Image by Lucio Alfonsi from Pixabay
Many of my new patients come in with shopping bags filled with supplements, wanting to know which they should continue and which they can stop. Often, as Andrew mentioned here, people don’t remember why they’re taking something, or they read, somewhere, that a given supplement was a remedy for everything but death.
Here’s the thing, though: nearly every medicinal herb you can name is antimicrobial, antioxidant, and anti-inflammatory, at least. Many of them are also anti-cancer, protecting against DNA mutation. They’re nearly all chock-full of phytonutrients, vitamins and minerals. You could cherry-pick almost any herb and make similarly spectacular claims, if the studies have been done. Does that mean you should be taking ALL of them in supplement form?
My $0.02 from a Christian worldview is that God is good, and He wants us well. Because of this, He’s provided a myriad of different tools (called modalities in naturopathic medicine) to can get us there, and it hardly matters which one you pick.
What does matter is the way in which you use them: that is, the dose, the timing, and the philosophical reasoning behind it. It’s possible to use nearly anything to either suppress symptoms, or to heal root cause—this is related to the concepts of hormesis, as well as germ vs terrain theory.
Because of that, there’s almost no one-size-fits-all to a supplement regimen either. Once upon a time in the not-so-distant past, we could get all our nutrients from our food, and wouldn’t need any supplements at all. Unfortunately, modern farming practices and industrial processing of prepackaged food products have made that a thing of the past. At the same time that the nutrient content of our food has been on the decline, the same industrial processes and technological advancements have made our world increasingly toxic. This has, to varying degrees, overwhelmed our previously sufficient detoxification pathways, crippled our mitochondria, and set us up for chronic oxidative stress and inflammation. Which of these (or which combination of these) is the biggest problem for a given individual depends on their genetic predispositions, epigenetic changes, exposures, stressors, and lifestyle choices.
Physicians who have been practicing naturopathic medicine a lot longer than I have observe that cases have become increasingly complex over recent generations, corresponding to the increasing toxicity of the Western world.
I don’t doubt it.
Approaches for individualized treatment range far beyond supplements, but they do include supplements. This is why there’s almost nothing that I prescribe for everyone—though there are a few favorites that I prescribe quite a lot. Here’s a few of those categories, with some common variations.
As previously mentioned, even unprocessed foods are no longer the way God made them anymore. Buying organic and from farmer’s markets is better, but there are no guarantees, even if the crops planted are heirloom, crops are rotated and fertilized with organic material, and no pesticides or herbicides are used.
Because of this, and because I’d prefer people not take each individual vitamin and mineral in a separate capsule (if only for cost, and because inactive ingredients can add up), I generally recommend a multivitamin for almost everyone.
Which one can vary, though there are a few rules of thumb. First: look at the minerals (magnesium, calcium, selenium, zinc, etc). These are always complexed with something (unless they’re whole-food based vitamins). If the word next to the mineral name is “oxide,” “carbonate,” or “sulfate,” it’s not absorbable. It should be a chelated version, which is anything else ending in -ate (such as “citrate,” “orotate,” “glycinate,” etc).
Second, look at the type of folate and B12. If they’re folic acid and cyanocobalamin, it’s a crappy brand. (There are rare exceptions when I think people need folic acid rather than another form, but cyanocobalamin is never good.) Better forms are 5-MTHF or folinic acid (though again—there are some who don’t tolerate these forms)), and either methylcobalamin, hydroxycobalamin, or adenosylcobalamin.
Third, look at the inactive ingredient list. It should be very short, and one giveaway that it’s junk is soybean oil. I’m not necessarily against soy, but if it doesn’t say it’s organic or non-GMO, it is GMO, and I’ve yet to see a high quality supplement listing soybean oil as an inactive ingredient.
Fourth, you want a capsule instead of a tablet (with the exception of whole food based multivitamins, which are always tablets). This is because it takes very robust stomach acid to break down most commercially prepared tablets. As we age, stomach acid production declines, and those who have blood type A have lower levels of HCl in the first place.
Beyond that, there are other potential variables for given individuals. Some people really need certain types of B vitamins and not others, as mentioned above. (Those who can’t handle synthetic B vitamins at all usually do need a whole food based multivitamin.) Some need higher levels of nutrients to help balance blood sugar, such as chromium and vanadium (UltraNutrients is my favorite for this).
Some people are low in iron, in which case I’ll often choose a prenatal (regardless of age. Pure Encapsulations is my favorite for this).
Other people are too high in iron, in which case I’ll choose a multivitamin that doesn’t have any (Polyphenol Nutrients is often the one I pick for this).
Some are basically healthy and really don’t want to take a lot of pills, in which case I’ll choose a one-a-day (O.N.E. is my favorite for this).
Some can’t swallow pills—for these I try to avoid gummies (since the nutrient content is generally quite low, to make space for the gelatin and sugar and whatever else), but they’re better than nothing. I’d prefer either a liquid version, or opening capsules and mixing them in with something to disguise the flavor.
There’s a lot of possibilities. One thing to note: make sure you take anything with minerals in it with food, otherwise it’s likely to make you nauseous.
Supplement: Essential Fatty Acids
Essential Fatty Acids are called “essential” because your body can’t make them—you have to consume them. They’re critical for cellular functioning. While it is possible for you to eat enough of them to maintain the proper omega 6:3 ratio of 4:1, anybody consuming any appreciable quantity of prepackaged foods (which is most of us, let’s be honest) probably isn’t doing it. That’s because the highly inflammatory omega 6 fatty acids are high in the vegetable oils used in all manner of crunchy, salty processed snacks. Not only that, but other variables, such as micronutrient deficiencies and stress, can affect your ability to utilize the omega 3’s from your food, too. So even if you eat fish several times per week, you’re still most likely closer to the typical American omega 6:3 ratio of 20:1 than you are to the more optimal 4:1.
Because of this, I usually recommend most people take an essential fatty acid, somewhere in the ballpark of 1000 mg of EPA. I prefer essential fatty acids from fish over krill, only because krill tends to be pricier, but it’s otherwise fine. Fish oil isn’t all created equal, though. You want a high quality brand that tests their fish for heavy metals, does quality control to ensure that you’re actually getting the essential fatty acids rather than a large amount of “filler” oil instead, and one that doesn’t smell fishy (if it does, it’s likely rancid). I prescribe EPA/DHA from Pure Encapsulations most often, though I do like the Nordic Naturals brand quite a lot too.
I don’t prefer flax oil except for vegans who can’t do fish, simply because it takes more steps to convert it to a usable form.
There are people who don’t need probiotics every day—they’re the ones who don’t have any particular gut pathology going on, and who eat fermented foods daily, like our ancestors did historically, as condiments. Most likely anyone doing that is also getting an abundance of prebiotics from their diets, too.
Everyone else really should be taking regular probiotics. Your microbiome is like an army, protecting you against foreign invaders (pathogenic bacteria, parasites, etc). It also helps to educate your immune system about the difference between friend and foe, making it very important to mitigate against and prevent allergies and autoimmunity. It also helps you break down your food.
This is an army you want to replenish regularly, one way or another, and there are many ways in our modern world for it to get depleted. These causes range from direct or indirect antibiotics (indirect would be consuming agriculture industry animals that have been given massive doses of antibiotics in their feed) to birth control pills to PPIs, and beyond.
For someone who is otherwise healthy, I generally recommend a 50/50 blend of bifidobacillus to lactobacillus. For someone with SIBO, or with suspected SIBO, or who just tells me they feel worse with probiotics, I’ll choose one that’s prebiotic-free. Some argue that for those with SIBO, soil-based probiotics are better. In my experience they’re not necessarily better, but they’re a fine alternative.
Ideally, we’d get every nutrient we need from our food, but that’s no longer realistic. Almost everyone really needs to be on a multivitamin, and most also need to be on an essential fatty acid and a probiotic, at least.
Beyond that, there’s no one-size fits-all supplement regimen. There are lots of potentially good options, though. Often as I sort through a person’s shopping bag of supplements, I’ll just shrug and say, “Does it help you?” If the answer is yes, then sure, stick with it. If the answer is “I don’t know, but I read such great things about it!” then I’ll say, “Up to you.” If it’s no, and they have no idea why they’re on it, I get rid of it. I try to whittle the list down to at least no more than around ten, though, as a general upper limit.