1. The patient must
bring in all vitamins, minerals, enzymes, herbs, amino acids and other
nutriceuticals he or she has, whether they currently take them or not.
The reason I also want products not currently used is to see if the patient
has anything beneficial or detrimental on the shelf.
2. Ask the patient
a. the amounts (number
of tablets or capsules) consumed per dose;
b. the number of doses per day;
c. the number of days dosed per week;
d. how the dose is delivered (with or without food; if with food,
before, during or after the meal);
e. side-effects experienced.
3. Read all labels carefully.
a. Determine the patient's
daily dose (the number of reported tablets or capsules taken multiplied
by the number of daily doses).
b. Compare what the patient takes to the label and determine if the dose
is correct. (It is not uncommon for the amounts on a label to be for more
than one pill, or for patients to assume what is listed on a label is
for only one pill. For example, a calcium product may state that five
tablets provide 1,000 mg of calcium citrate. The patient may have been
taking two tablets daily, thinking he or she was ingesting extra calcium,
when, in fact, they were getting 60 percent less than the recommended
c. Determine the product's expiration date.
4. Use a reference text to rule out any contraindications with prescribed
medication the patient currently uses.
5. Open each bottle
and examine the contents.
a. Are the capsules or tablets uniform in size and color?
b. Is there evidence that the product is breaking down (cracks in the
c. Determine if the smell is abnormal; if strong or foul smelling, ask
the patient if the smell has changed with time.
6. Ask the patient where the products are stored.
a. Is there a possible
heat contamination for a product stored near the kitchen stove?
b. Is there possible moisture contamination for a product stored in the
7. If you suspect a product may not be fresh, whether expired or not,
ask the patient:
a. when the product was purchased;
b. if the product could possibly have been exposed to unfavorable environmental
c. if the size, color or uniformity of the capsules or tablets has changed
since the date of purchase; and
d. if he or she has ever felt a difference when using the product correctly.
Reasons Patients Use Supplements
My next step is to
ask the patient why he or she uses the products. The most common reasons
general prevention or "insurance";
prevention of a condition or disease that runs in the family;
prevention of a condition or disease publicized by the media, or on advice
an untrained friend, acquaintance or family member;
a noticeable difference is felt when the product is or is not taken;
primary therapy for a diagnosed condition;
complementary therapy (along with medication) for a diagnosed condition;
primary therapy for an undiagnosed or self-diagnosed symptom complex.
Goals of Assessment
1. Rule out serious pathology - undiagnosed or misdiagnosed.
2. If the product
is used as a primary therapy for a diagnosed condition, ensure that the
a. Knows the consequences
of substituting the dietary supplement for prescription medication.
b. Ingests the correct dose of the correct product (for a given condition)
at the correct time, with a formula that is bioavailable, noncontaminated
and not expired.
3. If the product is used as a complementary therapy with prescription
medication, use a referenced text (PDR or Nutritional PDR) to ensure that
the supplement does not interfere with the prescribed medication.
4. If the product
is used as primary therapy for an undiagnosed or self-diagnosed symptom
Diagnose the condition,
or refer to a qualified practitioner who can.
If the diagnosed condition can be safely managed with dietary supplements,
see 2b, below left.
5. If used for general prevention or prevention of a specific condition:
a. Ensure the product
is adequate for the desired needs.
b. See 2b.
6. If used due to some form of media report, or advice from an untrained
a. Make sure what
the patient is taking is really necessary.
b. Refer to an appropriate allied professional, if indicated. (See 2b
if use of the product is indeed warranted and supported with evidence-based
7. If a product is unnecessary, contraindicated, excessively dosed, or
potentially harmful, causing imbalances with other nutrients or interactions
with medications, do not hesitate to give appropriate counsel:
a. Advise and recommend
that the patient discontinue use immediately.
b. Clearly document all recommendations in the chart notes.
When deciding if a
new product or substance is worth recommending to a patient, verify the
1. Human research
has been conducted at the target group (age, sex, disease or condition,
2. The doses studied
are the doses that are recommended.
3. Forms of the product
contain the same form of nutrient used in the study.
4. The studies or
trials are blinded.
5. The funding is
provided from neutral parties. (Product donations, if made, are done so
with no strings attached.)
6. The actual trials
and published data were by investigators free of financial ties.