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) labeled as an unethical practice, but we are here to outline why that is faulty reasoning and how you can present your services to patients in a way that also communicates why they are valuable and helpful.
WHY PROVIDE SUPPLEMENTS DIRECTLY TO PATIENTS?
Reason #1: Efficacy
Very often, nutritional supplements do not contain what they are said to contain. Dr. den Boer shared an experience from when he first began recommending supplements to his patients. He sent a batch of supplements 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 you observe that 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.
If you are not offering the supplements directly out of your office, then offering specific product recommendations will ensure the greatest treatment success amongst your patients. With nutritional supplements, you must be certain of the quality and efficacy of the ingredients.
Without specific recommendations, patients are likely to head to a grocery store or big box pharmacy shelf, where they are unlikely to have access to quality options. Product labels alone also do not provide the information necessary to make a good decision. Because a plethora of products are available, and only a few of those are high-quality and efficacious, it is worth guiding your patients to specific options you have personally vetted.
Reason #2: Safety
Dr. den Boer shared a recent patient presentation of severe myalgia and chronic fatigue symptoms. The symptoms were likely triggered by 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 mitochondria dysfunction the patient was experiencing.
As clinicians, we cannot do stability testing on all fish oil products that are available to patients over the counter, but we can give product recommendations based on reputable, vetted companies that we work with.
It is our responsibility to ensure the products we recommend are safe. Offering supplements in our office ensures that patients get products that we trust and are most likely to support our patients’ health.
HOW DO YOU CHOOSE 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.
HOW SHOULD YOU TALK TO YOUR PATIENTS ABOUT THIS?
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.
IS IT UNETHICAL TO EARN MONEY FROM SUPPLEMENT SALES?
It is no less ethical than a surgeon who makes money from referrals or completing 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 healthcare products in the right dosages for specific outcomes. Practitioners additionally provide patient education by explaining to the patient why and how the 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.
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.
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. A whole tribe of people have 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.
This blog post has been adapted from a video series in which Dr. den Boer and Dr. Saxena discuss sticky topics within functional, integrative and lifestyle medicine. More content from this series will become available to Lifestyle Matrix Resource Center members.
Shilpa P. Saxena, MD
Dr. Saxena is a Board-Certified Family Practice physician whose passion and purpose come to life through sharing her innovative patient education and practice management solutions in her classic ‘keep it simple’ style. She serves as Faculty with the Institute for Functional Medicine, the Arizona Center for Integrative Medicine, the University of Miami, Miller School of Medicine, the Metabolic Medical Institute at George Washington University and most recently, joined the Lifestyle Matrix Resource Center serving as the Clinical Expert for the CM Vitals Program. Dr. Saxena is an expert in the Group Visit medical model, creator of Group Visit Toolkits, and co-author of The Ingredients Matter: India.
Adrian den Boer DC, ND
Educated in both the Netherlands and the United States, Dr. Adrian den Boer 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.