Supplements

In My Humble Opinion
21

The main issue is that most people don’t know what they need. And nutritional supplements are not like prescription medications—they can take 6-8 weeks to see results.

I have had a long list of health problems over the last 30 years, but the worst is treatment-resistant depression. For a while I tried herbs and homeopathy, none of which worked. A little over 11 years ago, I started taking supplements recommended by a woman who ran a rehab place in Minnesota. I felt normal for the first time in years. Vitamins and amino acids mostly.

In the last couple of years, it felt like things were seriously falling apart. Went to the doctor, no clue, changed doctors, no clue. In November I started seeing an orthomolecular doctor. They’re very expensive and don’t take insurance, because they actually take the time to really assess you. They do in-depth testing of your genetics and physical chemistry. I found that I have gene markers that make it hard for my body to process certain things or certain forms of things. I was taking B-12, but learned I needed to take a methylated B-12 because I have a methylation issue.

I feel like a new person now. She added some supplements I had never heard of. The depression lifted and the sobbing and suicidal thoughts stopped. I have more energy and I have stopped craving carbs constantly.

Some may say it’s a placebo effect. I’m 59 years old with a lot of experience with this body and how it operates and the effects of meds and supplements and I know when something is working for me and when it’s not.

So the key for me was finding someone who has knowledge and experience and doesn’t mind doing the detective work it takes to find out what your particular body needs. YMMV

22

The only supplements that I would fight tooth and nail to keep are Vitamin D3 and probiotics. You can tell me probiotics aren’t supposed to work, or they are unproven, or whatever, but they help me with digestion in a way that is invaluable to me. I teach upper elementary school. The last thing I need when dealing with 4th grade boys is excessive gas. Since I started taking probiotics, I don’t have that problem anymore.

23

Doctor suggested vitamin B and Fish oil. So I do that.

I also throw in a multi vitamin :shrug:

Once in a while I’ll take a Tryptophan capsule as a sleep aid.

24

“Orthomolecular” and other alt med types don’t take insurance because it generally doesn’t cover non-evidence based woo.

*apparently “orthomolecular” means “unlike physicicians who just throw drugs at your problem, I sell you loads of supplement pills”.

25

About ten years ago, my physician ordered me to start taking multivitamins. I went with the smallest, lowest-dose multivitamin I could find. I recently moved to another state, and haven’t raised the issue with my current doctor; I probably should.

I also take a magnesium supplement. A few years ago I had PVCs (premature ventricular contractions), which felt like a slight “zap” sensation in my chest. My physician insisted that they were harmless and I should ignore them, but they were driving me INSANE. A friend suggested that magnesium might help, and it did. The PVCs stopped within a couple of days and have never returned.

My knees have been bothering me lately, so I’m giving glucosamine a try. It’s been a couple of months and I haven’t noticed any improvement. :frowning:

26

From a viewpoint on vitamin and mineral supplements for healthy people, published in the latest (3/6) issue of the Journal of the American Medical Association by two authors affiliated with the Division of Preventative Medicine at Brigham and Women’s Hospital/Harvard Medical School:

Pregnancy: folic acid, prenatal vitamins
Infants and children: for breastfed infants, vitamin D until weaning and iron from age 4-6 mo
Midlife and older adults: some may benefit from supplemental vitamin B12, vitamin D, and/or calcium

Certain “high-risk subgroups” are commonly recommended to take supplements - these include bariatric surgery patients, those with pernicious anemia, Crohn’s disease or other inflammatory bowel disease, celiac disease, age-related macular degeneration, people on certain medications (i.e. proton pump inhibitors, metformin), or (drum roll) those with “restricted or suboptimal eating patterns”, for which multivitamins/multiminerals, vitamin B12, calcium, vitamin D and magnesium may be beneficial.

Other important points: “Given recent concerns that calcium supplements may increase the risk for kidney stones and possibly cardiovascular disease, patients should aim (to meet the RDA for calcium*) primarily by eating a calcium-rich diet and take calcium supplements only if needed to reach the RDA goal (often only about 500 mg/d in supplements is required).”
“Multivitamin/multimineral supplementation is not recommended for generally health adults.”
“…some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance—e.g. high dosease of beta carotene, folic acid, vitamin E, or selenium—may have harmful effects, including increased mortality, cancer, and hemorrhagic stroke.”

My take from evidence-based recommendations is that in general it’s better to get micronutrients from foods, rather than trying for isolated large doses from pills of uncertain composition and quality.

27

I used to work as a microbiologist in the supplement industry. It’s fucking scary. The previous lab manger in my company used to set expiration dates by walking across the street to WalMart and seeing what expiration dates were on the bottles there.

28

^ The FDA doesn’t require expiration dates on supplements. Surprisingly, they’re not required on food either (with the exception of infant formula). I remember a story on the news several years ago about how after eggs were expiring on store shelves they were put in new cartons with new dates on them, and it was legal.

29

Jackmannii, thanks for that excellent summary of who may actually benefit from supplements, based on actual factual peer-reviewed scientific evidence. It pretty much mirrors what I’ve been telling my patients, save that it appears I’ve been a bit lax about making sure my higher risk patients on metformin have enough B12 and folate. Though IIRC, the evidence for that wasn’t terribly strong before. Has that changed?

30

That summary just touches the surface. There are plenty more supplements that there is adequate scientific evidence for benefits for certain individuals. One example being omega-3 during pregnancy:

This is one part of a continuing education video I uploaded to YouTube years ago featuring an Army doc going over studies and benefits of omega-3 supplementation for both adults and children:

31

Here’s a study on one of the supplements I’m taking. L-5-MTHF methyl folate.

32

The American College of Obstetrics and Gynecology does recommend adequate intake of omega-3 fatty acids for pregnant and breastfeeding women - but it does so by calling for them to eat at least two servings of fish or shellfish a week. It does not recommend they take omega-3 supplement pills.

I note that a postscript to your linked article about its authors says: “Dr. Greenberg has no conflict of interest. Dr. Bell and Ms. Van Ausdal are full-time employees of Twinlab, a manufacturer and purveyor of dietary supplements. The company sells products containing omega-3 fatty acids.”

:dubious:

33

If a woman is not going to eat fish, pregnant or not, but she will swallow a couple capsules a day, would it not make sense to for her to do so when pregnant, because of the American College of Obstetrics and Gynecology’s recommendation to consume adequate amounts of omega-3 fatty acids while pregnant and breastfeeding?

It is far from uncommon for those with vested interests to be the one’s hiring researchers to perform studies. We have lots of peer-reviewed, journal published studies that give us data we otherwise wouldn’t have. Money drives research; that’s not a secret. There are other benefits for certain populations to supplement with omega-3 according to research. It makes sense that there would be. Most people don’t consume enough EPA and DHA directly nor do we convert enough ALA into them to get maximum benefits we could if we did.

34

Beyond the issue of contaminants/uncertain composition affecting many supplement pills, there are factors favoring consumption of nutrients in foods rather than in pill form.

One is that you can miss out on beneficial compounds in foods that are not contained in supplement pills (for instance, red wine may be superior to resveratrol supplements for this reason). Another is that body uptake from pills may be inferior to that from foods - and this has been demonstrated in studies showing it’s better to eat fish than take fish oil pills.

35

I brought up how to go about finding reputable supplement companies earlier. There are without a doubt issues with supplement regulation in the US, although supplements aren’t “unregulated” as the myth goes and has been repeated in this thread.

Speaking of contaminants, the presenter in the video I linked to earlier mentions the ALSPAC study by the NIH that was performed after it was recommended in the US that woman lower their consumption of fish due to concerns of contamination of heavy metals.

We can’t replace eating food with pills and powders. No one is suggesting that. “It’s better to eat a well-balanced diet” recommendations aren’t likely to get many people to do so. We know we should but we don’t. I know many people that aren’t going to start eating fish a couple times of week because they’re told it’s good for them. There is evidence that certain benefits of omega-3 need higher doses than eating it a couple times of week. For people that want those benefits and aren’t going to eat fish no matter what, supplementation may be a good idea. The same can be said for getting other nutrients from supplements.

36

I take a multivitamin because my diet is lousy, and fiber tablets because I like to poop on a regular schedule - first thing in the morning, prior to my shower. I don’t otherwise have a Sheldon-like bathroom schedule, but I like starting my day with a clear mind, an empty colon, and a clean body.

37

There’s good evidence that fears about contaminants in fish are overblown.

“Avoiding fish is certainly one way to avoid mercury or PCBs. But is that the wisest choice, given the benefits of eating fish? Drs. Mozaffarian and Rimm put this in perspective in their analysis in the Journal of the American Medical Association. (1) First, reviewing data from the Environmental Protection Agency and elsewhere, they calculated that if 100,000 people ate farmed salmon twice a week for 70 years, the extra PCB intake could potentially cause 24 extra deaths from cancer—but would prevent at least 7,000 deaths from heart disease. Second, levels of PCBs and dioxins in fish are very low, similar to levels in meats, dairy products, and eggs. Third, more than 90 percent of the PCBs and dioxins in the U.S. food supply come from such non-seafood sources, including meats, dairy, eggs, and vegetables. So, given these limited health effects, low levels in fish, and major sources from other foods, the levels of PCBs and dioxins in fish should not influence your decision about which fish to eat (just as it does not influence your decision about whether or not to eat vegetables, meats, dairy products, or eggs, the major sources of PCBs and dioxins)…
At the levels commonly consumed from fish, there is also limited and conflicting evidence for effects of mercury in adults; thus, the Environmental Protection Agency, the Food and Drug Administration, the Institutes of Medicine report, and the analysis by Mozaffarian and Rimm all conclude that this evidence is insufficient to recommend limitations on fish intake in adults, given the established benefits of fish consumption for cardiovascular disease. In fact, the easiest way to avoid concern about contaminants is simply to eat a variety of fish and other seafood…
The healthiest approach for women who are or may become pregnant, nursing mothers, and young children is to eat two servings per week of fish or other seafood, including up to one serving per week of white (albacore) canned tuna, and avoid the four fish species higher in mercury (shark, swordfish, tilefish, king mackerel). It is important that women recognize that the list of fish and seafood that they should eat is far larger than the few specific species to be avoided…
So, these recommendations emphasize that women who are or may become pregnant, nursing mothers, and young children should eat fish, avoiding only four specific (and generally rarely consumed) fish species. Importantly, the latter limitation does not apply to the rest of the population, for whom the evidence supports simply choosing a variety of fish and seafood.”

And if one is concerned about contaminants - that problem (along with mislabeling) plagues a significant number of fish oil supplement products.