The popularity of complementary and alternative medicine has increased dramatically in recent years sending supplement sales skyrocketing worldwide. With the COVID19 pandemic this trend has only increased. People have more time than ever to research their health conditions and the supplement industry is ready to offer quick solutions. Like many industries, supplement brands have pivoted during this time and are now targeting people worried about their immune health, touting vitamin C, D and zinc combinations as the saviour for immune systems everywhere.
But before you spend your hard earned money on a new supplement, might I suggest you check in with your pharmacist?
Why you ask? Because supplements can be dangerous if not properly evaluated properly prior to use.
Common safety issues with supplements
It once was the case that supplements beyond your classic vitamins and minerals were provided in a naturopathic physician’s office and patients could only access what had been prescribed to them. Now, there is a distinct lack of clinician oversight with high potency supplements found in the naturals section of many grocery stores and online through retailers like amazon and well.ca. When I ask my clients what prompted them to start taking these products they will often cite a Youtube video, or a blog post with no mention of a discussion with a clinician.
When new clients come to me the first thing I do is analyze their supplement regimen. Invariably there will be a list of drug therapy problems to contend with. Here are the top issues I will commonly find:
Lack of evidence for effectiveness and safety
Due to the unregulated nature of supplement manufacturing, we only have small scale, short term studies to draw from. There is often a lack of evidence for using the supplement for reason the patient is reporting. Lack of evidence does not necessarily mean lack of effectiveness, but it means that we cannot prove it is effective, and the patient has to accept that reality. Often the patient has been misled and expects more from the supplement than the data suggests we should.
The short term studies means that we also cannot prove safety beyond a certain point. If we’ve only ever studied a supplement for one month, I cannot tell you it is safe to take daily for years. This again, is not something made clear on the bottles or marketing materials of supplement brands.
Doses above safety limits
With the number of different sources of information available to patients it can be hard to know what dose to take. The bottle might say one thing, but an internet blog will tell you another. I have often come across doses that are well above the tolerable upper limit for a vitamin or mineral. The tolerable upper limit is the intake level where we can say the ingredient likely doesn’t pose any health risks to almost all individuals. It’s important to note that the level reflects nutrients from all sources, not just supplementation. Furthermore, it is not a recommended daily intake, but rather a level to remain under (26).
Interactions with conditions, drugs, supplements and food
Any supplement is bound to interact with other aspects of your life, but you would never know from the packaging. Interactions can be with other supplements, prescription medications, food and medical conditions.
Condition-Supplement Interactions:
Supplements can interact with other conditions you may have. For example, many ingredients can act like estrogen and are not recommended for people with hormone sensitive conditions like breast cancer and uterine fibroids.
Drug-Supplement Interactions:
Supplements can additive effects with the drugs you take making it more likely that you experience side effects. They can also work opposite to your prescription medications making them less effective. Then there are the metabolism interactions where the supplement may make a drug metabolized faster or slower by your body leading to either ineffective dosing or higher chances of side effects.
Food-Supplement Interactions
Food can increase or decrease the absorption of various ingredients and in severe cases can change the way your body metabolizes them.
Supplement-Supplement Interactions
Just as supplements can interact with prescription drugs, they can interact with each other too!
Check with your pharmacist first
The above list may seem like a landmine of potential issues to avoid. And it is. But your pharmacist has been specially trained to sift through complex information and give you the facts in a way that can help you make an informed decision. Having a relationship with your pharmacist and checking with them before starting a new supplement is key to keeping you safe.
REFERENCES
As always, references can be found here.
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