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Expanding Dietitians Competencies in Supplement Recommendations: Do You Know How to Choose & Recommend a Safe and Quality Supplement?

Five key questions to think about for supplementations in your practice.

RC-HS1.jpgJorie Janzen is the director of sport dietetics for the Canadian Sport Centre Manitoba and holds a private practice working with corporate health and wellness, and athletes with disordered eating. She received her undergrad degree at the University of Manitoba and furthered her education with the IOC Diploma in Sport Nutrition, and is a Certified Life Coach. Some of her experiences have come from working with various national and international networks, provincial, national and Olympic/Paralympic level athletes, the NHL, Royal Winnipeg Ballet, RCMP, and Sport Medicine Fellowships. With each opportunity, Jorie coaches clients to thrive in an environment that expects high performance on demand. Connect with Jorie at www.joriejanzen.ca.

  
As a sports dietitian, athletes continuously ask me about supplements. Which ones are safe? What brands are best? What will keep me healthy? What will allow me to excel? Years ago I would have said, “Just choose a well-known brand”, or “Just buy what is on sale”, or “All supplements are pretty much the same”! And, of course, I have even suggested that, “If you eat a balanced diet, you won’t need supplements”
 
And, I think if it were not for the fact that I work with athletes, I might just be saying the same thing today!  However, I came to realize that when an athlete’s medal, sport’s career and life long reputation could be taken away in an instant, I started my journey on how to be better equipped to ensure the safety of my clients.
 
To make a recommendation for or against a supplement should be an evidenced based decision, which may be difficult for athletes or the general consumer. I hope that dietitians can be a go-to source for this information by understanding the safety, efficacy and appropriateness of supplementation. 
 

 
Five key questions to expand your competency on supplementation
  1. Is the product safe? To assess the safety of a supplement, learn about Good Manufacturing Practices (GMPs), pharmaceutical grades, purity and interactions with other supplements or medications. Purity, for instance, refers to the levels of lead, pesticides, mercury, insecticides and other harmful substances. Contact the manufacturer to request a “certificate of authenticity” and to find out what GMPs have been practiced.  This certificate ensures that rigorous protocols have taken place. 

  2. Is it legal?  A significant number of supplements continue to test positive for banned substances – unintentional or not. When it comes to making sure the supplement is safe and legal, use the World Anti-doping Agency resources for ingredient checks.  (Keep in mind, this simply means that you are basing safety on what’s on the label, not necessarily what’s truly in the supplement).

    You could also check for banned substances through quality assurance programs such as Informed-Sport or Informed-Choice. These programs provide proof that the batch tested came out clean.  The best option however, is to have the sport certified product third party tested for safety – but this takes money. 

  3. Do you know what to look for on the label? Look for indication that the product has gone through a quality assurance program, where the product has been tested in the lab and also randomly at the retail level.  Two recognized certification programs are LGC or NSF.  

  4. Do you know how and when to recommend a supplement or a combination of supplements? This is probably the most important and one where most practitioners are least confident! We need to look at the evidence emerging and learn about effective doses and duration. Learn about side effects.  Which sports, health conditions, training situations require supplementation?  For athletes, some considerations are weight loss, body composition, nutrient intake – and even travel as they may be going to a competition in a location where food safety is questionable. 

  5. 5. Is there evidence it will work?  The evidence is extremely important.  We also need to look at supplements used in studies as well as outliers.  Outliers are ignored too often.  What if you were the outlier?  Would you not want to know why supplementation did or did not work for you?  Great resources are PEN and DC networks. I also like to look at Examine.com and The NutriSearch Comparative Guide to Nutrition Supplements.
 
Other considerations to discuss with clients:
  • Side effects.  High doses can be harmful, as can interactions with other supplements and medications.
  • Affordability.  More expensive may mean a higher quality product.  However, not everyone can afford these supplements.  Be ready to provide clients with supplements options in different price ranges.
  • Form of supplement.  Some forms are more bioavailable than others.

Bottom Line
This past summer at the Dietitians of Canada Conference I heard from several of my peers that they either did not believe in supplementation (outside our food scope), or if they did, they had no idea how to judge a quality supplement. I want to make it very clear - yes, we are about food first!  But as professionals in food and nutrition, we have to be competent and confident in supplementation.  Athlete or not, there are circumstances where people will need to supplement either short or long term. I believe that we need to be leaders in this area and make it an important part of our professional role.
 

 
 
Other resources:
ConsumerLab.com
Health Canada Multivitamin/mineral Monographs
CRN


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Editor’s note: Do you feel confident in the area of supplementation?  IThis may be a new practice area for many dietitians – but Jorie makes a great point that we need to keep to learning and become better equipped and knowledgeable in this field.  Do you have anything that has helped you when talking supplements with clients? 
 
Disclaimer: The opinions of the bloggers are their own. Dietitians of Canada encourages submissions and provides publishing support but does not guarantee the accuracy of the information provided. Please contact the writer directly for concerns or questions about the content.
 
 
  1. It is a great article. You will surely like this also because it is a great stuff, yeah it’s give us lots of interest and pleasure I have enjoyed reading many of the articles and posts contained on the website, keep up the good work and hope to read some more interesting content in the future
  2. Hello colleagues! Someone connected regarding the use of the word "prescription" in our field. Legally, the word prescription is protected and we as RDs can not use it as we as a profession recommend but do not make prescriptions.

    First of all, I absolutely agree that we are to recommend and guide our clients and not prescribe supplements...although I did not realize the word was protected.

    The title unfortunately of the blog on my part is somewhat misleading and does include the protected word. Becoming competent in supplement prescription so we can make safe quality recommendations was not intended to say we make prescriptions. Rather, If clients are coming with a prescription or we see one ordered and or are just asked for advice, we do need to be able to judge a supplement and provide our recommendations. In the entire blog content there is no mention of prescriptions. There is use of recommendations. The title has been modified to keep within our scope of practice.

    As I was discussing this with the college I thought if I was not aware that the word could not be used how many of you do not know either! Even with editing and proof reading with colleagues the title did not even come across as what looks like "we" are prescribing or making a prescription around supplements. So, thanks to a fellow colleague for capturing this error.

    The title has been modified to be very clear and to avoid any possible legal action. I am writing this not because I have to, rather, because I felt it to be important that we keep our profession professional and I hope I have helped another fellow RD out there from my error.

    Here is to safe practice!

    Jorie

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