The Truth behind supplements: Why don’t doctors recommend them?
by Dr. Harrison Weisinger, MBBS, PhD.
“Why don't doctors recommend supplements?” – This is a question I get asked a lot by people, online. I think it’s a good question. After all, if supplements really worked, doctors would prescribe them, right?
Unfortunately, for several reasons, it’s just not that simple, and here's why:
1. The effects of supplements are less obvious than many drugs.
If I took 100 people that have never had a sleeping tablet in their lives and gave each of them something like diazepam (“Valium”), I could reasonably predict that every single person would feel drowsy within an hour. But unfortunately, very few things in health are this predictable.
Think about the effect of alcohol, for instance, which by and large is quite a simple molecule with a well-studied metabolic process. As simple as it is, though, three different people could drink exactly the same quantity of alcohol and behold as one of them gets rowdy, one of them gets sleepy and the last one gets chatty!
In the case of most supplements (and many drugs for that matter), however, the effects are subtle and may vary from person to person. The exception to this may be the case of vitamin or mineral deficiency, where the effects of deficiency that are being experienced disappear with supplementation. Knowing who will and won’t benefit from supplements is difficult for a doctor to predict, especially when there is an inadequate number of clinical trials. I’ll get on to this in a minute.
2. Doctors are trained to use clinical guidelines and research evidence in a certain way.
These are nervous times for medical practitioners, who feel an expectation to provide excellent care to every single person, every single time.
Mistakes, made even with the best intentions, can cost a professional their reputation or career. Because of this, doctors rely on published clinical guidelines (which themselves vary and have evolved enormously – smoking used to be prescribed for asthma!) and “evidence-based medicine”.
By design, both clinical guidelines and evidence-based medicine are conservative, awaiting overwhelming evidence of benefit before making a recommendation. This makes prescribing supplements less likely, not necessarily because they don’t work, but because they haven’t been proven to work. There is a big difference.
3. Absence of evidence is not evidence of absence.
There is a famous statistics paper by this very title and it’s a favourite of mine. The concept I’m trying to describe relates to the imperfections of the scientific process – and in particular, the frailties of funding such science.
Here’s the snapshot: if scientists wish to test the effect of a new treatment (say, a new drug, or a diet or a supplement) and the effect is thought to be important but not all that large, an enormous number of subjects is required to ensure that the results of the study are statistically valid. Enormous numbers of subjects translate to enormous expense, so it is rare for any organisation to fund such research unless there is the potential for sales in the billions. This is why supplements, which are rarely patented or protected, are not typically tested in large-scale trials.
Imagine that we wanted to prove, to the satisfaction of those writing clinical guidelines for doctors, that curcumin extract reduces inflammation in arthritis and improves quality of life.
Given all of the limitations of the above points, it would take on the order of billions of pounds and the best part of 50 years to reach our desired level of understanding. In other words, we’ll never really know.
This is why I believe that the fundamental issue, when it comes to testing supplements such as curcumin or omega fatty acids, is that of safety. Once demonstrated to be safe, consumers can effectively assess, for themselves, whether a supplement delivers benefit - and without waiting for something that will probably never happen.
Despite the above limitations, what we do know is that supplement sales are on the rise.
This begs the question“why would anyone spend money on something that gives them no benefit?”I doubt anyone would.
All of this suggests that many supplements are working – perhaps in subtle ways, perhaps over the long-term and there really is no clear way to know what will work without trying it.
Having written all of this from a professional perspective, I’ll now tell you what I think, personally. I’ve been using various supplements for close to 30 years, which corresponds to the time I first started pushing myself, physically. At 18 years of age, I was pretty seriously into the gym with a goal to get bigger and stronger. Supplements like protein powder and creatine were very new but I wasn’t about to wait for the research to see if they worked!
Similarly, I used supplements when I played university basketball, and continue to now, as a competitive cyclist. I believe that what we ask of ourselves is no longer normal. Think about it. Is it normal to work 40 hours, or more in an office, care for your family and still manage sessions at the gym or yoga studio? Or is normal to run a 26km half-marathon? Or ride in the hills for 4 hours? Not at all! So, it seems unlikely that an ordinary diet can help people do extraordinary things.
I know I’m not alone in this belief as most if not all of my medical friends and colleagues (whom not surprisingly demand high performance, both physically and mentally) use a variety of supplements to improve their health and wellbeing.
Dr. Harrison Weisinger is Medical Director for Truth Origins, a company committed to bringing you high-quality supplements, and the information you need to decide on what’s right for you.