12 minute read
FILLING IN THE GAPS
Proper use of dietary supplements can bolster your body’s resilience.
BY ELLEN SEELEY
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WHEN PANICKING OVER A LOOMING health threat such as the COVID-19 pandemic, we may instinctively grab all the vitamin C, D3, zinc, and elderberry at our corner pharmacy to feel some sense of protection. But such knee-jerk actions highlight some integral questions about the proper role of dietary supplements in our health regimens. re they necessary? Helpful? ffective? Safe?
It’s time to confront some inconvenient truths We can’t out-supplement unhealthy lifestyles, nor is it wise to use proximity and price as the primary determinants of our supplement choices. undamentally, it’s better to first attend to our nutrition, sleep hygiene, movement, stress management, time outdoors and social connection. Once our lifestyle ducks are in a row, we can consider what benefit dietary supplements might offer. A SELF-REGULATED INDUSTRY
Several large health institutions, as well as many doctors, hold the opinion that supplementation isn’t necessary if we eat a healthy diet. n October 2021 article in the Journal of Family Medicine analyzes data from a number of research studies and finds, here is limited evidence supporting clinically significant benefit from supplementation in healthy patients with well-balanced diets.”
This makes sense at face value, but it overlooks certain factors, including soil-nutrient depletion from industrial agriculture; the prevalence of processed, nutrient-poor food in many of our diets; our declining nutrient-absorption capacity as we age; any drug-induced nutrient depletion; and the impact of other environmental inputs on our nutrient status. Stress, for example, causes us to burn through many nutrients at an accelerated rate.
Therefore, supplementation may sometimes be indicated. An uninformed and haphazard approach, however, can cause anything from profound healing to great harm. Such is the range of outcomes we can expect from a largely self-regulated industry.
The 1994 Dietary Supplement Health and Education Act (DSHEA) ruled that, rather than undergoing review and regulation by the U.S. Food and Drug Administration (FDA), vitamin and supplement companies are responsible for the safety, purity and accurate labeling of their own products. That means, aside from avoiding actual medical claims (including using verbiage such as “treat,” “prevent,” “heal” or “cure”) and sticking to “structure/function” claims (such as “supports healthy blood sugar levels,” for example), supplement companies are free to formulate and market products pretty much as they please.
While supplement companies must ensure that any marketing claims they make are backed by su cient evidence so as to not be false or misleading, such evidence doesn’t require D verification. Says Santa Rosabased neurologist Dr. Allan L. Bernstein, who has conducted clinical trials of B vitamins, “Due to cost and confounding variables, it’s hard to find double-blind, randomized, controlled clinical trials being conducted on most supplements.”
Given this uncertainty, how do we proceed as consumers? Ideally, we select supplements under the supervision of a qualified medical practitioner. If this isn’t feasible, we can search the National Center for Biotechnology Information’s PubMed database (pubmed. ncbi.nlm.nih.gov) for meta-analyses that validate the benefits of certain supplements. We can then look for evidence of third-party certifications that will lend confidence when choosing from that supplement category (see rusted hird-Party ertifiers, page 22).
METABOLIZING SUPPLEMENTS
Vitamins can be either water-soluble or fat-soluble, which means that our bodies absorb and store them in two different ways easy absorption in water, with excess amounts removed by our kidneys and a lower storage capacity (necessitating frequent replenishment); or, alternatively, dissolution in fat, breakdown via bile, and accumulation in our skeletal muscle, liver, and fat tissue, giving our bodies a reservoir from which to draw over time.
Vitamins and minerals are critical for good health, yet research shows that many of us fall short on certain types. A National Health and Nutrition Examination Study (NHANES), which assessed 16,444 individuals, found multiple, widespread micronutrient deficits. ortunately, not all deficiencies reach a dangerous level. According to “Micronutrient Inadequacies in the S Population, a 201 overview article by the Linus Pauling Institute at Oregon State University that examined the NHANES data, “Micronutrient inadequacies defined as nutrient intake less than the estimated average requirement — are common in the United States and other developed countries. Such inadequacies may occur when micronutrient intake is above the level associated with deficiency but below dietary intake recommendations.”
Clearly, many of us have work to do to achieve nutrient su ciency. Doing so with food is optimal, but the aforementioned factors may necessitate supplementation. Fortunately, scientific literature and clinical practice have both yielded promising evidence for a wide variety of micronutrients and herbal compounds. Some of the most promising, in terms of the health concerns they help address, are detailed below.
THE Bs AND METHYLATION
he vitamins ( 1, 2, , , 6, , 9 and 12) are enzyme cofactors (that is, key ingredients) in many neurological, endocrine and metabolic processes. These eight essential nutrients work synergistically, but they also carry out their own unique functions.
Among the most crucial jobs facilitated by the Bs is methylation, a critical biochemical process that occurs billions of times per second and in every one of our cells. It produces, regulates and helps transport vital hormones, such as cortisol and melatonin, and neurotransmitters, including serotonin, dopamine, adrenaline, and norepinephrine. As such, it helps regulate our stress response, our brain chemistry, our immune function, and our capacity to detoxify. It is the biological “switch” that turns genes on and off.
Folate (B9) is perhaps the most important methyl donor; methylation is almost entirely dependent upon it. Bernstein notes, “In preg-
nant women, folate has been shown to prevent neural-tube defects in infants.” According to the U.S. National Institutes of Health (www. ncbi.nlm.nih.gov), folate deficiency is also frequently found in people with depression. 12 is another key methyl donor. It supports the brain, nerves, energy levels and red blood cell production. Deficiency (which is common in vegans, the elderly and individuals with malabsorption) can lead to fatigue, pernicious anemia, vascular disease, stroke, autoimmune conditions and dementia. Without su cient 12 to convert folate into -methyltetrahydrofolate (which creates the universal methyl groups SAMe and methionine), methylation can’t proceed.
Vitamin B6 (pyridoxine) is another methylation-helper with a bevy of benefits. Says Bernstein, “I’ve researched B6 for patients with carpal tunnel syndrome and had good outcomes. It also helps many women with their PMS symptoms. Plus, it’s an important co-factor in the production of serotonin, one of the chief neurotransmitters regulating our mood and digestion.” Pyridoxine works for most individuals, but those with liver problems should take the pyridoxal-5-phosphate (P-5-P) form, which the liver won’t need to convert. itamin 2 (ribo avin) also assists with methylation; its greater claim to fame, though, is helping with migraines. Bernstein notes that 2 mg of 2 can help, but the successful clinical studies used a ton 00 mg. We really don’t know what’s optimal.”
One huge caveat: Two common variants in the methylenetetrahydrofolate reductase gene (MTHFR) — which are estimated to occur in more than one-third of the U.S. population — significantly compromise methylation ability, leading to greater risk of high homocysteine (a neurotoxic amino acid), as well as other problems, such as migraines and miscarriages. If a blood test indicates the presence of one or both MTHFR variants, or high homocysteine, it’s important to supplement with the most bioavailable (aka activated) forms of the Bs: folate from methylfolate (or L-5methylfolate), and 12 from methylcobalamin. VITAMINS C, D, AND K2
Vitamin C is a major antioxidant and important cofactor for many immune, endocrine and metabolic functions. Deficiency is surprisingly widespread, and supplementation is quite safe (with excess indicated by loose stools and, possibly, kidney stones). It is best absorbed from whole-food sources (including citrus fruits), in liposomal form, or at least with citrus bio avonoids included (look for these terms on the label).
Vitamin D is a fat-soluble vitamin critical for proper immune function, bone metabolism, mood regulation and metabolic and cardiovascular function, due to its synergistic action with other nutrients and hormones. Many of us are deficient in it, so testing and supplementation can be transformative. Santa Rosa-based naturopath Dr. Elizabeth Large says, “Every single person I test for 2 -hydroxy vitamin D is in the 20s or even the 10s nanograms per milliliter, ng/mL]. I like to see people in the functional range of 0 to 0 ng mL. It’s surprising how low people are. Deficiency has also been seen to worsen COVID outcomes and is closely associated with autoimmune conditions.
itamin 2 is essential for bone metabolism as well, channeling calcium deposition appropriately without 2, calcium and D will default toward arterial calcification (and possible cardiovascular problems) and formation of kidney stones. 2 also regulates blood clotting. Unfortunately, tests for itamin 2 are not yet easily available, so speak with your physician if you’re experiencing heavy bleeding or poor clotting of injuries, nosebleeds, easy bruising, slow healing of injuries and/or easily fractured bones. VITAL MINERALS
Magnesium is responsible for catalyzing close to 00 enzyme reactions in the body, yet 6 percent of us fall short of recommended levels. This vital mineral facilitates the reaction in our mitochondria (our cells’ energy factories) which produces ATP (adenosine triphosphate, our energy currency). It also enables bone synthesis, gene expression, muscle relaxation, insulin sensitivity and the parasympathetic response (rest-and-digest mode). In particular, magnesium converts vitamin D into its active form so that it can help calcium absorption.
The most absorbable magnesium supplements are chelated, or bound, to one or more amino acids that help ferry them across the intestinal membrane into the bloodstream. Magnesium citrate is popular for its laxative effect, while magnesium glycinate and magnesium l-threonate help primarily for relaxation and, according to Bernstein, prevention of migraine. Magnesium malate has shown utility for muscular conditions like fibromyalgia. inc deficiency is rampant ( percent of Americans fall short of optimal levels), yet this mineral is crucial for supporting immune function, digestion and metabolic health. It also aids collagen synthesis, assists in mood regulation and cognitive processes, and enables taste and smell. Like magnesium, zinc is best absorbed when chelated to an amino acid.
Iron deficiency is also widespread, leading to anemia, decreased work capacity, and impaired immune and endocrine function. Vegetarians and vegans may obtain quantities equaling those in omnivores’ diets but still end up deficient, since non-heme iron (from plant foods) is much less absorbable than heme iron (from meat, fish and poultry). alcium also can impede iron absorption. Supplements can be constipating, so look for food-based or, specifically, GI-friendly varieties that include vitamin C, which enhances absorption.
SUPPORT ESSENTIAL FUNCTIONS
The omega-3 fatty acids EPA and DHA play vital roles in neurological, cognitive, cardiovascular and metabolic health. They also can’t be made by our bodies but must be obtained from ingesting fish or algae. Our ideal omega 6-to-omega 3 ratio, essential for managing in ammation, falls between 1 1 and 1. Yet many of us range as high as 2 1. he prevalence of omega-6s in cheap industrial seed oils — and, therefore, the restaurant and packaged-food industries — means many of
us must work extra-hard to compensate with more P and DH but the effects on our in ammation, cell membranes, moods and metabolisms are worth it.
Glutathione is our body’s master antioxidant; one molecule of it is used in every single detox reaction. ollowing the wildfires of recent years, Dr. Shiroko Sokitch, a functional M.D. based in Santa Rosa, has prescribed glutathione to many patients with smoke-related health challenges. In addition to fighting free-radical damage, glutathione helps our bodies detoxify certain carcinogens, heavy metals and harmful chemicals. oenzyme -10 has demonstrated effectiveness in supporting proper mitochondrial function (ATP synthesis), thereby helping fuel every single bodily process. Statin drugs, typically prescribed to lower cholesterol, deplete o- 10. ssuming you have the go-ahead from your physician, it’s best taken in its active form, ubiquinol, which is more easily absorbed by the body.
HERBAL CONSIDERATIONS
St. ohn’s Wort, -H P, and L-tryptophan can negatively interact with other serotonin-related substances, both herbal and pharmaceutical. Activated charcoal, often used for digestive complaints or in detox protocols, binds powerfully to any substance it encounters and can reduce the absorption of nutrients, other supplements and medications.
Curcumin, the phytochemical in turmeric root, has proven a powerful tool in fighting pain, in ammation, joint deterioration, cognitive decline and immune dysfunction. It is, however, di cult to absorb unless combined with black pepper or ingested in its essential-oil form. Sokitch says, “I prescribe turmeric to many of my patients, but it has to be a therapeutic dose...which is hard to find on store shelves.”
Just because herbs and vitamins are natural doesn’t mean we should take them casually; consult your practitioner for guidance. Bernstein and Sokitch both urge caution with any herbs sourced from China or India, which are often contaminated with heavy metals and other toxins. Says Sokitch, “I only prescribe traditional Chinese medicine remedies made in the United States, which are third-party tested.”
GETTING IT JUST RIGHT
he benefits of most nutrients form a bell curve, meaning deficiency is problematic, but so is excess. The “Goldilocks zone” for many nutrients is still unknown, cautions Bernstein: We have no idea what the optimal level is. here is, however, significant evidence suggesting toxicity is possible not only with fat-soluble vitamins and minerals but water-soluble vitamins and herbs as well. ernstein recounts that, Women who experienced PMS relief with vitamin B6 got numb legs and feet when their intake rose too high.” Excessive folic acid, if improperly metabolized (as with MTHFR polymorphisms), can lead to cardiovascular disease and cancer risk. Vitamin D toxicity can result in hypercalcemia and arterial calcification, and vitamin A in excess can cause headache, bone pain and liver damage.
Even herbs require cautious use, ideally under practitioner oversight. Herbs used for infection and microbial balance, like oregano oil, are easily overused. Says Dr. Guillermo Ruiz, an Arizona-based physician who practices naturopathic endocrinology specializing in metabolic optimization, We need to use specific doses, in specific time periods. Otherwise, these herbs can create dysbiosis an imbalance in the gut microbiome . here are people who have been using allicin found in garlic] or oregano oil for months or years, for example, and in them we see a loss of homeostatic bacteria, dysbiosis, and symptoms similar to those of an actual infection.”
In the developed world, serious vitamin deficiency syndromes are rare, thanks to sufficiently balanced diets and availability of fortified foods. However, if you’re experiencing symptoms such as severe fatigue, neurological dysfunction, sensory deficits or other significant red ags, deficiency may be a factor. Your doctor can request blood tests for many nutrients (such as D3) and indicators of nutrient status (including ferritin, for iron), as well as for genetic markers like MTHFR. Once you know your levels, you can supplement in a targeted way.
Supplements aren’t always the answer, but they can be tremendously helpful if used judiciously and under the guidance of a qualified medical practitioner. The key is to “supplement” a healthy lifestyle, so your body’s systems can rebalance themselves.
About the author: Born and raised in Sonoma County, Ellen Seeley earned a master’s degree in community development from UC Davis. Today, she is a freelance writer and copy editor for health and lifestyle publications as well as working in the wellness department at Oliver’s Market.
