Have you ever been asked about ashwagandha? Or had a patient who prefers valerian root over trazodone for sleep? In the ever-evolving landscape of healthcare, patients frequently turn to dietary supplement use to address a variety of health concerns. As healthcare professionals, it is our responsibility to guide our patients with evidence-based recommendations while also supporting their holistic well-being. However, most of us have had little or no training on the risks and benefits of the various dietary and herbal supplements on the market.
In this blog post, we will explore five commonly used dietary supplements – ashwagandha, turmeric, biotic, berberine, and valerian root – with a focus on their potential benefits, risks, and considerations for healthcare providers when discussing these supplements with patients.
Before we dive into the specific supplements, a quick reminder that dietary supplements are classified as food, not medication, and therefore are not subject to any pre-market approval. It’s best to look for supplements with the “USP Verified” mark, which shows that the supplement was made in a facility following the Good Manufacturing Practice standards.
Ashwagandha
Ashwagandha, a staple in Ayurvedic medicine, has gained significant attention for its potential to alleviate stress, anxiety, depression, and sleep disturbances. There are several studies supporting the anti-stress and anti-anxiety activity of ashwagandha; there are fewer studies supporting its use for depression and sleep, but the few studies we do have show positive effects.
While research indicates the efficacy of ashwagandha in mild to moderate anxiety and stress management, healthcare professionals must exercise caution due to potential herb-drug interactions. Ashwagandha has GABA-mimetic and serotonergic activity, so it should be used with caution in combination with medications like some antidepressants and benzodiazepines. It may also interact with many other drugs, including diabetes and hypertension medications, immunosuppressants, sedatives, anticonvulsants, and thyroid hormone replacement.
Long-term safety data is limited, and it should be avoided during pregnancy and breastfeeding. Additionally, it may increase testosterone levels, necessitating careful consideration for patients with hormone-sensitive conditions.
Turmeric
The active ingredient in turmeric is curcumin, and it’s celebrated for its anti-inflammatory properties. However, curcumin is unstable and has low bioavailability when taken orally, which makes it difficult to study. There are studies showing improvement in symptoms in patients with inflammatory medical conditions, although there is a wide range in treatment protocols and results. Turmeric is generally safe and well-tolerated, however, with a low risk of harm if patients want to try it. The only exception is that there is some concern that turmeric may affect platelet function and clotting, so be careful with patients on anticoagulants.
Biotin for Hair Loss
Biotin, a water-soluble B-complex vitamin, is often marketed as a solution for hair loss. However, its effectiveness is confined to individuals with biotin deficiency. For patients without a biotin deficiency, there’s no clear benefit when it comes to hair loss (although there is some evidence that it may help with splitting, brittle nails). While biotin is generally safe, primary care healthcare providers should educate patients on the need for cautious use and its potential for interference with thyroid hormone assays.
Berberine
Berberine has been promoted on TikTok as “nature’s semaglutide,” but there is no good evidence that it helps with weight loss. It does show promise for improving metabolic health and may be helpful as an adjunct to medications for diabetes, hypertension, and hyperlipidemia, but it has many drug-drug interactions, which makes it a more risky supplement to recommend.
Valerian Root
Valerian root is often sought after as a natural remedy for sleep disorders, particularly insomnia associated with anxiety. There are studies that show efficacy when it’s used in its whole root form, but inconsistencies in product potency and stability of active ingredients pose challenges. Long-term safety data is lacking, and healthcare providers should inform patients about potential side effects which may include headache, stomach upset, agitation, heart disturbances, drowsiness, dry mouth, and vivid dreams.
Conclusion
As clinicians, our commitment to evidence-based practice remains paramount when discussing dietary supplements with our patients. While these supplements offer potential benefits, they are not a substitute for traditional medical treatments with more robust evidence showing efficacy. It is our duty to engage in informed conversations with patients, emphasizing the importance of consulting healthcare professionals before initiating any supplement use in their wellness routine.
Supplements can play a supportive role in healthcare, but their use should be guided by patient-specific factors, potential interactions, and available scientific evidence. By offering well-informed guidance, we can empower our patients to make choices that align with their overall health and well-being, fostering a collaborative approach to holistic healthcare.
For a more in-depth discussion of this topic, check out our Common Supplements Lightning Round discussion on Primary Care RAP February 2023.
