By Kristin Rothwell, NurseZone Feature Writer
Herbal and other dietary supplements are fast-becoming trendy among many
health-conscious consumers, according to JoCoHealth.net, a health and
information Web site sponsored by St. Luke’s Health System.
However, the Journal of American Medical Association estimates that 40
percent of consumers do not inform their doctor or nurse practitioner that they
are using such products. According to a study that was published in the January
2003 issue of the Journal, one in six patients who take prescription drugs is
concurrently taking one or more supplements.
Unfortunately, many consumers are unaware of the dangers of mixing dietary
and herbal supplements with prescription drugs, and the possible side-effects of
taking many of these supplements—even if taken on their own.
Carol Dalton, RN, CNP, at Helios Health Center in Boulder, Colorado, said
that nurses need to have some basic knowledge of herbs and supplements to help
educate their patients.
She recommends that nurses have access to good reference guides whether found
online or in resource books. Because there are so many supplements on the market—many
in varying mixtures—Dalton said practitioners need to have the proper
resources at hand to help people when they have questions about the supplements
they are taking.
A Prevention magazine survey of consumer use of dietary supplements in
2000, found that an estimated 22.8 million consumers used herbal remedies
instead of prescription medicine, and an estimated 19.6 million used them with a
prescription product.
With statistics like these, Dalton said that it’s becoming much more
imperative that nurses and other health care practitioners ask patients not only
about the medications they are taking or the allergies they may have, but also
about the supplements they may be ingesting. She noted that communicating these
questions needs to be done in a non-confrontational manner.
"Patients are often leery about saying, ‘I take this, this and this’
because they are afraid they’re going to be criticized," Dalton said.
"I think the practitioner needs to be non-judgmental so the patient feels
comfortable….it’s important not to put a patient down and if a practitioner
isn’t knowledgeable enough on the subject, then she should refer the patient
to someone who is."
While herbal supplements are classified by the Food and Drug Administration
(FDA) as part of a general group of "dietary supplements," the FDA
does not review or regulate herbal supplements before they are marketed to the
public. In addition, manufacturers producing herbal remedies classified as
dietary supplements are not required to perform studies on effectiveness, dosage
or safety.
In March 2003, the Food and Drug Administration took action to help consumers
assess accurately labeled and unadulterated dietary supplements by proposing a
new regulation. The proposed rule would, for the first time, establish standards
to ensure that dietary supplements and dietary ingredients are not adulterated
with contaminants or impurities, and are labeled accurately to reflect the
active ingredients and other ingredients in the product.
"This proposed regulation is another major step in our efforts to help
Americans take more control over their own health," said Mark B. McClellan,
M.D., Ph.D., commissioner of Food and Drugs, in a statement. "Too often,
consumers purchase dietary supplements based on inaccurate or incomplete
information on what they are getting."
While it seems that herbal remedies are available to treat every medical
ailment from headaches to depression, consumers are urged to be informed by
treating supplements with the same seriousness as prescription medications.
Dalton said this is particularly important because patients should know if they
are taking the right supplements, whether the supplements they are taking can be
combined and if they are taking too much or too little of something.
As an example, Dalton shared that consumers might not be aware that St. John’s
Wort can enhance the effects of anesthesia during surgery, so it’s important
that they stop taking the herbal supplement a few weeks prior to surgery.
While there are certain supplemental products patients need to stop taking or
others they should take more of around surgery time, she said, patients probably
wouldn’t ordinarily think about any of these things causing concern.
"People need to be aware that supplements do have medicinal effects in
the body," she said.
"Consumers shouldn’t be shy about telling their practitioner what they’re
using and taking."