This blog post has been adapted from a video series in which Dr. Adrian den Boer and Dr. Shilpa P. Saxena discussed sticky topics within functional, integrative and lifestyle medicine. More content from this series is available to Lifestyle Matrix Resource Center members.
As a functional medicine provider, you likely have experienced, or will at some point experience, discomfort and uncertainty around how to best provide supplement recommendations. A common concern amongst practitioners is that they do not want to come
off as supplement “pushers” by having a supplement shelf or mini shop in their offices.
Offering supplements directly to patients for a fee can be (incorrectly) stigmatized. If you're providing this valuable service to your patients, we hope you can feel confident that it benefits their health for several reasons.
Benefits of Providing Supplements Directly to Patients
Very often, nutritional supplements do not contain what the label says. Dr. den Boer shared an experience with this issue from when he first began recommending supplements to his patients. He sent a batch in for independent testing, and the vitamin C supplements averaged only about 10-20% of the active ingredient compared to what was listed on the label. Even more suspect were the probiotics, where only two out of seven tested contained live activity.
If your patients do not respond how you would expect based on the evidence available, consider that the supplements they are using are less potent than labeled. It's important to choose manufacturers that have a record of efficacy and quality ingredients.
Also, if you are not offering the supplements directly out of your office, then providing specific product recommendations will ensure the greatest treatment success amongst your patients. Without specific recommendations, patients are likely to head to a grocery store or big box pharmacy shelf, which may not offer high-quality, efficacious options. Product labels alone do not provide the information necessary for your patients to make an informed decision. Because an overwhelming number of options are available, it is worth guiding your patients to specific products you have personally vetted.
Dr. den Boer shared a patient presentation of severe myalgia and chronic fatigue. The symptoms may have been triggered by a contaminated, over-the-counter, high-dose fish oil supplement the patient was taking. In this case, it's difficult to know the quality of the oil and whether or not improperly distilled contaminants, such as mercury, could lead to patient symptoms. An unvetted supplement likely created more issues for the patient, leading Dr. den Boer to have to address the resultant mitochondrial dysfunction the patient was experiencing.
While clinicians cannot be expected to do stability testing on all fish oil products that are available to patients over the counter, they can give product recommendations based on reputable, vetted manufacturers. Offering supplements in your office ensures that patients use safe, trusted products that are most likely to support their health with predictable outcomes.
Choosing the Best Supplements for Your Patients
You will save your patients and yourself time and money if you stick with brands that conduct quality batch testing or have their products verified by a third party. Supplements available at grocery stores and big box pharmacies will usually not meet those standards. Once you have vetted a product, it can help to recommend that same product to your patients consistently. For example, if you know a specific fish oil supplement reliably changes lipid parameters, then you know that you may need to find another solution if lipid parameters do not improve for a particular patient taking the same supplement.
Explaining the Benefits to Your Patients
Explain to your patients that if they use untested or unvetted supplements and their symptoms do not improve (or get worse), then you will be less able to identify the reason. Suppose they use a supplement that has been tested and proven to contain what it claims to contain. In that case, you will be able to more definitively determine if the supplement was unhelpful so that you can explore together with your patient other potential root causes or solutions.
Ethical Considerations for Selling Supplements
Selling supplements to your patients is no less ethical than a surgeon who makes money from referral procedures or practitioners who charge for follow-up office visits. Offering supplements is a service, and it takes effort, time and money to accumulate the knowledge to curate the best therapies and understand when to apply them. Surgical procedures require a lot of time and money to learn to perform, and functional medicine services are no different.
By providing these services, we help patients receive effective, safe health care products in the right dosages for specific outcomes. Practitioners additionally provide patient education by explaining why and how these therapies are expected to work for them. It also is more convenient for patients since many individuals report spending copious amounts of time shopping for and researching supplement options on their own with poorer outcomes.
As a lifestyle or functional medicine physician, you offer a valuable service with verifiable outcomes through clinical evaluation or laboratory testing. That is proof in the pudding.
The Bottom Line
If you are struggling with these supplement questions while you're growing your functional medicine practice, it's important for you to know that you have support. Your peers have already been prescribing supplements successfully, and we know it has both clinical and financial benefits. Providing safe and effective supplements to your patients can achieve both of those benefits ethically.
Shilpa P. Saxena, MD, IFMCP is a board-certified family physician whose passion and purpose come to life through an uncompromising dedication to the ‘health’ and ‘care’ aspects of healthcare. Beyond continuing to practice as Medical Director of Forum Health Tampa, Dr. Saxena serves as Chief Medical Officer at Forum Health. In addition to over 15 years of progressive patient care, Dr. Saxena is Faculty with the Institute for Functional Medicine, as well as contributing faculty or physician educator roles with the Andrew Weil Center for Integrative Medicine, George Washington University’s Metabolic Medicine Institute, University of Miami Miller School of Medicine’s Department of Family Medicine and Community Health, and Universidad San Ignacio de Loyola (Lima, Perú). She joined the Lifestyle Matrix Resource Center team over 10 years ago to help providers, patients and practices around the world deliver effective shared medical appointments through her Group Visit Toolkits. She also continues to serve as the Clinical Expert for the CM Vitals Program.
Educated in both the Netherlands and the United States, Adrian den Boer, ND, DC, IFMCP is a board-certified and licensed Naturopathic and Chiropractic physician. In addition, Dr. den Boer is fully certified as a functional medicine doctor. Dr. den Boer has treated over 10,000 patients successfully by utilizing multiple resources to manage patient care. Most recently, he joined the Lifestyle Matrix Resource Center as the Clinical Expert serving the MSK Solutions Pain Recovery Program.