Dietary Supplements and Natural Products: How to Fully Disclose to Your Care Team

Most people think if it’s natural, it’s safe. But that’s not true. You might be taking ginseng for energy, St. John’s wort for mood, or glucosamine for your knees-and not telling your doctor. You’re not alone. In fact, 77% of American adults use dietary supplements, and more than half have chronic conditions like high blood pressure, diabetes, or heart disease. Yet, only about one in three people tell their doctor about them. That’s not just an oversight-it’s a risk.

Why Your Doctor Needs to Know What You’re Taking

Supplements aren’t like vitamins you take to fill a gap. Many are powerful. St. John’s wort, for example, can cut the effectiveness of birth control pills, blood thinners, antidepressants, and even some cancer drugs by up to 57%. Ginkgo biloba, often taken for memory, can cause dangerous bleeding when mixed with warfarin or aspirin. Garlic supplements can lower blood pressure so much that they interfere with anesthesia during surgery. These aren’t hypothetical risks-they’re documented cases that show up in emergency rooms every day.

The FDA doesn’t test supplements before they hit the shelf. Unlike prescription drugs, which go through years of clinical trials, supplements are sold under a 1994 law that lets manufacturers skip safety and efficacy reviews. The agency can only act after something goes wrong. In 2022, there were over 16,900 reported adverse events linked to supplements-though experts say less than 1% of actual incidents are ever reported. If your doctor doesn’t know you’re taking something, they can’t see the full picture. And that’s when mistakes happen.

The Disclosure Gap: Why People Stay Silent

Many patients don’t tell their doctors because they assume their provider won’t care. Or worse-they think their doctor will judge them. A 2022 survey found that 68% of patients felt dismissed when they brought up supplements. Others believe natural means harmless. One patient told the AMA Journal of Ethics: “I didn’t think my doctor needed to know about ‘natural’ stuff.” That’s the dangerous myth.

Providers aren’t always better prepared. Medical students get less than three hours of training on supplements during four years of school. Many doctors don’t know the names of common herbs, their dosages, or how they interact with medications. When a patient says “I take ginseng,” the doctor might not know whether it’s Panax ginseng or American ginseng-two different plants with different effects. Without specifics, there’s no way to check for risks.

How to Talk to Your Care Team-Without Feeling Awkward

The problem isn’t just patients hiding information. It’s also that doctors rarely ask. Research shows that when providers use open-ended questions, disclosure jumps from 29% to 72%. Here’s how to make it easy:

• Don’t wait for them to ask. Bring it up during your first visit: “I’ve been taking a few supplements to help with my energy and sleep. Can we talk about whether they’re safe with my other meds?”
• Use clear language. Say “supplements,” “herbs,” “natural products,” or “vitamins you don’t get from food.” Avoid saying “I just take a little something.”
• Bring the bottle. Or take a photo of the Supplement Facts label. That way, your doctor sees the exact ingredient, dosage, and brand.
• Be specific. “Ginseng” isn’t enough. Say “Panax ginseng, 400 mg daily.”
• Include everything-even if you think it’s minor. Peppermint oil, echinacea, fish oil, turmeric, melatonin-all of them can interact.

One nurse practitioner in Toronto started asking: “What supplements or natural products are you taking that your pharmacist might not know about?” Disclosure in her practice doubled within six months. The key? Making it normal. Not weird. Not judgmental. Just part of the conversation.

What Your Provider Should Do

It’s not just your job to speak up. Providers need to ask-and document properly. The American Medical Association now recommends screening for supplement use at every visit. Hospitals across the U.S., including major ones in Toronto and Vancouver, have started requiring it on admission forms. But it’s still not standard everywhere.

Good documentation includes:

• Exact name of the product (e.g., “Ashwagandha (Withania somnifera)”)
• Dosage and frequency (e.g., “500 mg twice daily”)
• Reason for use (e.g., “for anxiety” or “for joint pain”)
• Where it was purchased (retail store, online, imported)
• Any side effects noticed

Electronic health records now have tools to flag interactions. Epic Systems, one of the largest EHR platforms, is adding a dedicated supplement module in mid-2024 that will automatically check for 1,200 known drug-supplement interactions. But that only works if the data is entered. If you say “vitamin D,” and the system doesn’t know the dose, it won’t catch anything.

Common Supplements with High Risk, Low Disclosure

Some products are used by millions but rarely disclosed. Here are the top offenders based on national survey data:

Supplements with High Risk and Low Disclosure Rates

Supplement	Common Use	Disclosure Rate	Key Risk
St. John’s wort	Depression, anxiety	8.4%	Reduces effectiveness of birth control, SSRIs, blood thinners, and cancer drugs
Ginkgo biloba	Memory, circulation	12.7%	Increases bleeding risk with warfarin, aspirin, NSAIDs
Garlic	Heart health, immunity	10.9%	Can lower blood pressure too much, interfere with anesthesia
Echinacea	Cold prevention	18.9%	May interact with immune-suppressing drugs
Glucosamine/chondroitin	Joint pain	22.3%	May affect blood sugar in diabetics, interact with blood thinners
Green tea extract	Weight loss, antioxidants	15.1%	Can cause liver damage at high doses

These aren’t outliers. They’re common. And they’re dangerous when taken with prescription drugs.

What You Can Do Right Now

You don’t need to wait for your next appointment. Start today:

1. Go through your medicine cabinet. Write down every supplement, herb, or natural product you take-even if you haven’t used it in a while.
2. Take a photo of each label. Include the Supplement Facts panel.
3. Check your prescription list. Are you taking blood thinners, antidepressants, diabetes meds, or heart drugs? Those are the ones most likely to interact.
4. Call your pharmacy. Ask them to run a check for interactions between your prescriptions and supplements. Many offer this for free.
5. Next time you see your doctor, say: “I’ve been taking a few things on my own. I want to make sure they’re safe with what you’ve prescribed.”

There’s no shame in taking supplements. Many people use them to feel better, manage stress, or support their health. But safety comes from transparency-not secrecy.

What’s Changing-and What’s Next

There’s movement to fix this. The FDA launched the Dietary Supplement Ingredient Database (DSID-5) in January 2023, which gives providers verified ingredient amounts for 650 supplements. The Supplement Safety Act, introduced in March 2023, would require manufacturers to list all products with the FDA-a step toward accountability. And more hospitals are making supplement screening mandatory.

But the biggest change has to come from you. Until patients start speaking up, and providers start asking, the risk stays the same. And that’s a risk no one should take.

Next Steps: Make It a Habit

Don’t wait until you’re in the ER. Start today. Keep a simple list: supplement name, dose, why you take it, and when you take it. Update it every time you change something. Bring it to every appointment-even if you’ve been seeing the same doctor for years. If you’re seeing multiple providers, share the list with all of them. Your safety isn’t a one-time conversation. It’s an ongoing practice. And the only person who can make it happen is you.