Dietary supplements

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Dietary supplements are a big business in the U.S. The National Institutes of Health (NIH) Office of Dietary Supplements noted in April 2024 that Americans spend about $60 billion a year on dietary supplements.

Congress passed the Dietary Supplement Health and Education Act (DSHEA), which significantly altered the FDA’s regulatory authority over supplements, in 1994. Instead of the FDA proving a supplement is safe before it is marketed, the FDA must generally prove a supplement is unsafe to remove it from the market.

The U.S. has a very long history of ineffective medical treatments. (Sometimes called “snake oil” although the oil from a specific species of snake from China contains beneficial omega-3 fatty acids so genuine - though rare - “snake oil” actually does work.)

@TheReitStuff just posted about the benefits to his family from taking collagen which I wrote about a few years ago.

Of course, I still take collagen. I take a lot of supplements so I thought I would post about them.

  1. Collagen. My grandmother told me about this about 50 years ago. Collagen is essential for good skin and hair. It’s also key in healing tendons which are 100% collagen. Also bones are 40% collagen. I’m 71 years old and my skin is mostly smooth and much less wrinkled than friends my age. I take 2 tablespoons of collagen per day. I buy organic, grass-fed beef collagen whenever it’s cheapest in bulk. Costco.com sometimes has a good sale when Vital Proteins collagen is $1 per ounce or less. Then I buy in bulk and have it drop-shipped to my house.
  2. Daily multivitamin. Some nutritionists say this isn’t needed for people with a good diet but I like to fill in the gaps.
  3. Vitamin D during non-sun seasons. I take 5,000 I.U. per day from October - May which gives me a measured blood level of 45 ng/ml. Vitamin D deficiency is widespread and has been linked to cancer and diabetes. Also depression – no more Seasonal Affective Disorder for me once I started Vitamin D. https://www.grassrootshealth.net/
  4. Fish Oil for essential omega-3 fatty acids.
  5. Lite Salt (brand) which is 50% potassium chloride, 50% sodium chloride. This provides potassium to regulate blood pressure and balances the sodium which is essential in small amounts. Lite Salt also provides iodide. I cook everything at home, very little processed foods.
  6. Milk of Magnesia to provide 300 mg of magnesium per day. This helps balance the calcium I eat in yogurt. I take this an hour before bedtime since magnesium is said to help sleep.
  7. Melatonin, 5 mg an hour before bedtime.

Those are the ones I took for years. Since my open-heart surgery left me feeling so weak I added others which seem to be helping.

  1. d-Ribose which was recommended in the book “Reverse Heart Disease Now: Stop Deadly Cardiovascular Plaque Before It’s Too Late,” by Stephen T. Sinatra, James C. Roberts. Ribose is an ingredient in ATP, the energy molecule.
  2. Creatine. Recommended for muscle-building in seniors as well as young athletes. Muscle wasting is a big problem in seniors and can lead to frailty and falls. I exercise with weights twice a week and also do Zumba twice a week.
  3. Ceylon cinnamon which is said to help insulin sensitivity. Ceylon cinnamon doesn’t have coumarin like the more common spice, Cassia cinnamon. I’m pre-diabetic – runs in the family.
  4. Lithium orotate, 5 mg. I read recently about brain health benefits so I figured, what the heck? Can’t hurt. Why not try it. Almost immediately, I found I was more clear-headed when waking up so I intend to continue taking it. (Li+, K+ and Na+ are monovalent cations while Ca+2 and Mg+2 are divalent cations.)

Gosh, that’s a lot of supplements! But I take each for a specific reason.

Wendy

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I come from a medical family. Mostly we avoid all of this.

But with age my parents do take a multivitamin. I take 1000 IU of D.

Most of these things are not needed. Many of them if taken in larger quantities may have questionable effects. Needs a lot more study.

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Eating right is cheaper and healthier.

The Captain

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Than what?

Spending a fortune on pills and potions (Big or Little Pharma) is obviously sub optimal and something of a waste if the consumer is looking to compensate for overall craptaculous dietary and other lifestyle habits. I’m reasonably confident that actual pharmaceuticals with a demonstrable track record of efficacy likely have a better track record than a supplement that doesn’t, but it doesn’t have to be an either/or…..either.

Folk whose lifestyle choices have been consistently on point don’t have much to lose….and maybe plenty to gain…..from a rational use of supplements “just in case”. Problem comes when supplements are touted heavily instead of appropriate medications that have been recommended.

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VeeEnn,

Just in case is an obsessive society. Overdoing supplements is a very bad idea. It is early to quote the evidence, but the obsessive use of supplements comes with a cost.

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No, “just in case” is just that. At least, in my case. Nothing obsessive about thinking rationally about dietary intake, and taking measures to make choices on available evidence for oneself based on personal goals and circumstances. A bit like looking both ways when crossing a one way street. It only looks obsessive to folk who don’t bother.

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Have you taken any measures to address this? You mentioned following Peter Attia on the other threads on supplements and he is very much concerned on addressing T2D long before it rears it’s head.

Back at the start of 2021 ..…. when I decided to put some of the insight I’d gained from the guest lectures on Attia’s podcast (and other places) into action, and take what my “mildly elevated LDL-C” was trying to tell me a bit more seriously ….. I did wonder if incipient insulin resistance might be an underlying reason. I had no reason to imagine that might be the case given the Usual Suspects on my metabolic panel (A1c toggling around 5.4 for as long as I remember it being measured, and fasting glucose low 90s) However, seeing as these numbers don’t begin to change until the relatively late stages of metabolic dysfunction, was “wondering if….”

This coincided with a lot of stealth marketing for continuous read glucose monitors for “non diabetics” … for supposedly identifying “ideal” nutrition strategies in endurance sports, AS AVERTISED in Runner’s World, for instance. I recall also a lot of dismissive talk on endocrinology circles about misuse of medical technology for biohacking and whatnot….oftentimes citing Peter Attia who recommended them unreservedly in order to get a better handle on metabolic health (along with oral glucose tolerance testing).

They weren’t available OTC at the time so, in the earache I was giving my husband in the run up to our annual physical that year, I asked if he’d prescribe one for me or do an OGTT if our PCP dismissed my concerns (they do that sometimes :wink:) “Why not do just do a circulating insulin for your HOMA-IR?”, he asked ……. and then returned the earache gift by way of a guest lecture. So I asked for that along with the Apo-b and Lp(a) add ons and CAC scan.

As it happened, my HOMA-IR worked out at 1.1 ….not technically “optimal” per standard guidelines but apparently unusually insulin sensitive for my age. The others, well…..not so optimal. I would definitely have gone the CGM route if I hadn’t found the underlying familial hypercholesterolemia hidden in plain sight.

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It looks as if there’s enough to read here that’s not behind a paywall for anyone interested to get the gist of the rationale behind CGM in non diabetics (before diabetes gets a hold). Makes sense to me, as the saying goes…..

Continuous glucose monitoring to improve health in non-diabetics Continuous glucose monitoring to improve health in non-diabetics

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Most people that take supplements do. The question is whether there is science to back it up. And a bodily need for them (or are you just making expensive urine?).

For example, quality studies of collagen have shown improvements in skin elasticity. However, those studies used commercial collagen supplements that had other stuff in them (minerals and such). So did the collagen make the difference, or the other stuff? This is from Harvard.

Melatonin probably isn’t necessary. Your body does that automatically in the evening. The combination of the circadian rhythm, dim lights in the evening (and no blue light), induces an increase in melatonin for 2-3 hours before bed. Stay away from your computer and cellphone (both of which probably offer a night mode that cuts out the blue light), and it should be automatic. There are situations where it is very helpful, especially combating jet lag (which is a disruption of your circadian rhythm). However, if you take it, you should take it at least 2 hours before bed. Not just one. One hour isn’t enough time for it to work in your system. The published recommendation is 2-3 hours.

Note: not medical advice. I’m not a doctor. I’m a physicist who knows how to find and read studies.

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Now here’s one of the big problems when reading “studies” in disciplines outside of the field you’re familiar with. Physicists are smart people…..put chemists in there too….and that’s probably why I never aspired to be one. Anyways one of the things that it’s not so easy to get to grips with for folk in the “hard” sciences like yourself is the relative lack of certainty in biology, biomedical sciences in particular……and especially nutritional sciences. Relatively new fields, still full of gaps in knowledge and with knowledge acquisition that’s often dependent on current technology, along with more variables than you could shake a stick at. About as different from the investigative environment yer average physicist or chemist is familiar with, right? Don’t get me wrong….the time honored method, results, conclusion still hold but the QED tends to be contingent on available data and subject to change when more data become available.

In the biomedical sciences….and nutritional sciences in particular there are very few solid answers to the big questions right off the bat. Much is inferential that builds with the passage of time and oftentimes is observational in nature…the RCTs that’re the Gold Standard in research are difficult for practical, economic, and ethical reasons. Hence the fondness for rodent research ……especially for the resume padders and the NIH grant dependent ….. regardless of whether such research translates to free living humans.

Now, here’s the other issue…..and it’s not confined to supplements, either ……and it’s timelines. When studying interventions in people medicine, you’re looking at a potentially long lived critter, right? Oftentimes an intervention where you’re looking to havean impact on future results that might manifest long after the researchers have themselves died.

This is surely the case with nutrition and lifestyle choices in general. It’s one of the reasons I don’t get too complacent with regards to my own skepticism about the use of supplements, and what we think we know about them in the here and now based on what we can’t yet find in the literature.

Whilst I do believe that it’s unlikely that one single compound can make a difference between survival and not given enough attention to decent eating habits, However, I’m well aware that those RDA values you see on vitamin and supplement containers are historically based on just this…..suffient to survive….and that many of the supplements don’t even have that. Thing to ask yourself with these studies….say those you mentioned on collagen….how long did these investigations run for? Anywhere close to Wendy’s timeline??

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Talking about long term preventive actions.

I got caught yesterday at work without having my Starbucks decaf, which is 13% caffeinated.

Woe onto me.

I am done with coffee unless I make it at home with a water processed decaf.

Today without any coffee or decaf from yesterday, I have had the best night of sleep in years. Truly feeling great this morning. Love where I am at this morning.

Chocolate will be for very rare ocassions.

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@VeeEnn you have mentioned some important issues!

The Grassroots Health Nutrient Research Institute, which has supported research into Vitamin D for almost two decades, is trying to publicize widespread Vitamin D deficiency in the face of short studies that do not show a benefit. I read their research showing a reduction in breast cancer with adequate Vitamin D blood levels and began taking Vitamin D. I figured, what’s the harm? In the process of bringing up my Vitamin D level I discovered that it was an anti-depressant. (Living in the Pacific Northwest with long, gloomy winter nights and dark days.) Gradually, I began to sense when my Vitamin D was low because a wave of depression would loom out of nowhere and wash over me. Now I take 5,000 I.U. per day beginning in mid-October because that is what keeps my blood level at 45 ng/ml. (I have skin tone level 3 and get adequate sun in the summer.) https://www.grassrootshealth.net/

Another example happened just last week. I was reading an article in The New York Times about taking NAD+ as a supplement. The article mentioned Parkinson’s Disease (PD). This piqued my interest since I have a genetic mutation and was recently diagnosed with early PD, a rather terrifying diagnosis.

I did some research on Perplexity. To my amazement, I learned that recent research showed that people with PD have a deficiency of niacin (Vitamin B3, a precursor to NAD+) which affects the mitochondria. Imagine that!!

A low dose of niacin (100-250 mg) is enough to correct the deficiency. It’s a higher dose than the RDA (15 mg per day) but much lower than the dose used to lower cholesterol (1500 mg per day). PD patients who take niacin have higher energy, better mood and better physical capabilities. So easy, so inexpensive! Why didn’t my neurologist tell me about this?

My point is: added to your other excellent observations, there is a big difference between healthy, young people and old, sick people when it comes to needing supplements. As we age our bodies gradually lose their metabolic and biochemical pathways. Other factors, such as stress and skin color, may have an impact.

A black person may need more Vitamin D supplementation than a white person.

An old person will need collagen supplementation while a young person won’t. (However, collagen supplements have been shown to speed healing of torn tendons in young athletes.)

A person with PD may need niacin supplements while a well person may not. I just added 100 mg daily niacin to my supplement list in an effort to increase energy. (Along with CoQ10 and d-ribose.)

I have been taking collagen for 15 years. (Basically since menopause.) Now that I’m over 70 I can clearly see the difference in my skin quality compared with other women my age. I have a few wrinkles around my eyes but not the overall skin wrinkling they have.

The dry weight of a human body is about 20% collagen. It forms the intercellular matrix of every tissue (including the heart) and is 40% of bone mass. Skin is visible, but what about the heart? Here’s an image of a pig heart with the red muscle cells removed by washing with a strong detergent. This shows only the collagen intercellular matrix.

Decellularized-pig-heart-As-published-by-Ott-et-al-perfusion-decellularization-is
Decellularized-pig-heart-As-published-by-Ott-et-al-perfusion-decellularization-is643×396 54.2 KB

Don’t you think I want my heart to maintain its collagen strength as much as I want my skin to be unwrinkled? I don’t know whether the heart’s collagen is static or replaced over time…but I would rather be safe than sorry. I can tell you for a fact that my torn posterior tibial tendon didn’t begin to heal until I doubled my collagen intake.

I’m not trying to tell anyone to take supplements. I am only mentioning what I do for my own specific age and conditions.

Wendy

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I’ll add that with the needs of the young vs the old …. for a good many conditions, it might be that supplementation might need to begin in the young for optimal benefit in old age. Depending upon what any one individual wants for themselves when they become Chronologically Enriched (Peter Attia’s Centenarian Decathlon) To just survive……or thrive.

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True. There is a lot of variability in biological systems. That’s at least part of the reason that -for example- blood tests have ranges for various factors. Like TSH. It isn’t a number out to 4 decimal places. It’s a range. Within that range is “normal”. Outside that range, and they start to look at possible causes.

Even actual medical people don’t seem to have a lot of background on nutrition. Which I always found surprising. I guess they don’t require a semester or two in med school.

I admit I am very leery of various supplement claims. They are unregulated, unchecked, the dosages aren’t standardized, and they can insinuate almost anything they want in their advertising. Which is why I’m big on getting tests. My prior example of 1poorlady on chemo…her B12 was high, her B6 was low. They initially told us to get a “B-complex” vitamin. But, because of the detailed tests, we were able to target the deficiency (B6).

There’s also multiple types of D vitamins, and unless you ask they don’t always test them. You need the proper D vitamin (and, as studies have shown, K2) to affect your bones. The wrong type won’t help much, and the calcium you are taking is just as likely to grow kidney stones as anything else.

So the flip-side of biological sciences being a bit “squishy” is that there is a lot of deceit and bad information out there, often propagated by social media and Big Supplements. Just as an example, my neighbor takes a few grains of -I think- borax every day. Apparently social media claims it helps various issues. At the time, I googled it, and found nothing reputable claiming it was good, and a lot of reputable sources saying it’s very bad. But he’s convinced, because social media is more reliable than actual medical science (apparently).

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Well, depending upon what you consider nutrition to be (say the latest new discovery that the naturapaths etc are touting) they certainly do not…..or most other examples of the medical disciplines, come to that. I would imagine, though, that the sum total of all the “ologies” that make up the curriculum for the basic sciences in medical school and allow for a fundamental understanding of how the body works…..anatomy, physiology, biochemistry, molecular biology etc etc….along with acquiring an understanding of how to apply critical thinking skills to new data that become available takes up a heck of a lot longer.

Whenever I hear this I like to point out that someone of stature, say Anthony Fauci, graduating medical school without ever being taught a thing about AIDS/HIV, Hepatitis B or C and a whole host more. However as his postgraduate training progressed, he was able to apply the knowledge base mentioned above….along with biology, immunology etc etc to recognize when faulty reasoning prevailed when denialism etc reared its head.

Biology is not like physics

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This is a layman’s misunderstanding. Doctors have an encompassing knowledge of disease and treatment. Most of them see minor to no efficacy in supplements.

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Depends on the case. I’ve been in the room with doctors who will say “unnecessary” for one, and then recommend another. Almost always based on testing (e.g. B6 levels, iron levels, etc).

And some supplements can be dangerous. Specifically, the fat-soluble ones. They get stored in the fat. If you burn the fat, you can get a burst of -for example- vit D. Too much, and there is a risk of toxicity. Which -IMO- is why people shouldn’t be shoving this stuff down their throats without consulting their PCPs.

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Yes, it depends on the case. Case management should not be coming from snake oil salesmen. Blog posts are not a good guide.

Note I am talking about diseases, not nutrition.

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L

But why do you characterize folk who’re opting for judicious and mindful use of supplements to be “shoving this stuff down their throats” if, perchance, they’ve not received the endorsement of their PCP…..especially since you’ve queried a possible lack of didactic training in nutritional science in medical school.

I get that folk tend to be a bit suspicious when others are doing something different from themselves…..to the extent of suggesting they’re fearful of death if they’re making more effort, or, somehow reckless pill poppers for delving into data poor areas where they, personally, fear to tread (“Beware……here be dragons”)

As I mentioned upstream, what’s currently recommended as the RDA for most vitamins or supplements (if there is one) are historically based upon recognised levels that known for the difference between adequate and nutritional deficiency. Tested at a time when such molecules were newly identified. No one was looking for a level that might be optimal…..or even “a bit better”.

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If you are going to quote him, read him more carefully.