients and providers need to know and posted it on our website. The Natural Medicines Research Coalition also has a very good site for information on this topic, as is the FDA advisory list for supplement warnings and the National Center for Complementary and Integrative Health at the NIH.

Healio Primary Care: What are your top concerns about supplement use? What adverse effects of supplement use have you seen in practice?

Jonas: The number one concern is quality because supplements are not regulated before hitting the market, and not all of them contain what the packaging says they contain. If supplements are imported from overseas, there also might be toxic metal contamination of these products. High doses of supplements like gingko and garlic can create an anticoagulant effect, which may be a problem for people on anticoagulant drugs. There are also products like St. John’s Wort that alter the metabolism of a lot of different medications. NSF International, Consumer Lab and the U.S. Pharmacopeia evaluate the quality of supplements and will certify their quality of companies. Look for their seal.

The second area of concern I have is the dosing and interaction that some supplements have with prescription drugs, and vice versa. A third is that supplements are not covered by health insurance, meaning these add to the medical debt that many people have.

Healio Primary Care: How often should PCPs ask their patients about supplement use?

Jonas: There are three times they should do this. If a physician has never asked about it, he or she should start at the very next visit. Be thorough and direct. Another time would be after the patient has had a major health condition, such as cancer or a heart attack, as they will often start taking supplements then. A third time would be during an integrative health visit in which the physician asks questions about supplements and the prescription medications he or she is on.

Healio Primary Care: The survey also revealed barriers to patient-provider discussions. What advice can you share with PCPs for initiating conversations about supplement use?

Jonas: Explicitly ask them about supplement use in a non-judgmental way. I often talk to patients about nonpharmaceutical approaches to care, sometimes during an integrative health visit. Our website has a questionnaire physicians can use to ask patients about their behavior and lifestyle, their social, emotional and mental issues and their supplement use.

Another key to these discussions is to not judge your patient. We saw in the survey that some of the respondents were concerned about being judged for the supplements they were taking. Make sure the patient understands you are there to assist and guide them.

Reference:

Three in ten Americans increased supplement use since onset of pandemic. https://www.eurekalert.org/news-releases/807544. Published July 21, 2021. Accessed Sept. 14, 2021.