Do As I Do, not as I Say.

Dr. Weeks’ Comments:  Back in 1993, while attending a cardiology conference, in response to a query, a show of hands demonstrated that 90% of the cardiologist attending took supplements including vitamin E and niacin and Vitamin C.  Shockingly, when the same group of doctors was then asked how many of them recommended supplements to their cardiac patients, no hands went up (except mine).  Little has changed.  Today, more than 25 years later, doctors continue to take better care of themselves than they do their patients because of the tyranny of the standard of care. What’s that? Well doing anything different from the standard of care  (albeit better or worse)  -such as recommending supplements – can get the state medical board threatening to take your license. So doctors are timid and practice not scientific but rather consensus medicine. (As you know, science does not advance on the basis of consensus!) So, for your sake, always ask your doctor what she or he takes as supplements. They usually won’t volunteer that information unless asked…


More Physicians, Nurses Take Supplements Than Recommend Them

Marcia Frellick

December 24, 2018

Nurses, advanced-practice nurses (APRNs) and physicians who responded to a Medscape poll on thoughts surrounding vitamins and mineral supplements were more likely to take the supplements than recommend them.

The poll questions were posted August 22 and 165 nurses/APRNs and 950 physicians responded.

When asked whether they recommend vitamins and/or mineral supplements to patients, 24% of physicians and 31% of nurses/APRNs said they always or frequently do.

Answering how often they recommend other dietary supplements, 15% of physicians and 19% of nurses/APRNs said they always or frequently do.

But when asked how often they take dietary supplements (vitamins, minerals, or other supplements) the numbers were higher, and the disparity between physicians and nurses was marked: 71% of nurses/APRNs said they regularly take them compared with 31% of physicians.  Among both groups, those who were regular users of supplements more often recommended them to their patients (56% for physicians, 39% for nurses/APRNs) than did those who occasionally or never use them (11%).

The poll was taken after Medscape published a story saying that despite a lack of proven benefit and an association with harm in some studies, the supplement market in the United States alone was almost $30 billion in 2015 and the global dietary supplement market is projected to hit $278 billion by 2024.

“[S]ome antioxidant combinations (at least two of vitamins A, C, and E; β-carotene; selenium; and zinc) and extended-release niacin were associated with an increase in all-cause mortality,” the article said.

A family medicine physician commented on that story, saying, “I have been taking 15 supplement pills about 5x week for 40 years. I take ZERO pharm drugs. Normal blood pressure, healthy cholesterol, lipid and liver panels and no ED.  Better to take my 15 pills than to take the 15 drugs most of my patients take.”

However, a pharmacist responded: “As a pharmacist, I see that patients are confused. I tell them ‘best to incorporate into your diet by eating healthy natural foods; your body will always prefer the combinations in its natural form, over any supplement.’ ”

A nurse practitioner responded when the poll questions were posed, “Our first duty to patients is to discuss lifestyle measures which affect heath (ie, diet, exercise, stress management, sleep, connections, etc). That said, many of our patients’ diets (and our own) are far from ideal. And, as several have pointed out, our modern food supply is often depleted of important nutrients due to the manner in which our food is grown and stored. Also, there are some disease processes which can benefit from specific dietary supplements.”

Answers Differ by Physician Specialty

Answers in the poll varied widely by specialty. Obstetricians-gynecologists (37%), physicians in women’s health (37%), and pediatricians (32%) were among the most likely to always or frequently recommend vitamins and/or mineral supplements. Conversely, just 13% of gastroenterologists always or frequently recommend them, and 53% say they rarely or never recommend them.

Family medicine physicians were the most likely to take dietary supplements  regularly or occasionally (74%) and internists were the least likely at 53%.

Age seemed to play a role in whether physicians recommended supplements.  The youngest physicians (younger than 34 years) were less likely to say they always or frequently recommend vitamins and/or mineral supplements to patients (16%) while twice as many in the 45- to 54-year age group (33%) answered that way.

However, across physician age groups the numbers who said they take supplements did not vary by much and fell into a range between 63% and 71%.

When asked what kind of supplements they take, the top choice for physicians and nurses/APRNs was vitamins and/or minerals (87% of nurses/APRNs took them and 75% of physicians took them). The next most commonly taken supplements were specialty supplements (including omega-3 fatty acid, probiotics, and fiber). Those were taken by 46% of physicians and 58% of nurses/APRNs.

The top reasons for taking the supplements centered on improving health, filling nutritional gaps, improving wellness, and preventing disease. Only 11% of nurses and 20% of physicians said they took them to increase energy or performance.

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