How to cut a supplement stack from 111 pills to 30

What a supplement audit is, and what it is not

Longetic read the England and the Spain guidance on reviewing a long list of medicines and supplements side by side, and both land in the same place. You write the list, and a clinician decides what comes off it. What follows is the writing half, nine steps that turn a shelf of bottles into one dated page a prescriber can work from in the time an appointment actually lasts.

The number in the title is the kind of figure people quote when they describe cutting a long stack down. This page does not assess anyone's stack, it names no product, and it does not say which items are worth keeping. It is the paperwork, and the paperwork is the part you can finish this week without an appointment.

This is not a niche exercise. A US national survey covering 2017 and 2018 reported that "57.6% of adults aged 20 and over reported using any dietary supplement in the past 30 days", and among older US adults taking prescription medicines, "concurrent use of dietary supplements increased substantially from 53.9% to 65.7%" between the 2005 to 2006 and 2010 to 2011 survey rounds. Both figures are American, and the newer one is eight years old. They describe how ordinary the overlap is, not how common it is in Britain or Spain today.

The reason to write the list first is that the review itself starts with the same question. A 2015 special communication in JAMA Internal Medicine sets out deprescribing as a process, and its opening task is plain: "ascertain all drugs the patient is currently taking and the reasons for each one". Arrive with that already written and the appointment starts at step two.

Step 1. Put every bottle on one table

Every container from every cupboard, in one place: prescriptions, pharmacy purchases, herbal products and anything bought online. Spain's medication reconciliation recommendations ask people to keep the list current with medicines "y otros productos dietéticos", so this is not a medicines table. It is an everything table, and the things you would not have thought to mention are the reason it exists.

Expired containers go on the table too, and so does anything kept for a problem that has already cleared up. Neither is unusual, and neither is anything to feel embarrassed about: the point of the table is to see what is actually on the shelf, not what ought to be.

Step 2. Write one list, one line per product

One line per container, in whatever order they came off the shelf. Order does not matter yet, completeness does. The US National Institutes of Health Office of Dietary Supplements puts the whole exercise in one sentence: "Keep a complete record of any dietary supplements and medicines you take." One record, not two.

Paper is fine. So is a note on a phone. What matters is that a single artefact holds everything, because the two halves of a long list are normally kept apart: the prescriptions sit in a pharmacy record somebody else maintains, and the rest sit in your head.

Step 3. Copy the dose exactly as the label prints it

Copy what is printed, in the units printed, without converting anything and without rounding. You are not setting a dose and you are not judging one. You are transcribing, so that whoever reads the list later is reading the label rather than your memory of the label, which is the single most common place a list goes wrong.

This is also where a long list starts to shrink on its own. Two containers often turn out to carry the same substance under different front-of-pack names, and that only becomes visible when both are written on the same page in the same units. Note the duplicate, do not act on it.

Step 4. Add the time of day you take each one

Morning, with food, at night, twice a week: write the pattern you actually follow rather than the one on the label, and mark the lines where the two differ. Timing is the column that turns a list into a schedule, and it is the column a prescriber needs before anything can be moved, merged or stopped.

Items you take only occasionally belong here too, with a note of how occasionally. Galicia's 2026 programme protocol defines the bag a patient brings as covering what is used "de forma habitual ou esporádica", in Galician, which makes the occasional items part of the record rather than a footnote to it.

Step 5. Add who prescribed or suggested it, and why

Three short columns: who, when, and what it was for. Some lines will name a doctor and a date, others a podcast, a relative or a shop assistant. Writing the real answer rather than a tidy one is the whole point, because a line nobody prescribed is exactly the line a review exists to discuss.

Where several clinics prescribe for the same person, this column is the hardest to reconstruct later and the one that saves the most time in the room. If that is your situation, the companion piece on keeping one medication list across several prescribers covers who owns the list when nobody does.

Expect blanks, and expect to be in good company. In a 2012 US national survey of adults who used complementary approaches and had a primary care physician, "3094 (42.3%) did not disclose the use of their most used CAM modality". That is complementary approaches broadly rather than supplements specifically, and it is a 2012 picture, but it says plainly that the undisclosed column is normal.

Step 6. Put a question mark where a line stays blank

A blank in the why column is not a failure of memory, it is the most useful mark on the page. It tells the clinician where to start and it keeps the list honest. Do not fill a blank with a guess, and do not quietly drop the line in order to avoid the blank, which is the version of this exercise that wastes the appointment.

The clinical vocabulary for what you are flagging already exists. NHS Specialist Pharmacy Service writes that "Polypharmacy is the use of multiple medicines by one individual." and separates appropriate from "Problematic polypharmacy, sometimes referred to as inappropriate polypharmacy", which it says occurs when, among other conditions, "medicines are no longer appropriate." Your question marks are candidates for that conversation, not conclusions about it.

Step 7. Ask for the review your health system offers, and name the country

What the review is called, who runs it and who is offered it all change at the border. In England it is a structured medication review delivered through primary care networks, while in Spain the national material is a set of recommendations and the organised programmes sit with the regions. Ask using the local name and you will get a faster answer.

The table below is what each system publishes about itself, not a ranking and not a promise that a review is available on request.

England: the review has a name, and a contract behind it

NHS England describes a structured medication review as "an evidence-based and comprehensive review of a patient's medication" and states that "From October 2020, all PCNs are required to identify patients who would benefit from a SMR". The cohorts it names include people "in care homes;" and people "with complex and problematic polypharmacy, specifically those on 10 or more medications;". Two things follow from that wording. The review is identified by the practice rather than requested by the patient, and the guidance the page points to is the 2021/22 Network Contract document, first published on 31 March 2021. We also checked the NHS England page itself and it prints no published, last-reviewed or next-review date at all.

Spain: recommendations nationally, programmes regionally

Spain's picture is split in two. A Ministerio de Sanidad document on medication reconciliation in primary care for chronic patients recommends that people "mantengan la lista de medicación actualizada con los medicamentos y otros productos dietéticos" and that they "lleven consigo la lista de medicación siempre que soliciten asistencia sanitaria". We checked that document and its own cover prints no publication date, so it is cited here without one. The organised programmes are regional: Galicia's protocol, marked "Actualización marzo 2026", defines the bag a patient brings and sends the primary care pharmacist to carry out "unha revisión sistemática da medicación".

What we checked and did not find

We checked the nhs.uk "Medicines information" page and it does not tell readers how to ask for a medicines review, and it does not tell them to bring their medicines or a list to an appointment. That page was last reviewed on 10 October 2023 with a next review due on 10 October 2026, a date that had passed by two days when this article was written. In England the instruction to bring medicines does exist, but it lives in the professional-facing Specialist Pharmacy Service article, which tells clinicians to "Encourage them to bring their medications to the appointment" and to have them "prepare any questions or concerns they want to discuss". That is guidance to the clinician about you rather than guidance to you, and the distinction is worth keeping.

Step 8. Bring the list and the bottles, and change nothing first

Take both: the page is faster to read and the containers settle what the page cannot. Between writing the list and the appointment, change nothing: no stopping, no starting, no adjusting. An audit is a description of what is true now, and a description you have already edited is worth less than the untidy original.

The reason to carry the containers as well as the page is that the two get checked against each other. Galicia's protocol asks the patient to come "á consulta coa Bolsa de medicamentos" and tells them they must bring "os medicamentos acumulados no seu domicilio". The US Food and Drug Administration gives the same instruction for appointments in plain English, asking readers to "bring a list of all the dietary supplements and medications you are currently taking."

Spain's consumer decálogo from its food safety agency, in a second edition dated 2026, turns that into a duty to speak up: "Informe siempre a su médico:", "De los complementos alimenticios que esté consumiendo.", "En particular, si usted padece alguna enfermedad subyacente." and "Si tiene previsto someterse a una intervención quirúrgica." If you want the wider version of preparing for the appointment itself, the piece on what to write down before a doctor's appointment handles everything that is not the list.

Step 9. Keep the reviewed list, dated

What comes out of the appointment is a new list with a date on it, and that version, not the one you wrote, is the one that travels from here. Keep the superseded page as well. The difference between the two is the record of what changed and when, and it is the thing nobody can reconstruct a year later from memory.

A dated version also answers the question every later clinician actually asks, which is not what you take but when that was last checked by somebody qualified. The companion piece on what to keep after a doctor visit covers the rest of what leaves the room with you.

What the label is allowed to say, and what it is not

A food supplement and a medicine are different legal objects, and that difference is why a long list needs a clinician rather than a spreadsheet. Spanish law defines supplements as foodstuffs and forbids therapeutic claims on their labelling. Britain's health service publishes the practical consequence in one line about products that do not mix well with medicines.

Two of those lines carry most of the weight. AESAN writes that "Los complementos alimenticios no son medicamentos y no están destinados a prevenir ni tratar enfermedades.", and its 2026 decálogo adds "Un producto natural no es sinónimo de un producto seguro." The Comunidad de Madrid page, updated on 27 April 2026, says the same thing to patients and then tells them what to do about it: "Cuando consulte al médico o al farmacéutico acerca de su salud, dígale siempre las plantas medicinales que está tomando."

In England the consumer-facing version is narrower in scope but recently reviewed. The nhs.uk herbal medicines page, reviewed on 1 May 2026, says "There are some medicines that do not mix well with herbal medicines." and asks readers to "tell any doctor or healthcare professional treating you if you are taking a herbal medicine". We checked that page and it does not use the word supplements, so it speaks for herbal medicines and complementary therapies rather than for vitamins and minerals in general. The US Office of Dietary Supplements states the general case: "Supplements can also interact with some medicines in ways that might cause problems."

What happens when somebody measures this

Two kinds of evidence sit behind the advice, and neither is as tidy as the advice. Reviews do change prescribing, by amounts researchers can count, and written lists do improve what the clinician records, by less than most people assume. Both are worth knowing before you expect one appointment to settle a list that took years to grow.

The largest recent English measurement was published in the British Journal of General Practice in August 2026. Of 635,698 eligible patients aged 65 or over, 82,285, or 12.9%, received at least one structured medication review between April 2020 and September 2022. Where potentially inappropriate combinations were present, "between 12.5% and 40.0% were corrected up to 3 months later." The authors state the limit themselves: "Further work is needed to understand if these changes improved patient outcomes."

On the written list itself, a cluster-randomised trial reported in the Journal of the American Medical Informatics Association had patients review and correct their own medication list ahead of visits. The proportion of medications carrying "unexplained discrepancies was 42% in the intervention arm and 51% in the control arm". Nine points better, and still four medications in ten carrying an unexplained discrepancy in the arm that won. The World Health Organization's 2019 technical report on medication safety in polypharmacy is listed as providing "guidance on prioritising patients for medication review"; we could not open the report's own text from this session, so nothing further is attributed to it here.

That is the honest frame for the whole exercise. The list does not fix the list. It makes the conversation that fixes it possible, and it is the only part of the process that does not need an appointment, a referral or anybody else's diary. Longetic keeps the reviewed list with the date it was reviewed, alongside the lab reports and visit records it came from, and runs reminders on the dose schedule for whatever a prescriber has put on it; it does not check anything against anything, and it does not tell you what to take.

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