Nutritional Supplement Shotgun Therapy

I once had a new patient arrive with her forms completed, a stack of medical records under her arm, and a large bulging gym bag in tow, saying “I brought all the supplements I’m taking. I’m hoping you can suggest a few I might not need.”

One by one, she placed bottles and jars of varying sizes on my desk. When that space was fully occupied, she moved to the top of my examining table. Finally she said, “I think we’re out of room, so I’ll just leave these last few in my bag.”

I asked if she took them all every day and she said most of the time yes, though she sometimes skipped the ones that made her feel nauseated.

“Did you choose all these yourself or are these the recommendations of…”

She finished my sentence, “Oh, lot of people. You’re my third integrative doctor, but I’ve also seen nutritionists, chiropractors, a naturopath, and some of these are from a Chinese doctor. Also, my mom is really into natural medicine and against all prescription drugs, so she ordered a bunch more online.”

“Can’t you stop taking some?”

“Well some of these are from the past couple of years. I keep everything in case someone thinks I need to restart something.” She extracted about ten bottles, “For example, I’m not taking these any more.”

She figured she was taking between 30 and 40 supplements, including scoops of various powders, every day.

The ten she’d just shown me were long past their expiration dates and therefore pretty useless. I did some quick arithmetic on her daily supplement dose and figured she was spending between $500 and $600 a month.

“I’ll bet this gets expensive.”

“Is that ever true! Seems all my money is going for supplements. But I really want to get well.”

Life story

After reviewing the many pages of her medical records, I asked her to tell me her life story, including the biography of her illness. The supplement bottles scattered about seemed to be listening attentively as well.

We reviewed her eating habits in detail. Someone along the way had sold her a subscription for a box of meal-replacement bars (which arrived every 30 days), telling her that with the bars and supplements, she needed to eat just one meal a day. And ever since a well-meaning practitioner told her she had multiple food sensitivities, she’d eliminated dairy, egg, corn, gluten, and nightshade vegetables, though she admitted she hadn’t felt any better after doing so. She was also avoiding fruit (“too much sugar”) and I pointed out that just one of the meal replacement bars contained more sugar than a bowl of sweetened cereal.

When it came time for her physical exam, we worked together to move the bottles from the exam table to two spare chairs. Her exam was normal, though she did indeed look tired, not surprising based on the fatigue she’d described. At the end of our visit, I concurred with the diagnosis of two doctors she’d already seen: chronic fatigue syndrome with mild fibromyalgia.

Most people with chronic fatigue do eventually get better, especially when an underlying issue like adrenal or thyroid fatigue or chronic Lyme is identified and correctly treated. Understandably, along the way and out of sheer desperation many such patients see multiple practitioners, each with her own treatment agenda, and the supplement bottles start accumulating.

“Did these supplements help?” I asked. She said she wasn’t sure.

I asked if she thought her diet was healthful and she explained that because of all the foods she’d been told were “toxic” she didn’t eat much of anything, adding “But I’ve got those bars and the supplements.” She also mentioned that as an animal rights supporter she was vegetarian except for a once-monthly meal of fish.

As we discussed why I agreed with the CFS diagnosis, I added that I thought her quest to get well was being complicated by her inadvertent malnutrition and supplement overload. I didn’t want to repeat any of her tests that had been normal for years, but did suggest a couple new ones on her thyroid and adrenal glands along with a good Lyme disease screen.

From 30 to 4

From the 30 bottles of supplements, I selected four.

“Stay on these, but with a dose change.” And with a sweep of my hand, added, “The rest of these you can stop.”

Her eyes widened. “All of these?!”

I explained that what she’d been experiencing was something called shotgun therapy. Some well-intended practitioners don’t know exactly what’s wrong with you so they try everything, making an effort to cure you with a shotgun blast of supplements. They add supplements to what you’re already taking and hope for the best. They might also suggest you eliminate food groups you haven’t already eliminated and hope that doing so will make you well. This leaves you…

She finished the sentence, “Taking a ton of pills and not eating.”

Next step: nutrition

Her follow-up assignment would be to work with one of our nutritionists to learn about the benefits of eating actual food. They would walk through the process of reintroducing foods she thought she couldn’t eat, adding just one food group every few days while she listened for her body’s response.

The process, called elimination-reintroduction, is the easiest and most accurate way to determine if a food sensitivity actually exists. She’d already done most of the elimination part herself. The re-introduction, especially when doing so doesn’t trigger any symptoms, is the fun part, especially when you learn you can enjoy a nice plate of scrambled eggs with sweet peppers in the morning.

She would also completely avoid adding any new supplements. In the future, if a new health issue emerged for which a supplement might be recommended, she could try it but ultimately would discontinue it if she improved.

How to get rid of all the supplements? I suggested she empty the bottles into a single plastic bag, seal it, and toss it into the garbage, recycling all the empties.

Supplements are just that

We discussed the idea that nutritional supplements are exactly what the words mean. They’re intended to supplement what should be a nutritious way of eating. When you start considering blends of vitamins, minerals, amino acids, and herbs, like a Thyroid Support Blend, you’ll need some expert guidance beyond that provided by the website trying to sell the supplement.

If you start working with herbs, correct dosing requires years of education and professional certification. Just because a product is sold in a health food store does not mean DIY self-treatment is the best route to take.

Maybe it’s time to think about clearing out your own supplement house. If you’re basically healthy and eating well, I recommend just four supplements:

• A high-potency multiple vitamin, with iron if you’re menstruating, without iron if not or if you’re a guy.
• Vitamin D, about 2,000 IU daily year-round, because we live like moles under our cloudy skies and in our sunless offices.
• A high-potency antioxidant blend. These do appear to offer protection against a variety of chronic illness associated with getting older.
• A good fish oil product for heart health.

Then, depending on your personal situation and family risks, discuss specific supplement recommendations with a qualified practitioner. These might include enzymes or a probiotic for digestion, melatonin for sleep, or St. John’s wort for mood.

If you start a condition-specific supplement and notice no improvement in symptoms after a couple of months, stop taking it. Otherwise, you too might soon be arriving with a bulging gym bag.

Be well,
David Edelberg, MD