Academic medicine has never been enthusiastic about the general public taking unregulated supplements. These supplements cover a broad range, from common vitamins and minerals to more esoteric targeted supplements. I suspect one big reason for their distain is because of the relationship between many academic so-called experts and Big Pharma. Drugs can be patented for 20 years after their discovery, allowing drug companies a monopoly. This has resulted in some companies charging outrageous prices for drugs that are often inexpensive to manufacture. These profits also provide the funding for the academic studies to support the effectiveness of medications and many individuals in academic medicine benefit financially from participating in these trials, creating a possible conflict of interest.
Studies, Studies—Where are the Studies?
Because supplements are unable to obtain patent protection, there is little or no financial incentive to run the type of trials that are needed to show efficacy and safety of a given supplement. Many of the studies on supplements are small or of such poor quality that they provide no guidance on how supplements should be used clinically. As far as the general public is concerned, when it comes to supplements it is more or less a Wild West type situation.
I agree that many supplements are likely ineffective and improperly promoted, but in my opinion the risk of taking commonly available supplements like vitamins, minerals, anti-oxidants and so forth is likely overblown by academic medicine. They also often underestimate the risk of taking common medications like statins, opioids and Psychiatric medications, leaving patients in the lurch when it comes to deciding how to manage the substances that they take.
Another Boring, Banal and Inaccurate Lecture by the So-called Experts
A recent article was published in JAMA titled “Vitamin and Mineral Supplements: What Clinicians Need to Know” By JoAnn Manson and Shari Bassuk from Harvard. After reading this disappointing article, the first thing that was apparent to me is the misleading title. They mention possibly using omega 3 fatty acids to reduce the risk of autism and ADHD. Even a 9th grade science student knows that fatty acids are neither a vitamin nor a mineral. Oh well, why make a fuss about such a minor detail when the article goes on to trash many commonly consumed vitamins and minerals that likely have health benefits.
I agree that there isn’t strong research supporting the benefit of taking a multivitamin or most individual vitamins and minerals and I agree with the authors that in an ideal world you should get most of your vitamins, minerals and anti-oxidants from real food. The problem is, in our modern world with depleted soil and the overuse of fertilizers, much of the produce we consume is lacking in sufficient quantities of key vitamins, minerals and anti-oxidants. Many people consume large amounts of processed food that are devoid of these key nutrients, so taking a multivitamin every day seems like a reasonable thing to do. Although the ideal way to get adequate vitamin D is through sun exposure, that simply isn’t going to happen in the Northern latitudes during winter, so taking extra vitamin D3 makes sense to me. Recent research has shown that polyphenols from fruits, vegetables and berries have many health benefits, but very few people consume enough of these substances, so for most people taking a polyphenol supplement seems like a good idea. These usually come in powder form and contain polyphenols from dozens of fruits, vegetables and berries. To learn more about polyphenols, I recommend reading some of the blog posts from Barry Sears of Zone Diet fame.
If You Want to Really Improve Your Health, Follow the Inflammation
Barry is also one of the world’s leading experts on fatty acids, especially the benefits of consuming omega 3 fatty acids. This recent study claims to show that omega 3 fatty acids do not lower cardiovascular risk. It was a meta-analysis using an average of 1 to 2 grams of fish oil per day. We now know that omega 3 fatty acids form the core of the bodies’ anti-inflammatory defenses and the best way to be assured that you are getting the right balance of pro-inflammatory omega 6 fatty acids and anti-inflammatory omega 3 fatty acids is to measure the AA/EPA ratio. Ideally it should be between 1 and 3. The only culture to obtain this level are the Japanese. The average American ratio is between 18-20! If you are going to supplement your way down to a safe ratio, you need to take on average 10-12 grams of omega 3 fatty acids daily. Thus the dose in this study is really a placebo dose with no chance of being effective. The paper from Harvard fails to even mention these important issues and they only briefly mention that omega 3 fatty acids might help to prevent autism and ADHD but more research is clearly needed.
The authors mention that supplementing with vitamin K can interfere with the blood thinner warfarin. This is like telling your kid to look both ways before crossing the street. I can’t imagine that there is a clinician on the face of the earth who doesn’t already know about the interaction of vitamin K and warfarin and they are already educating their patients about this risk. If the authors really wanted to provide some useful information about vitamin K they could have discussed vitamin K2, the form of the vitamin that appears to move calcium out of blood vessels and into bone where it belongs, possibly lowering the risk of both CV disease and osteoporosis.
The Miracle of Brain Friendly B Vitamins
They also failed to mention the issue of homocysteine. Even though in short term trials a combination a B vitamins to lower homocysteine has not been shown to lower CV risk, many clinicians suspect that longer term trials would show such an effect. Those of us with an interest in brain disorders and Neuroscience are very aggressive at lowering homocysteine because high levels are very toxic to nerve tissue. We use a combination of L-methylfolate, vitamin B12 (preferably methycobalamin), vitamin B6 (preferably pyridoxal 5’ phosphate) and trimethylglycine (TMG). High homocysteine runs in my family as does Alzheimer’s disease. My homocysteine was once 18 and it is now 6 using the above supplements. Will controlled trials ever be done to determine if my approach is sound? I doubt it, but these supplements are inexpensive and safe, so to me the cost benefit ratio seems to be excellent.
When it Comes to Brain Health, Precursors Rule the Roost
They also fail to address a very effective way to eliminate many Psychiatric symptoms that result from low levels of monoamine neurotransmitters like dopamine and serotonin. Those in academic medicine along with their partners in crime at the drug companies managed to promote the overuse of Psychiatric medications that have a long list of serious side effects. There is a cheaper and safer way of increasing neurotransmitter levels by taking the precursors L-tyrosine and 5-htp in a ratio of 10 to 1. With these supplements, there is no tolerance or withdrawal and you don’t need to see a shrink to take them.
A Revolutionary New Disease Concept
We now believe that many people who have been diagnosed with a long list of common Psychiatric and metabolic problems in reality have just one disease–a form of food-induced brain dysfunction called Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. This common disorder is triggered by the long-term consumption of highly processed food. The above supplements play a key role in the treatment of CARB syndrome.
I also object to the overall tone of this JAMA article where the academic “experts” need to tell us dummy physicians who are actually treating patients how to use common supplements. I suggest that instead of wasting their time lecturing us, these experts should spend their time trying to undo all the damage they have done by promoting the overuse of many medications like opioids, statins and most Psychiatric medications.