In this post I’ll cover the case against supplements, why I take a select few supplements anyway, which high-nutrient foods I eat, and how I design my supplementation program and introduce new supplements.
I’ll also disclose which supplement I take that is also used as a psychiatric medication, and the herbal supplement that makes me go a little nuts if I take too much.
The Case Against Supplements, and Why I Take Them Anyway
The supplement industry is largely unregulated, and one result is that many supplements aren’t what they say they are. Big-box stores like Walmart have been caught selling wheat, rice, and other cheap fillers labeled as medicinal herbs. Multivitamin manufactures often determine the composition of their supplements based on which vitamins are cheapest to produce. Generally, vitamins from food are easier to absorb and are better utilized by our bodies than the cheap synthetic analogues found in most supplements.
Even if supplements are what they say they, and are manufactured with the highest quality standards, they may not benefit health. Isolated fat-soluble antioxidants such as vitamin E, vitamin A, and beta-carotene have been associated with higher cancer risk (and reduced bone density for vitamin A).
Food supplements, like fish oil, have also come under suspect. According to at least one meta-analysis the benefits of fish oil have been oversold, especially in terms of preventing heart disease. High doses of cod liver oil (high in vitamin A) can be dangerous, especially for women, with one study showing as little as 1.5mg/day of vitamin A (equivalent to about 5000IU) increasing risks of osteoporosis and hip fracture.
While too little iron can lead to anemia, too much iron is toxic for men (and post-menopausal women), and is associated with heart disease and accelerated aging.
So why take supplements at all?
I take supplements for three reasons:
- To protect against my known health vulnerabilities (like asthma and allergies).
- As nutritional insurance, in cases where I may not be getting enough of a particular nutrient from my diet (or sunshine, or gut bacteria).
- To modulate my cognitive or physiological state (to become more alert, calm, aggressive, motivated, etc.)
Food Based Nutrition
I try to get the majority of my nutrients from food. Some foods, such as the following, are packed with nutrients:
- eggs (B2, B5, biotin)
- wild salmon (Omega-3 fatty acids, B3, B6, B12, D, selenium)
- sardines (Omega-3 fatty acids, niacin, calcium)
- chicken liver (A, B2, B3, B5, B12)
- almonds (B2, E, manganese, magnesium, calcium)
- sunflower seeds (B1, B5, B6, folic acid, copper, magnesium)
- pumpkin seeds (B3, zinc, copper, manganese, magnesium)
- leafy greens (B2, folic acid, magnesium)
- oysters (zinc, copper)
- fermented/aged cheeses (K2, calcium)
I also consume a wide variety of fresh herbs and spices for both tastiness and health-promoting, disease-fighting phyotochemicals. My favorites are turmeric (I buy Madras Curry from Oaktown Spice Shop), ginger, cinnamon, oregano, and parsley. Though not all in the same dish.
Designing a Supplement Program
I experimented extensively with nutritional supplements when I was trying to resolve asthma symptoms. I found that some helped, some made my symptoms worse, and some had side effects.
Over the years I have refined my supplement program. I now do much less experimentation, and stick to a basic program that supports my health.
When I do introduce a new supplement, I’ll start with a conservative dose. I may then briefly increase the dose above the recommended amount to see if I notice any positive or negative effects. I won’t add a supplement to my long-term regimen unless it satisfies the following:
- I notice a clear benefit (physical or cognitive) or there is overwhelming clinical evidence that supports the health-promoting or disease-preventing benefits of the supplement.
- No negative side effects. Overstimulation and sleep disruption is the most common side effect I have noticed from experimenting with supplements. Once when experimenting with high doses of fish oil I noticed I bruised more easily, and that my blood clotted more slowly (for example from shaving cuts).
- No red flags about the brand or manufacturer of the supplement. While I do buy some inexpensive supplements from Trader Joe’s and Swanson Health Products, some brands are off my list because of less-than-stellar reputation and/or quality.
I have become more cautious with time. I don’t take any supplement more than 4 days a week, and I err on the side of lower doses.
What I Take and Why
This is my own supplement regimen, customized for my own needs. I am not recommending it for anyone else. I’m sharing the details to help provide some context for how to design your own protocol (if you need one).
I take Wild Salmon Oil from Trader Joe’s. The capsules are bright orange due to astazanthin content (ingested astazanthin may function as a natural sunscreen).
Update 4-8-16: I’m no longer using this brand — a capsule I tasted from the most recent batch tasted a little off. I’m currently experimenting with other brands.
Fish oil was the first supplement that I noticed had a clear positive effect in terms of reducing asthma symptoms. Clinical studies in regards to treating asthma with fish oil have had mixed results. Effectiveness may depend on genetic factors, how the case of asthma expresses (as chronic inflammation or acute constriction/spasm of the airways), or environmental factors.
I believe I was highly deficient in omega-3 fatty acids before I started taking fish oil, and that this deficiency was contributing to chronic airway inflammation. Since then I have increased my dietary sources of omega-3s, and reduced my fish oil dose from 4g/day to 2-4g several times a week.
At doses over 4g a day I noticed excessive bleeding from small cuts and easy bruising.
I take 2000-4000IU of Trader Joe’s vitamin D several times a week. Along with fish oil, vitamin D is the foundation of my asthma protocol. If I stop taking vitamin D for several weeks and I don’t get significant amounts of direct sunlight on my skin, my asthma symptoms sometimes return unless I’m very strict with my diet.
Clinical studies have shown that low vitamin D levels are associated with asthma, and that vitamin D supplementation sometimes but not always reduces asthma symptoms. I would like to see a study that uses my own protocol (vitamin D, fish oil, evening primrose oil, chelated magnesium).
Cod liver oil
I take a few capsules of Swanson Cod Liver Oil several times a week, primarily for naturally occurring vitamin A. Vitamin A supports male testosterone levels, and may be synergistic with vitamin D in terms of health effects.
Some people convert beta-carotene (from carrots, sweet potatoes, spinach, etc.) to retinol very effectively. I have a genotype that corresponds to poor conversion (I looked up the SNPs in my 23andMe results), so I make sure to get some vitamin A from animal sources.
Evening primrose oil
Used on its own, there is little evidence that evening primrose oil does much of anything. However it is a good source of GLA. GLA, alone and in combination of with EPA/DHA (from fish oil and other sources), controls blood pressure, reduces cytokine production, and facilitates production of PGE1.
I use inexpensive Evening Primrose Oil from Trader Joe’s. I take 1000mg several times a week.
There is a growing body of evidence that vitamin K2 supports bone health and may prevent arterial calcification. In addition to dietary sources, I take 100mcg of Swanson natto-derived vitamin K2 several times a week.
Supplemental molybdenum is probably unnecessary for most people, but I take 150mcg several times a week because low molybdenum is associated with esophageal cancer. According to my 23andMe profile I have a somewhat elevated risk for this type of cancer, so it makes sense to make sure my molybdenum levels are adequate. Molybdenum is an important component of the sulfite-detoxification pathway, and I do drink red wine (which generally contains sulfites as a preservative).
There’s good evidence that co-enzyme Q10 supports heart health and reduces blood pressure. Controlling blood pressure is one of the best strategies for long-term cardiovascular health, which is why I take this supplement (and also eat generous amounts of very dark high-polyphenol chocolate and cacao, and drink red wine).
However you can definitely have too much of a good thing with antioxidants such as coenzyme Q10, resveratrol, and even vitamin C. You need circulating free radicals in your body (including nitric oxide) for immune function, sexual response, and many metabolic and physiological processes. High levels of supplemental antioxidants may wipe out oxidative free radicals too effectively, this impairing normal physiological process and even increasing the risks of some diseases (including cancer).
There is also evidence that high levels of supplemental antioxidants such as resveratrol mute positive physiological adaptations to exercise (which are possibly triggered by increased free radical circulation). Moderate coenzyme Q10 increases exercise performance but higher doses may have negative effects.
I take 50mg of ubiquinone (a form of coenzyme Q10) several times a week. This is a conservative dose, but I have noticed a mild energy boost and moderate vasodilation from taking this amount.
Readers may be surprised to learn that I take lithium aspartate as a supplement. Lithium, the third element in the periodic table, is often used as a psychiatric medication to treat bipolar disorder (manic-depression), typically as lithium carbonate or lithium citrate. Side effects of high-dose lithium are quite serious, and include thyroid problems, sluggishness and dulled emotional response, dehydration, and risk of birth defects if taken during pregnancy.
Not only do I take lithium myself, but I mix it in with the salt in the salt shaker, meaning that my family and dinner guests also consume it!
Don’t worry — I’m not poisoning anybody. I typically mix in a 5mg capsule of lithium aspartate in a full salt shaker. This works out to a daily dose of no more that 50mcg/day, approximately 1/6000th of a typical psychiatric dose. The idea, as you might have guessed if you read this article in the New York Times, is to approximate lithium intake in areas where drinking water has higher-than-average lithium levels.
Multiple studies have found an association between high levels of lithium in drinking water (up to about 170mcg/liter) and reduced risk of suicide and homicide. If the relationship goes beyond association to causation, the question is why? Lithium may have neuroprotective and even neuroregenerative effects, as this article discusses. This article is more skeptical but concedes there may be a basis for very conservative lithium supplementation. It’s all in the dose. Microdose lithium may even be protective against Alzheimer’s disease.
Other regular supplements
In addition to the supplements above, I take conservative doses of the following supplements several times a week: MSM, chelated magnesium, vitamin C, chromium picolinate (I discuss why here), and zinc. I take supplements with breakfast or lunch as many have a moderate energizing effect (and I want to be able to fall asleep easily at night).
I take other supplements on an as-needed basis. A few worth mentioning:
I’ve found that about 200mg of bromelain acts as a potent anti-inflammatory if I experience asthma symptoms from massive dust or pollen exposure. Generally my diet and regular supplements keep me breathing easy, but it’s good to have a stronger remedy should I need it. At least one animal study supports this usage.
The company Vitamin Code has a unique approach to manufacturing vitamins that makes sense to me, and when I do take a multivitamin this is the brand I use. Paradoxically, the more a particular vitamin is isolated, the less effective it becomes. Cofactors (such as proteins and phytochemicals) may be necessary for biological utilization.
Even high quality vitamins disrupt my sleep, so I only take a multivitamin if I need to stay up late (and even then a partial dose).
I occasionally enjoy the testosterone-boosting effects of small amounts of tongkat ali, which I’ve discussed in more detail in this post. I take the powder (up to 800mg/day) as opposed to any concentrated extract; it’s cheaper and I can’t find any evidence that the extract forms are more effective (and I haven’t noticed any subjective differences in effects from taking the powdered root vs. the supposedly more concentrated forms). I’ve tried different brands over the years and they all seem to work well. The effects I notice are increased energy and motivation, increased confidence, obliteration of self-doubt and self-pity (even if warranted), and increased sex drive. However if I take even slightly too much I start flipping off motorists, scrawling angry diatribes on my bill stubs, yelling at my kid, and generally wanting to act like Dan Bilzerian.
Typically I will only use tongkat ali if I need to get “amped up” for a particular project or endeavor, and then only for a few days at a time. Side effects like insomnia, increased anger, and increased body temperature are possible. Ray Sahelian has a good article on dosages, sourcing, and potential side effects.
Creating Your Own Supplement Plan: Do’s and Don’ts
I hope you found this post to be useful. To summarize: be conservative. Here’s my list of Do/Do Not’s:
- do review clinical studies of any supplement you are considering, and consider the size, duration, and general quality of the study (and note who funded it)
- do research manufacturing processes, 3rd party tests, and brand reputation
- don’t assume that expensive supplements are more effective than reasonably priced supplements
- do be wary of extremely inexpensive supplements (and also very expensive ones)
- don’t introduce more than one supplement at a time
- do start with a conservative dose, then gradually work your way up (and possibly back down) to find the ideal dose for you
- do take notes in terms of what you notice re: how a particular supplement affects you
If I haven’t mentioned it enough, I’m not a doctor and I can’t give personal medical advice. Do your own research and find out what works best for you. Good health to you!