Canadian Journal of Public Health

, Volume 94, Issue 5, pp 363–366 | Cite as

Emerging Issues Associated with HIV Patients Seeking Advice from Health Food Stores

  • Edward MillsEmail author
  • Rana Singh
  • Misa Kawasaki
  • Lindsay Bast
  • Jason Hart
  • Amir Majlesi
  • Payam Kiani
  • Kumanan Wilson



To ascertain the recommendations, training and education of health food store employees and determine how they communicate the costs, benefits and risks associated with natural health products for the HIV/AIDS community.


Four male research assistants, posing as asymptomatic HIV-positive individuals, inquired of employees of all retail health food stores in a major Canadian city as to what is recommended for their condition. The research assistants asked about product costs, side effects, potential drug interactions and efficacy. They also inquired as to employee education related to Complementary and Alternative Medicine (CAM) and noted whether employees asked about which conventional medications they were taking and whether they recommended that the subjects seek physician or CAM provider advice.


A total of 32 stores were included. Eight store employees (25%) offered no advice; eight (25%) inquired whether the subjects were currently taking medications; six (19%) suggested visiting a physician; and eight (25%) suggested visiting a CAM provider. A total of 36 different products (mean 2.3 per employee) were recommended with considerable variability in product evidence and cost. The education of the employees varied from postgraduate education (n=3), to undergraduate degree (n=3), college level (n=5) in CAM, or no formal education in CAM (n=21).


There was considerable heterogeneity in advice on natural food products provided by employees of natural food stores and, in general, these individuals had limited formal training in CAM. The products they recommended had limited evidence supporting their efficacy and in some instances were potentially harmful and had considerable costs. The findings of this study support the need to further examine how best to regulate this growing component of the health care system.



Établir avec précision la formation et l’instruction des employés de magasins d’aliments naturels et les recommandations qu’ils dispensent et déterminer comment ils communiquent aux personnes vivant avec le VIH/sida les coûts, les avantages et les risques associés aux produits naturels.


Quatre adjoints à la recherche, se prétendant séropositifs pour le VIH, mais asymptomatiques, ont demandé aux employés de tous les magasins de détail d’aliments naturels d’une grande ville canadienne ce qu’ils recommanderaient vu leur état de santé. Les adjoints se sont informés des coûts des produits, de leurs effets secondaires, de leur efficacité et des interactions médicamenteuses éventuelles. Ils ont aussi interrogé les employés sur leur formation en médecines parallèles et noté si ceux-si leur demandaient quels médicaments conventionnels ils prenaient, et s’ils leur conseillaient d’obtenir l’avis d’un médecin ou d’un praticien en médecines parallèles.


L’enquête a porté sur 32 magasins. Huit employés (25 %) n’ont donné aucun conseil; huit autres (25 %) ont demandé aux sujets s’ils prenaient actuellement des médicaments; six (19 %) leur ont suggéré de consulter un médecin; et huit (25 %) leur ont suggéré de consulter un praticien en médecines parallèles. On a recommandé en tout 36 produits différents (2,3 par employé en moyenne), avec des écarts considérables dans la justification et le coût de ces produits. Le niveau d’instruction des employés variait; certains avaient un diplôme universitaire supérieur (n=3), de premier cycle (n=3) ou de niveau collégial (n=5) en médecines parallèles; d’autres n’avaient pas fait d’études en médecines parallèles (n=21).


Les conseils des employés de magasins d’aliments naturels présentaient des écarts considérables, et dans l’ensemble, ces personnes avaient peu étudié les médecines parallèles. L’efficacité des produits recommandés n’était pas éprouvée, et certains produits étaient potentiellement nocifs et très chers. Les résultats de l’étude confirment le besoin de pousser la recherche sur les meilleurs moyens de réglementer ce volet en pleine expansion du système de soins de santé.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Berger E. The Berger Population Health Monitor, 21. Toronto: Hay Group, 2000.Google Scholar
  2. 2.
    Health Canada, Building Together, Phase II in developing a proposed regulatory framework for natural health products, NHPD, Public Consultation, March 2001. Available on-line at: (Accessed January 20, 2003).Google Scholar
  3. 3.
    Fairfield KM, Eisenberg DM, Davis RB, Libman H, Phillips, RS. Patterns of use, expenditures, and perceived efficacy of complementary and alternative therapies in HIV-infected patients. Arch Intern Med 1998;158:2257–64.CrossRefPubMedGoogle Scholar
  4. 4.
    Ernst E. Desktop Guide to Complementary and Alternative medicine; An Evidence Based Approach. Toronto: Harcourt Publishers, 2001;196–200.Google Scholar
  5. 5.
    Piscitelli SC, Burstein AH, Welden N, Gallicano KD, Falloon J. The effect of garlic supplements on the pharmacokinetics of saquinavir. Clin Infect Dis 2002;34:234–38.CrossRefPubMedGoogle Scholar
  6. 6.
    Gotay CC, Dumitriu D. Health food store recommendations for breast cancer patients. Arch Fam Med 2000;9:692–99.CrossRefPubMedGoogle Scholar
  7. 7.
    Stoffer SS, Szpunar WE, Coleman B, Mallos P. Advice from some health food stores [letter]. JAMA 1980;244:2045–46.CrossRefGoogle Scholar
  8. 8.
    Aigner C. Advice in health food stores. Nutr Forum 1988;5:1–4.Google Scholar
  9. 9.
    Haidet, JM. Poor advice plus doubletalk: A probe of “health food” stores in central Ohio. Nutr Forum 1992;9:6–7.Google Scholar
  10. 10.
    Food and Drug Administration. Unsubstantiated Claims and Documented Health Hazards in the Dietary Supplement Marketplace. Rockville, MD: Food and Drug Administration, 1993.Google Scholar
  11. 11.
    Mills E, Singh R, Bast L, Kiani P, Hart J, Majlesi A, et al. Emerging issues associated with HIV patients seeking advice from Health Food Stores. International Scientific Conference on Complementary, Alternative & Integrative Medicine Research. Harvard Medical School, Boston, April 13, 2002.Google Scholar
  12. 12.
    Mills E, Singh R, Ross CP, Ernst E, Wilson K. Impact of Federal Safety Advisories of Health Food Store Advice. (In press)Google Scholar
  13. 13.
    Phillips LG, Nichols MH, King, WD. Herbs and HIV: The health food industry’s answer. South Med J 1995;88:911–13.CrossRefPubMedGoogle Scholar
  14. 14.
    Verhoef MJ, Rapchuk I, Liew T, Weir V, Hilsden, RJ. Complementary practitioners’ views of treatment for inflammatory bowel disease. Can J Gastroenterol 2002;16:95–100.CrossRefPubMedGoogle Scholar
  15. 15.
    Brazier N, Levine M. An evaluation of the quality of herbal product information provided by health food store retailers and pharmacists in a Canadian city. Can J Clin Pharmacol 2002;9:108–9.PubMedGoogle Scholar
  16. 16.
    Glisson JK, Rogers HE, Abourashed EA, Ogletree R, Hufford CD, Khan I. Clinic at the health food store? Employee recommendations and product analysis. Pharmacotherapy 2003;23:64–72.CrossRefPubMedGoogle Scholar
  17. 17.
    Vickers A, Rees RW, Robin A. Advice given by health food shops: Is it clinically safe? J R Coll Physicians Lond 1998;32:426–28.PubMedGoogle Scholar
  18. 18.
    CDC. Hepatic toxicity possibly associated with Kava-containing products-United States, Germany, and Switzerland, 1999–2002. MMWR 2002;51:1065–67.Google Scholar
  19. 19.
    Russell, PC. The White Coat Ceremony: Turning trust into entitlement. Teach Learn Med 2002;14:56–59.CrossRefPubMedGoogle Scholar
  20. 20.
    Anderson W, O’Connor BB, MacGregor RR, Schwartz, JS. Patient use and assessment of conventional and alternative therapies for HIV infection and AIDS. AIDS 1993;7:561–66.CrossRefPubMedGoogle Scholar

Copyright information

© The Canadian Public Health Association 2003

Authors and Affiliations

  • Edward Mills
    • 1
    Email author
  • Rana Singh
    • 1
  • Misa Kawasaki
    • 1
  • Lindsay Bast
    • 1
  • Jason Hart
    • 1
  • Amir Majlesi
    • 1
  • Payam Kiani
    • 1
  • Kumanan Wilson
    • 2
  1. 1.Dept. of ResearchCanadian College of Naturopathic MedicineNorth YorkCanada
  2. 2.University of TorontoCanada

Personalised recommendations