What Supplements Do I Take?

I get asked by many of my patients what supplements, if any, I take.  I preface any conversation with the classic parental advice of “do as I say not as I do,” and let my patients know that each individual has needs that are dictated by their circumstances.  I generally take supplements to be exactly that.  I feel that I am not getting enough of what I need of something to suit the lifestyle that I lead.  Generally speaking, if I lived in an area with fresh produce, grains and livestock, abundant fish and sunlight and if I took perfect care of body without any excesses, I would not take any supplements.  In the real world, here is my list:

1. Vitamin D₃ – The bulk of vitamin D gets created as pre-vitamin D through absorption of UV rays from the sun by the skin.  People at risk for vitamin D deficiency include those with minimal sun exposure, those who are obese or losing weight and people with issues of malabsorption.  In an ideal world I would live on an island with warm weather and plenty of sun exposure by spending much of my time outdoors throughout the year.  The reality is that I live in a northern city and spend most of my time indoors giving me minimal exposure to the sun for long stretches throughout the year.  There are clear links between vitamin D deficiency and multiple disease processes ranging from various forms or cancer to cardiovascular disease, metabolic bone disease and diseases involving the immune system.   A reminder: vitamin D is fat soluble, so take it with a fat-containing meal.

2. Omega-3/Fish Oil – These popular fatty acids have a healthy effect on brain function (particularly mood) and inflammation.  At high enough doses they can have powerful effects on depression and bipolar disorder that are comparable to traditional psychiatric medications.   Omega-3-fatty-acids also have an anti-inflammatory effect and can significantly lower triglyceride levels.  In an ideal world (on that island) my diet would consist of plenty of fish and would be low in unhealthy oils so this would not be necessary. 

3. Ginger – I take capsules of the whole root (not just isolated substances from within ginger that might have the wanted effect).  I take ginger for its anti-inflammatory effect.  This is not something that I recommend for all patients, but is useful for me in staying off of stronger, prescription strength anti-inflammatory medications that can be toxic to the kidneys particularly when taken frequently.  Without the chronic wear-and-tear of competitive sports, I probably would not bother with ginger.  Ginger tea, though, can be useful for nausea.  Cut up a bunch of fresh ginger root and boil it in water for 5 minutes.  Drinking a glass or two can have a relatively quick effect.

4. Tumeric – Again, I take the whole root in capsule form.   I am fearful of “anti-cancer” agents that are taken out of their natural environment.  While reported to have strong cancer-fighting properties, I take this herb (the primary ingredient in curry) for its anti-inflammatory effect. There appears to be an effect on the same enzyme as with the ginger.  Cultures that eat large amounts of turmeric in their diet also have low levels of certain types of cancer. 

5. Co-Q-10 – This enzyme (also known as Coenzyme Q) is produced by the body.  There is possibly some use for co-Q-10 in the management of heart failure patients.  Additionally, a recent meta-analysis suggested that blood pressure can be lowered by as much as 10 points when taking Co-Q-10 supplements, in addition to already reported positive effects on insulin resistance.   I originally took it to help with stamina in athletics.  I have not found a tremendous amount of data to back that up, but it is something that I continue to take given the personal response that I have other positive benefits associated with it including.  It should be noted that, since this is a natural substance produced in the body, the body might not produce as much when on it.  I have found that I feel a little shaky the first day after stopping it, so I tell my patients that either you are on it daily or not.  Some of my patients also find that they have a little bit of insomnia if they take it too late, so I recommend they take it in the morning. 

You Need More Vitamin D…For Now

Vitamin D has been all the rage of late.  Here is a brief review from the New York Times.  Once considered strictly a regulator of calcium and bone mineralization recent findings suggest that vitamin D deficiency is associated with several types of cancer, cardiovascular disease, osteoarthritis, osteoporosis and immune system disorders, raising risk of infection, auto-immune diseases, including rheumatoid arthritis, multiple sclerosis and type-I diabetes. 

I have found that the overwhelming number of patients that I see have at least insufficient vitamin D levels, while at least half have vitamin D deficiency.  Those at highest risk are obese patients, patients with digestive disorders and, not surprisingly, people who work long hours at desk jobs without sun exposure (lawyers and investment bankers tend to have the lowest in my practice).  In fact, over the past year I have only seen a handful of patients not already taking supplemental vitamin D that meet the suggested 25, OH vitamin D level of 40 ng/ml.

My advice is to start at 1000 IU of vitamin D₃ daily to be taken with a meal (aiding the absorption of this fat-soluble vitamin).  For those at higher risk or whose vitamin D levels do not rise, I suggest 2000 IU or even more aggressive dosing for those severely deficient, although I have found that this moderate supplementation usually is sufficient.   This is not the first vitamin to gain public favor – vitamins A, C and E were popular not that long ago, although follow up studies on broad use of them as supplements in healthy individuals has yet to yield convincing evidence of their benefit.  For now, the association of vitamin D deficiency and disease is convincing.  Whether follow-up studies demonstrate efficacy of vitamin D supplementation in preventing and managing these diseases will ultimately guide recommendations. 

To read the full NY Times article, click here.