Editor’s note: the following interviews have been lightly edited.
Medical Bag: What are your thoughts on why many healthcare providers are not familiar with the way dietary supplements are regulated?
Sidney Stohs, PhD: There are a variety of reasons for this. Many providers assume that they should be regulated as drugs, and misinformation from multiple sources is an issue. There is far too much reliance on “social media science” rather than peer-reviewed science published in reputable scientific journals. The majority of what is presented via social media as nutrition science is inaccurate and/or misleading, often based on someone’s misinterpretation or misunderstanding of current knowledge. Major news agencies often misinterpret or do not understand the results of a study and draw inaccurate conclusions. Unfortunately, many healthcare providers feel that they do not have the time to fact check and rely on popular and social media for their information regarding dietary supplements.
Mr Norman Tomaka: We believe that this lack of familiarity can be attributed to a few causes, with potentially the one with the most impact being the distinction between what constitutes a dietary supplement and what is a drug or pharmaceutical agent. The formal definition of dietary supplements as described above differs from the definition of drugs as a “substance that is intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or animals.”1 So, by definition dietary supplements are not technically formulated with a therapeutic intent, but to supplement dietary needs.
As a result, it can be hypothesized that healthcare providers would traditionally would have less of an awareness of the regulations, efficacy, and overall effects that these supplements could have on patients because supplements are not designed for treatment purposes, which is the primary focus of a healthcare provider. Pharmaceutical agents, however, have a defined role in therapy, and thus providers are much more knowledgeable about these. Other reasons for lack of familiarity include the lack of robust efficacy data, various brands and formulations of products, and previous lack of focus in pharmacy academia, among others.
Mr Jeffrey Lucchino: One of the main reasons is the misconception that dietary supplements do not have any regulations. Some healthcare providers have been practicing since well before the passage of the DSHEA. Also, media attention regarding dietary supplements is typically presented in a negative light. Supplements are only mentioned in the media when there’s an AE related to their use or recall.
Another reason for the lack of awareness is the limited education regarding supplementation. Most healthcare providers might attend one class throughout their academic career that relates to supplementation; it’s not a main area of focus in the education of a healthcare professional.
Medical Bag: What are some of the issues that may arise due to this lack of awareness and the misconceptions regarding the regulation of dietary supplements?
Dr Stohs: Many patients have multiple nutritional deficiencies due to poor diet. Dietary supplements can play a role in meeting these needs and improving health. Some healthcare providers simply recommend that no one should use dietary supplements because they are “unregulated and may present a major health hazard,” leading to a situation in which nutritional issues are correctable but not addressed.
Mr Lucchino: One of the potential issues is the recommendation of certain dietary supplements, brands, or ingredients that could be dangerous or ineffective to an individual. In search of various supplements, a consumer will find 20 different companies that make the same product. How does one know which brand to pick? Without knowing which companies are third-party tested, follow the current GMP regulations, and have a good reputation, the healthcare provider is leaving the patient/consumer to judge which product and brand to pick. In most cases, the consumer will choose the cheapest product, and that product may not have enough of the active dose or may have an ingredient that could conflict with a patient’s medication.
Another area of concern is the misconception that all supplements are bad, which is a common belief among healthcare providers. I do agree that nutrition and lifestyle are the primary areas to focus on; however, many supplements have been proven effective through research in humans.
Medical Bag: What do you recommend that providers do in order to increase their knowledge in this area?
Dr Stohs: Healthcare providers need to obtain information on specific dietary supplements from reputable experts associated with agencies such as the American Herbal Products Association and the American Botanical Council. These agencies provide current, detailed information regarding specific topics based on current peer-reviewed research and not on non-expert ideas or convictions. The FDA maintains safety data and relative safety information can be readily determined. Healthcare practitioners need to take the time to obtain information from reputable and reliable scientific sources.
Mr Tomaka: First and foremost, it would be recommended that providers familiarize themselves with the distinctions between drugs and dietary supplements, along with their regulatory similarities and differences. This information can be obtained through primarily literature found from reputable databases and journals. There is also secondary and tertiary information regarding these topics that can be reviewed objectively.