The World Health Organization (WHO) reports that the number of people afflicted by non-communicable diseases such as heart disease, cancer, diabetes and chronic respiratory diseases is increasing over time.
In fact, worldwide, conditions such as these now cause approximately 40 million of the some 55 million total deaths recorded each year.1
What’s perhaps most startling is that the WHO also notes that 80 percent of some of these major health conditions can actually be prevented. This means that as many as 32 million people could potentially have lived to see another day. They could have given their loved ones more hugs. They could have helped more friends. They could have made more contributions to their community and their society.
This serves as an important reminder that the status of our health is largely in our own hands. That it is the actions that we take—or don’t take—on a regular and consistent basis that oftentimes determines how well we fare mentally and physically in the years ahead. But are Americans listening? According to one survey, the answer is yes.
Americans and supplements
In 2015, the Council for Responsible Nutrition released results of a consumer survey, revealing that nearly 70 percent of adult Americans take some type of dietary supplement.2 Among the reasons cited for adding various pills, powders, and other forms of nutritional supplements to their diets, these participants said that their goals were: to increase overall health and wellness (50 percent), to fill dietary nutrient gaps (30 percent), to enjoy a higher energy level (30 percent), to strengthen their immune systems (30 percent), and to improve bone and heart health (25 percent each).
This is great news because it indicates that more than two-thirds of the population is taking positive action in an effort to achieve higher levels of health. And whether they’re doing it to proactively prevent disease or to help remedy a condition they already have, it’s arguably a step in the right direction.
This survey also revealed that 85 percent of those who take supplements share this information with their health care practitioners. A total of 55 percent also reported that they trusted their doctor’s advice as to which vitamins, minerals and herbs could help them feel and be their best.
As a DC, it’s likely that you’ve had conversations like these with your own patients. Again, while this is good because it means that they’re looking after their health and they trust you to be a valuable part of the process, it can also be dangerous territory as making any sort of diagnosis or supplement recommendation based on what you think may be happening with them is normally outside the chiropractic scope of practice.
So what can you do to help your patients get the nutrients they need without putting yourself and your practice at risk? Fortunately, there are a few options, even if your practice is in a state that has strict scope-of-practice limitations.
The first thing is to educate yourself, according to Adam Killpartrick, DC, CNS, a nutrition scientist. He suggests a couple of ways you can achieve this goal. For instance, you could enroll in a comprehensive functional medicine program, one that provides proper chiropractic protocols.
“This is a fairly sizable commitment, not only as it relates to time,” Killpartrick, says, “but also a commitment to understand the physiological rationale behind the protocol that is being recommended.” It’s also a commitment that can pay off in terms of providing higher quality patient care.
The second option involves “leaning on supplement companies for their protocols and recommendations.” For instance, Killpartrick himself wrote an online Clinical Protocol Guide.
“This guide breaks down each system and highlights key areas that should be focused upon clinically and the most appropriate recommendations,” Killpartrick says. “It also contains the testing recommendation for that particular system and ‘Clinical Tips’ offered by the panel of practitioners who compiled the information for the guide. While this particular tool can be used as an educational platform, it’s really designed for clinical application within the practice for the busy DC who wants a well thought-out protocol and be able to recommend it with confidence.”
A third way DCs can learn more about applying supplements into their clinical practice is through the help of a mentor. “This is how I was introduced to supplements and clinical nutrition both from a physiologic perspective, as well as a practical and financial perspective,” Killpartrick says.
And if you don’t have a mentor who can provide this knowledge, Killpartrick says that there are other ways to obtain this level of help so you can better serve your patients. For instance, his company is currently piloting a program to facilitate mentorships for young practitioners.
Listen to your patients
A second way to provide supplement advice without stepping outside the scope of practice is by “following what chiropractors are already doing—keep listening to patients,” says Cheryl Myers, RN. An integrative health nurse, author and expert on natural medicine, Myers says that often this involves talking with them about the symptoms they’re experiencing.
“Since most patients probably have some degree of acute or chronic pain, there are supplements that chiropractors can recommend that address it,” Myers says. “For example, clinically tested curcumin (BCM-95) and standardized boswellia have shown promising results for muscle and joint pain in patients with osteoarthritis and rheumatoid arthritis.”
Myers also stresses the importance of chiropractors taking the initiative to “steer their patients in the right direction regarding the forms of these supplement ingredients.” This involves providing information about absorbability, potential adverse effects, the benefits they may receive from particular supplements based on research and science, and any other factors that could potentially impact the effectiveness of the supplement (such as diet).
Take a complete history
Howard F. Loomis Jr., DC, is an expert on nutrition, and he recommends taking “a careful and complete case history, a thorough review of the patient’s dietary preferences, cravings, and foods that are avoided” to give you a clearer understanding of their total overall health. This enables you to provide a more individualized recommendation when helping a patient choose the right supplements.
Completing a full case history can also help you “guide the patient in understanding the specific effect their diet is having on their symptom pattern,” Loomis says. For example, if a client admits to having digestive difficulties, you can share how “vitamins and minerals are directly connected to carbohydrate, protein, or lipid ingestion and digestion,” he says.
As an illustration, Loomis points out that carbohydrate digestion could be problematic if there is lactose or gluten intolerance. Or that lipid intolerance is related to gallbladder or biliary dysfunction.
Knowing a patient’s complete history can also assist you in making recommendations regarding the dosages of key supplements as “the physical signs and symptoms of deficiency, and even excess, of these essential nutrients are well established,” Loomis says. For instance, low vitamin D levels—which are generally those below 20 ng/mL—may be the reason behind a patient’s feelings of muscle weakness, decreased endurance, mood changes (particularly anxiety and depression), or chronic pain.3
Just as it is important to help patients find the right type of supplements, it is equally necessary to help them select the product line or brand that can potentially offer the most effective results. This can be accomplished by teaching patients how to review their supplemental choices in two key areas: product quality and bioavailability.
“The source, potency of raw material, and manufacturing process are of great importance,” according to J. William Beakey, DOM, LAc, who works with integrative medicine professionals, “because advanced testing for quality control is essential to ensure product excellence.” Some rely on the Food and Drug Administration (FDA) to help with this process, but their role is often less involved than many would think.
“While the FDA might randomly inspect some facilities for adherence to current Good Manufacturing Practices (cGMP), they do not test products to determine if, in fact, the product inside the bottle is what is claimed on the label,” Beakey says. For instance, in 2016, the New York Times published an article sharing the results of an investigation conducted by the New York State Attorney General’s office which found that “four out of five of the products tested from major retailers did not contain any of the herbs promised on their labels.”4
Additionally, FDA compliance isn’t always known, because “companies that have been inspected by the FDA and passed with excellence aren’t allowed to inform consumers,” Beakey says, adding that “companies that have never been inspected need not mention that.” That’s why it’s so important to choose a supplement company that is reputable as “the integrity of a company selling supplements means everything.”
Ask the right questions
This requires that you as a DC do your own homework so that the recommendations you make are for high-quality, effective supplements. When doing this homework, “don’t be afraid to ask questions,” Beakey says, and here are a few to consider:
- What does their manufacturing process look like? Are their products manufactured entirely in-house or do they employ the help of other businesses?
- Does the company meet and implement cGMP standards, even before being required to do so? In some cases, companies will exceed those standards, Beakey says, making them a good pick.
- How do they test their products? “State-of-the-art testing such as high performance liquid chromatography (HPLC), thin layer chromatography, atomic absorption spectroscopy, and other methods are part of the process to ensure the best product,” Beakey says.
- What are their quality control measures? Beakey says that these measures “should include microbial testing for bacteria, yeast and mold, and testing for heavy metals like arsenic, lead and mercury, and for pesticides.”
- Who does their quality control tests? Do they do them themselves or use a third party? “Some supplement companies have complete control of the entire manufacturing process and conduct their own quality control testing, in addition to a certificate of analysis that may accompany raw material,” Beakey says.
- Do they retain samples of product for future testing? This is important, Beakey says, “so expiration dates can be validated.”
- Do they talk about and explain quality control procedures or is there a glaring omission of that subject? “High-quality companies often have events to allow physicians to tour their facilities,” Beakey says.
Asking these questions helps support the importance of supplementation, as Beakey notes that “one terrible outcome of using cheap, low-quality supplements from unknown sources is that the patient doesn’t get the intended benefit and the use of supplements in general gets a black eye because ‘they don’t work.’”
Advising without diagnosing
Giving patients supplement recommendations within your scope of practice is possible. That is, as long as you educate yourself, listen closely to your patients, and learn their compete medical history first.
Also, if you recommend only the substances that you believe in, the ones that have passed your thorough investigation by providing all of the right answers to the questions you’ve asked, then at least you know that you’re giving them the information they need to do the one thing that they want more than anything: achieve a higher level of health.
Christina DeBusk is a freelance writer who specializes in content related to natural health and wellness, personal development, and small business marketing. She can be contacted through ChristinaMDeBusk.com.
1 Noncommunicable diseases (NCD). World Health Organization. http://www.who.int/gho/ ncd/en. Published April 2011. Accessed May 2018.
2 2015 CRN Consumer Survey on Dietary Supplements. Council for Responsible Nutrition. http://www.crnusa.org/ CRN-consumersurvey-archives/2015/. Published Oct. 2015. Accessed May 2018.
3 “Vitamin D deficiency: Symptoms, causes, and prevention.” Medical News Today. https://www. medicalnewstoday.com/articles/318060.php. Updated June 2017. Accessed May 2018.
4 Example: O’Connor A. What’s in Your Herbal Pills? Firm Promises DNA Testing for Proof. The New York Times. Sep 28, 2016. Well. https://www.nytimes.com/2016/09/28/well/ eat/nbty-promises-genetic-testing-of-its-herbal-supplements.html. Accessed May 2018.