Strengthening Clinical Decisions on Supplement Use Through Evidence and Patient Education

In this Pharmacy Times interview, Leena Pradhan-Nabzdyk, Ph.D, MBA, CEO and co-founder of Canomiks, discusses how the company’s platform, WhatToTrust, can serve as a valuable first-line tool for both consumers and health care professionals in evaluating dietary supplements. She explains that while supplements are regulated by the FDA for quality, identity, purity, and potency, the science behind their efficacy and potential interactions with medications is still evolving. Because of this, WhatToTrust focuses on assessing whether a product is scientifically backed by cross-referencing company claims with publicly available research and clinical trial data. Pradhan-Nabzdyk emphasizes that pharmacists and other clinicians can use this information to better guide patients toward safe, evidence-based supplement choices, while also acknowledging existing knowledge gaps and the need for more research into ingredient-drug interactions

Pharmacy Times: Beyond consumers, how can health professionals—including pharmacists and physicians—use WhatToTrust to better support patients in selecting safe and effective products?

Leena Pradhan-Nabzdyk, Ph.D, MBA: So it's the same way—you could be a consumer, or you could be a healthcare professional. We don't recommend what people should take because, again, unless we know people's medical history, it's really hard to recommend. We just stick to the fact that we are scientists, and we focus on evaluating a product based on the information that's out there about its science.

We also are, at this time, not going deeper into what exact study was done and whatnot, because we don't want to clutter the information. We want to make sure that it's as seamless and easily conveyed to the end user—whether that’s a healthcare professional or a consumer.

We do keep a record of those tests and clinical trials that a company has undergone. We also cross-reference information if there is something on a product's website. Because we get all this information from a product's website, we then go to public databases like PubMed to make sure that if a study was cited, it is truly for that particular product or that particular ingredient.

If a product does not mention a clinical trial, and we know that a particular ingredient they have used has undergone a clinical trial, then we still give them credit, because we want to bring the most factual information to the consumer or the end user. Again, this is a quick reference for both healthcare professionals and consumers.

The first level of screening is whether there was science. Was there any science used or not? Or is this product just throwing things together? That doesn’t mean it’s not going to be effective—it just means they haven’t tested it, and we cannot say definitively whether it’s going to work or not. And even if all the studies have been done, it may still not work in a particular population or a particular person. But at least we know that there was some science done, or at least a good amount of science done. It really depends on the individual response to those types of products.

But again, coming back to your question—for pharmacists and healthcare professionals, I think that this could be what WhatToTrust will be: your first-line screening as to whether a product is solidly, scientifically backed or not.

Pharmacy Times: For pharmacists and other health professionals who are often asked about supplement safety, what key points should they emphasize to patients when the science is still evolving?

Pradhan-Nabzdyk: This is a great question. So, first of all, there is a myth that dietary supplements are not regulated. That's not true. They are regulated, although not to the same degree as prescription medications or even over-the-counter medications. Dietary supplements are not medications. They are not supposed to treat, cure, or prevent a disease.

That said, the FDA does require quality testing and safety testing—what we call identity, purity, and potency testing. Basically, if you see a product label that says “50 milligrams of calcium,” they are supposed to test every batch to make sure that (a) it is calcium and (b) it is 50 milligrams of calcium. For purity—or what we call contaminant testing—companies must conduct batch-to-batch testing for heavy metals and for microbes such as Salmonella or E. coli.

On top of that, especially for dietary supplements, they must be manufactured in a facility that follows good manufacturing practices (GMP), just like those used for drug production. Those are some of the requirements set by the FDA. Having said all of that, those are the minimum tests that are required.

Now, there is often an issue—and again, the science is evolving—and that’s why I talked about innovation right from the beginning. We don’t fully understand the interactions between drugs and particular ingredients used in dietary supplements. If it’s a single-ingredient supplement, it’s probably easier to cross-reference studies. But if it’s a multi-ingredient dietary supplement, and someone is taking medications for migraines or stronger medications for conditions like IBD, diabetes, or heart disease, we don’t have enough data.

I think this presents a great challenge for new investigators entering the fields of pharmacy, molecular biology, or natural products. With the advancement of AI and computational technologies, we can even begin to analyze these potential interactions computationally. By putting together data on what we know about certain drugs and ingredients, we can start—at least at the ingredient level—to see how they may affect each other.

So, I don’t have a great answer to your question about safety. And when I think of safety, I’m talking beyond contaminants and beyond the quality of the ingredient or the product itself. I’m talking about safety related to whether a person can take a supplement while on a particular drug. These are the types of questions we need to ask more often about these products. That’s a vast, open space for research—and one that could easily become a PhD thesis.