In terms of increasing knowledge with regard to specific dietary supplements, unfortunately, there are currently few reliable resources. Drug information and clinical databases such as Lexicomp, Micromedex, and UpToDate provide baseline material and potential uses for dietary supplements, but this is not entirely comprehensive due to the lack of data required in the approval process.

Mr Lucchino: I recommend that providers refer clients to a dietitian. Dietitians are well-versed in supplementation and can provide the patient with the correct information. Providers can also expand their education in supplements by reviewing research on the ingredients, brands, and dosages of any supplement or product of interest. This is an excellent way to expand knowledge and gain more of an understanding of the risks and benefits of any supplement of interest.

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Medical Bag: What are some of the remaining needs in this area, in terms of research or otherwise?

Dr Stohs: A major need is greater enforcement of existing regulations by the FDA and appropriation of more funds for the FDA by the US Congress. Healthcare practitioners should become familiar with well-known and reliable suppliers of dietary supplements and avoid companies and products that make claims that sound too good to be true. Most AEs associated with these products are due to the addition of drugs to the supplements by unscrupulous companies, and involve weight loss, sports performance, and sexual performance products. Such products are technically no longer dietary supplements but illegal drugs.


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Mr Tomaka: Due the consumption of dietary supplements becoming increasingly more common, it is imperative that healthcare providers understand how these supplements might have an impact on patient care. Although reviews of AEs involving dietary supplements indicate low incidences overall, there are still potential risks for theoretical toxicities associated with drug-nutrient or drug-herb interactions. Therefore, it is critical that healthcare providers be diligent in obtaining a comprehensive list of all prescription and over-the-counter medications and dietary or herbal supplements that patients may be taking, as this could affect therapeutic outcomes.

Another point of emphasis would be the advancement of evaluating the efficacy of specific dietary supplements in providing desired outcomes through investigational studies and research. The primary objective should be to determine whether there is a true benefit to taking a dietary supplement for a particular indication as opposed to subjecting a patient to the potential aforementioned risks — toxicities, interactions, polypharmacy — along with being ever-mindful of the economic burden of implementing therapy.

Mr Lucchino: Education is the main need in this area. This should come from the provider doing their own research or collaborating with another healthcare professional — such as a dietitian — to gain more knowledge in this area. If all healthcare providers became educated in supplement ingredients, dosages, reputable brands, quality third-party certifications, and the regulation of dietary supplements, the number of AEs and ineffective dosages could be reduced drastically.

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References

  1. Stohs SJ, Preuss HG. What health care professionals should know about the regulation and safety of dietary supplements. J Am Coll Nutr. 2017; 36(4):306-309.
  2. US Food and Drug Administration (FDA). Dietary Supplement Health and Education Act of 1994. Public Law 103–417. Section 3. Definitions. https://ods.od.nih.gov/About/DSHEA_Wording.aspx#sec3. Accessed January 31, 2019.