Take Your Supplements With a Big Grain of Salt

— We must guide patients who get lost managing their own care

A photo of a man with a pile of various vitamin supplements in his hands.
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    Fred Pelzman is an associate professor of medicine at Weill Cornell, and has been a practicing internist for nearly 30 years. He is medical director of Weill Cornell Internal Medicine Associates.

Recently, my family and I took a day trip, just to get out of the city, and drove down through New Jersey, Pennsylvania, and Delaware to take in some sights.

Being hard-core Manhattanites, we don't own a car, but it's always an adventure renting one and discovering what we can along the way.

One of the places we stopped was a massive indoor-outdoor farmers market outside Wilmington, Delaware.

Apparently in the summer months there are acres of outdoor flea markets, fresh produce brought in from surrounding farms, and an endless variety of vendors. In the winter months, it's primarily indoors, housed in a massive warehouse-like structure that seems to go on for miles and miles.

Inside there is an overwhelming array of little shops, tucked in with no rhyme or reason, jamming both sides of walkways going up and down and across.

Fresh fish and other seafood.

Cowboy boots and cowboy hats, leather belts, and vests.

Vintage magazine and comic book stores.

Clothing and skeins of cloth of every imaginable type.

Bulk sales of everything from tea and coffee to incense and perfume.

At one of the vendors, which seemed to sell everything from candy to candles to herbal remedies, I saw the bin in the photograph below:

Photo credit: Fred N. Pelzman, MD

It was one of many bins packed into the store, laden with a jumble of bottles of herbs, vitamins, and supplements.

On one side of it was a bin with massive blocks of bulk herbal teas, on the other side of it were huge packets of dried ginger and ginseng.

The label on the bin said "Any vitamin on this table $2 or less," and it was an incredibly diverse and mixed-up jumble of items.

The bottles indicated various dosages of single vitamins from the recommended daily allowance up through crazy mega doses, weird combo multivitamin mixtures, dozens of different types of supplements, along with multiple bottles with vague descriptive names such as Mega Multi Men, Heart Health, and Beautiful Hair, Skin, and Nails.

Seeing this pile of stuff for sale made me think about how much our patients are managing their own healthcare out in the world, without much guidance from us, figuring out what ails them, what they might need to do better, trying this or that to get themselves healthier.

Sure, much of this stuff probably isn't going to hurt them.

Many times, when my patients ask me if they should take huge doses of vitamin C, or they bring me some supplement that they saw advertised on late night TV to improve their memory, I tell them that the claims from these things are not substantiated, and that many of them probably just lead to expensive vitamin-infused urine.

But usually, this stuff nags at us as well, makes us think about the things our patients are not doing that maybe they should be doing, choosing instead to believe some huckster's claim or an unsubstantiated statement on a bottle of pills at the local pharmacy.

Yes, I would rather my patients get the vitamins and minerals they need from a healthy nutritious balanced diet, but many of them can't, due to living in a food desert or having limited resources, or just not knowing what they should actually eat.

And we've all had many patients tell us they didn't want to take a prescription medicine for something, but would rather rely on a "natural" pill that they got at their local health food store.

Written right there on the bottle for most of these things is that FDA disclaimer saying, "This product is not intended to diagnose, treat, cure, or prevent any disease."

Yet, that is what is being promised.

That being said, when I give my patient a prescription for a blood pressure medicine, I'm only hoping that by lowering their blood pressure I'm preventing long-term complications, but there are no guarantees, we are all playing a numbers game.

True, in general, we have randomized controlled trials, and we put a lot of faith in the science behind what we do.

Many of our patients take certain medicinal products that have cultural and historical relevance for them, following the traditions of their family, and who are we to say that what the medical system believes is true is always going to be better than what generations of people before them thought and did?

There are many out there who are trying to make a buck off people who are scared, may be less health literate, and are often desperate for something to help them sleep, control their anxiety or depression, improve their sex lives, stop their hair loss, help them lose weight.

In the practice of medicine, we've all seen patients come to us after trying things on their own for many years, sometimes asking for help, sometimes sick from the supplements and other natural things they've tried.

And we worry that when patients self-medicate, they may be avoiding coming in for necessary healthcare interventions from the healthcare system, such as the patient with hypothyroidism who has been trying to manage their various symptoms on their own. Or the patient with abdominal pain and weight loss who's been terrified of seeing a doctor and trying to treat things with something that someone on TV recommended, or a friend told them had helped them.

As partners with our patients on the journey through the healthcare landscape, we want and need to know what they are doing, out there in the world, in the vast majority of the time they spend not interacting with us.

That's where healthcare happens, that's where health and illness occur.

Getting our patients the education and information they need is critical, and despite limited evidence, we should do our best to investigate and counsel when we can, to try and help make sure that everyone's doing everything in their own best interest. Especially knowing there's almost no chance that a pharmaceutical company is going to do any randomized clinical trials on melatonin, selenium, omega-3 oils, co-Q10, methylene blue, or yohimbine.

We need to make sure our patients use these products with as much information as they can, and try and help guide them towards the things that we think are best for them.

When we got back to NYC, we returned the rental car and walked back to our apartment.

We passed a new storefront on Broadway, described as a "Hyper Wellness Center," offering IV infusions of multivitamins and supplements, to recharge the immune system, boost energy, cure a hangover.

Take it all with a grain of salt.