Do you tell your doctor about the vitamins you take?
Are you one of the millions of Americans who take vitamins or other supplements? It is an expensive proposition – and not always the wisest choice for your health, according to our expert.
“It is an important topic because first of all, the supplements could be useless,” said Christopher Butler, MD, at Emerald Physicians in Hyannis. “But second, they could be harmful, and third, they can interact with some prescription medicines.”
Americans spend about $30 billion a year on complementary medicine, according to the National Health Interview Survey conducted by the National Center for Complementary and Integrative Health (NCCIH) and the Centers for Disease Control and Prevention. Of that $30 billion, over $14 billion is spent on dietary supplements and herbal remedies.
Talking about this topic with patients is part of what Dr. Butler calls “the art of medicine.” It’s important to respect the patient’s belief system and have discussions about why they think it’s necessary to take a supplement. He is willing to give advice to patients about specific ingredients, but points out that the scientific data is limited on a lot of them.
“Patients do have their belief systems and we in healthcare have to be aware of that,” he said. “But we also have to negotiate with that because the bottom line is we are just trying to make people’s health better.”
Bad reactions to supplements cause about 23,000 trips to emergency departments every year, according to a study published in The New England Journal of Medicine. While body building and weight loss supplements cause a good number of those emergencies, other supplements can create health problems as well.
For example, St. John’s wort can make the blood thinner warfarin less effective and interfere with the efficacy of oral birth control. Beta-carotene and Vitamin A can increase the risk of lung cancer in smokers by up to 28 percent, according to the New England Journal of Medicine. The National Institutes of Health reports that Vitamin E can increase the risk of healthy men developing prostate cancer by 17 percent, and both kava and comfrey can cause severe harm to the liver if ingested in high doses.
“One of the major issues is the uncertainty about these ingredients,” Dr. Butler said. “As a practicing physician, I can tell you that I know next to nothing about most of the supplements that people will mention and that’s not because I’m stupid. It’s because the information isn’t there.
The Food and Drug Administration does not study these supplements in the same way it studies prescription medicines, he said.
“So, we do not have the database on these ingredients that we do for prescription drugs, and that means I can’t answer the questions of whether they are safe or effective.”
Even if vitamins or supplements are harmless, a vitamin that is helpful in our diet is not the same as the chemical derivative of that vitamin, Dr. Butler said.
The American diet falls short in a lot of areas, such as too much salt and sugar, but most people are not deficient in vitamins because so many foods are fortified with things we need, like Vitamin D. Over the years, Dr. Butler said he has noticed that about 99 percent of patients who ask him what supplements they should take are perfectly healthy.
His answer to them is that unless they have a deficiency, they do not need a vitamin or supplement.
“There’s a joke, and it’s not a very funny joke, but what do you get when you have a healthy person taking extra vitamins and supplements? What you get is very expensive urine,” he said. “Your body knows not to absorb those things. It all gets excreted in your urine.”
Do You Tell Your Doctor?
One alarming statistic is that a lot of patients don’t tell their physician they are taking supplements or herbal remedies. Dr. Butler pointed out a study based on a telephone survey of over 1,000 people done by NCCIH and AARP revealed that only 33 percent of patients who participated in the survey had reported using complementary treatments to their healthcare provider. That means the overwhelming majority did not.
At every visit it is important to let your healthcare provider know about all over the counter medicines, supplements and herbal remedies you take, especially if you are also taking prescription medicines.
Despite the numerous studies that show that supplements are ineffective at best and can sometimes actually cause harm, it’s hard to convince some patients that it’s true, according to Dr. Butler.
“There is this real disconnect between what is scientific data or what we might call evidence in contrast with patients’ preferences and patients’ belief systems,” he said. “Folks can have very solid, very entrenched beliefs about supplements. For some people it’s just part of their belief system that a supplement is better than a prescription or better than doing nothing at all.”
The latest supplement to fall out of favor is omega-3 fatty acids. A recent story in American Family Physician concluded that omega-3 supplements have no positive effect on blood pressure, cardiac events or mortality. The science behind the story is compelling, but Dr. Butler said convincing patients will be difficult. The number one belief people have, that he has seen throughout this career as a practitioner, is that a pill is the cure for most issues.
That mindset, especially with the older population, is part of what drives both the pharmaceutical and the supplement industry, but people should proceed with caution, said Dr. Butler. He warned that you have to view all sources of information on various supplements very cautiously. He tries to steer his patients toward a few websites he considers reliable.
Note: As of 5/1/2019, Emerald Physicians joined Medical Affiliates of Cape Cod (MACC), a division of primary and specialty care physicians from Cape Cod Healthcare.