Why you should be careful when adding supplements to your routine
A booming national industry means dietary supplements generally aren’t hard to find or purchase. But local experts have some cautionary words for older adults looking to add supplements to their health regimens — especially if they’re already taking prescription medications.
Preliminary research
“The problem with the supplement industry is that it is not FDA regulated,” Lori Newcomb, a board-certified geriatric pharmacist and lead consultant pharmacist at Guardian Pharmacy of Atlanta, told The Atlanta Journal-Constitution.
Seniors considering adding a supplement, she said, should determine whether the substance is certified with the United States Pharmacopeia, the drug compendium released by the United States Pharmacopeial Convention.
“If the supplement is not USP certified, then you have no idea its origins, how it’s manufactured, the concentration of the active ingredient that you want, so any supplement you take can be extremely dangerous, especially if you’re on prescription medication,” Newcomb said. “To me, it’s like playing roulette.”
Supplements can magnify or minimize the effects of medications in the body, she said.
“Many, many supplements will make other medications either not clear appropriately or clear too much,” she said. “So, you’re either not getting a full dose of your prescription medications, or you’re getting too much because those supplements are interacting with your prescription drugs.”
Dr. Anna Mirk, a geriatrician and associate professor of medicine with the division of geriatrics and gerontology at Emory School of Medicine, agrees that consumers should look for USP-verified supplements or those bearing the National Science Foundation international stamp.
“If a supplement has those stamps on them, they’re more likely to contain what they say they contain,” she said.
Interactions
Older adults who take any type of medication should be particularly careful when considering supplementing. Here are a few types that can interact with medications:
- Ginkgo biloba: This supplement is a popular non-prescription treatment for depression. But many seniors are on non-steroidal anti-inflammatory drugs for arthritis or pain, which carry an increased risk of bleeding — a risk that rises when they interact with ginkgo. Ginkgo can also interact with the blood thinner Coumadin, which many patients with atrial fibrillation take, Newcomb said.
- Supplements beginning with a G: According to Mirk, a good rule of thumb is “if it starts with a G, it makes you bleed more.” Like ginkgo, ginger and garlic can interact with certain blood thinners and with NSAIDS like ibuprofen.
- Saint John’s wort: Patients often take this supplement for depression, but it can cause negative effects combined with selective serotonin reuptake inhibitor-classed drugs, which doctors often prescribe as antidepressants. Serotonin syndrome can result from these interactions. Saint John’s wort can also interact with certain heart medications. It can have adverse effects in combination with antiretrovirals, so HIV patients should avoid it, Mirk said.
Older people undergoing cancer treatments also need to be aware when it comes to supplements.
“Because those chemotherapy drugs are so specific, you really don’t want to have anything else on board that could be a potential interaction and could cause that drug to be less effective,” Newcomb said.
Check first with your provider
The research process on supplements should always include communication with a health care provider. Newcomb recommends older adults make a connection with their pharmacist.
“Pharmacists know supplements no matter whether they’re geriatric pharmacists or not,” she said. “Your pharmacist should be your trusted friend and just a wealth of information.”
For various reasons, Mirk said, consumers might start taking supplements on their own, without physician oversight.
“Oftentimes, patients may have health beliefs, or they may have heard from a friend or seen on TV, and they feel like certain supplements might be helpful for them, and they kind of, just on their own, start taking those,” she said.
Popular supplements she’s seen make their way into patients’ daily routines include Zinc, vitamin C and echinacea, as well as those claiming to offset the effects of Alzheimer’s disease or memory issues. These might be products older adults see on TV, she said.
Going over full medication regimens, including any supplements, with a provider is something Mirk advises. Sometimes, a doctor might prescribe a supplement for a patient with a deficiency, she said. She listed calcium and vitamin D as having possible positive effects for osteoporosis patients. Kidney disease patients, she said, can also require dietary supplementation.
A qualified provider can also help with decisions that can save money. Some supplements can be expensive, non-FDA approved, and come with little evidence for efficacy, Mirk added.
“Some supplements are not going to cause harm, but they’re just wasting money.”
Mirk said memory supplements can fall into this category.
“Really, we should be telling patients to save their money and do things that will help their memory like exercise, eat a healthy diet, control their diabetes, their blood pressure. Those things are harder than taking a pill,” she said.
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