Do You Really Know What’s In Your Supplements?

Dr. Michelle Cameron, ND

 The Top 5 Reasons To See A Naturopathic Doctor When Navigating Supplement Use 

1. All Supplements are NOT Created Equal: the issue of quality control

The absence of consistent product quality standards is a persistent barrier to the safe and efficacious use of natural medicine. Supplement manufacturing is not held to the same regulatory framework as prescription drugs, creating a conundrum for both patient and physician alike. Patients often do not understand their naturopathic doctor’s uneasiness with supplements purchased at a local pharmacy or big box retailer, but there’s a legitimate reason for this. We can’t guarantee the quality of the product.

It hasn’t been the best year for the supplement industry. In February 2015, the New York Times published an article exposing the supplement industry for substandard quality control and blatant mislabeling of products. When the Attorney General authorized an analysis of several over the counter (OTC) nutritional and herbal supplements sold at major retailers such as GNC, Target, Walgreens, and Walmart, the results were disturbing. Almost 80 percent of the supplements tested, including products claiming to contain ginko biloba, saw palmetto, and St. John’s wort, did not contain the key plant ingredients listed on the label. To add insult to injury, several products were found to contain fillers or contaminants that were not listed as ingredients. In some cases, substances such as wheat or powdered legumes were present which could pose health risks to those with allergies.

Also unsettling, a study presented at the 2015 International Thyroid Congress and Annual Meeting of the American Thyroid Association reported the presence of unlabeled and clinically significant levels of thyroid hormones, including thyroxine (T4) and triiodothyronine (T3), in popular brands of OTC weight-loss supplements. One supplement was found to have as much as 66.6 µg/day of T3 content, more than would be normally prescribed as physiologic hormone replacement in most individuals. The potential adverse effects of unknowingly ingesting excess thyroid hormone are numerous and may lead to weight loss, palpitations, menstrual irregularities, or heat intolerance. If prolonged and in high enough doses, bone loss and/or atrial fibrillation may also occur.

As clinicians, we recognize that safe and valid manufacturing processes are inherent to the integrity and efficacy of professionally prescribed natural products. In our busy naturopathic clinic, medicinary items are carefully selected based on rigorous quality standards that our vendors have chosen to participate in. Potency and contamination tests for selected products are confirmed by independent laboratories to ensure consistency with product specification. Supplement vendors undergo on-site facility audits to ensure safe manufacturing processes. This is a great resource for understanding quality control programs for supplements.

2. Natural Does Not Necessarily Mean Safe: the issue of drug-herb interactions

Supplements and herbs absolutely have the ability to interact with drugs. This is important, especially considering that a staggering 70% of Americans are on at least one prescription drug and more than half of all Americans receive at least two prescriptions. Drug-supplement interactions can increase or diminish a drug’s effectiveness with potentially adverse consequences. Some supplements may elicit blood-thinning effects and should be discontinued prior to surgeries, certain preparations of licorice have been shown to cause high blood pressure, and the use of St. John’s Wort may contribute to decreased efficacy of birth control pills. The list goes on.

It is important to discuss all medications and supplements with your naturopathic doctor for this reason. Naturopathic doctors study botanical medicine and pharmacology side by side during medical school and drug-herb interactions are emphasized. A conventionally trained medical doctor does not typically receive this as part of their medical education. Your naturopathic physician has a breadth of knowledge and experience in this area and can help navigate this often overlooked and uninformed aspect of natural medicine with you.

3. Indication: use the appropriate supplement to treat the condition

One of the beauties of natural medicine lies in the ability of the physician to utilize a supplement, herb, or nutrient to elicit a variety of effects for a wide range of conditions and illnesses. This is truly what allows NDs to individualize care, incorporate creative prescribing in our practice, and think outside of the box. This is not without its disadvantages, either. When a patient is using a supplement improperly, treatment is either ineffective and/or there may be an increased risk for an adverse side effect or harm. Plants are complex and their constituents elicit a wide range of physiological and biological properties in the body. Naturopathic doctors receive extensive training in botanical medicine and have a deep understanding of targeted, safe, and effective therapies to treat illness and disease. Furthermore, there are a number of natural medicines that have been studied to be as effective as their pharmaceutical counterparts and often without side effects. In some cases, natural medicine is ideal for those patients who are unable to tolerate a drug. Attempting to choose supplements on your own without the guidance of a licensed health professional can be daunting, overwhelming, and costly. Schedule an appointment with a naturopathic doctor and let us take the guesswork out for you!

4. Therapeutic dosage: dose is KEY

Lack of effective therapeutic dosing is one of the most common reasons I encounter for treatment failure in my private practice. Patients will often tell me that a supplement or herb did not work for them in the past and understandably, they are now frustrated or skeptical of natural medicine. This is often because the dose was too low or sub-therapeutic. On the other end of this spectrum, patients may not tolerate a natural medicine well or may be experiencing adverse side effects. In this case, they may be taking too much of a medicine or administering a supplement on too frequent a basis. Natural medicine does not really differ from conventional medicine here. Effective prescribing encompasses an understanding of the therapeutic dose (the quantity of any substance required to effect the cure of a disease or to correct manifestations of deficiency) and ensures that the desired effect is elicited. Again, your naturopathic doctor’s training, education, and clinical experience are integral in determining the appropriate dosing of supplements, nutrients, and herbs to accommodate individual health needs.

5. Education: naturopathic doctors are THE experts in natural and integrative medicine

Naturopathic doctors undergo four years of rigorous medical training in both conventional and natural medicine. We are required to have a bachelor’s degree and must complete the same basic premed pre-requisites as medical doctors prior to admittance to an accredited naturopathic medical school. The first two years of naturopathic medical school are comparable in both areas of study (basic medical sciences) and credit hours as compared to conventional medical doctors. Likewise, the final two years of our naturopathic medical training are patient-centered, with clinical training focused on direct patient care in an outpatient setting. During this time, we learn to diagnose and treat disease, provide follow-up care, and make appropriate referrals when indicated. Preventative medicine is foundational to our education and practice and is strongly emphasized during our training. Naturopathic medicine requires the careful integration of the healing power of nature with the rigors of modern science and as such, is a true model of holistic care.

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