Supplement Scope SOP

Registered Dietitian Nutritionists (RDNs) play a crucial role in promoting health and well-being through personalized nutrition plans and evidence-based guidance. The scope of practice for RDNs encompasses a wide range of responsibilities aimed at optimizing nutrition intake and supporting overall health outcomes, including:

• Ordering and monitoring evidence-based nutrition interventions to meet person-/population-centered nutrient and energy needs, including but not limited to prescribed diets, medical food/nutrition supplements, and dietary supplements.

• Evaluating, educating, and counseling related to the use of nutrition-related pharmacotherapy plans, over-the counter medications, dietary supplements, and food-drug, drug-nutrient, and supplement-drug-nutrient interactions.

• Keeping up to date on current findings regarding dietary supplements.

• Per the Standards of Conduct in the Nourish Handbook (Section 5.1), dietitians affiliated with Nourish are strictly prohibited from commercially benefitting from involvement with any nutrition recommended interventions, including selling or profiting directly or indirectly from third-party testing, diagnostic referrals, products, or services.

• While it is not identical, Nourish uses the Academy’s position on supplement sales for reference and guidance.

• This article from the Academy of Nutrition and Dietetics, outlines potential conflicts of interest related to the recommendation and sale of dietary supplements.

• For patients undergoing specialized treatments (e.g., fertility treatments, cancer therapy, chronic disease management), it is critical to coordinate with the prescribing provider or care team to prevent potential interactions between supplements and medications.

• If there is any uncertainty about the safety or appropriateness of a supplement, the RDN should refrain from making a recommendation until the patient’s provider approves it to avoid contraindications or unintended effects on the patient’s treatment plan.

The RDN should document the following details regarding any supplement recommendations in the intervention section of the chart note:

• The supplement recommendation, including name, dosage, frequency and intended use.

• The clinical rationale and evidence supporting the recommendation.

• Benefits and potential risks discussed with the patient.

• Communication details with the care team, including the provider’s feedback or approval.

• The patient’s understanding and consent regarding the recommendation.

Example of intervention details for supplement recommendation:

• Educated patient on benefits of Omega-3 Fatty acids for heart health, joint health, and mental health. Provided patient with examples of different food and supplement sources of EPA and DHA.

• Recommended 1,000 mg of combined EPA and DHA per day. Supplement should provide at least 500 mg EPA and 500 mg DHA per serving. Recommended patient take supplement with meal that contains fat to enhance absorption. (NIH) Advised selecting a high-quality, third-party-tested fish oil supplement to ensure purity and potency.

• Coordinated care with primary physician to align on supplement recommendation. No drug-nutrient interactions identified. Will reassess supplementation needs in 3-6 months as indicated by patient’s most up to date lipid panel. 

Nourish RDs wishing to increase their understanding of supplements should:

1. Check the Clinical Reference Guides located in the Nourish portal under “Internal Resources.” Most of the Guides include information on pharmacological and supplements related to a particular disease state.

2. Consult one of the data base resources for a literature analysis on a particular supplement(s) (e.g., Examine.com, natural data base, Dietary Supplement Label Database). RDs can use their annual education reimbursement to cover the cost of these subscriptions.

3. Collaborate with peers in Slack using the Slack Community Guidelines.

4. Collaborate with peers in Case Review and Collaboration Meetings (CRC).

5. Utilize the Nourish Educational Fund to purchase educational materials such as courses, books, seminars, subscriptions or conference admission.