When looking to grow business with supplement sales, pharmacists should first educate themselves.
Kathy Campbell, PharmD
Bowe Craine, PharmD
Dipan B. Ray, MPharm, MS, PhD, RPh
Nina Chhabra, PharmD
Americans are desperate to be well. Being well, however, is not the business model of modern medicine, according to Kathy Campbell, PharmD, clinical community pharmacist and CEO/owner of Dr Kathy Health, LLC, and Medicap Pharmacy in Owasso, Oklahoma. The American health care system is structured to respond to a patient’s diagnosis, not prevent disease.
The $40 billion supplement industry,1 which includes vitamins and nutraceuticals, represents Americans’ willingness to spend money to be healthy. “Pharmacists are perfectly positioned and trained to understand the chemistry of supplements and foods, and as well as drugs and diseases,” Campbell said. “They can assist customers by recommending appropriate supplements. Sales of these products can also benefit a pharmacy’s bottom line.”
Bowe Craine, PharmD, co-owner and pharmacist in charge at Okie’s Pharmacy II Inc., in Blaine, Tennessee, agreed, and said that pharmacists should be at the forefront of not only selling supplements, but that they should also educate patients on OTC products that may not be FDA approved.
When looking to grow business with supplement sales, pharmacists should first educate themselves. “Research the most common products in various categories, and then analyze which ones fit your community’s needs,” Craine said. For example, if you have a large patient population with inflammatory conditions, such as irritable bowel disease or arthritis, then you should start with products like turmeric, fish oil, or cannabidiol (CBD) oil.
“Get out from behind the counter and talk to customers,” Craine said. “Ask how they feel about their current therapies and if they’re sufficient. Be confident in your ability to make recommendations about products that can improve quality of life. Not only will you increase your sales and profit margins, but you will also create loyal customers and build trusting relationships.”
Campbell recommended attending an 8-hour continuing education course from the National Community Pharmacists Association and Dr Kathy Health, Creating Health-Pharmacist-led Lifestyle and Weight Management, which teaches supplementation basics and foundational training in assisting patients with health.
When researching supplements, Craine uses UpToDate, PubMed, or the Dietary Supplements Labels Database to study their safety, efficacy, and various uses. National Center for Complementary and Integrative Health’s website is also recommended to get a better understanding of the usefulness and safety of supplements with evidenced-based research, advises Dipan B. Ray, MPharm, MS, PhD, RPh, senior director of experiential education at Touro College of Pharmacy in New York, New York.
Nina Chhabra, PharmD, a natural medicines specialist at Northwell Health/Vivo Health Pharmacy in New Hyde Park, New York, subscribes to reputable databases, such as the Natural Medicine Database, which provides detailed information regarding supplements like their level of effectiveness, safety information, dosing information, and possible drug interactions. ConsumerLab.com provides third-party testing results. The National Institute of Health’s website shows if any clinical trials were conducted to support a particular product’s usage, she said.
By far, the most popular supplement Craine sells are multivitamins. “Consumers take them mainly to avoid vitamin deficiencies which can lead to problems such as osteoporosis, muscle cramps, and fatigue,” he said.
Hemp-derived CBD topped Chhabra’s list in 2019. Patients use this product to help manage anxiety and stress, for insomnia or to support sleep, and for different types of pain related to fibromyalgia, headaches and migraines, and muscle and joint pain.
Vitamin D is the most popular supplement currently used. It helps the body absorb calcium in order to increase bone density and therefore reduces the risk of developing osteoporosis, especially in women and the elderly, he said.
Adverse Drug Reactions
In addition to serving as a resource on which supplements to take, pharmacists should make customers aware of possible adverse drug reactions.
A general myth is that most supplements are safe because they’re derived from natural sources. “The truth is that a majority of herbal supplements interact with other drugs and can have significant adverse effects,” Ray said.
For example, Chhabra noted that turmeric, curcumin, and fish oil supplements can thin blood. If a patient takes a blood-thinning agent such as aspirin or warfarin, she warns them to stop taking these supplements before surgery or any medical procedure that could affect their clotting time.
Chamomile, often used as a sleep aid, interacts with birth control, Craine pointed out. Ginger, which prevents nausea and vomiting, can lower blood sugar and interact with blood thinners if high doses are taken. Yohimbe may aid with erectile dysfunction, but it can raise blood pressure and heart rate and cause tremors.
Consumers should understand the importance of selecting the most appropriate products depending on their medical histories and current medication use. “Before using any such products, patients should share their current medications and over-the-counter products with their physicians and pharmacists so they can counsel them about any potential risks and benefits,” Ray said. “I encourage patients to report any side effects to physicians or pharmacists immediately.”
Because the kidneys and liver break down supplements just as they do prescription drugs, Chhabra asks customers if they have any issues with these organs. “Supplements can cause interactions for patients who take prescription drugs because they can compete with the same pathway,” she said.
Craine aims to ensure that customers buy products from reputable companies. For example, he’ll recommend a multivitamin with the United States Pharmacopeia (USP) seal of approval. “This seal means you can trust that the bottle’s contents contain exactly what the label states,” he noted.
Craine asks patients for feedback as well. “I want to know if a product helped or if it had side effects, so I can relay that to other patients,” he said.
The most frequent questions Chhabra gets from patients is if a product is safe and if it works. “I emphasize that safety is our primary concern, however it is hard to find robust clinical evidence about efficacy,” Chhabra said. “This is simply because large trials that can show this are rarely performed. Unlike prescription drugs, supplements are considered safe unless proven otherwise.”
Currently, Chhabra also receives many questions about hemp-based CBD products. “Although CBD appears to be safe, it is relatively new and we’re still learning its exact uses,” she said. “I recommend patients start taking low doses and slowly increase the dosage every 2 to 3 days until they feel an effect. But I caution them to only use products that provide third-party testing results, which can help ensure it’s a quality product and reveal its CBD content as well as any contaminants such as heavy metals, pesticides, and bacterial growth.”
The most frequently asked question consumers ask Ray is, “How much should I take?” He pointed out that all vitamins need to meet a certain Recommended Daily Allowance (RDA) as stated on the label to achieve desired benefits.
Supplements, Vitamins, and Nutraceuticals: What’s the Difference?
The best way to describe the differences between vitamins, supplements, and nutraceuticals is to consider supplements as the main category that these agents fall into.
The Dietary Supplement Health and Education Act of 1994 (DSHEA) defines dietary supplements as “a product intended to supplement the diet that bears or contains 1 or more dietary ingredients, including a vitamin, mineral, herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total dietary intake, or a concentrate, metabolite, constituent, extract, or combination of any of the aforementioned ingredients.”2
Nutraceutical products are generally derived from food sources intended to be used for health benefits, whereas vitamins are organic compounds that are needed from external sources, such as food, because the body can’t make them, explained Chhabra.
“If someone can’t obtain enough of a necessary vitamin from a food source alone, they may use a supplement that contains that specific vitamin,” Chhabra said. “Vitamins are essential for bodily functions, whereas nutraceuticals are used to supplement the diet and are typically food or food sources and are used for a specific health benefit.”
1. Statista. Total US dietary supplements market size from 2016 to 2024. https://www.statista.com/statistics/828481/total-dietary-supplements-market-size-in-the-us/.
2. National Institutes of Health, Office of Dietary Supplements. Dietary Supplement Health and Education Act of 1994 Public Law 103-417 103rd Congress. https://ods.od.nih.gov/About/DSHEA_Wording.aspx#sec3