The Rational Use of Nutritional Supplements

More is not always better, and who has time for all those supplements anyway?

This post will grant you clarity on the oodles and oodles of conflicting nutritional information currently available in our wild and wonderful world. If you would like personalized nutritional recommendations, then now is the time to schedule a consult with me. This post will give you a physician's perspective, which is decidedly at odds with what a lot of health influencers and wellness gurus would tell you. If you're tired of wondering what supplements you should take and what foods you should eat, then this post is for you. To see supplements that I recommend, you can check out my online supplement store here. But which ones are right for you? That’s why you should book a consultation with me.

Hippocrates said, "let thy food be thy medicine, and thy medicine be thy food." I take that to heart in my practice and do everything that I can to use food, rather than supplements, to treat nutritional deficiencies. The truth is that there are adequate amounts of micronutrients in food to do this, it's just a matter of selecting the right food for you, your genomics, and the demands of your environment and lifestyle. For example, folate is degraded by UV light, so it stands to reason that the more UV light you get, the more folate you would need to maintain adequate levels. Melanin (the pigment that makes skin dark) prevents UV light from degrading folate, acting as a kind of natural sunscreen. Sunscreen also prevents UV light from degrading folate. The more time you spend indoors, the more sunscreen you wear, and the darker your skin, the more protected your folate stores are and the less you are likely to need in your diet. Likewise, the foods richest in folate grow when UV light is at its strongest - beans, beets, and greens are my top three. I am not surprised to see folate deficiencies in patients who get an abundance of UV light and don't eat at least two of these three top sources of folate multiple times per week.

UV light is a critical element of a healthy life. Are you getting enough UV light? You can find out in this blog post.

While I agree that our food should be our medicine, there is a place for nutritional supplementation. I think this should be done rationally and with clear objectives. There are, in my experience, only two reasons to use any therapeutic. First, it makes the patient feel better and has no significant downside. For example, cocaine makes patients feel better, but I do not recommend it because of substantial downside risk. Nicotine, by contrast, has a mild downside risk and enormous therapeutic potential, so there are cases where I will recommend it to patients. Cocaine and nicotine are both plant-based medicines, which I will discuss in my next blog post... Nutrients are a different story, but whereas with drugs we run into toxic or addictive side effects, with nutrients we run into what I will call, "imbalances." More on this in a moment. The second reason to use a therapeutic is to fix a quantifiable and objective metric of health, such as a vital sign or a laboratory abnormality. For example, low magnesium levels are associated with increased death in acutely ill patients, so I am always careful to replace magnesium in acutely ill patients. Most patients with low magnesium levels also feel better with magnesium repletion, but they do not always notice it. Just because they do not feel measurably better with each dose of magnesium does not mean that we should not administer it. Likewise, a patient with high blood pressure needs treatment to lower it, regardless of how they feel. Virtually all high blood pressure is due to chronic imbalances in mineral and water intake (more on this in a future blog post). You might treat high blood pressure with any combination of therapies, but the point is to normalize vital signs (not just blood pressure) while not causing the patient any harm.

In the case of nutrition, we are either targeting a goal nutrient level in a given tissue (hair, blood, urine, etc) or we are using a nutrient to treat a symptom (such as using magnesium to treat a headache). We are either adjusting parameters as a pilot might adjust course or altitude (based on labs), or we are operating based on best-practices and interpretation of the scientific literature.

When considering what supplements to take and how to take them, I define each of my answers to the above question and I come up with a plan to ensure success. For example, when we identify a potassium deficiency, we should have a plan to not only replete the potassium, but to ensure that the plan worked. Everyone has different demands on their nutritional status that are influenced by everything from their dietary intake to their exposure to noise pollution to their bed-time. If you're taking supplements month after month just because you had a deficiency once upon a time, I invite you to schedule a consultation with me to find out what your nutrient levels actually are.

When we take supplements to treat symptoms, presumably they are effective because the body is deficient in them. However, this should beg the question, why are you deficient? I see far too many people taking magnesium for their headaches, body pains, anxiety, or sleep. This is like having to take out a pay-day loan every month when your rent is due. This a recipe for intransigent poverty. If you are constantly taking magnesium to treat headaches, this reflects a poor lack of nutritional planning.

Your net level of any nutrient is determined by 1) intake, 2) demand within the body, and 3) losses. Deficiency can result from inadequate intake, excessive demand, or excessive losses. Excessive demand and losses are distinct in my opinion. For example, you can passively lose magnesium and potassium in your urine just because you are eating a diet that is high in acid. There is no special "demand" here, only excessive loss. Someone who is exercising at a high level may have a combination of excessive demand for nutrients to fuel muscles, where those nutrients are broken down or used to build new cellular components, and excessive losses, due to increased urine and/or sweat production. Patients who require high doses of supplements for long periods of time are doing something to cause these continued losses. For example, a heavy machine operator will have high losses of magnesium due to noise pollution, but he may not be willing to leave his job to mitigate this. A business owner may work long hours every day of the week, but may not be able to reduce those hours and still maintain his business operations. Many of you are trading your health for money, only to turn around and have to spend your money on your health.

This is exactly what Big Pharma is counting on, as I discuss in my book, “Dying to Be Free.”

This leads many patients to the world of multi-vitamins and blind nutritional supplementation. When this approach breaks down, people finally contact me and we figure out what they are doing wrong, and sometimes why their supplementation regimen has become the root of their problem. One of the most pernicious lies in the nutrition world is that blindly taking large doses of nutrients is safe. You can get away with it, but it can create long term problems and, in extreme cases, it is dangerous. Nutrients interact with one another. Copper, zinc, molybdenum, and manganese are all so similar in structure that they compete with one another for absorption and metabolism. This means that high doses of any of these can create deficiencies of the others. Most patients never reach a severe enough state of deficiency for a doctor to pick up on it. I will find sub-clinical deficiencies all the time. Patients improve as we replete their nutrients.

As we replete the body with the nutrients it needs, the body becomes more and more resilient. The complaints that pushed us to supplement or test nutrient levels start to disappear. Patients who do not experience this gradual improvement in their physical state are either not taking the right nutrients, or are missing something that is causing increased demand or loss of nutrients. Isolating and mitigating the cause of excessive demands and losses, and determining the proper intake through a combination of diet and supplements is the key to optimizing nutritional status. These are the fundamentals of how you build a supplementation regimen rationally. I see far, far too many people wasting their time and money on supplements when they have no idea what their nutritional status is or what their demands and losses are like.

What supplements do I recommend? You can see them here. But which ones are right for you? I’ve recently expanded my team and my offerings, and I encourage you to schedule a consultation.

Clarity lies in labs and a comprehensive assessment of how your lifestyle is affecting your nutritional status.

Next time, we will discuss the rational use of herbs and adaptogens.

Until then, be well,

Dr. Stillman