It’s important for providers to be aware of all dietary supplements, if any, that their patients are taking due to the potential for interactions with other supplements, medications, and some medical conditions. In addition, some products might contain unsafe ingredients, including ones legitimately available only through prescription, which can result in adverse reactions. Even products with documented health and/or performance benefits for specific conditions—such as iron, vitamin D, whey protein, and creatine—should be evaluated holistically.
Just as you would ask about a patient’s medications as a part of the medication-reconciliation process to determine potential risk, remember always to ask about his or her supplement use too. Although having your patient bring his or her supplements into the office is the best way to get this information, the guidelines here will help you obtain a comprehensive dietary supplement history.
Ask your patients:
- ▢ Are you currently taking any dietary supplements? Think about the different forms your supplements might come in. Are you taking any of the following:
- Bars
- Capsules or tablets
- Chews or gummies
- Gels or goos
- Liquids or extracts
- Pills
- Powders
- Shakes
- Be sure to describe examples of dietary supplements—such as single- and multi-vitamin/mineral supplements, protein powders or shakes, fish oil, probiotics, fiber powders or gummies, “pre-workouts,” testosterone boosters, and nootropics (cognitive enhancers)—to get the “whole picture.”
- ▢ Are you currently using botanicals and/or other products that contain caffeine, such as coffee, tea, soda, energy drinks/shots, or “pre-workouts”? (See the OPSS article about caffeine for names of other sources of caffeine.)
If your patient answers “yes” to either of the questions above, ask the following questions to get more information. For each supplement, ask:
- ▢ What is the name and brand of the product you are taking? Where do you usually purchase the supplement?
- ▢ How do you think the supplement helps you? (Service Members might take supplements for different or multiple reasons, such as to improve health, enhance performance, increase muscle mass and strength, gain or lose weight, enhance sexual activity, improve energy or focus, and/or relieve stress or anxiety.)
- ▢ Do you know if your product has been tested by a reputable third-party organization? (Visit the OPSS article about third-party certification for examples of prominent third-party certification organizations.)
- ▢ Do you “stack” or otherwise combine supplements to enhance the desired results? If so, which supplements do you combine?
- ▢ How much do you take at one time? How often do you take it? And how long have you been taking it or do you plan to take it? Do you ever exceed the dose recommended on the label or packaging?
- ▢ Have you experienced any unintended effects such as tingling, skin flushing, rash, nausea, dizziness, headaches, muscle and/or joint aches, or rapid heart rate after taking any of these products?
Note: Report all adverse events to FDA.
Remember to document your patient’s responses in his or her medical record; then perform and document a full medication reconciliation to reduce the risk of adverse events. Visit Natural Medicines (using the “Find out how your supplement rates” button on this page) for information about potential interactions between dietary supplements and drugs, other dietary supplements, medical conditions, lab tests, and more. If you don’t yet have an account with Natural Medicines, you can register for a free account using your .mil email address.
Updated 18 September 2017
