It is frequently assumed I take many supplements as part of my health routine. A lot of wellness practitioners I know do have extensive supplement regimens and recommend similar when working with patients. It is really no different from associating your standard MD with pharmaceuticals. But just as with prescription medications supplements are a tool and one I feel is often abused as pharmaceuticals are. It is not hard to understand why as both are an easy way to address many issues. Where supplements differ, however, is that people equate their intake to ideal health and this is a thought I mostly disagree with. I see overuse of supplements all the time and I blame much of this on the wellness industry itself, many colleagues and other functional providers included. Part of this is influenced by wellness messaging that sensationalizes aspects of health making a lot of people feel they need to be taking something in order to be truly healthy or to solve a particular issue. But this isn’t always the case and the entire foundation of this messaging I find no different from pharmaceutical marketing, which is often misleading and arguably unethical at times.
The supplement industry is the quieter sibling of the of the pharmaceutical industry, in my opinion, but just as rapacious. As an example, Nestle owns a surprising portion of the cheaper supplement brands out there, is actively acquiring privately held, higher-end supplement companies, and announced in 2019 they are developing personalized nutrition assessments, the results of which will undoubtedly steer you to buy more of their products (direct to consumer testing is a whole topic itself that I’ll perhaps address in a future post). The wellness industry is set to be worth 50 billion by 2025 and the majority could care less about your actual health. It is simply business but my point is we all need to have our critical thinking hats on as we continue to be bombarded by messaging from these industries – to be able to see that it is largely advertising designed to make us think we need something we probably don’t, even if the products being offered are legitimate.
In the face of this growing business sector, most of the health-oriented practitioners within it are not there to take advantage of your health needs and can help you navigate the field for your benefit. The number of supplements and tests available to you is growing exponentially and, while many may well be useful, naturopathic doctors and similarly-trained practitioners are the only true experts in whether you need them and can help guide you in knowing what is worth your time and money. I come across many patients that have tried to sort through this information themselves or relied on friends and the internet for advice and often find that :
- They have taken a test or supplement that is not indicated or has no clinical utility
- They have no benchmark to know if something is helping them or not
- They are not taking a therapeutic dosage (worse yet, dosing too much)
- They are using a less effective chemical form or delivery method
- The supplement is poor quality with excessive fillers and potential allergens and contaminants
- There are better alternatives, sometimes cheaper as well
I do think supplements can be beneficial and use them with nearly all patients as part of a treatment plan, with intention of discontinuing them as some point if appropriate. I myself have needed vitamin D and iron supplementation in the past due to low levels and resulting symptoms from this. In my medical practice, I use supplements for the following reasons:
- Support the body with an irreversible condition: chronic illness takes a systemic toll on the body and I use long-term supplementation in these patients for palliation of symptoms, to support weakened or dysfunctional systems that are part of the illness or consequences of it, or to replace nutrients that are more quickly depleted in the chronic disease state and by the pharmaceuticals often involved treating it.
- Support of a long-term issue: in most cases, the longer an issue has existed the longer the road to recovery will be. I use supplements short-term in these cases as treatment and/or to provide support to the body and help with symptoms while we work on the longer-term foundational pieces that will help set them up to no longer depend on these supplements in the future.
- Correct malnourishment or overt/borderline deficient states: this may occur due to a chronic illness, older age, lack of dietary intake, increased need (e.g. pregnancy), increased elimination states (diarrhea, heavy perspiration, blood loss, etc.), treatments such as chemotherapy, or, at times, genetic SNPs that make it more difficult for some to maintain certain nutrient levels. Many medications also deplete our nutrient status by either directly disrupting absorption or indirectly by increasing the demand for these nutrients in the metabolism of the drug.
- Acute needs: illness, pain
- Prophylactically: to help stave off illness or known health issue ahead of a potential trigger such as being around someone who is ill or risk of a urinary tract infection. Or a pending hangover 😉
- Pharmaceutical replacement: the side effects from medication can make it hard for some to continue treatment and sometimes there is an effective herbal alternative to consider. Supplements may also be used to aid in the weaning off of a pharmaceutical.
With the exception of athletes and other individuals that put high demands on their physical bodies, I don’t use supplements for the “extra” nutrients or support in the absence of an issue/complaint or to “keep” me healthy or to “biohack”. A true state of health, to me, is one in which we don’t rely so heavily on exogenous substances whether that be pharmaceuticals or supplements and this is something I help all my patients work toward if ideal health is the goal.