What supplements are most beneficial for your patients? Supply them with the facts about the efficacy of supplements and vitamins.
I am continuously bombarded with questions about the many miracle supplements. Patients regularly ask for advice about the efficacy of various supplements. Some bring in bottles of pills or labels and others bring advertisements. Many want to know about the veracity of claims made on infomercials.
The short answer to my patients’ questions is, “I don’t know.” Consider the following information: Researchers1 examined the contents of commonly used supplements for prostate disease and compared levels of nutrients in the pills to what is stated on the label. They tested several brands of vitamins E and D, selenium, and saw palmetto and also compared the amounts in different lots of the same brand to determine the consistency of the manufacturing process. A total of seven samples were tested for vitamin E, five for selenium, four for vitamin D, and six for saw palmetto (Figure 1).1
If patients ask whether product A is good, you can only reply that you do not know because adequate nutrient levels may not be in the supplement. Unless we know for sure about manufacturing, we cannot know about quality.
The Placebo Effect
Doctors often tell me at seminars and conventions that I need to try miracle product A because it will make me feel great. First of all, what does great mean? Second, how can anyone presume that someone else does not feel great since we cannot jump into someone else’s body and make that determination? Finally, it can mean different things to different people. We must wade through the colorful adjectives used to describe the outcome of taking miracle products.
There are two likely reasons why miracle products make people feel better. First, because of the placebo effect, and second, because most people are deficient and almost anything will make them feel better.
It is not uncommon for doctors and patients to denounce the placebo effect because it implies that a doctor’s treatment did not have value and that patients suffered from a psychosomatic problem. In fact, the placebo effect is quite powerful; perhaps being at work in up to 70% of positive patient outcome.2 We cannot make product claims, just because someone feels better.
Several years ago, researchers3 wanted to examine the placebo effect in weight lifting. They engaged 15 male athletes involved in heavy weight lifting for 2 years. Those who made the greatest gains over the preliminary 4-month training period would be selected for the second phase that involved steroids.
Eight of 15 subjects were selected and six participated in the 4-week steroid trial, during which they were supposedly going to receive Dianabol. However, all received a placebo instead. Strength data was collected during the last 7 weeks of the preliminary period and compared to placebo. As it turned out, strength gains were substantially greater during the placebo period.3
The term nocebo is used to describe negative outcomes that are derived when subjects are given inert substances. In one study,3 researchers examined the effects of beta-blocking drugs on the ability to perform single bouts of exercise or to train aerobically. Before starting each study, a cardiologist gave comprehensive information on beta-blockers, including their cardiovascular treatment utility and side effects. One of the authors stated, “I was amazed to note that during the course of 6 years of study, the most serious side-effects almost always appeared in the subjects taking the placebo.”
Obviously, perception of the intervention plays a huge role in determining the therapeutic outcome. This must not be forgotten when using supplements. All the more reason to be sure that you are working with a company that guarantees that the content of the supplement is in line with values presented on the label.
Assuming that a miracle product works, it is easy to explain why results tend to be positive. Consider that it is known that much of the American population is deficient in one or more nutrients, or at least our intake of the required nutrients is less than adequate.4
The American Diet Problem
If the average patient is deficient, then any supplement will probably be helpful. This is not at all an unreasonable conclusion. Why? Because pathetic adequately describes the average American’s diet. For example, 80% of American children and adolescents and 68% of adults do not eat five portions fruits and vegetables per day.4 As a consequence of such deficiencies, it is possible for dietary changes and supplements to create seemingly miraculous outcomes.
Infertility. Can miracle supplements improve fertility? In one study, 24 subfertile men took a daily supplement that contained both 66 mg of zinc and 5 mg of folic acid for 26 weeks and experienced a 74% increase in total normal sperm count.4 Was this a miracle or the natural outcome of better nourishment?
Weight loss. Efficient fat loss can seem miraculous to many. Ames believes that micronutrient deficiencies drive obesity. This is because energy-rich but nutrient-poor diets will create a state that drives us to eat more to obtain adequate nutrients. In other words, the overweight and obese are constantly hungry because they are deficient in key nutrients.4 When such individuals adopt a low-energy, nutrient-dense diet and take a multivitamin, it is not uncommon for them to feel less hungry and to lose weight naturally.
Premature aging. Our mitochondria make free radicals when they make ATP for cell energy. The free radicals can damage tissue and cause premature aging. Ames has worked with lipoic acid and acetyl carnitine and found that they reduce free radicals and spare our tissues from free radical damage.4 Coenzyme Q10 is also effective.
Magnesium. Consider the recent study5 about magnesium intake in the American population. White males averaged 352 mg per day, Latino males 330 mg, and black males 278 mg. White females averaged 256 mg per day, Latino females 242 mg, and black females 202 mg.
The RDA for magnesium is 420 mg per day for males and 320 mg for females, which means Americans are severely deficient in magnesium. Magnesium deficiency is likely to lead to diverse symptoms because magnesium is involved in more than 300 metabolic reactions, so symptoms can show up in the neuromuscular system, cardiovascular system, renal system, skeletal system, and central nervous system.6 Correction with magnesium may appear miraculous, but it is not.
When asked if a particular miracle product is beneficial, I suggest providing your patients with this type of information. Patients need to know that they are likely to be deficient in several key nutrients and by eating better and taking good supplements, they are likely to feel better. When the pain and other symptoms disappear, it can seem miraculous, but in reality, it is just normal physiology. CP
David R. Seaman, DC, MS, DABCN, DACBN, FACC, is currently a faculty member at Palmer College of Chiropractic Florida and speaks at state meetings and chiropractic college seminars. He has written articles for peer-reviewed chiropractic journals, chiropractic magazines, and state association journals and also . Seaman’s nutrition text is utilized at several chiropractic colleges. He can be reached via email: seaman_d@palmer.edu.
References
1. Feifer AH, Fleshner NE, Klotz L. Analytical accuracy and reliability of commonly used nutritional supplements in prostate disease. J Urol. 2002;168(1):150–154.
2. Turner JA, Devo RA, Loeser, JD, VonKorff M, Fordyce WE. The importance of placebo effects in pain treatment and research. JAMA. 1994;271(20):1609–1614.
3. Wilmore JH, Costill, DL. Physiology of Sport and Exercise. Champagne. Chicago: Human Kinetics; 1994:321–323.
4. Ames BN. The metabolic tune-up: metabolic harmony and disease prevention. J Nutr. 2003; 133(5 suppl):1544–1548.
5. Ford ES, Mokdad AH. Dietary magnesium intake in a national sample of US adults. J Nutr. 2003;133(9): 2879–2882.
6. Durlach J, Bac P, Durlach V, et al. Magnesium status and ageing: an update. Magnes Res. 1998;11(1):25–42.
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