Meeting patient health challenges with supplement ‘prescriptions’ from your own ‘supplement superstore’
A growing number of chiropractors are “prescribing” dietary supplements. Surveys report that more than 80% of practitioners recommend dietary supplements to their patients to help them achieve better health and well-being.1,2 Why are these practitioners going the extra mile in patient care? Because studies suggest there may be a link between chronic musculoskeletal problems and a higher risk of chronic health conditions like cardiovascular disease, metabolic disorders and osteoporosis.3 Adding targeted supplements to a patient’s treatment plan may reduce common risk factors for chronic conditions and help them achieve better whole-body health, and they can come from your own “supplement superstore.”
The benefits of prescribing supplements
Including dietary supplements as a part of your practice provides more comprehensive care and, as a result, enhances patient health. More specifically, adding provider-directed supplements to patient treatment plans can:
- Aid patients in choosing appropriate high-quality nutrients at the proper doses for their personal health needs
- Foster better patient adherence to their treatment plan
- Reduce a patient’s risk of contraindications or drug-supplement interactions
- Work synergistically with chiropractic treatments
Robert G. Silverman, DC, CCN, and the author of “Inside-Out Health: A Revolutionary Approach to Your Body,” is a firm believer in the benefits of adding dietary supplements to patient care. “The addition of nutritional supplements with the application of chiropractic techniques has revolutionized my approach to treating musculoskeletal injuries,” he says. Prescribing supplements doesn’t just add value from a patient-care perspective; Silverman also notes that it provides the practice an additional revenue stream, especially when it comes from your own supplement superstore.
Supplement protocols to address everyday health challenges
Chiropractors often see patients with everyday health challenges that not only impact their well-being in the moment, but increase the patients’ odds of developing more serious problems down the road.
And that matters since, according to Silverman, “Six out of 10 Americans suffer from one chronic disease — and 4 out of 10 suffer from two or more.” Using supplements to address common health issues can help keep patients from becoming one of these statistics.
Among the specific health concerns chiropractors see most often, general wellness, gut health and oxidative stress top the list. Fortunately, there are effective supplement protocols clinically shown to help with all three of these health challenges:
General wellness — According to findings published in Mayo Clinic Proceedings, less than 3% of Americans are living a healthy lifestyle.4 Instead of thriving, this means many patients are simply surviving. Adding the following core nutrients can help fill in nutritional gaps among those eating a typical Western diet and this, in turn, can help strengthen their overall health.
Multivitamins — Among consumers, multivitamins are one of the most popular supplements used to fill in nutrients that may be missing.5 But these multi-nutrient supplements don’t just act as “nutritional insurance.” Some studies suggest that the consistent, long-term use of a comprehensive multivitamin/multimineral supplement may reduce the risk of cardiovascular disease, improve cognition and mood, and protect against age-related macular degeneration.6,7,8,9 Choose a multivitamin that delivers the minimum 13 core vitamins and minerals required by the body.
Magnesium — Magnesium is required for more than 600 enzymatic reactions in the body, including energy metabolism and protein synthesis.10 It’s also critical for reducing a number of cardiovascular risk factors and for promoting better bone and muscle health.11,12 A 2022 meta-analysis of people over age 60 found that boosting magnesium levels resulted in significantly higher hip and femoral neck bone mineral density — and that might help ward off osteoporosis in older patients.13 But despite its importance, deficiency is common. A daily dose of an absorbable form of magnesium such as magnesium citrate can help insure adequate blood levels.14
Omega-3 fatty acids — Omega-3s are health-promoting essential fatty acids that must be obtained from food or supplements. Randomized clinical trials have found that regular omega-3 supplementation supports better cardiovascular health and cognition.15,16 In one 2021 trial of 138 overweight, middle-aged people, supplementing with DHA/EPA omega-3 fatty acids also appeared to slow aging by supporting longer telomeres, lowering inflammation and helping blunt the effects of stress by reducing cortisol levels.17
Vitamin D3 — Vitamin D3 is a fat-soluble nutrient that is critical for a healthy immune response and mood support.18,19 One 2017 meta-analysis of four clinical trials also found that vitamin D supplementation effectively improved arthritis pain and function in patients with knee osteoarthritis.20 The problem is that many people today have low vitamin D levels — a situation that is easily corrected via supplementation.
Gut health — Maintaining a healthy gut microbiome plays a pivotal role in a patient’s head-to-toe health. Not only is the gut responsible for the absorption of macro and micronutrients that fuel the body, Silverman points out that 80% of the immune system is found in the gut. Research reports that the gut microbiome also communicates with and influences other key areas of the body, including the brain, heart and lungs.21,22,23 Yet, thanks largely to stress, poor lifestyle habits and unhealthy food choices, many Americans are living with a compromised gut. The nutrients below, however, can improve gut health so it can accomplish its many vital tasks.
Fiber — Fiber plays an important role in nurturing beneficial bacteria in the gut while at the same time suppressing potentially harmful microbes.24 This is because certain supplemental fibers like arabinoxylans, galacto-oligosaccharides, inulin and oligofructose act as prebiotic compounds that “feed” health-promoting bacteria as they ferment in the gut.25
Glutamine — Glutamine is an amino acid best known for its ability to support the immune system.26 But it’s also critical for maintaining the intestinal barrier’s tight junctions and preventing pathogens, toxins and other harmful substances from passing into the bloodstream.27 But, as much as we rely on this important amino acid, the body’s ability to produce glutamine decreases with age. This can not only compromise the intestinal barrier but leave patients at greater risk of gastrointestinal problems like irritable bowel syndrome and inflammatory bowel disease. However, studies show that supplementing with glutamine can support the intestinal barrier’s integrity, reduce intestinal inflammation and promote a healthy microbiome.28
Probiotics — Probiotics are live microorganisms that confer health benefits by promoting a balanced microbiome.29 One 2021 systematic review of 14 clinical trials found probiotics improved micronutrient levels in healthy people.30 Other investigations show that supplementing with a multi-strain probiotic helps relieve a variety of gastrointestinal symptoms like abdominal pain, bloating, constipation and diarrhea.31 Some studies even report that certain probiotic strains can help manage weight gain — and this could be an important benefit since, as Silverman notes, “75% of Americans are either overweight or obese.”32
Antioxidant support for healthy aging — Dietary antioxidants are vital for managing oxidative stress and promoting healthy aging. Oxidative stress is created by an imbalance between damaging free radicals and the antioxidants that can neutralize them — and it can play a significant role in aging. For example, oxidative stress is involved in several age-related conditions such as cardiovascular disease, dementia and kidney disease. It also contributes to the sarcopenia and frailty that commonly occurs in the elderly.33 While a wide array of antioxidants can be found in fruits and vegetables, the Centers for Disease Control and Prevention (CDC) points out that only one in 10 Americans eat enough of these foods.34 That makes supplementation with the following nutrients essential.
Coenzyme Q10 — Coenzyme Q10 (CoQ10) is found in every cell in the body — and it’s one of the most significant lipid antioxidants for preventing the generation of free radicals.35 Yet, the body’s ability to produce CoQ10 declines with age. Research published in the International Journal of Molecular Sciences suggests that, because of its antioxidant power, supplementing with CoQ10 may help treat cardiovascular and neurodegenerative diseases, kidney disease, chronic obstructive pulmonary disease and non-alcoholic fatty liver disease.36 But be aware that there are two different forms of CoQ10: ubiquinone, the oxidized form, and ubiquinol, which is the active form of the nutrient. According to a recent clinical trial of older men, ubiquinol is significantly more effective for improving CoQ10 status.37
Glutathione — Glutathione (GSH) is often called the “master antioxidant” and is found in virtually every cell in the body. Made up of three amino acids — cysteine, glycine and glutamic acid — glutathione is crucial for preventing damage to important cellular components caused by free radicals and reactive oxygen species.38 But, like CoQ10, glutathione levels decline with age.39 Fortunately, it’s relatively easy to raise blood levels of this important antioxidant. One method is by supplementing with liposomal glutathione. According to one 2018 human trial, taking a daily dose of this bioavailable form of glutathione for one week increased GSH levels by 40% while simultaneously reducing oxidative stress biomarkers.40 Levels can also be elevated with supplemental n-acetyl-cysteine (NAC), a glutathione precursor that has been shown to boost intracellular glutathione levels in humans. But, because oral NAC supplements have low bioavailability, high doses (600 to 1,800 mg) are needed.41
Polyphenols — Polyphenols are antioxidant-rich compounds found in fruits, vegetables and whole grains. Meta-analyses strongly suggest that eating a diet rich in plant polyphenols can provide protection against a number of chronic diseases, likely due to their ability to reduce oxidative damage.42 Yet, nearly half of Americans routinely eat a poor-quality diet low in polyphenols.43 Taking a polyphenol-forward supplement like quercetin or resveratrol can help offset a nutrient-poor diet by protecting against the oxidative stress and DNA damage that contributes to chronic disease and premature aging.44 Active, otherwise healthy patients can benefit from polyphenol supplementation too. According to one 2017 systemic review and meta-analysis, supplementing with polyphenols for at least seven days improved antioxidant status in athletes, and this resulted in a 1.9% improvement in their exercise performance.45
New to prescribing supplements?
If you’re a chiropractor or other holistic health care provider new to prescribing supplements, you may be wondering where to begin.
There was a time in the not-too-distant past when providing high-quality dietary supplements to patients meant purchasing a variety of supplements to have on hand, keeping an inventory of those products along with their expiration date, ordering new stock as needed, and tracking the shipment and delivery of supplements. This was not only costly, it created added work for staff.
Fortunately, online dispensaries have made prescribing supplements faster, easier and considerably more cost-effective. When choosing an online dispensary to create your own supplements superstore, look for one that provides a comprehensive solution that eliminates the need to stock and track inventory, integrates with your electronic health record (EHR) system, provides a source of passive revenue and helps you offer value-added care to your patients.
JEFF GLAAD, MD, is a practicing integrative medicine physician and chief medical officer at Fullscript. He advises on company and product direction from the perspective of integrative and family medicine. He has been a member of the Fullscript Medical Advisory Team since 2019. In 2010, he opened GladdMD Integrative Medicine, blending health-promoting care with high-access technology. In 2011, he created and launched the web’s first nutrient depletion calculator, Mytavin.com. To learn more, go to FullScript.com.
- Stuber K, Bruno P, Kristmanson K, et al. Dietary supplement recommendations by Saskatchewan chiropractors: results of an online survey. Chiropractic & Manual Therapies. 2013;21:11.
- Holtzman D, Burke J. Nutritional counseling in the chiropractic practice: a survey of New York practitioners. Journal of Chiropractic Medicine. 2007;6(1):27-31.
- Williams a, Kamper SJ, Wiggers JH, et al. Musculoskeletal conditions may increase the risk of chronic disease: a systematic review and meta-analysis of cohort studies. BMC Medicine. 2018;16:167.
- Loprinzi PD, Branscum A, Hanks J, et al. Healthy lifestyle characteristics and their joint association with cardiovascular disease biomarkers in US adults. Mayo Clinic Proceedings. 2016;91(4):432-442.
- Multivitamin/mineral supplements: Fact sheet for health professionals. 2022.National Institutes of Health.
- Rautiainen S, Rist PM, Glynn RJ, et al. Multivitamin use and the risk of cardiovascular disease in men. Journal of Nutrition. 2016;146(6):1235-1240.
- Macpherson H, Silberstein R, & Pipingas A. Neurocognitive effects of multivitamin supplementation on the steady state visually evoked potential (SSVEP) measure of brain activity in elderly women. Physiology & Behavior. 2012;107(3):346-54.
- Pipingas A, Camfield DA, Stough C, et al. The effects of multivitamin supplementation on mood and general well-being in healthy young adults. A laboratory and at-home mobile phone assessment. Appetite. 2013;69:123-36.
- Serhan HA, Alma’aitah HW, Irshaidat S, et al. Ophthalmic manifestations of nutritional deficiencies: A mini review. Journal of Family Medicine and Primary Care. 2022;11(10):5899-5901.
- de Baaij JH, Hoenderop JG, & Bindels RJ. Magnesium in man: implications for health and disease. Physiological Reviews. 2015;95(1):1-46.
- Rondanelli M, Faliva MA, Tartara A, et al. An update on magnesium and bone health. Biometals. 2021;34(4):715-736.
- Kostov K, Halacheva L. Role of magnesium deficiency in promoting atherosclerosis, endothelial dysfunction, and arterial stiffening as risk factors for hypertension. International Journal of Molecular Science. 2018;19(6):1724.
- Groenendijk I, van Delft M, Versloot P, et al. Impact of magnesium on bone health in older adults: A systematic review and meta-analysis. Bone. 2022;154:116233.
- Kappeler D, Heimbeck I, Herpich C, et al. Higher bioavailability of magnesium citrate as compared to magnesium oxide shown by evaluation of urinary excretion and serum levels after single-dose administration in a randomized cross-over study. BMC Nutrition. 2017;3:7.
- Khan SU, Lone AN, Khan MS, et al. Effect of omega-3 fatty acids on cardiovascular outcomes: A systematic review and meta-analysis. EClinicalMedicine. 2021;38:100997.
- Martí Del Moral A, Fortique F. Omega-3 fatty acids and cognitive decline: a systematic review. Nutricion Hospitalaria. 2019;36(4):939-949.
- Madison AA, Belury MA, Andridge R, et al. Omega-3 supplementation and stress reactivity of cellular aging biomarkers: an ancillary sub-study of a randomized, controlled trial in midlife adults. Molecular Psychiatry. 2021;26(7):3034-3042.
- Jolliffe DA, Camargo CA Jr, Sluyter JD, et al. Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials. The Lancet. Diabetes & Endocrinology. 2021;9(5):276-292.
- Vellekkatt F, Menon V. Efficacy of vitamin D supplementation in major depression: A meta-analysis of randomized controlled trials. Journal of Postgraduate Medicine. 2019;65(2):74-80.
- Gao XR, Chen YS, & Deng W. The effect of vitamin D supplementation on knee osteoarthritis: A meta-analysis of randomized controlled trials. International Journal of Surgery. 2017;46:14-20.
- Rutsch A, Kantsjö JB, & Ronchi F. The gut-brain axis: how microbiota and host inflammasome influence brain physiology and pathology. Frontiers in Immunology. 2020;11:604179.
- Bartolomaeus H, McParland V, & Wilck N. Gut-heart axis : How gut bacteria influence cardiovascular diseases. Herz. 2020;45(2):134-141. German.
- Enaud R, Prevel R, Ciarlo E, et al. The gut-lung axis in health and respiratory diseases: a place for inter-organ and inter-kingdom crosstalks. Frontiers in Cellular and Infection Microbiology. 2020;10:9.
- Yang Q, Liang Q, Balakrishnan B, et al. Role of dietary nutrients in the modulation of gut microbiota: a narrative review. Nutrients. 2020;12(2):381.
- Carlson JL, Erickson JM, Lloyd BB, et al. Health effects and sources of prebiotic dietary fiber. Current Developments in Nutrition. 2018;2(3):nzy005.
- Cruzat V, Macedo Rogero M, Noel Keane K, et al. Glutamine: metabolism and immune function, supplementation and clinical translation. Nutrients. 2018;10(11):1564.
- Achamrah N, Déchelotte P, & Coëffier M. Glutamine and the regulation of intestinal permeability: from bench to bedside. Current Opinion in Clinical Nutrition and Metabolic Care. 2017;20(1):p 86-91. (keyword: supplement superstore)
- Deters BJ & Saleem M. The role of glutamine in supporting gut health and neuropsychiatric factors. Food Science and Human Wellness 2021;10(2):149-154.
- Meng HYH, Mak CCH, Mak WY, et al. Probiotic supplementation demonstrates therapeutic potential in treating gut dysbiosis and improving neurocognitive function in age-related dementia. European Journal of Nutrition. 2022;61:1701–1734. (keyword: supplement superstore)
- Barkhidarian B, Roldos L, Iskandar MM, et al. Probiotic supplementation and micronutrient status in healthy subjects: a systematic review of clinical trials. Nutrients. 2021;13(9):3001.
- Hungin APS, Mitchell CR, & Whorwell P, et al. Systematic review: probiotics in the management of lower gastrointestinal symptoms – an updated evidence-based international consensus. Alimentary Pharmacology & Therapeutics. 2018;47(8):1054-1070. (keyword: supplement superstore)
- Álvarez-Arraño V & Martín-Peláez S. Effects of probiotics and synbiotics on weight loss in subjects with overweight or obesity: a systematic review. Nutrients. 2021;13(10):3627.
- Liguori I, Russo G, & Curcio F, et al. Oxidative stress, aging, and diseases. Clinical Interventions in Aging. 2018;13:757-772.
- Centers for Disease Control & Prevention. Only 1 in 10 Adults Get Enough Fruits or Vegetables. 2021. (keyword: supplement superstore)
- Saini R. Coenzyme Q10: The essential nutrient. Journal of Pharmacy and Bioallied Science. 2011;3(3):466-467.
- Gutierrez-Mariscal FM, Arenas-de Larriva AP, Limia-Perez L, et al. Coenzyme Q10 supplementation for the reduction of oxidative stress: clinical implications in the treatment of chronic diseases. International Journal of Molecular Sciences. 2020;21(21):7870. (keyword: supplement superstore)
- Zhang Y , Liu J , Chen XQ , et al. Ubiquinol is superior to ubiquinone to enhance Coenzyme Q10 status in older men. Food & Function. 2018;9(11):5653-5659.
- Pizzorno J. Glutathione! Integrative Medicine. 2014;13(1):8-12.
- Sekhar RV, Patel SG, Guthikonda AP, et al. Deficient synthesis of glutathione underlies oxidative stress in aging and can be corrected by dietary cysteine and glycine supplementation. The American Journal of Clinical Nutrition. 2011;94(3):847-853. (keyword: supplement superstore)
- Sinha R, Sinha I, Calcagnotto A, et al. Oral supplementation with liposomal glutathione elevates body stores of glutathione and markers of immune function. European Journal of Clinical Nutrition. 2018;72(1):105-111.
- Tenório MCDS, Graciliano NG, Moura FA, et al. N-acetylcysteine (NAC): impacts on human health. Antioxidants (Basel). 2021;10(6):967. (keyword: supplement superstore)
- Pandey KB & Rizvi SI. Plant polyphenols as dietary antioxidants in human health and disease. Oxidative Medicine and Cellular Longevity. 2009;2(5):270-278.
- Rehm CD, Peñalvo JL, Afshin A, et al. Dietary intake among US adults, 1999-2012. JAMA.2016;315(23):2542–2553. (keyword: supplement superstore)
- Rudrapal M, Khairnar SJ, Khan J, et al. Dietary polyphenols and their role in oxidative stress-induced human diseases: insights into protective effects, antioxidant potentials and mechanism(s) of action. Frontiers in Pharmacology. 2022;13:806470.
- Somerville V, Bringans C, & Braakhuis A. Polyphenols and performance: a systematic review and meta-analysis. Sports Medicine. 2017;47(8):1589-1599. (keyword: supplement superstore)