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March, 2010

Nutritional Supplements: No Two Patients Are Alike

By DCPI Staff

We all know how terrific vitamin D, fish oil or other nutritional supplements can be for our patients. Many clinicians are encouraged to suggest supplements to every patient as a matter of course. While this may be lucrative for your practice, the truth is that every patient has their own unique nutritional needs. So what should you look for in selecting nutritional supplements to offer your patients?

When Dynamic Chiropractic PracticeINSIGHTS took this question to a panel of vendor experts, they unanimously agreed no two patients are alike, even if they present with what appear to be the same symptoms or complaints.

Guy R. Schenker, DC, with Nutri-Spec, based in Mifflintown, Pa., explained, "Two patients may present with identical symptoms, yet have entirely different metabolic imbalances underlying those symptoms. Clearly, offering disease-specific nutrition remedies is absurd. Even if a symptomatic shot in the dark happens to hit a bull's eye for one patient, the other will have at best wasted his money and may even experience an exacerbation of the metabolic imbalance responsible for his symptom.

"The key concept of biological individuality cannot be ignored," Schenker said.

Said Dr. Howard F. Loomis of Loomis Enzymes headquartered in Madison, Wisc.: "What is the state of the patient's extracellular fluid? Is the patient too acid or too alkaline? How will the supplement affect that issue? Why is the patient deficient in the ingredients of this supplement? Lack of the substance(s) in the diet is seldom the problem.

"Inability to digest and properly absorb the nutrients is almost always the problem. Is the supplement being used with a treatment plan to change the diet, improve digestion and waste removal? Unfortunately, this is rarely done," Loomis added.

There is also the question of possible drug-nutrient interactions, said Dr. David Seaman, director of clinical education at Anabolic Laboratories, in Irvine, Calif. Seaman said that it is important for the practitioner to know what kind of medications a patient may be taking, and the possible consequences of recommending a particular supplement."

He added, "As an example, patients commonly take beta-blockers and thiazide diuretics for hypertension and statins for hypercholesterolemia. Magnesium and calcium may reduce beta-blocker absorption and bioavailability, which means that these minerals should not be taken at the same time as the medications. If the medication is taken in the morning, then take the magnesium and calcium in the afternoon or evening."

Quality Is Key

Another important factor is the quality of the ingredients. Michael Roth, DC, with Drucker Laboratories, from Plano, Texas, said that practitioners should be certain that individual supplement ingredients are "GMP [Good Manufacturing Processes] certified, food-based from live plant sources in the proper balance and combinations, in a liquid form, bio-available, completely free of synthetics, chemical preservatives, and other toxic substances and most importantly, they should be truly organic."

Amy Friemoth, with Standard Process, in Palmyra, Wisc., agreed that genuinely organic products are critical.

"Manufacturers who grow many of their ingredients have the unique ability to control the quality of the ingredient from seed to supplement," Friemoth said. "Some manufacturers own certified organic farms to further enhance the quality of their ingredients."

Is It Effective?

Of course, the litmus test for any nutritional supplement is whether or not it's actually effective. That's the bottom line, according to our experts.

"Does it work?" was the question posed by Bryan P. Walsh, educational liaison at Apex Energetics, also based in Irvine.

"If a patient or client improves using a given supplement, it doesn't matter how fancy the label is or what type of research is behind it. Doctors ultimately want to know if it will work in clinical practice."

One way of determining efficacy is by using rigorous scientific standards when manufacturing the products.

Doug Gaynor of Metagenics, based in San Clemente, Calif., agreed with Walsh that supplement effectiveness is all-important: "Without clinical testing on formulated products, a provider is asking you to 'test' the nutritional product on your patients. Companies that demonstrate a real commitment not only to third-party research, but also proprietary and independent human clinical testing before product release, are typically the most dedicated to providing safe and effective products for your patients."

Marketing Claims Are Essentially Meaningless

"Totally ignore all the health food industry hype regarding the latest and greatest nutrition cures," Schenker said. "In 10 years, today's most popular supplements will be long forgotten. Totally ignore the sales literature from 'professional' supplement suppliers. Their disease-specific nutrition remedies will spin you in endless trial-and-error circles."

Another thing to watch out for: marketing that uses the phrase "pharmaceutical grade," said Dr. Seaman. "It is important to ignore the term 'pharmaceutical grade,' which has nothing to do with potency and purity of the raw material or final product.

"[For example], if you take oatmeal flakes and grind them into a fine powder, you now have pharmaceutical-grade oatmeal that can easily flow through a machine that tablets or encapsulates supplements and drugs."

The Patient Comes First

According to our panel of experts, when it comes to nutritional supplementation, pay attention to each patient's biological needs, ignore all the marketing hype and use products with a track record of successful outcomes and a good deal of positive feedback. Your patients expect no less.

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