Dietary Supplments: What the Industry does NOT want you to know
Much of what we believe is shaped by what we see, read and hear. The media's mes- sage about supplements--those substances regularly ingested as pills, powders and liquids by over one-half of all Americans in their quest to feel better and live longer--is decidedly mixed. We often read or hear stories about the benefits of taking supplements like vitamin E, St. John's wort or coenzyme Q10. Often these stories refer to published scientific studies demonstrating usefulness. A week later, we read or hear a report about the dangers of the same substance, with warnings by a designated expert to stay away from it.
This is not an article about the media or politics, but a few words about what's behind the news and what the media calls "science" are in order. Actually, one word is in order. The word is MONEY. Money vastly influences what is reported and the slant placed on that reporting. So where's the money? Most ads on the nightly news are drug company ads. And newspapers and magazines today are full of drug company ads. This means we should expect enormous bias against anything that would take away from pharmaceutical profits. Do you want to trust Rather, Brokaw and Jennings--or your own judgement?
To Take or Not to Take
Over thirty years ago, I read a little book called Vitamin E for Ailing and Healthy Hearts, by the Shute brothers. It's still a good read. The brothers, Canadian medical doctors, presented an open-and-shut case about the myriad benefits of vitamin E supplements. I began taking vitamin E and continue to this day. I also began researching the usefulness of vitamins, minerals, enzymes, herbs and special foods in the treatment of health problems. A number of these substances are helpful to anyone interested in optimizing health and extending the span of vigorous, active life. Others are appropriate for many people who develop problems typical of our culture. The question is really not whether or not to take supplements. Rather, the questions are which ones, when and how much.
These are hard questions, and because the answers are different for each of us and depend on individual needs, they can't be fully answered here. But some general questions that apply to all of us can be answered. In this article, I'll address the following:
- What is the difference in quality between one company's version of a given supplement and another's?
- Which supplements are important for most people? Why?
- What is the relationship between supplements and foods? Can supplements complement even a very good diet?
- What are some problems people commonly have that can be helped with proper supplementation?
Most people simply cannot determine what they are really getting when they buy supplements. Among the often unanswered questions:
- What are the sources of the vitamins and minerals used in a given vitamin or mineral product?
- Which sources are most like the vitamins and minerals in foods, and most likely to be beneficial?
- Do the herbs in a given herbal product have the potency to achieve the desired result?
- What are the effects of additives used in manufacturing the supplement? How absorbable is the product?
Sources and Forms
Vitamins and minerals come in many different forms. Some are derived from foods, such as vitamin E when extracted from vegetable oil and vitamins A and D when extracted from fish oil. Others are made in laboratories--they may then be labeled "natural" because they are made from "natural" precursors. Some are combined with dried foods and herbs and called "food vitamins."
A number of forms of synthetic vitamins A and D are used in supplements. All should be strictly avoided--even small amounts of the synthetic forms of fat-soluble vitamins may be toxic. In fact, the toxicity of these synthetic forms has contributed to the media frenzy about the alleged dangers of vitamins A and D. The media and the medical establishment do not distinguish between the synthetic forms and natural vitamins A and D as found in or derived from animal fats. Decades ago, researchers definitively established the benefits and safety of large doses of natural vitamins A and D. Traditional diets are rich in these nutrients, typically containing upwards of ten times the RDA amounts the government now tells us are adequate. There has never been any indication of anything but benefit from these natural forms of vitamins A and D, including for pregnant women. In fact, these nutrients are particularly important for pregnant women, and foods rich in vitamins A and D were emphasized for pregnant women in virtually all of the traditional cultures studied by Weston Price.
The warnings against vitamin A usually include mention of Arctic explorers who died from vitamin A overdose because they consumed polar bear livers. Actually, the early explorers did not die from eating polar bear liver. They did suffer from exfoliative dermatitis and hair loss. In 1988, a team of Swedish scientists discovered that polar bear and seal livers tend to accumulate the metal cadmium. The symptoms for cadmium poisoning are exfoliative dermatitis and hair loss, but don't expect to hear about this on the evening news. Rather, expect continuing stories about the alleged dangers of vitamins A and D. The media and the medical establishment work together to vilify the very substances that can prevent suffering and disease.
Cod liver oil is a wonderful supplemental source of natural vitamins A and D. I recommend from one-half to two tablespoonfuls daily of high-vitamin cod liver oil, described later in this article, to most of my patients. Carlson Laboratories' imports lemon-flavored Norwegian cod liver oil which is of top quality and is palatable for most people.
Vitamin E is another nutrient for which it is very important to select the proper form. Synthetic vitamin E is labeled, "d, l- alpha." This mixture of "d" and "l" forms is biochemically different from natural vitamin E which is labeled "d-alpha." Like synthetic vitamins A and D, synthetic vitamin E has detrimental effects. It is incompletely metabolized and may even disrupt the metabolism of natural vitamin E in the liver. The most beneficial natural vitamin E products come as mixtures of the alpha, beta, gamma, and delta tocopherol fractions. I use and recommend a product called "Unique E," made by the A.C. Grace Company, whose only product is this superior vitamin E supplement; it is the only mixed tocopherols produce that is completely free of soy oil.
To summarize, the fat-soluble vitamins (A, D and E) should always come from natural sources. As for the water soluble vitamins, there are natural sources that can provide small amounts for general use--acerola powder for vitamin C, for example, and low-temperature dried yeast flakes grown on an appropriate medium for B complex. However, for larger therapeutic doses it is necessary to use synthetic vitamins. How these water-soluble vitamins are formulated makes a big difference in how they are absorbed and tolerated.
Almost all of the vitamin C in supplements is made in a laboratory, despite labeling that implies otherwise. For example, the label might say, "ascorbic acid from sago palm." Dextrose, a form of sugar that contains no vitamin C at all, is extracted from sago palm and used as the base molecular material for a complex laboratory process that synthesizes vitamin C. Or, the label might say "vitamin C derived from the finest natural sources." True, but the vitamin C was synthesized. It might also say "with rose hips and acerola," which are then used as the base material for the tablet or capsule. But a tablet of rose hips or acerola can contain only about forty milligrams of truly natural vitamin C; the rest is synthesized.
Most significant in regard to the form of vitamin C is the buffering process, which complexes a mineral (typically either calcium, magnesium, or potassium) with ascorbic acid. Buffered vitamin C is gentler on the stomach than regular vitamin C, which because of its acidity often causes gas, bloating, and upset stomach. Buffered C offers superior absorption as well.
Labels often proclaim "natural" B vitamins, derived from yeast. But companies manufacturing yeast add laboratory-synthesized B vitamins to the food fed to the yeast during its growth, and then fortify the yeast further with additional B vitamins once it has grown. This allows the production of yeast at any B-vitamin potency desired, which is then used to formulate vitamin pills labeled "B vitamins derived from yeast." I generally recommend B vitamins as part of the multi vitamin-mineral-antioxidant formula that I use. For therapeutic doses of specific B vitamins, I usually recommend Thorne Research products.
Minerals in supplements are found in many different forms. Minerals occur in foods as part of molecules in which the mineral exists as a complex with other substances. Minerals in supplements are also found as complexes, and the substances with which they are complexed affect the degree to which the minerals are absorbed and utilized. Some mineral supplements are actually extracted from foods (for example, calcium hydroxyapatite), while others are complexed in the laboratory (for example, amino acid complexes of calcium) or found in nature (for example, calcium carbonate).
Calcium is the most commonly taken mineral supplement, and calcium supplements come in scores of different forms. But only one is actually a food extract and that is calcium hydroxyapatite. This is the form of calcium that naturally occurs in bone. Low temperature processing techniques are used to extract microcrystalline hydroxyapatite concentrate (MCHC) from raw bone--the best products utilize MCHC from free-range, pesticide-free New Zealand cattle. MCHC is a complex crystalline compound composed of calcium (about 24 percent), phosphorous, delicate organic factors (thus the importance of low-temperature processing), protein matrix and the full spectrum of minerals that naturally comprise healthy bone. Look for a calcium supplement in which the only source of calcium is MCHC. Many supplements say "MCHC" or "calcium hydroxyapatite" on the label, but when you read the ingredients carefully you discover that a secondary source of calcium, typically dicalcium phosphate--an inexpensive, poorly absorbed form of calcium--contributes an unstated percentage of the calcium to the supplement.
Many calcium formulas include magnesium; well-absorbed forms include magnesium aspartate, magnesium glycinate and magnesium oxide. Many other minerals may be complexed as aspartates or picolinates, which generally provide excellent absorption.
"Food Vitamin" Supplements
Understanding the "food vitamin" supplements is a bit tricky and warrants explanation. There are three general types of products that are often referred to as "food vitamins."
One type is made by taking standard USP (United States Pharmacopeia) vitamins (manufactured in laboratories by biochemical processes) and putting them in tablets or occasionally capsules with dried foods and herbs (along with fillers and other additives used in production). Taking these vitamins is no different from taking standard USP vitamins with a meal (but a lot more expensive).
A second type of "food vitamin" is supplements made by adding standard USP vitamins to a liquid broth containing yeast. As the yeast grows, the vitamins and minerals are incorporated into the cell structure of the yeast. The yeast is then killed in a drying process, and the residue is pressed into tablets with herbs, binders and manufacturing additives. The companies New Chapter and Megafood use this type of process to make their products.
Because of the amount of space taken up by the yeast, products made this way are very low in potency. Even if absorption is superior, the low potency and high cost makes them very cost-inefficient for anyone wishing to take, say, 500 mg of vitamin C, or 100 mg of Coenzyme Q10, or 400 IU of vitamin E, on a daily basis. Another problem I've encountered is that many people taking these yeast-based supplements for any length of time develop yeast sensitivities. This is particularly true for those with a history of candida problems (common in our carbohydrate-addicted culture).
The third kind of "food vitamin" supplements is products that are actually dried foods, often organic, pressed into tablets with the aid of manufacturing additives. Again because of size constraints, these products are necessarily of very low potency in terms of the amount of vitamins and minerals present, although some people feel they have potent effects. While they may be of excellent quality, they are very cost-inefficient. Taking these supplements might be compared to eating good organic foods, in very small quantities.
Potency and Purity
For herbs, potency depends on the quality of the raw herb used and the care taken in manufacturing. A tremendously wide range of quality is found in different products. A poor quality product may have no effect whatsoever; the same dosage of a superior product may work wonders.
How potent a given vitamin or mineral product will be depends on what forms the vitamins and minerals are in, and how much of the product is actually absorbed and utilized. Vitamins and minerals may be complexed in various forms, as described above; forms identical or close to those found in foods are generally better absorbed and utilized.
There are two issues relating to purity. First, are the raw ingredients pure? Reputable manufacturers insure that each batch of raw materials is laboratory-tested for purity and can provide users with copies of certificates of analysis. The other issue concerns the additives nearly all manufacturers use in the production of supplements.
Nearly all supplements contain stearates, manufacturing agents used as lubricants to speed up production. Most capsules and tablets are made by "jobbers" in mass production plants, which churn out a multitude of formulas for various companies. Magnesium stearate and stearic acid are lubricants added to raw materials in supplements so that production machinery will run at maximum speeds. This ensures that production schedules will meet profit targets.
Tablets also contain potentially allergenic binders, fillers and often coloring agents. They are coated with shellac (listed in the ingredients as "natural glaze") or vegetable coating (derived from corn, to which many people are sensitive). Potentially allergenic fillers are used to top off capsules.
These additives have a number of effects, including decreased absorption. In a study published in Pharmaceutical Technology, the percent dissolution for capsules after 20 minutes in solution went from 90 percent without stearates to 25 percent with stearates. These substances clearly affect the dissolution and rapid absorption of nutrients. Another problem is allergenic reaction, for even small amounts of additives may cause reactions in sensitive individuals. Fillers may contain hidden lactose or other allergenic ingredients. This is a major reason why so many people have adverse reactions to supplements, or fail to receive the significant benefits pure supplements will offer. For these reasons, I recommend that, when possible, people use additive-free supplements.
Because the supplement industry routinely uses additives in their products, manufacturers and distributors always deny that the presence of these substances is in any way detrimental. Nevertheless, it seems to me a simple matter of common sense that the most desirable products would not contain non-nutrient substances that are added solely to expedite the manufacturing process.
The only widely available supplements free of additives are those made by Thorne Research; they are available only through licensed health care professionals and in some pharmacies. My own company, Dr. Ron's Ultra-Pure, makes fifteen 100-percent pure, additive-free supplements. I personally use and recommend Thorne products, my own, and those of a number of small companies making additive-free specialty products.
Consider ancestral diets, invariably rich in animal fats from grass-fed wild or domestic animals, organ meats, and seafood wherever available. The following is a partial list of nutrients richly supplied in those foods, nutrients that are at best marginally supplied in most modern diets, even for those of us trying to follow Weston Price's teachings.
Vitamins A and D, EPA (eicosapentaenoic acid) and DHA (docosa-hexaenoic acid) are available from raw butter, cheese and whole milk from grass-fed animals, egg yolks, organ meats and seafood and best supplemented by using cod liver oil on a daily basis. Most cod liver oils commercially available have had the majority of the vitamin A and D content removed. I recommend premium high vitamin cod liver oil (available in orange, mint, and cinammon flavors, or plain), which contains the full complement of naturally occurring vitamins. Each teaspoonful of our premium high-vitamin cod liver oil supplies 12,000 IU of vitamin A, 1800 IU of vitamin D, and about 800 mg each of EPA and DHA. Carlson's lemon-flavored cod liver oil - which some people find more palatable because it is lighter and more flavorful - contains only one-tenth of those amounts of vitamins A and D. The EPA and DHA contents are the same, however, and I sometimes recommend Carlson's when high doses of EPA and DHA are desirable without correspondingly high doses of Vitamins A and D.
My general recommendation for most people is to take up to a tablespoonful a day of high-vitamin cod liver oil. I have never found vitamins A and D supplied in fish oils in that amount to cause an overdose problem. For patients under my care, I often prescribe more in certain circumstances, with considerable benefits. In monitoring blood levels, I've never found the amounts I've recommended to cause levels to be too high.
Calcium, magnesium, and trace minerals (including iodine, zinc, selenium and chromium), are available from whole raw milk, bone broths, Celtic sea salt and sea vegetables such as kelp and dulse. Calcium is best supplemented by taking calcium hydroxyapatite. Bones also contain magnesium and boron, which work together for a healthy skeletal system. I recommend 500 mg of calcium (in MCHC, microcrystalline hydroxyapatite) daily, and recommend two or three times that amount for people who do not have access to raw milk. A well-assimilated calcium supplement is good insurance for men and women alike against osteoporosis. The best calcium formulas contain magnesium and the trace minerals manganese and boron, which are important in the absorption and utilization of calcium. These can be taken in combination, as a multi-mineral supplement.
People with low thyroid function (usually undiagnosed because of the inadequacy of standard thyroid tests) often benefit from extra iodine in the form of a supplement, which should be used under the supervision of a knowledgeable practitioner.
As for zinc, I recommend 30 mg daily in the form of zinc aspartate, and up to 90 mg a day for those with an indication of deficiency, such as men with prostate problems.
I supplement selenium and chromium in the form of selenium and chromium aspartates in the amount of 200 mg each daily. Selenium is especially important as a supplement in areas of the country where the soil is deficient in selenium (such areas statistically correlate with higher incidences of cancer). Chromium is especially important for people with diabetes or other glucose metabolism problems. Therapeutic doses of these two trace minerals may be considerably higher than is generally thought, based on therapies now used at cutting edge alternative medicine clinics. Exact dosages need to be individually determined, but may be as high as 1000 to 2000 mg per day--levels previously thought to risk toxicity.
Vitamin E, Vitamin C, coenzyme Q10, alpha lipoic acid, oligomeric pro-anthrocyanidins (OPCs, as found in grape seed extract), and tocotrienes (vitamin E-like substances that complement the effects of Vitamin E) are richly supplied in organ meats such as heart and liver. They can be supplemented individually or in a multi-nutrient combination. Many researchers think this is a critical area to supplement. Ironically, the foods richest in many antioxidants--organ meats--are among those most vilified by the medical establishment for their cholesterol content. There is ample evidence that antioxidants help retard the aging process and prevent the development of chronic diseases.
I recommend anywhere from 100 to 1600 IU of vitamin E daily, in the form of mixed tocopherols, as mentioned above. The higher amounts are most important when cardiovascular disease is present, and for women experiencing symptoms during menopause.
Vitamin C may not be needed at all as a supplement if the diet is rich in vegetables, but is useful for most acute and chronic illnesses, sometimes in amounts up to several thousand milligrams a day.
I recommend that coenzyme Q10 be supplemented anywhere from 25 mg to 600 mg per day. Many people experience increased energy on coQ10, endurance athletes perform better, and people with high blood pressure usually find that adequate doses lower it significantly. CoQ10 is of critical, even lifesaving, importance for people with heart disease, and it is here that the highest doses are most helpful. Preliminary trials have even found that high doses are helpful in treating cancer. CoQ10 is best absorbed with fats, and the richest food source is heart. I use CoQ10 combined with a fatty acid base of tocotriene complex to enhance absorption. A gel form has also become popular, and although it is well absorbed, it is much more expensive and contains the additive polysorbate 80, a highly undesirable substance.
I recommend supplementing alpha lipoic acid from 25 mg to 600 mg per day. Levels are known to be lower in people with heart disease or diabetes, and studies show alpha lipoic acid to be of critical importance in the treatment of liver problems. Supplementation may be beneficial in virtually all chronic diseases. Benefits to athletes include enhanced energy production in muscle tissues, decreased glucose uptake by fat cells, and improved muscle recovery with alpha lipoic acid supplementation. Once again, organ meats are a rich source.
I recommend supplementing from 25 mg to 400 mg of grape seed extract per day. In addition to their potent antioxidant action, the OPCs in grape seed extract strengthen the blood vessels and capillaries, thus helping maintain vision and preventing disorders of the retina, including macular degeneration and diabetic retinopathy. One study of 805 men showed that the higher the intake of OPCs, the lower the risk of heart disease.
The coQ10 I use is encapsulated in a base of tocotriene complex. Tocotrienols, found in tocotriene complex, are members of the vitamin E family. They inhibit clot formation, reverse plaque buildup in arteries, reduce the risk of cancer and inhibit the growth of cancer cells, reduce inflammation and function as powerful antioxidants.
Fiber and Enzymes
These are supplied in the diet by a variety of plant foods (in the case of fiber), by raw foods (especially raw proteins) and by fermented foods such as cultured dairy products and lacto-fermented condiments and beverages. Most people do not obtain nearly enough of either. Fiber is not usually thought of as a nutrient, since it provides no calories, but it is of tremendous importance. Usually, I recommend 1-4 teaspoonfuls of pure grade A psyllium fiber first thing every morning, taken with two or three glasses of water; the larger amounts are recommended for those with gastrointestinal problems. Psyllium often works wonders. Since it is not absorbed, it simply bulks up the stool. The increased bulk stimulates easy and regular bowel movements.
Enzymes are provided only in raw and fermented foods, and the enzymes in raw proteins may be the most valuable. For those unable or unwilling to consume raw or fermented animal foods, I recommend two capsules or more of pancreatic enzymes once a day with a meal. Large doses of pancreatic enzymes can be an important part of treatment for cancer and other chronic diseases.
Organs and Glands, Herbs and Other Food-Derived Supplements
We have mentioned a number of special foods, such as cod liver oil, the sea vegetable dulse, and celtic salt. These are foods used in small amounts to provide rich sources of many of the nutrients I’ve described. A number of herbs and food-derived belong in this category, along with freeze-dried organs and glands, essential traditional foods prepared as outstanding food supplements useful in even the best diets.
The herbal products I most often recommend are liquid alcohol extracts and encapsulated dried herbal extracts. I recommend alcohol extracts made by the Eclectic Institute of Sandy, Oregon, because the company uses organic alcohol and is committed to growing and securing the finest quality herbs. A number of fine companies make encapsulated dried herbal extracts including Eclectic, Herb-Pharm, Gaia Herbs and my own company.
Bilberry helps build strong vision. Clinical studies in recent years have shown improvement in subjects with myopia and glaucoma. I suggest 1-6 60 mg capsules daily (containing 36 percent anthocyanosides).
Ginkgo may be the single most important plant medicine we have because it alleviates such a wide variety of problems. Ginkgo dramatically improves blood flow to both the brain and peripheral parts of the body. Over fifty double blind studies have proven ginkgo's effectiveness in conditions involving poor circulation in the arteries to the brain and other tissues. Ginkgo works in many ways. By stimulating the release of a substance called endothelium-derived relaxing factor, ginkgo relaxes the arterial walls throughout the body, resulting in improved circulation. In addition, ginkgo has a profound normalizing effect on the function of platelets, the clotting elements in the blood. Ginkgo makes platelets less likely to clot abnormally, thus enhancing circulation and exerting a protective action against Alzheimer's disease, hearing loss and strokes. Clinical studies have shown that people of all ages experience improved cognitive function when taking ginkgo.
Milk thistle regenerates liver cells and protects us from chemicals and toxins to which we all are exposed. Milk thistle dramatically enhances liver health by protecting the outer membrane of liver cells and acting as a powerful antioxidant in the liver. Milk thistle acts to regenerate damaged and injured liver cells, reversing the liver damage caused by toxins and ameliorating a host of medical problems.
I recommend ginkgo and milk thistle supplements that utilize both standardized extract and whole plant powder, insuring both guaranteed potency and the presence of the synergistic ingredients found in the whole plants. I recommend 1-6 capsules daily (60 mg ginkgo extract and 175 mg milk thistle extract per capsule).
Glucosamine and chondroitin sulfates
These nutrients are components of cartilage and are supplied in traditional diets by gristle and bone broths. For chronic and acute conditions, however, supplementation may be necessary. Both compounds have been shown in numerous studies to produce better results than NSAIDS (nonsteroidal antiinflammatory drugs) in relieving the pain and inflammation of arthritis. In one notable double-blind study, patients suffering from osteoarthritis took glucosamine and chondroitin sulfate supplements. Cartilage tissue samples showed that damaged cartilage had been significantly repaired after only three months. I use a combination product that provides 1500 mg of glucosamine and 1200 mg of chondroitin in four capsules. I recommend 2-4 capsules daily for many of my patients.
Spirulina is a nutrient-dense, chlorophyll-rich dried algae, available in capsules or as powder. I like a product called Spirulina Pacifica, the dried powder from spirulina organically grown in the waters off the Kona coast on Hawaii's Big Island. I recommend 2 teaspoons daily, added to water, smoothies or shakes.
Superfood Formula by Pure Synergy
This is a mixture of superfoods including the best quality forms of blue-green algae, seaweeds, mushrooms, herbs, sprouts and green juices, all dried at low temperature so as to preserve the enzymes and nutrients. A teaspoon or two added to water makes a great morning shake. It can be combined with the recommended dose of 2 teaspoons spirulina, mentioned above.
Phosphatidyl Serine (PS)
PS is another substance derived from food that enhances brain function. PS was originally isolated from beef brain. Over forty studies have proven that PS can reverse brain aging. State-of-the-art cognition tests have revealed improvements from PS. For example, on name-face recall, an excellent marker for brain aging, PS reversed the average test age of the subjects from sixty-four years test age to fifty-two years test age. That's a twelve-year recovery of cognitive function! Numerous published studies have shown significant improvements in mental function, depressive symptoms and behavior--even in subjects with moderate to severe senility. I recommend from 100 mg to 600 mg daily for many of my patients.
Living Better and Longer
Whole foods have always formed the core of my approach to health. In the early 1970s, I belonged to one of the first food co-ops in western Massachusetts. From there I went on to naturopathic medical school believing that if I learned enough about how food affects people, I could help them recover from most medical problems. That has turned out to be even truer than I realized then, as I discovered the work of Weston Price and other pioneers of nutritional therapy.
My studies and my years in practice have shown me that certain high-quality food supplements can play a critical role in preventing and treating disease and in optimizing health and longevity. Properly understood, these nutrients, herbs, concentrates, special foods and extracts complement even the best diets. As we embrace the wonderful health-giving qualities of traditional whole foods, we should also embrace the best of what modern science has given us. Scientists and clinicians have clearly demonstrated the efficacy of a wide range of products that fall under the general heading of "food supplements." Knowledge is growing rapidly, and so too is marketing hype that would have us believe that every new supplement is a magical elixir. The challenge and realistic goal is to separate the wheat from the chaff and apply this knowledge to live healthier, happier, longer lives.