Last week was an interesting week for me. I worked with some new and returning clients, which is not particularly interesting but some things jumped out at me after reflecting on my client interactions as well as learnings from educational events I also attended last week. The first educational event I attended was hosted by current students enrolled in my Masters program at Ryerson University and was all about the use of Natural Health Products by Canadians. The second event I attended was hosted by my local chapter of Crohns and Colitis Canada and was a naturopath presenting on managing IBD holistically. While these educational events were not linked, I found myself reflecting as the theme of the importance of collaboration in healthcare jumped out at me.
Back story: A 2010 study of Canadians reported that over 70% of Canadians use natural health products and I suspect that number is actually higher based on the fact many Canadians probably didn't report this and that this study was published 7 years ago. And why do I think many Canadians are not reporting? I suspect some fear what their health care practitioner will say about it, others aren't aware that they should and others would reply if asked that no one asked them which is why they hadn’t reported. Working in my practice primarily with clients living with digestive health issues, I would guess that over 95% of the clients I work with have or were at some point using natural health products - some of these products are things they've started on their own and others are things recommended by someone on their health care team - nutritionist, naturopath, family doctor, dietitian etc. And as I sat listening to the naturopath speak last week at the educational event for Crohns and Colitis Canada, there was mention of quite a few natural health products used in the practice of this naturopath in his work with patients living with IBD. Bottom line, those affected by IBD and others living with digestive health conditions are pretty likely to be using or have considered using natural health products.
At this point you might be thinking - why does this matter? It matters because natural health products are sold in Canada, without requiring a prescription but that doesn't mean they are without risk. I saw a client this week for example who indicated on intake paperwork that she takes vitamin D drops daily. When I asked during our session if she knew the dose she took, she told me each vitamin D drop she takes is 1000IU and the bottle says to "take a few" but she takes "about 10" daily. Had I not prompted her with questions about natural health product use I would not have gained this information that led to a conversation about what a safe dose of vitamin D is and why going above this can actually be quite dangerous (Note: excess vitamin D can actually cause a build-up of calcium in your blood that can cause problems with kidney stones, heart arrhythmias and can even be fatal).
As mentioned above, in my patient population I guess that about 95% are taking or have taken natural health products and this doesn’t surprise me given the number of products on the market and the claims made about their gut healing, health promoting benefits. For those of you living IBD or other digestive health challenges, who are taking or have questions about natural health products, what do I suggest you do? Below you'll find my top tips for how I suggest you tackle this subject matter so you can do so safely
1. Talk to your Gastroenterologist - the trade off of being funded by OHIP is you may not have much say in which gastroenterologist your family doctor has referred you to, nor are they the most accessible to you if you see them only once a year. Gastroenterologists and other specialists are a busy group no doubt, so showing up for your appointments prepared can help them help you. They are the experts in your digestive system from the outside - you live with it day to day, but second to your lived experience in many cases, they have literally seen your insides with a camera and have expert knowledge on what's going on and how the medications they've prescribed for you are meant to work. They are also likely to be pretty up to date on natural health products because they see patients like you every day who are taking and asking questions about their use. Bring to your appointments a list of any other medications you are taking and that also includes any natural health products you are taking as well as dose. Ask your gastroenterologist for their opinion and you might be surprised with the response your get, or their recommendation that you should run this by another practitioner on your team who may be equally or better equipped to comment. There is no harm in asking.
2. Slow and Steady Wins the Race – I’ve seen many clients whom after being first diagnosed with a digestive health condition, they want to tackle it all – total diet and lifestyle overhaul and start probiotics, omega-3s and other natural health products promising gut healing or anti-inflammatory properties but I actually caution against this. While some natural health products may be supportive, others may completely disagree with you and your digestive system. If you've started them all at once, how will you know what's caused what? In my practice, I'll advice you based on my assessment of where I think you should start as well as when you should start (maybe now is not the best time) and I'll suggest you take it one step at a time so you have time to learn how your body responds.
2. Choose Your Team Wisely – A team that communicates is a good thing. With a client’s consent, I send copies of my consultation notes back to gastroenterologists and family doctors as many read and appreciate the support I provide to their patients and the detailed information I have the luxury of obtaining during my lengthy client appointments. If you can, choose health care practitioners who share information like this within your healthcare team as it keeps everyone on the same page working for you. Another thing to remember is when it comes to working with non-OHIP covered healthcare professionals including registered dietitians, you are not just a client but also a paying customer using your extended healthcare benefits or paying out of pocket which means you absolutely can choose who you work with. If you’ve decided to work with more than one type of healthcare professional, choose ones that are open to the fact you are also working with multiple disciplines and who respect your choice. I have worked alongside a Holistic Nutritionist before and while we didn't see eye to eye on everything, we did agree on many things and a lot of the information she offered was a similar message to what I would have offered. I work with many clients now in private practice who are also working with naturopaths and again, a lot of their messages around removing ultraprocessed foods from your diet are similar messages to those that I would deliver. When it comes to natural health products there can be a bigger divide in our disciplines, but working with a team who is open to the fact you are working with other practitioners is a benefit to you and your quest for improved health and can help you navigate the world of natural health products and which ones might be appropriate for you.
4. Know that Disagreements Do Happen - So we are striving for openness but know it can't be all peachy and rosy. When a client who is also working a naturopath shows up in my office, I may disagree with some of the suggestions on natural health products and dietary suggestions that have been made. I can only speak as a Registered Dietitian because that is what I am, and I am bound by the College of Dietitians of Ontario to practice in an evidence based manner so when recommendations made by another practitioner who is not a Registered Dietitian are made, I may not always agree with them. If I disagree with advice you've received from another practitioner, I will have a conversation with you about why I feel this way based on how I practice as a Registered Dietitian. I may not agree with everything, but for me knowing that you've got the whole story and can now make an informed decision on your health is enough for me to know I've done my job and I'd rather have had the opportunity to share my rationale than for you to hide information from me for fear I will wag my finger at you with a frown on my face. Ultimately the choice is yours when it comes to natural health products - it's your life afterall!