It was my turn. Last week, I went to the doctor for a checkup. It is a good idea for a doctor to experience being a patient. Sitting on the other side of the exam table helps me understand your experience when visiting me.

I answered the usual questions about my health history, but I was surprised that when the doctor asked me about the medications and vitamins I take, she was mostly unfamiliar with the supplements I use, their purpose and why I take them.

So, I thought it would be a good idea to review issues regarding the uses of nutritional supplements, vitamins, herbal medications and “nutraceuticals”. This will be the first of 4 email blogs because there is a lot of information to cover.

When taking nutritional supplements, it is important to remember to share this information with your doctors, who may not be familiar with your choices, but who should be aware of what you are ingesting on a regular basis. Close to 60% of US adults take some dietary supplements¹, so it is shocking that many physicians are unfamiliar with “nutraceuticals”. Indeed, many doctors reject them out of hand. That is not a reason to avoid discussing your choices with your doctor, even if you get a smirk or head shake in response.

While it is generally true that there is limited evidence that taking vitamins enhances overall health, lack of evidence is not the same as evidence of lack! The choice to do so is largely personal. And there are good reasons to consider nutritional supplementation, despite controversy.  Nutrient deficiencies are quite common amongst the US population², so it is a good idea for each of us to consider our personal nutritional needs.

I approach nutritional supplementation in 3 basic categories.

Foundational supplements

Foundational supplements are those that most of the population should consider because deficiencies in this group are common: it is estimated that over 40% of the US Population is deficient in Vitamin D and amongst the elderly, over 70% are magnesium deficient³. Other common nutrients that are often lacking include iron, iodine, Vitamin B12, calcium, and Vitamin A. So, it makes sense to take a good multivitamin with minerals to ensure that any deficiencies are avoided. The conventional advice is that if one eats a well-balanced diet, nutritional deficiencies will be avoided, but the standard American diet is often not complete nutritionally. Moreover, many of the ultra-processed and fast foods we eat drain us of needed nutrients. The US food supply has also been criticized, as modern agriculture has resulted in foods that are less nutrient dense than in the past⁴.

I consider Omega-3 fatty acids (such as fish oil) in the foundational category because our typical diets are much higher in Omega-6 fats, which are associated with greater inflammation, adverse cardiac impact, and possibly higher risk of dementia. If you frequently eat fish or follow a vegetarian diet, Omega-3 supplement may not be needed.  But for the rest of us, it is a good idea.

So, with respect to foundational supplements, I take a multivitamin, Vitamin D, Magnesium, and an Omega-3 supplement daily.

Therapeutic Supplements

These include vitamins and nutrients, including botanical products. In many instances, herbal therapies emerge from ancient Chinese or Aryurvedic traditions The notion here is that we can enhance our health and prevent or treat certain conditions using nutritional therapies. For example, if you suffer with arthritis, there are a number of “natural” supplements that may help, such as glucosamine, or collagen products. Or perhaps you have slightly high cholesterol and rather than a statin, wish to try Red Yeast Rice or another natural lipid-lowering agent. Creatine is another example in this group, which has been demonstrated to enhance muscle growth and improve cognitive function.

There are many examples in this category and the choice depends upon your particular needs and concerns. The controversies have to do with good research-based evidence supporting their benefit and concerns about safety and product quality,

It is important to select products based upon your personal needs and interests. But choose carefully. Beware of exaggerated claims. Choose products for which there is good evidence of benefit and purchase from a high-quality supplement company. I often find my patients have a list of supplements, some of which they do not even understand why they have been recommended.  They may have purchased them  online from a discount seller.  That is a bad idea.

I am happy to discuss these choices with you—let’s make certain there is a good reason to choose product and let’s select a quality brand.

I take a creatine and collagen supplement, for musculoskeletal, skin and joint support, curcumin as a natural anti-inflammatory, astaxanthin as an anti-oxidant and protection from UV light damage.  I also use Berberine for metabolic and cardiovascular support

Geroprotective Supplements

A third category of nutritional supplements involves efforts to enhance healthspan and longevity, often termed geroprotective agents.  This is perhaps the most controversial category, as there is little evidence in humans that any of these nutraceuticals are truly useful, although in many instances, animal studies, usually in laboratory rodents, have demonstrated benefit. It is very challenging to perform longevity studies in humans, given the average lifespan of over 70 years. However, a deeper understanding of cell biology, genetics, and metabolism has led to efforts to find effective agents that delay disease onset and prolong health. As the hallmarks of aging are better understood, nutritional therapies to optimize our physiology are intended to target some of these mechanisms.

Geroprotective supplements are of course, optional. For those interested in a more aggressive approach to longevity, it is reasonable to consider one of several agents in this category. I plan to discuss this category in a future blog.

Keep in mind, though, that nutritional supplements represent only a small contribution to health optimization. Proper nutrition, quality sleep, regular exercise, stress management and hormone balancing are far more important than simply taking nutraceuticals, which should be considered, as they are termed, “supplements” to add to our health and lifestyle choices.

Here is a list of my daily supplements:

• Multivitamin
• Vitamin D3 with K2
• Omega-3 fish oil
• Berberine
• Creatine
• Curcumin
• Astaxanthin
• C15 fatty acid
• Hydrolyzed Collagen
• Magnesium l-threonate

These are my current personal choices, and they change from time to time, as new data emerges and as my particular health concerns arise.

Next time, I will discuss issues related to supplement safety, quality and how to choose your nutritional supplements wisely.

Learn more about our nutritional counseling here.

References:

^{https://www.cdc.gov/nchs/data/databriefs/db399-H.pdf}

^{https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/overview}

^{https://www.healthline.com/nutrition/7-common-nutrient-deficiencies – TOC_TITLE_HDR_8}

^{https://www.scientificamerican.com/article/soil-depletion-and-nutrition-loss/}