Any conventional pharmaceutical medication can have side effects. These side effects are described and reported after drug trials and research studies have been conducted. Side effects are further detailed in the marketing of the medication. In fact, it is comical to watch a 30-second television spot on a particular medication. More than half of the spot is devoted to the often numerous side effects of the medication. Furthermore, information on interactions, usage in pregnancy, usage while breastfeeding, usage by pediatric patients and dosing limits are outlined and made available in standard references for doctors treating patients. Furthermore, the formulations of the drugs must satisfy strict quality control standards to ensure conformity. These medications regularly contain virtually uniform quantities and ratios of substances.
The aforementioned is crucial, according to a May 14, 2014 report on www.webmd.com,1 since prescription drugs are playing an increasingly larger role in U.S. life, with nearly half of all Americans taking one or more medications. More people than ever are taking medication for chronic conditions such as diabetes, high blood pressure, elevated cholesterol levels and depression. In fact, a report entitled, “Health, United States, 2013” the percentage of Americans taking prescription drugs has increased dramatically. The report indicated that from 2007 to 2010, about 48 percent of people said they were taking a prescription medication, compared to 39 percent in 1988-1994.
Why is this important to natural products retailers? As previously mentioned, all health food store staff can assume that half of their customers are on a medication of some sort. And about one in four of these customers taking prescription medications also take dietary supplements.2,3 And this number is on the rise. All dietary supplements on health food store shelves have demonstrated some form of pharmacologic action used to produce certain benefits. In fact, even supplements that do not have a documented pharmacologic action can affect the absorption, metabolism and disposition of other drugs. And this is something retailers have to be acutely aware of.
The research regarding interactions between dietary supplements and other medications is extremely fluid and rapidly and continually evolving. As we know, dietary supplements are not subjected to the same rigorous safety and efficacy trials and premarketing approval process required of prescription drugs. As a result, there is often incomplete knowledge regarding interactions between dietary supplements and drugs, especially among patients with chronic diseases.
Marketed products containing dietary supplements may vary significantly. Even different batches of the same product from the same manufacturer may differ in content and potency. Previously in the U.S., dietary supplement products may not have contained what they were labeled to contain.
Thankfully, In June of 2007, the U.S. Food and Drug Administration (FDA) released its final rule on current good manufacturing practices (cGMPs) for dietary supplements. For the first time, supplements would be distinguished from other food products and subject to their own distinct set of GMP requirements if sold or offered for sale in the U.S.
The FDA’s objective in drafting the final rule was to establish quality, process and recordkeeping controls to help assure that supplements manufactured or sold in the U.S. met specifications for identity, purity, strength and composition, and are manufactured under conditions to prevent adulteration. This goes a long way toward helping health professionals and retail staff to more effectively provide better guidance when it comes to taking both dietary supplements and prescription medications.
Ensuring Smart Supplementation
Retailers must never forget they are in the business of selling dietary supplements and understand what this truly means. The word “supplement” means something added. In this case, you’re “adding” to a basic healthy diet and lifestyle, or to a prescription medication or therapy to treat a medical condition. A dietary supplement regimen on its own will not necessarily cure or treat a particular condition. It’s also important to remember that not all supplements are beneficial, especially when taken in toxic doses or combined with other medications. And this is where things can get dicey for retailers. First and foremost, a retailer must counsel their customer to talk with a health professional they trust. Once this occurs, they have to evaluate the information presented by their customer and draw from their own knowledge to provide useful guidance. I’ve been a part of the natural products industry for more than 20 years. On numerous occasions I have seen the media create misleading headlines in an effort to demonize the great compounds that are a part of so many science-based, innovative, natural products formulas offered by our industry. That said, it is so important to direct your customers to work with health professionals who practice an integrative approach to health solutions. Retailers must also make every effort to research any product they may be considering recommending. Legitimate products will have data supporting efficacy as well as information on possible contraindications. Before you consider recommending a dietary supplement to a customer that is taking a prescription medication, ask yourself:
• Does your customer truly need this supplement?
• Is this supplement safe and supported by legitimate science for efficacy?
• Does this supplement interact with any drug or food your customer consuming?
• Do you know enough about this supplement?
If you’re considering using a dietary supplement in place of drugs, consult your health care provider first. And remember, just because the dietary supplement is “natural” doesn’t mean it will provide health benefits. Again, be sure any dietary supplement you are considering taking is supported by clinical data showing efficacy.
Nonetheless, retailers need to be aware of dietary supplements that may interact with prescription and/or over-the-counter medications. Taking supplements with medications (whether prescription or OTC drugs) can cause dangerous interactions. The following are some of the well-documented negative interactions retailers need to be aware of:
• Calcium: can interact with heart medications, certain diuretics and aluminum and magnesium-containing antacids.
• Coenzyme Q-10 (Co-Q10): can interact with anticoagulants, blood pressure medication and chemotherapy drugs.
• Echinacea: can change how the body breaks down certain medications in the liver.
• Ginseng: can increase the risk for internal bleeding when taken with anticoagulants or NSAIDs and may cause side effects when taken with MAOI antidepressants.
• Ginkgo biloba and vitamin E: can increase the risk of internal bleeding when taken with aspirin or anitcoagulants such as warfarin (Coumadin).
• Magnesium: can interact with certain diuretics, some cancer drugs and magnesium-containing antacids.
• Saw palmetto: can interact with anticoagulants and NSAID pain relievers.
• St. John’s wort: known to adversely affect selective serotonin reuptake inhibitor (SSRI) drugs (anti-depressant drugs), blood pressure medication and birth control pills.
• Vitamin K: can interact with blood thinners such as warfarin (Coumadin).
With nearly half of all Americans taking one or more medications, and approximately half of Americans aged 65 and older take five or more medications, retailers need to do their due diligence when advising their customers on possible interactions with medications. Always advise your customers to talk to a health care professional, regardless of how well you believe you understand the various interactions. Truth be told, unless you are a health professional, it is not your place to make these recommendations. The well being of your customer should not be in your hands. It should be in the hands of their doctor. VR
2. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA. 2002;287:337–44.
3. Gardiner P, Graham RE, Legedza AT, Eisenberg DM, Phillips RS. Factors associated with dietary supplement use among prescription medication users. Arch Intern Med. 2006;166:1968–74.
Mark Becker is an account manager for Vivion, a raw materials distributor, based in Vernon, CA. He has worked as a natural products sales and marketing executive for 15 years. Becker has written more than 300 articles and has hosted or been a guest on more than 500 radio shows. He obtained a bachelor’s in journalism from Long Beach State University and did his master’s work in communications at Cal State Fullerton. For almost 30 years he has participated in numerous endurance events, including more than 150 triathlons of Olympic distance or longer, 102 marathons and numerous other events including ultramarathons and rough water swims from Alcatraz to the mainland. He has relied on a comprehensive dietary supplement and homeopathic regimen to support his athletic, professional and personal endeavors. Follow Mark Becker on Facebook at Facebook.com/marklbecker and on twitter at Twitter.com/becker_mark. For more information, access www.vivioninc.com or www.EnergyatLast.com.