I'm going to let you in on a little secret: Doctors don't know everything.
The word doctor itself originated as an agentive noun of the Latin verb docēre, meaning 'to teach'. That 'teaching' part is something that a lot of modern doctors have forgotten. In our haste to get patients in and out of the office in as little time as possible, many of us have bypassed the teaching part all together in order to go directly to that little white prescription pad.
The big losers in all of this is that the lovely little town doctors of yesteryear are a dying breed and insurance companies and actuaries are dictating how doctors treat their patients. This is compounded by the fact that the advent of the internet has turned our patients into armchair researchers who present to our offices with pages of print-outs on what they have self-diagnosed themselves with, or on treatments that they would like to explore with or without our help. And so, in our haste to process patients quickly, we find that it is easier to NOT recommend something that we are unfamiliar with than to look into it further for our patients.
I'm not saying that there are not great doctors out there, because that couldn't be farther from the truth, but the unfortunate statistic stands that the average doctor received only 23.9 hours of education in nutrition during their entire medical school career.1 Nutrition is a broad term -- and typically involves learning about the wonders of fat, protein, and carbohydrate metabolism and recognizing overt signs of individual nutrient deficiency. Very, very few doctors can claim that they learned much, if anything, about specific dietary supplements or herbs.
So when you go to your doctor and consult with them about the safety of a dietary supplement, be prepared that your doctor's knee-jerk reaction to your question may be to deny, deny, deny. Here is my rundown on the most common arguments you may hear from your doctor on why you shouldn't take a dietary supplement:
- Argument 1: Dietary supplements are not regulated by the FDA, therefore they are unsafe. This is the same FDA that brought you Raxar, Tequin, Duract, Vioxx, Bextra, sibutramine, dexfenfluramine, Rezulin, Avandia -- all drugs they deemed 'safe' but had to pull off the market because of overwhelming adverse reactions, including death. The same FDA that approved all of those artificial joints, repair mesh, and surgical hardware that you see mentioned in attorney commercials (and now subject to mass recall and class-action lawsuits) every time you turn on your TV. The same FDA that routinely extorts nutritional supplement companies.2 The same FDA that routinely hires all of its upper level and leadership positions directly from drug companies (or drug companies hire directly out of the ranks of the FDA in a well known, 'I'll scratch your back if you will scratch mine' system). I think I made my point. The fact that the FDA declares something to be safe is more indicative of a multimillion dollar payout than bonafied, objective science. But I digress, the FDA does not regulate dietary supplements per se but they do heavily regulate the manufacturing facilities that dietary supplements are made in and strictly regulate what companies say about dietary supplements. That is why it is illegal for a cherry farmer to post on his website that cherry juice is known to reduce the uric acid crystals associated with gout, but Pfizer can spend millions of dollars a year advertising how Viagra can give you enough wood to build an ark.
- Argument 2: I've treated dozens of patients that have _______ [insert health horror story: liver failure, kidney damage, brain cancer, tennis elbow, died, etc.] from taking 'natural' supplements. I will be the first to agree that not all supplements are safe. Furthermore, just because something is natural, does not mean that it is without risk, but I will also be the first to point out that 20,500 people died in a given year from FDA approved medicines and zero people died from 'unapproved by the FDA' supplements.3 If you look at Adverse Drug Reactions (ADRs) in general, the FDA reports that there are over 2 million ADRs yearly resulting in ~100,000 deaths, making it the 4th leading cause of death ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents, and automobile deaths.4 Yet according to the Governments own Government Accountability Office (GAO) , between 2008 and 2011, the FDA received 6,307 Adverse Event Reports (AERs) for dietary supplements, this averages just over 1500 per year yet, according to the GAO's own report, over half of the US population takes dietary supplements. This means that nearly 200 million people are taking dietary supplements in a given year, yet only 1500 people report an adverse reaction. Of those 6307 AERs, only one death was reported and it was "vaguely and probably irrelevantly concurrent with an “unknown dietary supplement or homeopathic agent”—with no deaths reported before 2009. By way of contrast, the same report shows that FDA-approved drugs caused 80% of Poison Control fatalities. More than 100,000 calls to Poison Control Centers, 56,000 emergency room visits, 2,600 hospitalizations, and nearly 500 deaths each year are attributed to Acetaminophen (Tylenol) alone."5 So, forgive me if I call 'BS' on your doctor personally treating dozens of people that had organ damage from the supplements they bought at the health food store. It is statistically impossible.
- Argument 3 : Supplements don't do anything but give you expensive urine and the manufacturers just want you to spend more and more money with them. Cough, cough, pot calling the kettle black! Hmmm, and big pharma has your best interests at heart? What about those hospitals that bill you $20 for that single aspirin or ibuprofen tablet? No matter how you break it down, supplements do not compete on any level with the drug companies. The top 50 pharmaceutical companies are responsible for $610 billion of annual revenue.6 Compare that to the nutritional industry which had revenues that topped $32 billion for dietary supplements during the same year.7 The simple fact is that most supplements cost a mere fraction of their drug counterparts, and no one makes a lot from individual dietary supplements because they are natural substances and therefore cannot be patented. That is the exact reason why you don't find dozens of double-blind, placebo-controlled trials on supplements - there is no money in it. A company isn't going to hire a team of researchers and spend tens of thousands (if not more) to do a trial proving the efficacy of green tea extract, when a) they legally can't promote any results that prove the supplement did something, b) the margins or mark-up on supplements and raw materials is comparatively very low, and c) all of the other manufacturers that sell green tea extract could use the same data to sell their product (why help your competition?). There is no practical advantage for them to pay for studies. Furthermore, most supplement manufacturers would be required to identify or disclose the exact ratios of ingredients in their proprietary formulas in published data otherwise it would not be reproducible by third parties. Given the low margins and lack of patents, you can see why supplement manufacturers would be reluctant to disclose the only information that protects their trade secrets. Personally, I am more suspect of the doctor writing prescriptions for that expensive new statin drug that just so happens to sponsor their annual continuing education Caribbean cruise.
- Argument 4: Supplement companies pay big money to Google to cover up negative stories about adverse reactions. Please!!! Let.me.repeat: 610 Billion vs. 32 Billion, and 50 big players (companies) vs. tens of thousands. The doctors that would make this asinine statement are the same ones that deny that vaccine manufacturers aren't in it for the money. The same doctors that figure you must have been born with a metformin deficiency but taking chromium to regulate your insulin levels is 'crazy'. There isn't a supplement manufacturer out there that has enough disposable funds to pay off Google or any other search engine. Remember, the mainstream media covers up pharmaceutical negligence all of the time, after all, who is their #1 advertising group? The next time you watch television, grab a pen and a piece of paper and keep a running tally of every supplement commercial for every drug commercial. That alone ought to tell you who controls the media.
- Argument 5: Supplements don't 'cure' you. They are right on that. It is against the law for a supplement manufacturer to ever report or claim that their supplements 'did' anything. That is why every supplement advertisement or piece of literature that you will ever see contains the disclaimer :This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease. It is also why supplements rely on anecdotal testimonials of patients to promote them. But I would also hazard to say that the vast majority of drugs don't cure anything either. They simply address one set of symptoms, often resulting in another set of symptoms, which results in the need to take ever-increasing amounts of medications. This is the real reason why the average American takes 10 prescriptions per year. You are given one medication for one symptom, which results in a drug-induced nutrient depletion, which causes your blood pressure to rise, so you are given a medication for that, which affects your kidneys, so you are given a new medication for that, which constipates you and gives you headaches, so you are given two more medications for that, and before you know it you are taking 10 drugs per day and no one has ever checked for any drug interactions, you end up with liver damage from your 10 medications, but your doctor is more concerned about that weight loss supplement that might help you lose 50 lbs and therefore not need any of those aforementioned medications.
In my 10 years of having a nutritional based practice, I have run into all sorts of doctors. Some are ecstatic that their patients are being proactive and making changes to improve their health. Some deflect nutritional questions under the guise that it isn't their specialty, so they would rather not comment on it. Others get their ego all tied up in a knot when their patients seek advice from other practitioners. Some are so indoctrinated at the Church of The Mighty Pharmaceutical that they simply cannot rationalize anyone questioning their sacred doctrine. Regardless of what type of doctor you have, you have the right and the obligation to take ownership of your own health. If that means that your doctor isn't familiar with the ingredients in a supplement that you would like to take, find someone else to help you. That may be another doctor, it may be your pharmacist. You may simply need to reword how you ask your question. Instead of saying, "Hey Doc, Do you approve of this supplement?", you should ask, "Is there anything in this supplement that would be contraindicated with my medications or health history?" You may not think that there is a big difference between these two questions, but there is a world of difference legally. The first requires their medical opinion and approval, the second only is indicative that there is no overt contraindications and does not require the physicians approval. I have seen some doctors spouting off anti-supplement rhetoric on their blogs and Facebook pages lately, and it saddens me greatly. Reading their posts, they are the ones fear-mongering and creating hysteria instead of offering genuine support or information to the public. The Hippocratic oath centers on the tenet of First, do no harm. In addition, the modern Hippocratic oath contains the statements, "I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure."8 As a doctor, I find it abhorrent that another physician would be so callous to say that diet and exercise are the ONLY answer to weight loss. There isn't a doctor out there that has been in practice for more than a day that hasn't seen patients that were fit and active but over weight. If it were only as easy as diet and exercise no one would be fat. Now, lifestyle modification is crucial to overall health, but some people simply need that added boost that supplements can give them. Completely ignoring drug induced nutrient depletion, or the grossly inadequate nutrient content of modern food, it is virtually impossible to get everything you need from diet alone.
So if your doctor isn't familiar with supplements, or tells you not to take something, you need to ask them specifically 'WHY?" If it is one of the cop out arguments mentioned above, you now know how to react. If they simply do not know, feel free to search out a second or even a third opinion. If there is a genuine reason why you shouldn't take a supplement, such as pregnancy, or a history of kidney or heart disease, then you did your due diligence and got appropriate advice. And always remember, doctors don't know everything and the really good ones are never afraid to admit that.
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1. Adams, KM, Lindell, KC, et al. Status of nutritional education in medical schools. 1,2,3,4. Am J Clin Nutrition, April 2006, vol 83. No 4, 941S-944S.
2. Adams, Mike. FDA Running Extortion Racket: : Natural Supplement Companies Threatened with Arrest if They Don't Pay Up. Retrieved 12/27/2013: /http://www.naturalnews.com/024567_FDA_health_the.html
3. United States Centers for Disease Control (CDC). 2008
4. Why Learn About Adverse Drug Reactions. Retrieved 12/27/2013 from http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/DrugInteractionsLabeling/ucm114848.htm
5. Supplements are Safe. Retrieved 12/27/2013 from http://healthimpactnews.com/2013/gao-report-supplements-are-safe-they-dont-kill-like-drugs-do/
6. 2012 Pharmaceutical Revenue. http://www.currentpartnering.com/insight/top-50-pharma/
7. Nutritional Supplements Flexing their Muscles as Growth Industry. Retrieved 12/27/2013 from http://www.forbes.com/sites/davidlariviere/2013/04/18/nutritional-supplements-flexing-their-muscles-as-growth-industry/
8. Modern version of Hippocratic Oath most commonly used in medical schools today. Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, 1964. Retrieved 12/27/2013 http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html
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