A Brief Rant on Supplements
In graduate school I took a course titled, “The Science of Supplements,” and being that I had a lot of doubts about supplementation, I was not looking forward to sitting through a class on the subject. My doubts about supplements came from seeing other health care providers use and overuse supplements, selling huge supplement regimes to patients, and telling them that they wouldn’t get better without these costly tablets, powders, or capsules. This model bothered me, it bothered me so much that I considered putting it in the “unethical ways to practice” category I had growing in my head. I felt that most of the evidence available on supplements was anecdotal at best and that it was always better to get your nutrients by eating whole foods.
Much to my surprise, the course was ALL about questioning supplements, researching supplements, and inquiring about the practices of supplement companies. What I learned in this class was that there are many supplement companies that do not have good practices. I learned that practically anyone could make and market a supplement because there aren’t many regulations in place—this fact still angers me. I also learned a lot about the efficacy of supplements. The class required hours scouring PubMed for decent research articles and what we found was often troubling: the research, in regards to supplements, often varied.
I would say that this was one of my favorite classes because it taught us to think critically. And while this class may have made me a bit more cynical when it came to supplements, it did show me where supplements have a place. I realized that research is often times inconsistent when it comes to many different topics—this is what pushes us to continue to ask questions. I realized that we could have all the research in the world and yet we may never have definitive answers. I remember one day in class when we were going over a research paper (I don’t remember what the supplement was) and the findings were that not enough people benefited from the supplement to show statistical significance; so the class concluded that this supplement didn’t work. My professor stopped us and said something like, “well it improved symptoms in X number of patients, and do you think if you told these patients that the supplement didn’t work they’d agree? No, because it worked for them.” Cue light bulb going off, statistical significance while important was not everything. What may work for some may not work for others, and we may never know the reason why.
So do we trust research or not? Do we use supplements or not? What is the bottom line here?
I love keeping up to date on research, that being said I know research isn’t everything, it is just our attempt to further understand something. It is best to use an evidence informed approach, where a clinician is informed of the research out there and uses it but also relies on the patient’s presentation and their own clinical expertise.
I am incredibly picky when it comes to supplements and don’t just trust any brand out there. I tell everyone that just because it is “natural” doesn’t mean it is safe; often times supplements will have the same or similar active ingredients to pharmaceuticals or may interact with other pharmaceuticals so always consult with a health care provider and only take as directed. I also tell people that there is a science to supplements; it often isn’t as straightforward as one may think. I will use an example of a patient who found that her TSH (thyroid stimulating hormone) was low, so she found a supplement for Hypothyroidism and started taking it without the direction of a health care provider. When I inquired why she was taking the supplement she told me her thyroid was low, I asked for her labs and I did find that in fact her TSH was low. However, LOW TSH is indicative of HYPERthyroidism—not HYPOthyroidism, the result? She was most likely making her hyperthyroidism worse by taking a supplement for hypothyroidism. Not her fault, she was trying to do the right thing, but by misunderstanding what her labs meant and trying to take care of it without consulting a professional she used supplements incorrectly which could have been dangerous.
I have learned that while it is easy to overdo it when it comes to supplements, they do have their place. I do personally use supplements and recommend them to patients. But I do not think it is best practice to put all your trust in a pill. This is why the supplement industry makes big bucks; we want the easy way out, a magic pill to solve all our problems. It is much easier to take a pill than to eat healthy, but as we know easier doesn’t always mean better or healthier. The bottom line? Do what you can nutritionally and when you can’t, use high quality supplements (under the direction of a health care provider of courseJ) to fill the gaps. What is a nutritious diet you may ask? I always land on Michael Pollan’s advice: “Eat food. Not too much. Mostly plants.”
Want to know what supplements I take personally? Just ask!