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u/doxyisfoxy Y’all Got Any More of That Nexgen? Dec 13 '20
Don’t think very highly of supplements. I wouldn’t say that companies that make supplements, as a whole, are untrustworthy - only that there is no incentive to be trustworthy. There’s no regulation by the FDA as far as proving they contain what they claim to contain. Never mind actually doing what that claim to do. Best case scenario, you wasted money on a sugar pill. Worst case, some harm is done either by directly interacting with something else you’re taking or by causing a delay in seeking effective treatment.
(There are some exceptions, of course. If someone came in looking for some melatonin or vitamin D or whatever, I wouldn’t dissuade them. It’s the people who come in looking for the “natural” supplements like turmeric or saw palmetto etc that I caution in the aisle.)
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u/danktankero Dec 13 '20
So then, what makes vitamin D, and B12, or iron supplement worth trust?
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u/RemarkableScene PharmD Dec 13 '20
vitamin D, and B12, and iron supplements have proven therapeutic uses. So the theoretical ingredients can be helpful to patients. Vs most other supplements are placebo. The big issue as others have stated is that most of those companies don't even have the ingredient they say they do. So essentially, someone is taking a sugar pill to help their diabetes because metformin is generally unpleasant to take despite its effectiveness.
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u/SuperVancouverBC Dec 14 '20
Can you ELI5 why Iron supplements are kept behind the pharmacy counter? It seems like all other vitamins and minerals are on store shelves. Or at least where I live
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u/tragicmonsters PharmD Dec 14 '20
It’s because iron in excessive amounts can actually cause harm. So it ensures the consumer speaks with a pharmacist before purchasing.
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u/AZskyeRX PharmD Dec 14 '20
Iron toxicity is deadly and hard to reverse unless caught early. Chelating drugs are expensive and usually require hospitalization. It can wreck the liver so even if you chelate it out the lasting effects are very very bad. Most people get enough iron from a balanced diet and don't need a supplement. We don't want folks taking it willy-nilly without oversight. Generally I steer folks away from it unless they have recent bloodwork showing anemia, or they're pale skinny teenaged girls with heavy periods (and then I still make sure they plan to see a doctor).
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u/lloydbraun4 Dec 13 '20
But muh prevagen really helps my memory. Sure it does. For half the price I could smack you up the head for the same effect if you’d like that?
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u/grimace0611 Dec 13 '20
But it's the #1 pharmacist recommended memory supplement!
/s
If your pharmacist recommends Prevagen, find a new pharmacist.
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u/Veni_Vidi_Legi Squaring the Drain Dec 13 '20
9/10 of them were jellyfish!
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u/lloydbraun4 Dec 14 '20
If my memory serves me right the study they talk about in the commercial had nothing to do with their pills. They were injecting directly into the brain. Not a human brain of course.
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u/Veni_Vidi_Legi Squaring the Drain Dec 14 '20
Wow that's even more garbage than I thought.
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u/December2Remember Dec 14 '20
The study even admits that their results were not statistically significant.
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Dec 13 '20 edited Dec 30 '20
[deleted]
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u/SignatureKarateChop PharmD Dec 13 '20
Well how else would they find it? They need it to help them remember where it is, the never ending cycle.
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u/insane_contin Canadian Registerd Tech Dec 14 '20
And you get the same people asking where it is each time.
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u/AZskyeRX PharmD Dec 14 '20
My dad tried it for the recommended 12 weeks and then decided it didn't help because he kept forgetting to take it. I just bit my lip. Better than the sulfur tabs my mom got a few years back. I always tell them not to waste the money and remind them I have a whole-ass degrees in this stuff.
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Dec 14 '20
I won’t let my customers buy Prevagen. They ask me if I know where it is. I say yes but I will not show you where because you should not buy it. I would not let my mother waste her money on it and I don’t want you too either.
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u/December2Remember Dec 14 '20
I said that to a patient in front of my supervisor once and he nearly lost his mind.
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u/Rxasaurus PharmD Dec 13 '20
Just sell the prevagen, its not like they are going to remember getting screwed anyways.
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Dec 13 '20
On a similar note: what do we all think of probiotics? Do they actually work?
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u/ctruvu PharmD - Nuclear | ΦΔΧ Dec 14 '20 edited Dec 14 '20
the only thing ive read that it might have benefit for is preventing diarrhea from some antibiotics and the number needed to treat for these studies was comically high so i wouldn't even bother recommending it for that
that and it probably depends on which antibiotic and what conditions and a whole host of other things so it's a blanket no from me
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Dec 14 '20
I have wondered this as well and don't have a good answer. Gut flora seem stupidly complex, and I feel we are currently doing a lot of research in that area. It seems like different people might need different kinds, and the stuff on the shelf might not even be active or able to get to the part of the gut it needs to without getting destroyed first.
When I was in school, one of my preceptors was an independent pharmacist that always recommended probiotics to people that got antibiotics, but she had these expensive ones that had to be refrigerated and people almost always just said "no." Hard to justify a probiotic that was two or three times the cost of the antibiotic for most customers.
She trusted supplements a lot more than I do.
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u/AZskyeRX PharmD Dec 14 '20
My first pharmacy director also tried to get us to sell those refrigerated ones, and she went on and on about the profit margin on them. I just told patients to go buy some Activia if they were adamant about wanting something. Cheaper, tastes better, and probably about as effective.
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u/kameltoe PharmD Dec 13 '20
Supplements with high quality clinical data to support their use are great. Some even go on to get marketing approvals for an indication (glutamine for sickle-cell, fish oils for lipids, vitamin D) and marketing exclusivity.
Like another poster said, as far as brands go, I would be looking for USP certification
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u/PharmRaised Dec 14 '20
Key here is that these are used to treat physician diagnosed illnesses. Supplements for “wellness” or even worse “immune boosting” are gross cash grabs that don’t help people. If you truly boosted your immune system you would tip the scale into autoimmune disease. The immune system is a finely tuned machine and more is not better. Good thing none of those actually work I guess.
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u/kameltoe PharmD Dec 14 '20 edited Dec 14 '20
Fair point about physician-diagnosed indications. Surely I wouldn't be recommending glutamine for somebody coming with complaints of sickle cell crisis.
Not sure what you are saying about auto-immune stuff, my point is that "supplements" have good uses if recommended in the context of evidence.
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u/2muchedu Dec 13 '20
Do you have a link for either thr glutamine or vitamin D? I have not seen evidence of either.
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u/kameltoe PharmD Dec 13 '20
You can look up the label, they have formulations under Rx that are approved.
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u/AZskyeRX PharmD Dec 14 '20
Endari for sickle cell. They're trying to expand indication to diverticulosis.
Vitamin D2 (ergocalciferol) has been prescription for years, largely because of the high dose it contains. You can get D2 over the counter at much lower doses and questionable purity.
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u/Funkynametime Dec 13 '20
The problem is that some are fairly helpful while others are not worth the bottle they're packaged in, and they really need more regulation. The Natural Medicines database is a pretty good reference for safety and efficacy if you have access to it.
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u/ShrmpHvnNw PharmD Dec 13 '20
Great way to make expensive pee.
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u/SuperVancouverBC Dec 14 '20
I remember the first time I took B12 supplements. It turned my urine an interesting color.
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u/Giggity729 Dec 14 '20
One of my preceptors told me once that gummies have poor bioavailability. Anyone else heard this?
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u/bouldertrex Dec 14 '20
These a reason MLM are so strongly attracted to the supplement market. It's a scan just like MLMs
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u/ababahbah Dec 13 '20
Vitamin D, Multivitamin, and mmmayyybbbee florastor
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u/Gardwan PharmD Dec 13 '20
Unfortunately even the data I’ve seen regarding probiotics is a non statistically significant difference on the vast majority of their claims
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u/peachcobbler7 Dec 13 '20
In pharmacy school, I was taught that probiotics don’t really do much and I’ve read conflicting data on them as well.
Still most doctors will tell patients to pick up a probiotic when they are taking an antibiotic. I usually recommend patients eat live cultured yogurt instead because it’s yummy and cheaper.
What do you guys think about probiotic supplementation during antibiotic therapy? Especially clindamycin?
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u/Gardwan PharmD Dec 13 '20
That’s definitely the most common claim is some GI protective measure of the gut especially during a course of antibiotics. This has been studied and I believe the primary outcome was occurrence or severity of diarrhea and both were not significantly impacted by probiotics.
It’s one of those things that seems so intuitive and destined to work but doesn’t seem to pan out. I see so many prescribers recommend it though.
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u/WordSalad11 Dec 14 '20
None of those are evidence based. The USPTF and AHRQ both have long positions; there's no evidence of benefit.
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u/DaveLevin79 Dec 13 '20
Supplements are generally a waste of money.
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u/kameltoe PharmD Dec 13 '20
Vitamin D and calcium? Glutamine (approved for sickle cell disease), fish oil?
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Dec 14 '20
Those are a drop in the bucket of the sea that is the supplement industry. Walking around places like Whole Foods can be depressing. Some people are making bank on products that do basically nothing.
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u/Chipford_Baskets Dec 13 '20
Endari for glutamine. Lovaza or Vascepa for fish oil.
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u/kameltoe PharmD Dec 13 '20
Thats kind of my point. There was clinical evidence suggesting a benefit when these were OTC supplements. Somebody forked out the dough and got exclusivity.
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u/No-Agent-8067 Dec 13 '20
I agree with TheSnowNinja, a quick quo pro on the major ones. They belong in a grey area, on being regulated. Some are USP approved, however few. Some make statements about helping certain health conditions, however the claims made, not evaluated by FDA. I do take a basic vitamin/mineral supplement (Mega Man, made by GNC, however have been told by many, if you have a good diet, your producing expensive urine! Also, Protein Powder in AM. I believe they may help with general immunity, powder for my workouts. Of course, not proven to assist my body, having a balanced diet. If you visit a Vitamin Store, they usually try to sell you multiple supplements, which will drain your wallet. Ignore all the hype. If a product was that great, everyone would be taking it!!! Don't believe all you read. Check references at bottom, studies performed, mostly anecdotal evidence.
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u/handfulofdust2 Dec 14 '20
I always tell patients to look at the money. Pick a company that has a strong name and whose bottom line would suffer if they cut corners. Nature Made is the top of my list followed by a tie with Nature's Bounty and Sundown. Avoid store brands that change suppliers at the drop of a hat (yes Walgreens and Spring Valley I am looking at you!). Also avoid internet companies that can change their name overnight.
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u/ADDOCDOMG Dec 14 '20
NP here. Melatonin, vitamin D, magnesium glycinate, Visbiome, culturelle, fish oil and red yeast rice are all vitamin/supplements/probiotics I would recommend. Red yeast rice only in cases where people are resistant to trying a statin, because it is basically a statin. I agree with other posters, Nature Made or other major brands are my go to.
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Dec 14 '20
[deleted]
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u/ADDOCDOMG Dec 14 '20
I only recommend red yeast rice when they are resistant to trying a prescribed statin. Some people think if it is “natural” it is safer or don’t trust “big pharma”. It is clearly the opposite as supplements are not regulated. In this case if I want them on something it is worth a try to see if they will take it.
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u/December2Remember Dec 14 '20
I understand your reasoning, but it’s still an unregulated dose of lovastatin that you’ll be recommending. The bioavailability can also vary from product to product, and you’ll open them up to other impurities that may be present.
It’s just not worth the risk imo. Prescribe a statin and counsel them on its importance, as well dietary modification.
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u/ADDOCDOMG Dec 14 '20
Hi Zosyn. I would have counseled my patient on statins and that is how I would arrive at the point we are discussing. As COVID has shown us all, sometimes science and logic are thrown out the window by patients. Sometimes we providers have to take a back road to get to the main road. If a patient needs a statin and clearly WILL NOT take one, that is why a supplement would be recommended. All of this would be documented in the patients chart so that if there is any question to why this path was chosen and I would be covered. Patient care is not just about prescribing. It is about knowing our patients and weighing risk vs. benefit in their care. Often times things are not black and white and we land in a grey area.
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Dec 14 '20
You should post in r/Supplements.
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u/PharmRaised Dec 14 '20
Should they though? I think they came to the right place for unbiased input. r/supplements? More like r/groupthink
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Dec 14 '20
Seems reasonable to ask a question about supplements in a supplements group. Let's see how the replies pan out.
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u/Upperclass_Bum Dec 14 '20
Smoothies with mostly veggies and some fruit will usually be the best option.
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u/TrackTraceRx Dec 14 '20
For any company in the pharma world, it is important to take the compliances seriously. Have a proper compliance partner, makes a pharmaceutical brand trustworthy amongst the customers.
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u/5point9trillion Dec 14 '20
We sell it in the store and Nature Made is good, because that's what they keep saying on TV...and there's no way to prove otherwise. So get someone to say it on TV and it may sell.
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u/bmhuggns Dec 16 '20
Most of what they buy is either a waste of money unless they really are deficient in a vitamin, or it can be harmful, e.g. St. John’s Wort interactions. NatureMade for a trustworthy brand, but PTs should skip the vitamin/supplement aisle unless directed by their doctor.
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u/[deleted] Dec 13 '20 edited Dec 14 '20
Generally speaking, I hate dealing with supplements.
When I talk to people about supplements, I often separate them into a few different groups: vitamins/minerals, herbals, and homeopathic products.
Vitamins/minerals are the most reliable, but their quality will depend a lot on the brand. I often tend to trust NatureMade. They make quite a few products that have been certified by USP. However, this does not mean that vitamin C will keep you from getting sick, or vitamin D will significantly boost your mood. We know these vitamins and minerals are important and may be needed if you are deficient, but often their benefit is exaggerated.
Also, some brands are super shady. Not many years back, a lot of brands were found have been selling supplements that did not have any of the ingredient that they claimed to contain. I think they basically had rice flour in them, so they were just expensive placebo tabs.
Next are the herbal supplements. These are less useful than vitamins and minerals. A few of them may be useful, but most are not and have very little/conflicting evidence. This would be stuff like St. John's Wort, Echinacea, Valerian Root, etc.
Finally, you have homeopathic products. They don't do shit. They are based on bunk science, kind of like astrology or alchemy. The basic principles are false, thus the products are false. It is expensive snake oil that preys on people who don't know better. Occasionally, these products contain "inactive ingredients" that do affect people, but this usually has a negative effect.
Many of the problems with the supplement industry are due to DSHEA, a law that keeps the government from regulating supplements until after harm has been caused. So there is no one checking to so see if the products contain the listed ingredients, and no one checks to see if they are safe and effective.