Supplement Overload

I have seen Memes on social media platforms that say something to the effect of “a good physician helps get people off of their medications”. I agree with this wholeheartedly. Physicians are very good at starting people on pharmaceutical medications and never with the intention of discontinuing them. We are good at addition but not at subtraction, with some almost being experts at multiplication. It is inherent to the training we receive in medical school and the thought that we need to fix everything quickly with a pill. We want to fix things, we want our patients to feel better, and we believe this is the right way. “A pill for every ill”.

What about supplements though? Nutrients, herbals, homeopathic?

I always enjoy hearing stories from my patients about their other doctor’s recommendations, or seeing comments in the media and from “medical experts”, that supplements are worthless, they don’t do anything, and you should be careful taking them because they can be harmful. So are they inert substances that do nothing or are they powerful compounds that can be harmful if misused? You cannot really have it both ways. So the people and organizations that recommend prescribing pharmaceutical drugs ad nauseum, with known side effects, a high incidence of adverse events, and that can contribute to hospitalizations and death, are talking negatively about supplements that they have 0 training in? Think about that for a moment.

Are supplements okay to take endlessly, adding as you go? No, not really.

• Can they have some harmful effects? Yes.
• Do they cost a lot of money? They can.
• Are they necessary for the rest of your life? No, probably not. It depends.

I do think they are and can be beneficial when used appropriately. If we are addressing nutrient deficiencies they can be invaluable in supporting cellular metabolic processes. If someone is suffering from severe symptoms like anxiety, insomnia, chronic pain and inflammation, immune system concerns, hormonal imbalances, and so on, there are great herbal options available. Ultimately, we are looking to restore balance and improve function. That does not mean that we should use supplements solely without addressing why these symptoms or conditions have developed in the first place.

Supplement choices should be made according to need. What are we addressing? What should we start with? How long should we continue them? When do we discontinue them or modify the dosing?

While we generally do not worry that a conventional medical physician (MD/DO) is going to start us on supplements for much anything (there are exceptions to that rule but this is not a bad thing), there are naturopaths, homeopaths, chiropractors, acupuncturists, herbalists, dietitians, nutritionists, health coaches, etc. that will recommend supplements for conditions. Some are exceptionally good at recommending them. I also see some self-declared supplementologists start themselves on a variety of them for all types of symptoms and conditions.

I have seen people in my practice that arrive for their 1st consultation with me carrying a shopping bag filled with supplements. I think the highest quantity was 30 bottles. Most were started by other integrative medical practices, some were self-initiated. In 8 years of practicing functional medicine, I have never placed anyone on that many supplements and most of my patients are on less than 5 per day.

When I prescribe/recommend supplements it is with the intention of addressing specific symptoms, conditions, nutrient deficiency, metabolic imbalance, and possibly dysbiosis. We identify the problem and offer nutraceutical options to help assist the healing process, rebalancing the imbalanced, and restoring improved function. When we have achieved that goal it is time to pull back, reduce the number of supplements, modify the frequency of a supplement. In my opinion, a great physician helps to get people off of their need for supplements and medications. The supplement recommendations are to assist the patient, not to replace the need to actually make changes to their diet and lifestyle factors that have led them to where they are. We always focus on root causes. I will not compromise on this and stand firm on my approach that the way to heal and move forward is by addressing these.

I explain to my patients that we are starting with supplements, whichever they may be, as a therapeutic intervention to assist in the process of healing and rebalancing, symptom improvement, addressing inflammation, etc. This is often more intensive, daily, and may need to be maintained for several months. Eventually, we want to reach the point of supplementation that is intended to “supplement” a healthy diet and lifestyle. Maybe all they will need is a basic multi, vitamin D, and some magnesium or an Omega daily or a few days per week. I do not know where we will land (I do not own a crystal ball) when all is said and done but I do know that my goal from Day 1 is to achieve this goal. An individual that feels great, has minimal symptoms, improved or resolved conditions, and takes minimal supplementation. That is our greatest success.

I recently had a follow-up appointment with a wonderful lady that I have been working with for the past 18 months. I am pleased to say that she has come a long way. At one point in time, due to the various symptoms and conditions we were addressing, based on lab testing (conventional and functional), we had her on 17 supplements per day. I did not start her on 17 from the beginning. They gradually increased due to how she was progressing at the time. She is now feeling symptomatically improved, a completely different person than I met almost 2 years ago. She has done great. She put in the effort to make the necessary changes. We have now eliminated several of those supplements, reduce the frequency of several more to a couple of times per week, and are maintaining only a handful daily. There will be more reduction over the next few months. We assess, reassess, and make modifications as we go. That is how medicine should be practiced.

An important lesson in all this is that healing takes time. Conditions and physiologic imbalances do not recover overnight. Each individual is unique in their experiences, deficiencies, imbalances, genetics, exposures, and abilities. It is important to work with the individual to assist them in moving toward a state of optimal health and wellbeing. It is not a one-size-fits-all. We do not have pre-made supplement packages that we hand out to every new patient. We identify the need and then recommend what is indicated.

Can supplements be beneficial? Yes

Can supplements assist in restoring balance to hormones, nutrients, immune function, etc? Yes

Do supplements have potential harms, interact with other supplements or medications, and have side effects? Yes

Should supplements be continued forever without reassessment and determination of need? No

Should supplements be used in place of a healthy diet and lifestyle? Absolutely Not!

Medications do not improve your health, they improve symptoms or make lab numbers look better. They can reduce the risk of future disease by slowing down the process but they don’t stop it. Supplementation alone does not result in healing, they also help reduce symptoms. An effort will need to be made and changes implemented to achieve that goal.

Do not settle for the status quo. Your body and its health is the most precious possession you have. You may not appreciate this until you actually start to lose health and your quality of life, but you should definitely prioritize it. It is never too late to improve your health. Don’t let anyone ever tell you otherwise.