supplementsWhen I opened the electronic medical record, I was astounded at the length of Jim’s med list. After all, he was in his 30’s and appeared to be reasonably healthy. On closer review, it was apparent that all of his “medicines” were supplements which he had prescribed for himself. The list included many of the familiar products: fish oil, coenzyme q10, resveratrol, curcumin, ginkgo biloba, vincopectin, zeaxanthin with lutien, alpha-lipoic acid and a multivitamin. It also included several less familiar names: vanadyl sulfate, mega GLA with sesame lignans, bromelain, thymic immune factors and more. He was spending a small fortune which led to some obvious questions. Was all this making him healthier? Is there a better way to spend all that money? What’s the science behind this multi-billion dollar supplement industry? Before proceeding, I’ll make one unscientific observation: My patients on truckloads of supplements are rarely the healthiest. Often I wish they would spend the money on healthy food or exercise programs. That’s unfortunately a hard sell in our pill oriented culture. Pills

By now most people know the story of vitamin E. In the 90’s, cardiologists recommended it for most of their patients. The “cardioprotective” dose was “known” to be 400 iu. Between 2000 and 2010, numerous studies reversed that opinion. Vitamin E, in pill form, was found to increase strokes, certain cancers and even overall chance of death. To be fair, most of these studies were done with synthetic vitamin E while natural vitamin E has been found to be much more effective.

Another common supplement, calcium, has taken it’s lumps recently.  Several studies have suggested increased rates of heart and blood vessel disease. Many believe that this occurs in folks with inadequate vitamin D and perhaps vitamin K2 which are crucial for transporting calcium to bones. If it doesn’t go to build bone, it’s next option is blood vessels. We also find that supplemental calcium can lead to an increase of kidney stones in those who are at risk while equal amounts in food do not increase that risk.

fish oilEven fish oil, which I have long supported has had some disappointing studies recently. Many other similar examples could be given. With all of these studied supplements a common theme is emerging.  The reason these nutrients were put into supplement form is that they were found to be critical to good health in their natural food sources and often shown to help prevent cancer, heart disease, macular degeneration and other common serious diseases. What is it about whole food that beats pills? My best one word answer is “synergy”. Foods have combinations of nutrients that work together that we cannot recreate in pill form. Whole foods also contain many nutrients that we have not yet identified. Spinach, which I wrote about spinach saladlast week, is a nutritional powerhouse which contains 20 or more crucial micronutrients. To get everything it contains into a pill would make it impossible to swallow, incredibly expensive and even then would be incomplete without fiber and many nutrients lost in processing. Another example is found in nuts like walnuts and almonds which have repeatedly been shown to prevent heart disease. As noted above, when we try to pull out nutrients contained in nuts like vitamin E and magnesium and vitamin B6, and give them in pill form, we do not find any reduction in heart disease.

I’ve presented a grim picture of supplements so you may be wondering if I recommend them at all.   In my opinion, the appropriate use for supplements is to provide a crucial or beneficial nutrient that is either impossible or impractical to get in adequate amounts from food. Examples would be magnesium which likely is inadequate in foods now due to soil depletion. Vitamin B12 is frequently poorly absorbed from food especially in older people or those on certain meds and must be given as a shot or under the tongue. CoEnzyme Q10 is depleted by statin drugs and must often be supplemented to restore adequate levels. Folate is not properly metabolized in many people and a supplement form which is methylated can be better utilized in the body. Many folks will simply not eat enough fish to get adequate omega 3 fatty acids so high quality fish oil can be a reasonable substitute. (although not equal to fish)   There are other examples. Perhaps the most popular one of the moment is vitamin D. Will deal with it in the next post. Bottom line: Eat a wide variety of delicious whole foods, restrict sugar and starch to a minimum and avoid manufactured fats and other toxic additives like the plague!