Good Medicine Doesn't Hand Out Supplements "Willy-Nilly"
A recent professional conversation about supplement safety brought up a familiar claim: that naturopathic physicians recommend supplements casually, without appreciating their interactions or potential harms. The concern about safety is worth discussing. The assumption about the profession deserves a closer look.
For those who have worked in integrative medicine for decades, the interesting question has never been how many supplements a patient can take. It is how nutritional, botanical and pharmaceutical treatments might fit together, where the evidence is strongest, and what makes sense for the person in front of us. Respect for that work begins with understanding what responsible practice actually involves.
Supplements can serve meaningful purposes in clinical care. Correcting a documented nutrient deficiency, addressing inadequate intake or absorption, and exploring selected evidence-informed therapeutic applications are reasonable reasons to consider them. But their effects depend on the ingredient, dose, formulation, underlying conditions and other treatments a patient uses.
Accredited naturopathic medical education devotes substantial attention to clinical nutrition, botanical medicine and pharmacology. Students study the therapeutic actions of natural compounds alongside contraindications, toxicology and drug–herb interactions. These subjects are taught for a reason: natural products can be biologically active, and good intentions do not replace good clinical judgment.
This training provides a particular depth in natural therapeutics that may not be a central focus in many conventional healthcare curricula. It does not make every naturopathic physician an expert in every medication or diminish the expertise of physicians, nurse practitioners or pharmacists. Good practice welcomes collaboration.
The goal is neither to prescribe supplements routinely nor to dismiss them reflexively. It is to understand when they may help, when they may interfere, and when the better recommendation is to simplify treatment.
Begin With the Patient, Not the Product
A good recommendation begins with the patient's story, not a product catalog. Nutrition, medical history, medication use, symptoms, laboratory findings and treatment goals all provide context. The clinician should know about prescription drugs, over-the-counter medications, herbal preparations and existing supplements before adding another intervention.
A person with low vitamin B12 because of impaired absorption has a different clinical question from someone hoping that a large collection of supplements will compensate for poor sleep or an inadequate diet. In one case, targeted repletion may be important. In the other, better nutrition, activity, sleep or treatment of an underlying condition may offer more benefit than another bottle.
Why Naturopathic Medical Schools Teach Interactions
Accredited four-year naturopathic doctoral programs teach conventional biomedical and clinical sciences along with dedicated coursework in clinical nutrition, botanical medicine and pharmacology. Botanical training includes the actions of plant compounds, dosing, contraindications, toxicity and potential interactions with medications. This is an intentional part of the curriculum, not an incidental introduction to supplements.
The emphasis matters. A clinician who has spent significant time studying botanicals, nutrients and their therapeutic applications may bring knowledge to a medication review that complements the expertise of a conventional physician or pharmacist. Many MD, DO and NP programs devote less curricular time specifically to botanical therapeutics; their education also includes important training in diagnosis, pharmacology and clinical management. The disciplines overlap, but they are not identical.
For a patient taking an anticoagulant, for example, the question is not simply whether an herb is “natural.” It is whether the combined effects may change bleeding risk. For someone taking a drug processed through a metabolic enzyme affected by a botanical compound, the relevant issue is whether that compound may increase or reduce medication exposure. NCCIH's medication–supplement interaction guidance describes why a complete review is essential.
The point is not that naturopathic physicians always know more than colleagues in other fields. It is that training in natural therapeutics is a genuine professional competency, worthy of recognition and professional respect. Patients benefit when clinicians share complementary knowledge rather than reducing healthcare to competing titles.
Biological Activity Creates Opportunity and Responsibility
Natural compounds can influence enzyme systems, nutrient metabolism, inflammatory pathways, coagulation and other physiological processes. Those mechanisms are part of what makes them interesting. They also make dosage, formulation, product quality and the clinical setting important.
St. John's wort is a well-known example: it can alter the metabolism and transport of certain drugs, reducing their effectiveness. Excessive doses of some vitamins and minerals can create toxicity. Other products may be unsuitable before surgery or in people with kidney disease, liver disease, pregnancy or a bleeding disorder. These are reasons for clinical literacy, not reasons to dismiss the entire field of nutritional or botanical care.
A Nattokinase Case and the Importance of Context
Nattokinase, an enzyme associated with fermented soybeans, has generated scientific interest because of its fibrin-related activity. Its potential effects on clotting also deserve careful evaluation.
In a 2021 case report, a 92-year-old woman with complex medical conditions experienced serious intra-abdominal bleeding associated with a ruptured hepatic cystic lesion while taking over-the-counter nattokinase. She died. The authors described nattokinase as a possible contributor, not a proven cause.
The published case report makes no mention of a licensed naturopathic physician who graduated from an accredited naturopathic medical school recommending nattokinase. In fact, it does not identify any healthcare professional as having recommended it. The 92-year-old patient was taking over-the-counter nattokinase for atrial fibrillation, despite having several significant medical conditions. Her dosage was unknown. She reportedly sometimes took a handful of capsules, and because she lived alone, no one could confirm how much she was consuming.
Was the supplement self-prescribed? Recommended by a friend? Promoted through advertising, social media, or an online health influencer? We simply don't know, and the published report provides no evidence supporting any of these possibilities. What we do know is that an elderly, medically complex patient was taking an uncertain quantity of a biologically active supplement with potential effects on blood clotting.
The tragedy deserves careful attention, particularly regarding supplement education, appropriate dosing, and clinical oversight. However, using this case to imply negligence by naturopathic physicians, when no such involvement was documented, does a disservice to both the profession and the scientific discussion. Unfortunately, that is precisely the implication made by a healthcare professional who recently cited this case report on LinkedIn.
The case is worth learning from because it illustrates the importance of evaluating bleeding risk, medical complexity, dosage, and concurrent treatments. A case report can provide an important safety signal, but it cannot establish the frequency of an adverse event, prove causation, or justify sweeping conclusions about an entire healthcare profession.
Five Questions Behind a Thoughtful Recommendation
- What is the clinical purpose? Is there a deficiency, a clear therapeutic indication or a measurable goal?
- What evidence applies? Is the expected benefit established, promising but emerging, or largely promotional?
- How might it interact? Review medications, other supplements, dose, health conditions and contraindications.
- Can we trust the product? Ingredient identity, purity, labeling, manufacturing standards and appropriate dosing matter.
- How will we reassess? Decide what would justify continuing, changing or discontinuing the intervention.
These questions are not bureaucratic obstacles to supplement use. They are how a useful therapeutic option becomes a thoughtful clinical decision.
When a Clinic Also Offers Supplements
HormoneSynergy® offers supplements, so the possibility of financial influence deserves an open acknowledgment. Patients should be able to ask why a product is recommended, whether a comparable alternative exists, how long it may be needed and whether improving food intake or changing another part of the treatment plan would be preferable.
A recommendation should stand on its clinical rationale, regardless of where the product is purchased. We want the supplement list to reflect the patient's needs, not a commercial objective.
Respect Across Professions Is Part of Good Medicine
Dr. Kathryn Retzler's clinical approach brings together nutrition, lifestyle, medications, laboratory findings, hormone care, body composition and cardiovascular assessment according to the individual patient's needs. Sometimes a supplement is useful. Sometimes a prescription is appropriate. Sometimes a referral, a food-first intervention or simply stopping an unnecessary product is the best next step.
Good clinicians across disciplines understand this. There are meaningful differences in training and scope between naturopathic physicians, MDs, DOs, nurse practitioners, pharmacists and other healthcare professionals. Acknowledging those differences should increase understanding, not diminish mutual respect.
Good medicine doesn't hand out supplements willy-nilly. It knows enough about them to recommend them thoughtfully, and enough about the patient to know when not to.
Related Reading and Resources
For a closer look at naturopathic education, board examinations, pharmacology requirements and prescribing privileges, read What Does It Take to Become a Licensed Naturopathic Physician?. Explore the HormoneSynergy® Longevity Resource Library for related topics.
Our complimentary Vitamin & Nutrient Assessment offers a starting point for reflecting on nutritional habits and supplement use. It is educational and does not replace an individualized clinical review.
For thoughtful, physician-informed perspectives on nutrition, preventive medicine and healthy aging, subscribe to the HormoneSynergy® Longevity Letter.
Frequently Asked Questions
What is the difference between a licensed naturopathic physician (ND) and someone calling themselves a naturopath with an unaccredited certificate—the “UN-D” distinction?
The distinction begins with education, national board examinations, state licensure, prescribing privileges, and professional accountability. In Oregon and other U.S. jurisdictions that license naturopathic physicians, applicants must graduate from an approved four-year doctoral naturopathic medical program. Programs accredited by the Council on Naturopathic Medical Education (CNME) include biomedical sciences, diagnosis, pharmacology, clinical nutrition, botanical medicine, and supervised patient care.
Applicants must also pass the required Naturopathic Physicians Licensing Examinations (NPLEX) and satisfy additional state licensing requirements, which may include jurisprudence examinations. Once licensed, naturopathic physicians are accountable to state regulatory boards, professional standards, continuing-education requirements, and legally defined scopes of practice.
Prescribing privileges are another important distinction. Licensed naturopathic physicians in states including Oregon, Washington, Arizona and others have substantial pharmaceutical prescribing authority, subject to state formularies and applicable restrictions. In Oregon, appropriately registered naturopathic physicians may prescribe authorized controlled substances in DEA Schedules II through V. Not every naturopathic physician chooses to prescribe medications, and prescribing privileges differ considerably among states. These privileges arise from state licensure and applicable law, with additional federal DEA registration required for controlled substances.
By contrast, the term naturopath may be used in some jurisdictions by individuals whose education consists of an unaccredited certificate or distance-learning program. Such credentials do not, by themselves, qualify an individual for licensure as a naturopathic physician in any U.S. state or confer the pharmaceutical prescribing privileges granted to appropriately licensed naturopathic physicians. They should not be presented as equivalent to an accredited doctoral medical education, national licensing examinations, or a state-issued professional license.
This does not mean that everyone using the term naturopath lacks education or knowledge. However, individuals whose only credentials come from unaccredited programs have not completed the approved naturopathic medical education and licensing pathway required of licensed naturopathic physicians. Patients and fellow healthcare professionals should recognize these differences when evaluating a practitioner's education, clinical qualifications, professional credentials, prescribing authority, and legal scope of practice.
At HormoneSynergy®, we sometimes use “UN-D” as informal shorthand for this unaccredited-credential distinction. “UN-D” is not an official professional title or regulatory category. Patients and healthcare professionals can ask four practical questions: Did the practitioner graduate from an accredited or otherwise state-approved naturopathic medical program? Have they passed the required national licensing examinations? Do they hold an active state-issued professional license? What diagnostic, treatment, and prescribing privileges does that license authorize?
This is not about dismissing natural medicine or minimizing anyone's interest in it. It is about ensuring that similar-sounding titles do not obscure substantial differences in medical education, clinical training, professional accountability, and legal authority.
Do naturopathic physicians study drug–supplement interactions?
Yes. Accredited naturopathic programs teach biomedical pharmacology and dedicated botanical and clinical nutrition coursework, including contraindications, adverse effects and drug–herb interactions.
Are natural supplements always safe?
No. Biological activity may produce benefits, adverse effects or interactions depending on dose, product and individual health circumstances.
Should everyone take a daily supplement regimen?
No. Supplement needs vary with diet, absorption, medication use, medical history and goals. Some people benefit from specific products; others may not need them.
How can I tell whether a recommendation is appropriate?
Ask about the intended benefit, quality of the supporting evidence, potential interactions, product quality and the plan for reassessment.
Sources and clinical note: Council on Naturopathic Medical Education, Naturopathic Education; California Board of Naturopathic Medicine, Curriculum; NCCIH, Medication–Supplement Interactions; Ramachandran et al., Nattokinase-Associated Hemoperitoneum (2021). This article is educational and not individualized medical advice. Review changes to medications or supplements with your clinician.
This article is part of the HormoneSynergy® Longevity Medicine education series covering preventive cardiology, metabolic health, hormone optimization, body composition, and advanced diagnostics for healthy aging.
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