special subjects
Overview of Dietary Supplements
Other Concerns
Additional areas of concern include Use of dietary supplements instead of conventional drugs Stability of supplements (especially herbal products) once manufactured Toxicity Interactions between supplements and drugs or disease states Contribution to incorrect diagnosis Most information about these concerns comes from sporadic individual reports (see table) and some research studies. Despite these concerns, many patients strongly believe in the benefits of supplements and continue to use them with or without a physician’s involvement. Patients may not think to disclose or may wish to conceal their use of dietary supplements. For this reason, the outpatient history should periodically include explicit questions about past and new use of integrative, complementary, and alternative therapies, including dietary supplements. Many physicians incorporate some supplement use into their practice; their reasons include proven benefit of the supplement, a desire to ensure that supplements are used safely by patients who will use supplements anyway, and the physician’s belief that the supplements are safe and effective. Common concerns about the use of supplements include the following: Placebo effects can simulate true efficacy, particularly if the patient and/or physician strongly believes in the supplement. Therapeutic responses to supplements, placebo-mediated or otherwise, could be mistaken as evidence that confirms a particular, possibly incorrect, diagnosis. There are few data to guide patient counseling regarding supplement safety. But some experts believe that the overall number of problems due to dietary supplements is rare compared with the overall number of doses taken and that the supplement, if correctly manufactured, is likely to be safe. As a result, these experts advise purchase of supplements from a well-known manufacturer, and many recommend buying supplements made in Germany because there they are regulated as drugs and thus oversight is stricter than in the US. The supplements discussed in The Manuals are ones that are most popular, are effective, or have some questions about their safety. More complete information is available through theNIH National Center for Complementary and Integrative Health. 