Nutritional Supplements: Healthy for Your Patients & Healthy for Your Bottom Line

O ne of the most com­mon questions I am asked whenever I speak to doctors is whether or not they should offer vitamin and nutritional supplements to their patients. One thing is clear, whatever we doc­tors think of it, your patients have already made up their minds! Nutritional supplements are big business, and a sig- nificant proportion of the population is taking them. It's estimated that about half of all Americans regularly use nutritional supplements not prescribed by their doc­tors. A quick trip to the local health food store will reveal tablets with every imagi­nable combination of nutrients, vitamins, herbs, homeopathic remedies, whole food products, neutra-ceuticals, and more, in countless doses and formulations. And it's not just the health food store. These days, the local pharmacist and even the super­market offer much the same spec­tacle. Vitamin companies spend millions of dollars in advertising hoping to convince the consum- ers to buy their brand. Catchy phrases and fancy buzzwords are used to entice, stimulate and often mislead the general public. Clinical nutrition is a field that devel­oped in the 1940's to treat individuals with specific nutritional deficiency diseases, like scurvy and pellagra. By the 1960's, however, experts were beginning to rec­ognize that certain doses of nutrients had the power to prevent illness. Today, re­searchers and scientists continue to un­cover the therapeutic role of individual nutrients in the prevention and treatment of disease. For example, antioxidants like beta-carotene, selenium, vitamin E, and vitamin C have been shown to protect against the development of heart disease, cancer, and other chronic degenerative diseases. In the 1990's, the business of unproven, disproven, and irrational medical claims became a cottage industry on the fringe. Advocates called it "alternative medi­cine", really intending it as an "alternative" to scientific facts and principles. Con­sumers purchased a vast array of pills and potions with no scientific evidence or sound physiologic or pharmacologic basis. It's no longer unusual for patients to go to the doctor for an examination only to walk out with a shop­ping bag of vitamins, products or creams. More doctors are selling health-related products; and, for this reason, it is impor­tant that you select reputable nutritional supplement companies. Choose compa­nies that use an FDA approved labora- tory, conduct regular ingredient assays, and those that manufacture nutritional supplement formulas that make sense. A rose is a rose, but a nutritional supple­ment is not a nutritional supplement. For example, prices for Vitamin C can vary from five dollars a bottle to thirty dollars per bottle. Is there a difference between vitamins? The FDA allows questionable fillers and binders, such as cork by­products, chemical FD&C dyes, sodium benzoate, dextrose, ethycellulose, and propylene glycol, to name only a few. There are also varied units of measure­ment displayed on nutritional labels. In­terpreting these labels requires the exper­tise of a professional who understands the difference between them, along with the latest laws and regulations placed on the industry. You should ask the compa­nies you deal with to provide you with ingredient assays, so that you can be sure that the supplements you are dispensing are the real thing and not just fillers. Are You "Allowed" to Sell? A word of caution, prior to dispensing nutritional supplements to your patients, you should check the scope of chiroprac­tic practice in your state. The scope of practice varies from statc-to-state when it comes to dispensing supplements. The chiropractic scope of practice in the state of New Jersey, for example, does not al­low chiropractors to "sell, dispense or derive any financial benefit from the sale of vitamins, food products or nutritional supplements." By contrast, the chiroprac­tic scope of practice of the state of New York allows chiropractors to perform "nu­tritional counseling, including the dis­pensing of food concentrates, food ex- tracts, vitamins, minerals, and other nutritional supplements." When prescribing supple­ments to your patients, be sure to perform a thorough drug and dietary history. Many supple­ments can produce unwanted side effects when taken in com­bination with prescription and over-the-counter drugs. For ex­ample, one popular herbal rem- edy, Saint John's Wort, is now known to interfere with the action of a wide variety of prescription medications. To help keep you up-to-date about the nutritional sup­plement market, the publishers of the Phy­sicians ' Desk Reference recently released the PDR for Nutritional Supplements, which provides scientific analyses of the health benefits—or lack of—for hundreds of over-the-counter products ranging from vitamins to shark cartilage. A good relationship with the supple­ment company's sales representatives can also be very helpful. An effective sales representative will keep you in­formed of the latest advances in their product line, and will also provide you with useful patient education materials. Some nutritional supplement companies provide physicians with nutritional sur-, veys and assessments that are helpful in determining the supplementation needs of your patients. Others provide semi­nars with crcdcntialcd experts on a vari­ety of nutrition-oriented topics. Those doctors who are considering adding nu­tritional supplements to their practice would do well to sharpen their clinical skills with continuing education courses on the subject. Those chiropractors who become passionate about the possibili­ties of nutrition can also complete a 300-hour course of studies toward a Diplomate through the American Board of Chiropractic Nutrition. Watch Your Inventory An important practice management tip, when providing supplements to your patients, is to maintain careful control over your inventory. Select and stock only those supplements that you are cer­tain will be purchased by your patients. Nutritional supplements have an expira­tion date stamped on the bottle. And, while it may be cost effective to purchase supplements that you sell in quantity, bulk purchasing often results in over­stocking of supplements. Allowing sup­plements to sit on your shelves past their date of expiration can be very costly, and poor inventory management can result in a drain on your cash flow rather than an added source of revenue. Once each quarter, perform a thorough inventory analysis of the supplements on your shelves. Pay careful attention to those supplements that are about to expire. You can offer a special "clear­ance" price to move the supplements off your shelves prior to their expiration. Some supplement companies will even allow you to trade slow-moving products that are not selling fast enough in your practice with others in which you do a higher volume. By carefully, tracking the quantity of those supplements that sell well in your practice, while maintaining a vigilant watch over those which don't, you can effectively forecast the level of inventory that should be kept. Chiropractic care does not exist in a vacuum. Good nutrition plays an inte­gral role in the maintenance of optimal health. When properly researched, and effectively managed, advising your pa­tients to include nutrition as part of their overall approach to wellness can be both healthy for your patients and healthy for your bottom line. Dr. Mark Sanna is the CEO of Break­through Coaching, LLC, the leading re­source for personal coaching to chiro­practic and multidisciplinaiy practices throughout the country. He can be reached at Breakthrough Coaching, LLC, by calling 1-800-7'-ADVICE.