Advising Patients On Use of Dietary Supplements

November 18, 2015


Dietary Supplement Use

As Integrative Registered Dietitian Nutritionists (RDN), we follow a Code of Ethics, which states, among other important principles such as practicing with integrity and honesty, that "The dietetics practitioner practices dietetics based on evidence-based principles and current information."

Nutrition science continues to evolve at a rapid speed and the use and regulation of dietary supplements continues to elicit challenges when advising our patients and clients regarding their supplemental needs. The complexity of interactions, manufacturing practices and lack of oversight can alter the intended benefits and consequently cause adverse reactions.

DIFM continues to support members' needs related to this area of practice for evidence-based research with access to the Natural Medicines Database, a comprehensive research bank of specific information on dietary supplements, use, recommendations, interactions etc. and many other accompanying resources. We also work on continuing to educate our clients and patients of the unique bio-individuality they possess and being cautious, informed, and vigilant about the current research is a necessary component of any nutritional intervention.

Last week, the New England Journal of Medicine published an article about emergency room visits related to adverse events from dietary supplements. Based on a nationally representative probability sample and using 10 years of data, they reported that each year adverse events from dietary supplements were responsible for 23,000 emergency room visits. Most common issues were tachycardia, chest pains and palpitations in young people, choking, nausea and abdominal pain in elders, and unintended ingestion by children.

As integrative RDNs, it is important that we help our patients understand how to use dietary supplements wisely. Below are some action items we can take from the article:

  • It is important to buy reputable brands that do not sell adultered products – this is hard to identify because quality information is not readily available. Many obscure brands taint their products with drugs or banned substances that cause harm or don’t do adequate testing to ensure their products are safe. Look for 3rd party certification, buy nationally known brands, subscribe to Consumer Labs, check the Office of Dietary Supplements (ODS) website for warnings and recalls.
  • Weight loss and ergogenic (body building and energy) supplements pose the biggest risk – especially if bought off the internet or from international or obscure retailers. We need to educate young people about the risks.
  • More is not better: many people think the serving size is just a suggestion and that more is better.
  • For elders, take care in swallowing pills – not a handful at a time but one at a time with ample water.
  • Make sure children do not have unsupervised access to dietary supplements.

Comparatively speaking, dietary supplements have had far fewer adverse events reported than pharmaceutical drugs. The FDA reported that during 2008 – 2011 there were 2.7 million adverse events related to pharmaceutical drugs. RDNs need to be vigilant in our recommendations of safety. If people don’t use dietary supplements wisely, there could be more regulatory restrictions put on them.


Geller A et al. Emergency department visits for adverse events related to dietary supplements. NEJM. 2015;373(16):1531-1540

US Food and Drug Administration. Reports Received and Reports Entered into FAERS by Year.

Food and Drug Administration website.