Dietary Supplements Compound Health Issues for Older Adults

The abundance of pharmaceutical advertising has taught patients to beware of drug side effects. The Food and Drug Administration (FDA) requires drug manufacturers to disclose these risks alongside any potential benefits.

But not for vitamin and herbal supplements.

The FDA considers them “foods,” not “drugs.” However, dietary supplements also can cause side effects and unwanted interactions with other substances.

This is a big concern for older adults with growing health issues, says Ronan Factora, MD, of Cleveland Clinic’s Center for Geriatric Medicine.

“The older population tends to take a lot of supplements by choice,” he says. “They could be lured by TV commercials or the advice of friends. And because they never hear a long list of potential side effects as they do with drugs, they assume there aren’t any.”

Compounding the problem, many supplements — which are easy to access, without a prescription — tout benefits that have little or no scientific evidence.

Supplements to watch for

“Too much of some dietary supplements can be harmful,” says Dr. Factora. “Some can interact with prescription drugs or change how the body metabolizes them.”

He lists these examples:

• Excess vitamin A may increase risk of osteoporosis.
• Excess vitamin B6 can produce neurological problems, such as imbalance and peripheral neuropathy.
• Garlic, ginger, ginkgo and ginseng can increase the risk of bleeding in people taking blood thinners.
• John’s wort, which some take for depression, can cause serotonin syndrome if combined with an antidepressant.
• Echinacea, kava, cinnamon and melaleuca may inhibit or accelerate metabolism in the liver, causing statins, anti-seizure medications or others to either be less effective or potentially produce more side effects.

How geriatricians can protect their patients

“We need patients to know as much about taking their dietary supplements as they do about their prescription medications,” says Dr. Factora. “They should treat them the same.”

He recommends geriatricians do these three things:

1. Ask patients to list everything they’re taking and how much. Specifically ask them about over-the-counter medications, vitamins and herbs. “I ask my patients to bring in the bottles so they don’t need to remember names and dosages,” says Dr. Factora. “That’s also helpful for looking at exactly what’s in multivitamins and other combination supplements and spotting any overlap. Patients may be getting more of one substance than they realize.”
2. Ensure supplements are doing what patients expect. That includes discussing indications for the supplements and possible side effects. “Patients may be surprised that herbals do have side effects,” says Dr. Factora. He cautions the use of supplements marketed only for general health or wellness. “That’s very vague. To make sure a supplement is working, there needs to be a specific benefit,” he says.
3. Urge patients to stop taking ineffective supplements. “Doctors tend to prescribe more medications than they remove,” says Dr. Factora. “With dietary supplements, we need to reverse that.”

It’s hard for physicians to keep up with the ever-expanding market of dietary supplements, Dr. Factora admits. That’s why he encourages patients to talk with a pharmacist.

“For people that want to take control of their health and boost their wellness with dietary supplements, it’s important to learn from a professional that best understands the properties,” he says.