Lauren Howell, PharmD
With 77% of Americans taking at least one supplement on a regular basis, it is more important than ever for pharmacists to know about these products. Career and job site Zippia compiled a 2023 report on the supplements industry that indicates the top 10 supplements in the United States. Since supplements are not FDA-regulated, pharmacists can play a vital role in counseling patients about these products, the data that exist around them, and any contraindications to their use.
Vitamin D
Vitamin D is a fat-soluble vitamin that is available as D3 (cholecalciferol) and D2 (ergocalciferol). Vitamin D deficiency has been reported to increase the risk of fractures, cancer, diabetes, cardiovascular disease, depression, and death. There is limited evidence regarding optimal vitamin D levels and mixed evidence regarding who should be evaluated for vitamin D deficiency.
Vitamin D3 is the active form of the vitamin and therefore may provide the most benefit to the patient. Dosing of vitamin D can range from 400–4000 IU daily and is available as a prescription medication at higher doses than those that are available OTC.
Magnesium
Magnesium is available in many different formulations including magnesium oxide, magnesium chloride, magnesium citrate, magnesium lactate, and magnesium aspirate. It can be found in a number of different products, from those aiming to cool heartburn, to those that are thought to reduce constipation.
Most magnesium that humans need is provided through food and water, and the highest recommended dose for an adult is 350 mg/day. Individuals with a magnesium deficiency have been found to have increased inflammation markers.
Fish oil
Fish oil is commonly used to decrease inflammation and support the health of the heart, brain, and eyes. It is common for patients to experience adverse effects such as bad breath, burping, fishy aftertaste, heartburn, and upset stomach after taking fish oil. This supplement may interact with other medications such as aspirin, enoxaparin, heparin, and warfarin.
CoQ10
Coenzyme Q10 (CoQ10) is a nutrient that acts as an antioxidant and is naturally found in the body as well as in many foods. While most healthy people have enough CoQ10, evidence has shown that some individuals may benefit from supplementation. CoQ10 is thought to possibly lower blood pressure, treat heart conditions, and prevent adverse effects such as muscle pains, when taking statin medications. There is no established recommended dose of CoQ10, but a typical dose ranges from 100 to 200 mg. Drug interactions may occur in patients taking blood thinners, chemotherapy, or thyroid medications.
Multivitamins
There is no shortage of multivitamins from which patients can choose. It is important to remind patients that most vitamins and minerals that they need should be found in a healthy diet. Keeping in mind that too much of some vitamins and minerals can be dangerous, pharmacists should help patients choose a product that best matches their needs.
Probiotics
Probiotics are commonly used by patients to support digestive health. It is generally recommended to choose a product that contains at least 1 billion colony-forming units. There are a variety of microorganisms that can be found in probiotic products. Strains with the most evidence supporting use include Lactobacillus and Bifidobacterium.
Turmeric
Many patients use turmeric with the goal of decreasing pain and inflammation. There is evidence to show that it could possibly be effective for use in hay fever, depression, hyperlipidemia, nonalcoholic fatty liver disease, osteoarthritis, and itching. There are numerous possible drug interactions with turmeric that pharmacists should be aware of to counsel patients.
Vitamin C
Vitamin C, or ascorbic acid, is an antioxidant that is not naturally produced by the body. It is an important part of the healing process and commonly thought to provide support to the immune system.
Evidence shows that the benefits of regularly taking vitamin C supplements to reduce the severity or duration of a cold are minimal. Long term use of high doses of vitamin C can lead to adverse effects such as kidney stones.
B-Complex vitamins
B vitamins are a group of nutrients that play many different roles in the body. While most people get the recommended amounts through their diet, some factors such as age, pregnancy, medical conditions, genetics, and alcohol may cause individuals to require supplementation.
B-12
Vitamin B-12 is a water-soluble vitamin. Usual dosing ranges from 500 to 1,000 µg.
It is commonly used to enhance energy levels, but evidence shows that it has no beneficial effect on energy or performance in the absence of a nutritional deficit. ■