Monday, February 26, 2007

Basic Supplement Guide

The purpose of this guide is to provide a very basic introduction to the subject of nutritional supplements. It is written from the point of view of someone who has a fairly conservative outlook on the subject.

I. Bottom Line Up Front: Nutritional Supplement Recommendations

Below are listed my basic supplement recommendations. Keep in mind that you don’t NEED any of these, and they won’t give you magical benefits, especially if your diet and exercise habits are crap. But if you just want to know what I think are good supplements to take, you can read this part and skip all the exposition.

Basic multivitamins:

Jarrow Multi 1-to-3 (men) (3/day, approx. US$10/month)

NOW Eve (women) (3/day, approx US$10/month)

Most women should take a multivitamin with iron, while men, post-menopausal women and older people in general should take one without iron. Jarrow’s Multi 1-to-3 gives you useful amounts of all the essential vitamins and minerals with a minimum of fluff. NOW Eve has a few silly herbal ingredients, in doses too small to do anything anyway, but is otherwise a very solid formula. Neither is expensive, and either one is much more complete and better formulated than any cheap store vitamin. Both Jarrow and NOW are GMP-certified manufacturers.

High-end multivitamins:

AOR Ortho-Core (9/day, approx. US$45+/month)

AOR Multi Basics 3 (3/day, approx. US$30/month)

Jarrow Longevity Multi (6/day, approx. US$20/month)

These are listed in order of cost and completeness. AOR produces excellent products, but they are very expensive and probably overkill for the vast majority of people, especially the 9-a-day Ortho Core. Jarrow’s Longevity Multi is a 6-a-day that is nearly as complete as the AOR products, but is much more widely available and not nearly as expensive. AOR is also a GMP-certified manufacturer.

Omega-3 fish oil capsules:

NOW Super EPA (2/day, approx. $7/month)

Unlike most omega-3 supplements, it gives you a useful dose of 720mg EPA and 480mg DHA in only 2 capsules; most require 4 or even 6 capsules to get an equivalent dose. As noted, NOW is a GMP-certified manufacturer.

II. Introduction to Supplements – Cautions, Caveats and Crap Like That

To start, I think it is important to understand the relative importance of dietary supplements in the grand scheme of things. Which is to say, not very important at all. A good diet and regular exercise are vastly more important to your health and quality of life than taking any kind of dietary supplement. There is a good case to be made for the potential benefits of some supplements, but an unhealthy lifestyle can easily overwhelm any positive contribution they may provide.

To reiterate for the average person, supplements should be their lowest priority when it comes to improving their health. You need to take care of the big, important things first – diet and exercise – and then decide if you want to take supplements or not.

Next, it is important to realize that you really need to be a cautious consumer when it comes to choosing supplements. The supplement industry is poorly regulated, and provides many opportunities for con artists and dangerously sloppy operations. The most notable recent example of the latter was the discovery that the nation-wide supplement chain The Vitamin Shoppe sold multivitamins containing dangerous levels of lead.

So the first priority has to be choosing supplements that aren’t made by criminals or retards. I would suggest the following:

1) Buy from Good Manufacturing Practices (GMP)-certified manufacturers. To earn GMP certification, the company has to submit to a series of 3rd party inspections and audits. This doesn’t guarantee that the company makes good products, but does ensure that they at least had to undergo a certain minimum level of outside scrutiny.

A number of bodies issue GMP certifications. These include the NPA and NSF. They are analogous to the registrars who issue ISO 9001 quality system certificates to other manufacturers. Their lists of GMP-certified companies:

Don’t confuse “compliance” with “certification.” Anyone can claim compliance, but they have to actually pass their audits to earn certification.

2) Before buying from a company, do your research. With a quick search on Google, it is easy to find out if a company has a track record of poisoning its customers. For instance, “vitamin shoppe contamination” will tell you a great deal about lead-laced multivitamins.

Although it is a pay site, can be a worthwhile place to visit for its free content, including a section on current recalls & warnings. You can also check the FDA’s dietary supplement warning page.

III. Multivitamins

Multivitamins are a subject that is both very simple and kind of tricky. It is simple because there is a fairly solid medical consensus that taking a multivitamin is a reasonable way to ensure that you aren’t lacking some obvious vital micronutrient that may be missing from your diet. Everyone agrees that the ideal way to get nutrition is from real food, but it is also true that almost nobody has a truly ideal diet, so taking a multivitamin is a prudent course of action.

“Most people do not consume an optimal amount of all vitamins by diet alone. Pending strong evidence of effectiveness from randomized trials, it appears prudent for all adults to take vitamin supplements.”

So you should probably take a multivitamin, if only to make sure all your nutritional bases are covered. But which one? That is where it becomes tricky, because no two multivitamins are alike, and there is no one objective benchmark to use when judging them. From the same article:

“The evidence base for tailoring the contents of multivitamins to specific characteristics of patients such as age, sex, and physical activity and for testing vitamin levels to guide specific supplementation practices is limited.”

Translation: you can do it, but it is a pain in the ass if you want to get it right for your specific needs.

“What about the RDA/DRI?” you ask. “Why not just get 100% of the daily allowance and be done with it?” But there are several problems with that, too.

1) The DRI is typically about 10 years behind the current mainstream medical research. Hence it is often glaringly out of date. Mainstream medical research – not fringe publications – supports higher intake of certain nutrients for many people.

2) The generic DRI reported on the label often has little bearing on the specific needs of certain groups. Based on sex, activity level, age, or any number of other factors, your needs may differ from the DRI on the label, sometimes drastically.

3) The DRI is essentially a minimum value for reasonable health in the short term for the average person, not a value based on what will give you optimum health, best athletic performance or long-term disease prevention. If you care about any of these things, or are outside the norm, the DRI is of little value to you.

For these reasons, most people will not want to give too much weight to the DRI. But what’s the alternative? There really isn’t a clear-cut answer, but I have some basic suggestions.

1) In general, more is better. If you compare the results of mainstream medical research to the DRI, the DRI is invariably much lower than the amount that produced a positive outcome in any given study. Most vitamins are inherently low in toxicity, and most simply pass through your body when consumed in excess, and the upper tolerance limit (UL) set by the FDA is typically much, much higher than the RDA. This is most notably the case with the B complex vitamins and C, where the safe level set by the FDA is far above the DRI.

2) Conversely, most people will want to stay below the UL set by the FDA, since the UL is a conservative estimate of “the highest level of nutrient intake that will pose no risk of adverse health effects for almost all individuals in the general population.” The UL, not the DRI, is the FDA’s estimate of what is safe to consume, and is arguably the best guide to what a maximum safe intake of any given vitamin or mineral is.

The DRIs and ULs are summarized here:

An explanation of the UL is here:

This doesn’t mean that you should consume the UL of everything, just that the UL is a reasonable, conservative ceiling for your vitamin and mineral intake.

Not surprisingly, most “better than store brand” vitamins coincide with this line of thought; they give you more than the DRI for many things, but well below the UL.

3) Men , post-menopausal women and older adults in general will want to take a multivitamin that does not have iron, while most women will want a supplement that does contain iron.

IV. Individual Vitamins & Minerals

I’m not going to go into too much detail here, because anybody with a brain is going to do their own research before piling on additional vitamins and minerals on top of a multivitamin. Instead I’m going to provide some resources you can use as a starting point to make up your own mind. Most people don’t need to take vitamins and minerals above and beyond a good multivitamin, but there is mainstream medical research suggesting that certain additional vitamins and minerals can produce positive outcomes. You can read about them below (and elsewhere) and draw your own conclusions.

University of Maryland Medical Center:

Linus Pauling Institute at Oregon State University:

V. Omega-3 fatty acids

Most people are interested in vitamins and minerals, but the supplement with by far the most mainstream research supporting its intake is Omega-3 fatty acids, specifically EPA and DHA from fish oil. The list of health benefits backed up by legitimate research is truly astonishing.

If there is one supplement you should take, it is an Omega-3 fish oil supplement. Recommended intake is approximately 540-720mg EPA and 360-480mg DHA. Don’t look at the total mg of fish oil, but the amount of EPA and DHA; some fish oils are extremely weak. I personally favor NOW Super EPA because it gives you a useful dose of EPA and DHA in only 2 capsules.