The Role of Nutritionists: Bridging the Gap Between Supplements and Patient Safety
Empowering Informed Supplementation for Optimal Health and Safety in Clinical Practice
In today's health-conscious world, dietary supplements have gained immense popularity, especially during the Covid-19 era. This popularity has lead to an explosion of products that have been bought to market with claims of various health benefits.
Supplements are readily available over the counter, however in more recent years specialist supplements are being sold through distribution companies and consumers are only able to access products via a referral from suitable health professional.
There is growing concern about the safety and appropriate usage of over the counter dietary supplements, particularly when they are being purchased online through unverified websites or though Amazon where there does appear to be some issue around the selling of counterfeit products. It is also important to be aware of the proliferation of multi-level marketing companies that assert the existence of clinical studies supporting the efficacy of their products. A closer examination of these studies often reveals a concerning trend in that they are frequently funded by the very companies producing them. This raises questions about potential bias and the possibility of misrepresented publication of results. In light of this, it becomes crucial for buyers to exercise caution and vigilance when considering such claims.
Several concerns are associated with purchasing supplements over the counter, including:
Lack of regulation:
Unlike pharmaceutical drugs, many dietary supplements have not gone through clinical trials. Whether you agree with the current setup of clinical trials in the pharmaceutical world or not, this should not detract from the fact that supplements, like medications exert a pharmacological effect within the body. This oversight in regulation means that the safety, quality, and effectiveness of supplements can vary significantly in the marketplace.
Lack of consideration for drug / nutrient interactions:
Many supplements can interact with medications, exacerbate underlying health conditions, or cause adverse side effects. Without proper assessment and monitoring, individuals may unknowingly put their health at risk by combining supplements that are contraindicated or consuming excessive dosages.
Some examples of drug nutrient interactions include
Warfarin and Vitamin K:
Taking Vitamin K while on warfarin medication can lead to reduced coagulation and increased risk of bleeding. This can also be the case if you increase dietary K, which is why some physicians prefer to use other forms of blood thinners that don’t interfere with the vitamin K pathways
St Johns Wort and antidepressants:
St Johns Work works by inhibiting the the re-uptake of serotonin (5-HT), taken together with antidepressants increases the risk of developing potentially fatal serotonin syndrome.
Activated charcoal:
Can interact with any medication, and if taken together charcoal will reduce or even prevent the absorption of the medication.
Grapefruit and multiple medications:
Grapefruit and grapefruit juice can interact with numerous medications due to the presence of certain compounds that inhibit the activity of an enzyme called cytochrome P450 3A4 (CYP3A4). This enzyme plays a crucial role in the metabolism of many drugs
Supplement excipients:
Supplement excipients are the ingredients used in supplement formulations to enhance stability, improve absorption, or facilitate the manufacturing process. While these excipients are generally considered safe by supplement manufacturers, some individuals may have sensitivities or allergies to specific excipients.
Expedients that I generally get my patients to avoid, particularly if they experience PoTS or MCAS include:
Magnesium Stearate
Citric Acid
Silicon / Titanium Dioxide
Guar Gum
Carrageenan
Sweeteners
Maltodextrin
Lactose
Soy/ Soy bean oil
Sodium Triphosphate
Potassium Triphosphate
Talc
Inaccurate or Misleading Claims:
Marketing strategies in the supplement space often make bold claims that may not be substantiated by scientific evidence. Such misleading information can easily deceive consumers, giving them a false impression that supplements alone possess the power to cure or prevent diseases. Consequently, individuals may disregard the importance of seeking professional medical advice, potentially jeopardising their overall wellbeing.
How nutritionists can mitigate risk
Nutritionists are able to conduct a comprehensive dietary analysis, which is paramount in understanding the extent of a patient's vulnerability to nutritional deficiencies resulting from their diet. Furthermore, personalised assessment allows for the identification of other areas in need of specific support, such as chewing food appropriately, dedicating ample time to consume nourishing meals, or addressing dental and digestive health concerns. Through thorough assessment of symptoms, signs, and blood work, any expressed nutritional deficiencies can be identified, which will help prioritise interventions and help determine whether supplementation is indeed required.
Nutritionists should only be making supplement recommendations based on the evidence-base and through conducting a through drug nutrient interaction check. This way patients can make informed choices, secure in the knowledge that the suggested supplements have undergone comprehensive studies to establish their efficacy and safety when integrated into a comprehensive health strategy.
Regular follow-ups, accompanied by ongoing monitoring and necessary adjustments, play a vital role in promptly addressing any potential side effects or interactions that may arise. This diligent approach to care significantly minimises the risks associated with self-administration, ensuring optimal patient safety and well-being.
Tools to support nutritionists
Using AI to detect Drug/Nutrient interactions
A new database describing the molecular atlas and pharma-information of drugs (DrugMAP) is a free resource available to every one which provides the following
A comprehensive list of interacting molecules for over 30 000 drugs/drug candidates,
Gives the differential expression patterns for over 5000 interacting molecules among different disease sites
Details ADME (absorption, distribution, metabolism and excretion) relevant organs and physiological tissues
A comprehensive and precise network containing over 200 000 interactions among drugs and molecules.
The databased can be accessed here https://idrblab.org/drugmap/
One of the great aspects of this platform is its provision of detailed information regarding the molecular interactions and metabolism of drugs at their target sites. Fig 1, shows that I conducted a search for abiraterone acetate, a medication for prostate cancer and it retrieved data regarding the drug's therapeutic target, transport mechanisms, and metabolic pathways. Fig 2, shows the molecular interactions atlas of the drug, and this allows me to explore different functions and access valuable information on medications and other molecules that undergo metabolism via similar pathways.
Figure 1: DDT, DTP and DME of abiraterone acetate
Figure 2: Molecular interaction atlas of abiraterone acetate
The Natural Medicine Database
The is a paid subscription service, however membership access is usually given to Nutritionists who are registered with a professional body. The database allows the user to conduct a comprehensive drug nutrient interaction check and provides links to the evidenced based research papers. Users also gain access over 1300 monographs on natural ingredients, including vitamins, herbs, minerals, non-herbal supplements, naturally sourced chemical compounds, and foods. Each monograph provides evidence-based guidance on effectiveness potential safety concerns and interactions. This platform has been an invaluable tool to my clinical practice for 13 years.
https://naturalmedicines.therapeuticresearch.com/
While it cannot be argued that some dietary supplements can offer potential benefits, their availability over the counter without appropriate regulation poses risks to consumers.
By involving nutritionists as intermediaries, this will ensure that there is a higher level of safety and efficacy in supplementation practices. By working with a nutritionists patients have access to personalised assessment, evidence-based recommendations, monitoring, and integration with overall nutrition, all of which are crucial for overall well-being.
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