Six industry experts give advice on offering nutritional supplements for your secondary profit center

Most likely, your patients are already purchasing vitamins and herbs at their local drugstore. By offering supplements in your office, you can recommend the ones that are the best for your patients.

The question is: What is involved in offering nutrition products? How do you responsibly integrate this niche into your practice? Chiropractic Products spoke with six representatives from nutrition companies.

Daryl Deluca is vice president of Biotics Research Corp located in Rosenberg, Tex.

Mitchell J. Ghen, DO, PhD, is an integrative health consultant. He is the author of The Advanced Guide to Longevity Medicine and is a speaker on health, chronic diseases, and nutrition.

Ria Gilday, ND, CN, is an independent distributor of Nu-Med Inc, Sunrise, Fla, products. She has a private practice in Souderton, Pa, and runs the Queens Anti-Aging Center. Gilday is the host of a radio show, “Let's Talk Health” on WNPV AM1440 and has more than 20 years of experience in the health field.

David Love is vice president of sales and marketing for CFU Distribution Co, Blain, Wa, distributors of Brazilian Fresh Harvest Coral™.

Monicah McGee had been the manager of operations for 5 years of Physiologics® located in Northglenn, Colo.

Joe N. Messino is the director of sales and product training for Douglas Laboratories Inc, located in Pittsburgh. Douglas has been supplying nutritional supplements to the professional health care industry for 50 years and to the chiropractic profession for more than 25 years.

What should chiropractors look for when shopping for a nutrition company?

Deluca: The most important issues are safety, purity, quality, and effectiveness in the selection of a nutrition company. DCs should look for a company that deals exclusively with health care professionals. If doctors lose control over the management of their patients’ supplement program, they are not getting accurate feedback on the effectiveness of the protocol and therapies implemented.

Only purchase products from a company that manufactures its own product line. Only the manufacturer is in a position to control the process from beginning to end. Also of importance, companies with their own internal testing laboratories have the infrastructure or technical ability to perform their own testing. The quality of raw materials is important. To choose the highest quality raw materials is based on the company’s ability to validate the identity, quality, and activity of the materials selected, which also means the willingness to pay for the best material available.

It is important to feel comfortable with your nutritional products supplier. Ask to visit their production facility during production operations. Check the quality control procedures. Make sure products are produced in isolate environments to prevent cross contamination.

Ghen: Look for a company that can deliver in several areas simultaneously. First, the quality of the products is important, such as pharmaceutical-grade chemicals only. Doctors should ask about routine batch testing, microbiology sampling, and standards (based on sound and proven research, expiration dates, etc). The manufacturer should maintain strict quality control and cleanliness protocols. A scientific officer should be available address inquiries and clinical concerns product use. Other items of importance are customer service, return policy, date of expiration, private labeling, and shipping and handling discounts.

Gilday: Doctors should look for supplements that complement their businesses and areas of interest. Most chiropractors are dealing with pain in some way, muscular inflammation, fibromyalgia, or injuries.

Love: Chiropractors should look for a company that is focused on the professional health care community. Chiropractors have told us they want exclusive and certified products that they feel comfortable recommending to their patients.

McGee: First, determine whether the company manufactures its own products. A manufacturer is more likely to be independently audited by quality control guidelines to ensure product purity, efficacy, and consistency. Top manufacturers produce products according to GMP (good manufacturing practice) and USP (United States pharmacopeia) standards. These standards require proper testing and documentation of materials, as well as written standard operating procedures for each stage of the manufacturing process. A manufacturer accustomed to following stringent guidelines also is more likely to be FDA compliant in other areas, such as product labeling.

Messino: This can be summarized in three categories: quality, manufacturing excellence, and breadth of products. The nutritional manufacturing company should adhere to strict cGMPs in accordance with USP26 (United States pharmacopia section regarding nutritional supplements). The company should be ahead of the curve in areas like FDA regulations and the Bio-Terrorism Preparedness Act of 2002; have an in-house lab testing facilities for microbiology, physical properties, and disintegration; and provide an extensive product line, private labeling, custom formulations, and packaging options.

What nutritional products are the best sellers in chiropractic offices and why?

Ghen: Typically, combination items are best (products with two or more ingredients): cholesterol, male and female issues, immune boosting for adults and children, pain control, and inflammation reduction as well as arthritis.

Gilday: The best selling products are those dealing with pain, rejuvenation, and recuperation because those are the areas of interest for patients seeking chiropractic.

Love: Nutritional supplements that are 100% natural and have professional laboratory certificates of analysis seem to be the best sellers.

McGee: Since chiropractors frequently address joint inflammation and core nutritional needs, products such as glucosamine, multivitamins, and CoQ10 are popular.

Messino: In addition to joint-health, the products should address general and digestive health as well as the major health concerns of this nation—namely cardiovascular health, diabetes prevention, and immune support.

Are nutrition seminars recommended for DCs with a nutrition secondary profit center? If so, what topics are the most pertinent for new and current chiropractors?

Ghen: Seminars must include diagnosis, work-up of patient, and pertinent treatment modalities in all areas necessary to return to optimal functioning.

Gilday: Today, we have almost an epidemic of fibromyalgia and chronic fatigue syndrome. Doctors should look into seminars on these topics along with stress management and maintenance exercises appropriate for chiropractic patients.

Love: Nutrition seminars are an excellent avenue for chiropractors as they provide a first-hand look at the manufacturer and their products and learn how to build a successful secondary profit center. Topics that are the most pertinent include new products, patient education, and understanding the patient’s nutritional requirements.

Messino: Yes, continuing education in this field is paramount to their success and the health of their patients. Education sells products. It is what the chiropractic patient wants and needs since they already have an active interest in preventative, natural health. Men’s and women’s health topics are always at the top of the list.

What advice do you have for DCs offering supplements for the first time?

Ghen: Choose only a few products and become familiar with them from both an educational and marketing perspective, recognize their strengths and weaknesses, and let them be a stepping stone in increasing your education and patient-care routine.

Love: Doctors should consult chiropractic publications, Web sites, and trade shows to learn as much information as possible about the nutritional market.

Messino: I recommend the “core four” products. These are four products or categories that leading nutrition experts feel every person needs, regardless of what additional therapies may apply: 1) a comprehensive multivitamin/mineral; 2) an additional antioxidant in the form of vitamin C or E, grape seed, or green tea extract, CoQ10 or alpha lipoic acid to combat the constant free radical damage being done to our cells; 3) an essential fatty acid rich in omega 3—fatty acids is imperative for heart health, connective tissue, cellular health, and brain health; and 4) a probiotic supplement.

How important is patient education with nutritional supplements? Should DCs request educational materials from their nutrition companies?

Ghen: Education is the key to keeping and helping patients. Doctors should give handout materials to patients on the various nutraceuticals, but this should be secondary to what the doctor tells the patient. Having a good nutrition practice requires much of your time.

Gilday: Absolutely. I think education is of utmost importance not only for chiropractors. but also for their patients. Reputable companies that are doing research on their products will offer educational materials. If a company does not have educational materials to offer, I would question them.

Love: Patient education is very important as it helps patients learn about the products they are taking and provides a residual income for the DCs long after patients have purchased their first product. DCs should request materials to educate their patients on the products they are selling.

McGee: Because of potential drug interactions with supplementation, educating patients about nutritional supplements is imperative to an effective treatment regimen. Patients also are more apt to follow an alternative protocol when their health care practitioner provides a brief explanation about the recommended supplements.

When requesting educational materials, we recommend our customers seek articles that are not affiliated with specific brands or manufacturers. Unbiased third-party literature is the most desirable for doctors seeking protocol information.

What marketing techniques/tools do you suggest for chiropractors to attract new patients or retain current ones?

Ghen: Marketing techniques should be tailored to the individual practitioners. Techniques can include print, newspaper, radio, and television. The more you are in the public eye, the more likely a person will become a patient. Handouts and educational seminars are important for current patients. Ask them for referrals.

Gilday: The best marketing tool is education. Attending seminars and providing third-party information and literature about the connection between nutrition and whatever ailments patients may be experiencing.

Love: Chiropractors can attract new patients while retaining their current ones by constantly educating and communicating with their patients.

Messino: Referrals—you can compensate with free adjustments or supplement samples.

What are the most common potentially lethal drug and supplement interaction?

Ghen: Fortunately, there are not many potentially lethal drug/supplement interactions, however, patients on blood thinning medications must be cautious with the addition of several supplements, herbals, and essential fatty acids. Particular caution must be observed in patients with either singular or multiorgan failure such as heart, kidney, or liver.

McGee: Drug-induced nutrient depletions and interactions are common and often serious. Health care practitioners should ask about both supplement and prescription drug use at each patient visit. We provide our practitioners with a free list of the top prescribed drugs and their interactions and nutrient depletions, as well as any recommended supplementation. For a complete list of drug-induced nutrient depletions and interactions, we also refer to a variety of third-party research references.

Messino: Since ephedra is now off the market for the most part, the most common interactions to watch for are blood thinning drugs and certain herbs like ginkgo biloba and garlic. Also, St John’s wort and certain drugs for depression as well as for HIV and transplant rejection. But, even though these may produce unwanted interactions, they are not necessarily lethal.

What do you wish to see happen in the nutritional products market?

Ghen: There should be more standardization, self-regulation, and peer review in the nutritional market. Independent laboratory testing with quality assurance including the publishing of the results and making them easily available to the health care community.

Gilday: I wish to see the substantiation of supplements on a much greater spectrum than we already have, particularly on the role of supplements in preventing degenerative diseases.

Love: We wish to see a standards organization formed to provide a certified testing process to relieve the industry of inconsistency and inaccurate test results.

Messino: Education, education, education. Health care practitioners of all types must embrace natural, alternative, and integrative treatment options. They can do this by taking advantage of the educational materials available to them by quality supplement manufacturers.

Julie Z. Lee is a contributing writer for Chiropractic Products.