Joanna Cosgrove08.30.10
Pharmacists are among the most important wellness advocates a patient can have when it comes to medications, their side effects and their potential for interaction with other medicines. It should come as no surprise that they’re also among the most asked professionals about nutritional supplements too. With more consumers exploring supplements in an effort to take charge of their health, pharmacists have found it a necessity to become increasingly astute about the spectrum of herbs, vitamins and nutraceuticals.
“People are becoming more knowledgeable and aware of conditions and they’re researching more than they ever did in the past,” commented Bob Hartzell, RPh, CCN and owner of Catasauqua, PA-based Hartzell’s Pharmacy and Medical Equipment. “They’re looking for other things as either complementary or alternative ways for them to stay healthy and live longer.”
Mr. Hartzell said in recent years he’s observed an uptick in the frequency of supplement-related questions he’s fielded and attributed the phenomenon to a perfect storm of curiosity and access to information. “There’s increased media coverage that’s prompting more people to read about nutrition and more dietitians and clinical nutritionists, among others, promoting good nutrition and health on a variety of mediums,” he said. “I also think people have become frustrated with the lack of time physicians can devote to their needs [so they are taking matters into their own hands].”
Sophia De Monte, RPh, pharmacy manager for Costco Wholesale in Nesconset, NY, said she’s seen increased purchases of supplements that fall outside of one’s daily vitamin regimen. “In the past few years more people are purchasing supplements in addition to just vitamins which are more disease prevention specific or to treat an ailment,” she said. “While glucosamine and calcium supplements are popular, fish oils and omega 3 supplements have sharply risen in use. In general people are using supplements for anti-aging and wellness.”
Interestingly, she added: “I do find that many individuals come to the pharmacy asking about a supplement after having heard of it after watching or listening to either Oprah or Dr. Oz.”
Protecting and Advising
Both Ms. De Monte and Mr. Hartzell agree that their customers have been asking progressively pointed questions pertaining to supplement use, with the top questions often being “What is this used for?" and “What is the best dosage?”
Mr. Hartzell reported that his patients are typically in search of different perspectives on asthma treatments, options for GI issues, and wondering if supplements might help them if used in addition to whatever treatment they’re currently using. “I get a lot of questions on various health conditions especially those related to cholesterol issues, osteoporosis and constipation,” he said.
Ms. De Monte said that her customers often ask for her expertise in discerning between brands and formulations. “I am also asked to compare the difference between different products, such as Oscal versus Citracal or a glucosamine versus glucosamine with chondroitin or/+ MSM [as well as] what is the difference between vitamin D3 and D2,” she said. “Another question asked is whether the supplement will interact with any medications [or] will I be overdosing by taking different products together, a prime example would be a multivitamin, with a calcium supplement where they both contain vitamin D.”
But being able to dispense advice on any given supplement at a moment’s notice requires pharmacists to stay on top of research to keep up to date. “I may not be familiar with some of the lesser known products people ask me about, like specific kinds of mushrooms or some other product I might not be in tune with yet,” said Mr. Hartzell.
Ms. De Monte concurred, and added: “Being educated in all the different types of supplements can be time consuming, as each day more and more products are becoming available to the market.”
Issues related to product claims are among a pharmacist’s biggest annoyance when it comes to supplements. “The biggest problem I have with some supplements is the lack of reliable, unbiased and substantiated claims,” commented Ms. De Monte. “Some of the newer products on the market have not been tested regarding safety and drug interactions and therefore I do not feel comfortable recommending a product without good, strong resources in its favor or at least being on the market for two or more years. Many products have sub-therapeutic doses. I stay away from supplements that contain multiple ingredients other than a multivitamin with minerals.”
When asked a question about how a particular supplement might help a specific condition, Mr. Hartzell, who’s also a certified clinical nutritionist, will first preach the merits of a good diet in combination with supplements. “I’m big on moderation and believe that most of our health problems stem from the types of things we ingest. But I don’t think we can get all of the nutrition we need just by eating good,” he said. “We can’t get all we need of certain nutrients because of the way we farm and raise things. Omega 3s for example—we used to get them when the cows grazed, they got it in the grass and we got some in the meat. Nowadays they don’t graze and our bodies don’t produce omega 3s so we need to get them externally.”
In the same vein, Mr. Hartzell also believes pharmacists are uniquely able to give supplement advice regarding how supplements can help in combination with certain medications. “If, for example, they’re taking Lipitor, they can experience a suppression of the enzyme that produces CoQ10 so (as explained in the manufacturer’s literature) I can advise them to take some supplemental CoQ10,” he explained.
Given the proliferation of supplements and the pharmacist’s evolving role as the go-between for their customers, Ms. De Monte asserted that dietary supplements are uniquely positioned to become a “sub-specialty of pharmacy,” as it relates to understanding vitamins, herbals, nutraceuticals and their effects on the body and medications. “It is one more aspect of the practice, which for myself I do enjoy,” she said. “At times, consulting on these OTC products allows me more personal one-on-one time with my patients with a more meaningful dialogue.”
