Dr. Deborah Gordon dives into the controversies and misperceptions surrounding supplements.
1. I eat a good diet and don’t think I need supplements at all. Do I?
Perhaps you don’t. Maybe you have access to food that’s been grown organically on soil that’s been well-tended for generations, and you truly do eat recently collected eggs and the milk or the meat and organs of healthy farm animals. If not, you might consider a trial of supplements. The most popular supplements are vitamin D, fish oil, CoQ10, probiotics, and multivitamins.
2. But my own doctor told me that supplements are useless. And she cites plenty of research that vitamins are useless for our health in general, and for specific issues, such as cardiovascular health.
First, what happens inside you is not necessarily what happens in large studies. It’s best to learn about you. For example, you can check such things as vitamin D on a routine lab test from your physician or order your own lab tests through LifeExtension.com or DirectLabs.com or any of several other do-it-yourself lab test providers. Second: Studies about “vitamins in general” typically disregard the quality of vitamin products. The website Consumerlab.com evaluates supplements for purity and for truth of their labels. The results are highly inconsistent, suggesting discernment really matters.
3. Does cost matter?
Not always, but often. For specialized supplements such as multivitamins and fish oil, I’d rather see you buy a more expensive brand and take it half the time than buy a cheaper form and take it daily.
4. How do to you chose a good multivitamin?
- Check the form of vitamin B9 that’s included. “Folic acid” is the cheapest, oldest, and least helpful form of B9. A vitamin that includes B9 as “folate” or “folinic” has been more carefully crafted. It’s a good sign.
- Bugs Bunny can eat a carrot, absorb beta-carotene, and transform it into highly valuable vitamin A, aka retinol. Unfortunately, almost half of us are not so skillful and actually need retinol in our multivitamin, or lots of vitamin A in our diet. (Egg yolks, dairy, and liver are great sources.)
- Magnesium should be in some form other than magnesium oxide. The oxide is the cheapest form and may indicate everything else is cheap.
- Copper and iron should be included in vitamins for young women, but they should be excluded from vitamins for men and post-menopausal women. (Of course, in some settings, any individual man or older woman might need copper and/or iron, but not as a general rule.)
- Extra ingredients such as herbs and plant extracts can be nutritious, but for those, you could really eat the real food and season it with the real herb, fresh and organic!
5. I heard the best way to get Vitamin D is sunshine.
That’s true. Get it from the sun when you can. But that’s only when your shadow is shorter than you are, and where I live that’s only about six months of the year. The rest of the year, supplement with vitamin D in the D3 form, whatever dose it takes for you to achieve a level of 40-60 ng/ml. Personally, I think drops work better than capsules—my bias after 25 years of testing patients’ vitamin D levels. (If you take the drops, put the D right on a bite of food. It is lost in a cup or bowl of liquid.)
Vitamin D helps your body absorb calcium, but not every body knows what to do with it. Misguided calcium can settle in blood vessels or tendons; smart calcium goes to the bones and teeth. You can help direct your calcium to your bones with vitamin K2 from fermented dairy, or take vitamin K2 as MK7.
6. How do I choose a fish oil?
Fish oil is fragile! Exposed to too much light or heat, it can go rancid and do more harm than good. Fish oil may have many components, but the ones you want are EPA and DHA, which can come from fish or krill, and should total about 1000 mg. a day. Take fish oil with a good-sized meal to reduce the chance that it will “come back up” on you! For vegans, DHA can also be sourced from algae.
7. What about CoQ10?
It’s a sturdier product and most manufactured forms test well. If you’re over 50, take the Ubiquinol form of CoQ10 for better absorption.
8. Why are there so many kinds of magnesium?
- Magnesium never exists on its own. It needs another substance to pair with it. Here is a brief thumbnail sketch of each of my favorite forms of magnesium.
- Magnesium oxide is the cheapest form of magnesium: a great laxative, with only mild properties of calming.
- Magnesium citrate is versatile: a moderately good laxative and calming agent.
- Magnesium taurate uses the “taurate” portion for good access to muscles, so it’s particularly good for muscle cramps and often can help with a racing heart. (Isn’t your heart your favorite muscle of all time?)
- Magnesium lactate is the best absorbed, for people who are told they have low magnesium levels.
- Magnesium malate has been helpful for some people with chronic fatigue or fibromyalgia.
- Magnesium-l-threonate is the new kid on the block, the only magnesium that reliably crosses the blood-brain barrier, making it the most sedating and the least like a laxative. It also helps your brain make new connections between brain cells, so it’s useful in states of brain injury or decline.
9. How do I choose a probiotic?
The choices are encyclopedic, and many different varieties have been found to be helpful in different conditions. I recommend rotating among a variety of probiotics sources, including:
- Fermented foods and drinks
- Brands with Lactobacillus and Bifidobacterium species
- Brands with pre-biotics included
- Brands with soil-based organisms
10. Can supplements do harm?
Of course they can! A friend of mine didn’t take any supplements and then walked into Costco and bought every one on this list. Two weeks later, he was at his doctor’s office with mysterious and sometimes severe abdominal pains. The doctor’s advice: Stop the supplements! Sure enough, the symptoms went away.
Keep in mind that anything you do to, in, or on your body can provoke an individual and unwelcome reaction in you! Please be your own first physician by considering the following few precautions:
- Start any new medicines or supplements one at a time and believe your reaction. If vitamin D makes you feel nauseated, stop it, wait a few days and try it again. (In medicine we call that the Koch postulate: Something fails two tests, believe it.) It may be the supplement itself or it may be the brand.
- If you develop a new problem of any sort, consider a “supplement holiday” for a few days, and then restart them gradually.
- The reverse is not true: If you stop vitamin K2 for a while, you will feel no worse. You will think you are fine.