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."