What Supplements Should You Be Taking?

I’m not a fan of supplements and don’t make a big deal about making sure everyone who sees me is on them. I detest swallowing pills (even though I swallow many a day) and completely empathize with the low adherence rate most people have when it comes to taking a supplement. However, it’s a sad truth given the state of our lifestyles and our planet that supplementation has become necessary. I cannot ignore this any longer, nor does it do anyone good for me to keep quiet on the matter.  For more in depth reasons why I believe you should be supplementing your healthy diet, check out this post I wrote on Why You Need Supplementation. While there will always be outliers for whom general recommendations do not qualify, here are several supplements that I believe almost everyone needs to be taking. They are as follows:

Omega 3 Fatty Acids

Word on the streets is that our dietary Omega 3:6 ratio used to fall between 1:2 and 1:4 – meaning we ate about one gram of Omega 3 fats for every two to four grams of Omega 6 fats. Current estimates run anywhere from 1:16 to about 1:50 depending on who you ask. This is for a couple of reasons: We don’t eat a lot of seafood, the animals we do eat are no longer pastured for the duration of their lives and so they are fed an omega 6 rich diet of corn, soy, and other items and denied omega-3 rich grasses and grubs. Consequently their meat and milk is omega-3 deficient – and so are we.

Omega 3 fats provide the body with eicosanoids called EPA and DHA – these have an overall anti-inflammatory effect on the body and are known to support cardiovascular health, mental health, and can reduce chronic inflammation when introduced to a modern diet.
Vegetarians and others who supplement with flax and other plant sources are only getting about 2-3% EPA and DHA from these plant sources due to a complicated and highly inefficient ability for humans to convert ALA (the plant omega 3) to EPA and DHA. When we consume meat and milk, we consume EPA and DHA directly from the animal who has a more effective ability to convert plant omega-3s to eicosanoids than humans do. This is why I advocate use of fish oil instead of flax for omega-3 supplementation. While flax oil, walnuts and other vegetarian sources are great to bring the body closer to an optimal ratio of Omega3 to Omega 6, these sources should not be considered sufficient by themselves as a supplementation.

Considering chronic inflammatory diseases are our number one cause of death (think heart attack, stroke, diabetes, etc) and mental illness such as bipolar disorder, depression and schizophrenia is increasingly common it makes sense to ensure that regular omega-3 supplementation is in the entire family’s supplement regimen.

Nordic Naturals is a great over the counter source of fish oil and widely available. I also love the Metagenics 1000, as it is ultra potent with 1000 mg combined EPA and DHA per capsule.  I recommend finding the highest potency of EPA and DHA possible so you can take fewer capsules. 2-3 grams of combined EPA and DHA is a good place to start for dosing adults; depending on your health concerns you may benefit from 2-3 times as much; talk to a qualified professional about your needs. Do not take fish oil without physician consent as it can interact with some medication.

Vitamin D – Over 40% of adults have outright Vitamin D deficiency, regardless of where they live in the USA. In my practice it is quite commonplace – whether in San Diego or Seattle – and being outside often is not a foolproof assurance you are at optimal levels. There’s a lot we are learning about Vitamin D, but we do know that being indoors (or in your car) and wearing sunscreen reduces Vitamin D synthesis significantly, as does having darker skin. While a small number of foods provide Vitamin D, the majority is created in the skin from sun exposure. Considering we evolved living and working outside it is easy to see how easy it is to have suboptimal levels now. We do know that the current RDA of 800 IU is not likely to be enough for most and we know that less than 30 ng/ml blood levels are suboptimal, with deficiency being less than 20 ng/ml. There is some argument that ideal blood ranges are 50-100ng/ml and you will see this repeated often in the naturopathic and functional medicine communities but Alan Gaby, a pioneer in this area, is not convinced that levels this high are actually optimal. 50-70 seems acceptable with current knowledge. Please see resources for his explanation. My favorite Vitamin D supplementals are liquid; Biotics Bio-D-Mulsion and Thorne’s Liquid Vitamin D; liquid sources are easy to administer to adults and children are emulsified in oil, increasing absorption. These sources can purchased from a licensed practitioner. Individual dosing is dependent on current serum Vitamin D status and should be monitored regularly with supplementation, as Vitamin D is fat soluble and can therefore accumulate to excessive levels.

Quality Multivitamin – Given that less than 10% of Americans are getting 100% or more of the RDA of everything and the RDA is designed to prevent gross deficiency – not support optimal health levels of nutrients – it may be wise to consider a multivitamin. Those who argue against this practice are not acknowledging nutritional soil depletion nor the effects of stress, pollution, and modern lifestyle on nutrient demands.
Quality varies widely among multivitamins. Some are poorly absorbed – what physicians will often call “expensive urine”. Others are of a higher potency and quality – including forms of vitamins and minerals which are better absorbed by the body. Any one-a-day is not going to be optimal – there is limited absorption in all of these simply because the body is not designed to be able to take in 100% of everything in one dose just like we cannot get 50,000 people into a football stadium immediately because there are not 50,000 doors available to enter. The body will flush out what is unabsorbed immediately so a multivitamin that is divided into 2-3 doses will give you your money’s worth, even if you only take two of the three doses. The most absorbable form of each vitamin and mineral is too comprehensive to list out here – I recommend a pharmaceutical grade supplement company to provide your multi as they will be tested for quality and not have fillers and additives that are common in many grocery stores or large chain supplement stores.

IMPORTANT  SIDENOTE:
More than 30% of us have a genetic mutation called MTHFR that is connected to depression, heart disease, high homocysteine levels, ADHD, autism, and more. If you have this gene mutation your ability to metabolize B vitamins in enriched foods and supplements is compromised. You’ll need to choose a supplement that has methylated forms of B vitamins. My favorite companies for pharmaceutical grade multivitamins are Thorne Research and Pure Encapsulations.

Probiotics –  Most of us have had several rounds of antibiotics in our lifetime, drink tap water, are exposed to antibacterial soaps and exposed to glyphosate – an ingredient in pesticides such as Round-Up (which your neighbors put on their lawns, the city sprays in public green spaces, and is used on our crops). All these have a negative impact on the bacterial population of our intestines, as does seemingly unrelated aspects of modern living such as stress, sugar, refined flour, and lack of vegetables.
It is my preference that we get our probiotics from raw, fermented foods such as sauerkraut, kim chee, and fermented dairy products like kefir. If you choose this method and do not make your own make certain you are purchasing refrigerated pickled vegetables that state they are raw, fermented foods. Shelf-stable versions are pasteurized, killing the very bacteria we are wanting from these foods!

If you have digestive issues or autoimmune disease it is even more important to have a great diversity of bacteria available to you. In these cases probiotic supplements as well as raw, fermented foods are encouraged. You may also choose a probiotic supplement if you do not have the plate for ferments or do not have regular, easy access to them. Choose a probiotic that is at least 30 billion units per capsule. Quality and standardization varies wildly in these supplements, so choose a pharmaceutical grade company (like Thorne, Metagenics, or Pure Encapsulations) whenever possible. One study indicated that 30% of tested samples purchased in stores were contaminated and 20% had no viable probiotic activity at all, so this is definitely something to be mindful of.

Consumer Labs found these over the counter brands, among several others,  to be accurately labeled in potency and quality:

21st Century Ultra Potency Advanced Probiotic

Culturelle

Garden of Life RAW Probiotics and Dr Formulated Women’s Probiotic

Conditionally Ideal: The recommendations below are optional unless symptoms of suboptimal levels apply to you; then I’d recommend making it a regular part of your supplement regimen.

Magnesium – Some might argue with me on this one, but I have seen magnesium be very effective for a number of things in my practice; insomnia, muscle and menstrual cramping, migraines, muscle stiffness, constipation to name the biggies. Magnesium is also helpful to combat cardiovascular disease and high blood pressure. Estimates are that less than 30% of U.S. adults consume the Recommended Daily Allowance (RDA) of magnesium. And nearly 20% get only half of the magnesium. Remember – the RDA are broad recommendations that most people need to avoid disease (in this case seizures, cramping and/or heart arrythmias with prolonged deficiency) – we have yet to really know and recommended optimal amounts for vitality and vibrancy. If most are not meeting the RDA, chances are this is a valuable supplement to be taking – especially if you have cramping, difficulty sleeping, constipation, or feel tight and stiff for unknown reasons you call “getting old”. A chelated form of magnesium is best to avoid diarrhea. I recommend NatureCalm or 400-800 mg magnesium glycinate for sleep, stress, and muscle cramping. You know you have too much if you have loose stools – back up your dose if needed. Epsom salt baths are also very soothing and bring magnesium into the body for relaxation and calming of the nervous system. Kal Magneiusm Glycinate provides a higher dose per pill; I recommend Pure Encapsulations for those with food sensitivities.

If you want to take a food first approach with magnesium you can do so – this is best accomplished with a 100% whole grain diet with 6 or more cups of leafy green vegetables per day. If you can maintain this kind of diet and still have symptoms consider supplementation, as other factors may be at play which are inhibiting absorption from food.

B Complex –

If you have a MTHFR mutation, are under high levels of chronic stress, have high homocysteine levels or experience depression and anxiety a stress B Complex may be valuable to you. It is also a useful supplement if you regularly consume alcohol, as B vitamins are important for the liver’s detoxification pathways and can help prevent hangovers (but I’m hoping you aren’t drinking that much). As discussed above, when in doubt choose methylated forms of B vitamins to ensure you absorb them. Thorne Research, Ortho Molecular, and Pure Encapsulations all offer great products and you can talk to a licensed practitioner for more options and to get tested for MTHFR mutations.

EDITED TO ADD: Most of these supplements can be found on Amazon – however you may be purchasing from a third party (even if the name of the buyer is the same as the company) and quality standards cannot be ascertained because the product is in the hands of a ‘middle man’. After I noticed discrepancies in pill size and color between bottles of the same supplement I stopped buying off Amazon in early 2017. I have set up an online dispensary that I now get many of my supplements from; check out Fullscript below to find most of the supplements recommended here:

Simopoulos, A.P. (2002) The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomedicine & pharmacotherapy; 56(8):365-79.

Forrest KY, Stuhldreher WL.(2011) Prevalence and correlates of vitamin D deficiency in US adults. Nutrition Research. 31(1):48-54. doi: 10.1016/j.nutres.2010.12.001.

Gaby, A.R. Vitamin D Deficiency: Irrational Exuberance?  Retrieved from: Integrative Practitioner.com

Flanigan, Jessica. WHAT’S UP WITH METHYLATION AND MTHFR? AIP Lifestyle, posted October 14, 2013.

Samsel, Anthony and Seneff, Stephanie. (2013) Glyphosate’s Suppression of Cytochrome P450 Enzymes and Amino Acid Biosynthesis by the Gut Microbiome: Pathways to Modern Diseases. Entropy, 15, 1416-1463; doi:10.3390/e15041416

Michener, Martin, PhD. The Microbiota Crisis: How the Herbicide Glyphosate is Killing Microbiomes. Health Impact News, Accessed Website 20 September 2016.

S Berman, D Spicer. Safety and Reliability of Lactobacillus Supplements in Seattle, Washington (A Pilot Study) The Internet Journal of Alternative Medicine. 2003 Volume 1 Number 2.