One might wonder how functional medicine doctors can keep up with the thousands of supplements and pharmaceuticals out there, let alone their combinations and interactions. Honestly, no one can know everything, even if they practice medicine for decades. Beyond that, even if you memorized all the current supplements, tomorrow a slew of new discoveries, products, and combinations would appear, promising just a bit more than the old formulas. If that were not challenging enough, each patient we see is unique, different from the last patient even if he has with the same condition. In caring for our patients, we have to start with some basic principles and use wisdom in applying them to the patient sitting in front of us.
Some of these principles will make perfect sense without having to even say them, but others may not be as obvious. Explaining all nuances of this process takes years of actual practice, but here are some of the thoughts going through our heads when we recommend some supplement.
First, all providers aim to do no harm. We want to advise therapies which are the least likely to cause side effects or discomfort. This seems obvious, but knowing which therapies are most likely to cause a problem in a given patient requires knowing both the patient’s condition and the supplement’s mechanisms. From there, we should ask the patient if they have reacted negatively to that supplement before. On top of that, knowing how the supplement might interact with other supplements or pharmaceuticals may require some double checking in databases.
Second, as we are wanting to bless our patients with feeling better, we must choose from a number of therapies that have potential to relieve symptoms or repair conditions. The better we understand our patients, the more specifically targeted we can be in choosing the right therapy. Each supplement will affect them in a few different ways. We want to match the various effects of the supplement up with the various needs of the patients. Recommending a calming supplement that also makes one sleepy is not the best for the anxious person during work hours, but would be great for the nighttime anxiety. In another example, we might have to set aside a supplement that seems great for their symptom because their sensitive stomach won’t allow it. We must treat the whole person each time and consider the whole picture in choosing therapies for them.
Besides understanding our patients, we must understand the tools of our trade: the vitamins, herbs, and nutrients that we recommend. There are multiple ways to learn about these tools. Supplement companies generally market their products as being the “go to” choice or the “best” or the “most advanced”. We can’t just take the word of every drug rep that knocks at our door. We have to understand a supplement beyond the marketing materials offered. Once we have a basic understanding of the mechanism, the effects and the side effects, we must then apply our tools and learn how the treatment actually works in real life with patients. Sometimes, a therapy seems perfectly suited when we start it but never actually has the effect we expect; this requires adjustment.
Third, we must consider how we combine therapies even beyond their potential interactions. Many patients have multiple conditions. For some, treating two, three, or more conditions simultaneously makes sense. At other times, we have to stage things out, starting with one set of therapies and then tapering those off after a period to aply a different set of therapies for the next few months. Sometimes the disease itself requires this step-by-step approach. Sometimes the complexity of the protocols is just too much for the patient to fit into their life all at once.
Fourth, we must consider not only the supplement but who is making it. Many supplements are simple and easy to produce. For there, we have a lot of options. In a significant number of cases, though, the particular herb or chemical is a little trickier to make, or we need it in a particular delivery form (liposomal, for instance). Here, we may find that only one or two companies are good. Even past this, we have the question of combination supplements. While our sensitive patient may prefer trying things one ingredient at a time, others want the simplicity of ‘one capsule, five supplements’ and understandably so. All of these factors must be considered.
Fifth, we have to consider the fillers and supplement packaging. Whether it’s alpha-gal patients who can’t tolerate products from mammals (red meat related) or any of the other reactions patients deal with (including those to veggie caps, gelatin, and filler powders), we have a lot to consider- to again ‘cause no harm’. Sometimes, we have to have things compounded without fillers or with special fillers.
Sixth, we have our pediatric patients, some of whom need a liquid or chewable form rather than a capsule or tablet. Most supplements have a liquid form, but sometimes this is not possible. For some of these, we can advise opening capsules and sprinkling on food or mixing in a liquid. That brings us to one final consideration, taste. Whether you’re a kid or an adult, all too many supplements just taste terrible. While companies are very good at hiding some horrendous flavors, sometimes the taste cannot be hidden. At that point, we either find a different supplement or regretfully ask them to wash it down fast with something that takes better.
All in all, a lot of thought is going into choosing each supplement for a protocol. You may see smoke coming out of our ears as the gears process in our heads for your individualized protocol. Even then, we will have to come back later and listen to how your body responded to that protocol in order to make adjustments. Every step in restoration requires listening and adjusting over and over until you have your healthier, more abundant life back.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.
