The Importance of Quality Supplements
As a Naturopathic physician, nutritional and herbal supplements are an important tool that I use very often as part of the treatment plan for my patients. They can be an extremely useful and effective tool when used correctly. There can, however be a variety of problems with supplements. I discuss these issues regularly with my patients, and thought it would be helpful to outline some of the more common issues that I see in a short article.
It’s not difficult to find articles online discussing the varying quality of supplements. A 2013 study (https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-222) showed that 59% of over the counter herbal supplements did not contain what the labels stated were in them. For some, it was a matter of the dosage being incorrect, but in many cases, different herbs were substituted (32%) and some contained huge amounts of fillers. This study even found that in one case, a Gingko supplement was contaminated with Black Walnut, an herb meant to be used short term as an antiparasitic. As a practitioner, I find this issue to be the most disruptive and dangerous when it comes to treatment. I often have patients who say they have tried something and it didn’t work. Without knowing if they were taking a trusted brand, it’s impossible to know whether the supplement really didn’t work, or if they were not taking what they thought they were.
DNA barcode results from blind testing of the 44 herbal products representing 12 companies.
Image source, BMC Medicine: https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-222
Although this is one of the most prevalent issues I see, it is also the easiest to correct. Most nutritional and herbal supplements have been well researched and an “effective therapeutic dose” has been established. The most common dosage issue I see is with Turmeric (curcumin). Turmeric is a fantastic herb with anti-inflammatory and liver protective properties, but it must be dosed rather high to work, often a few grams per day. Another dose related issue I see often is that a study will show that “X” supplement was found to be ineffective to treat “Y” condition, when another study using a higher dose did show it to be effective. An example of this is for vitamin B6. One study using 20mg of B6 for pregnancy related nausea and vomiting found it to be ineffective, while two other studies using 30-75mg found it to be effective.
Though supplement labels can give some guidance on the correct dosage, it can vary greatly depending on what is being treated. It is important to talk to your doctor to assure you are on the correct dose.
Sources, Pubmed: (PMID: 19077388, 14583914, 22189065)
This issue is a little trickier to navigate. Many vitamins and some herbs come in many different forms. A good example here is vitamin B12. B12 comes in 4 different forms- cyanocobalamin, hydroxocobalamin, methylcobalamin, and adenosylcobalamin. These forms all have different levels of activity in the human body. Methylcobalamin is by far the most active form, this is what I recommend to my patients. Unfortunately, the most commonly sold over the counter form of B12 is cyanocobalamin. This form takes some work for the body to activate, but is the least expensive form. Fun fact- the “cyano-“ part of the name refers to the cyanide molecule attached to the cobalamin (b12) molecule. Additionally, a hot topic of research is the MTHFR gene, which is involved in being able to activate B12. Many people are found to have defects in this gene, making it even harder for the body to utilize inactive forms of B12. For those of you who want to dive deeper into B12, Dr. Ben Lynch has a great video explaining the 4 forms.
Part of Plant
Botanical medicine can be very complicated, as most plants have many actions, and often different parts of the same plant have completely different actions, and some parts of a plant may be very useful while others do very little. An example of this is Stinging Nettles. The leaf of this plant is anti-inflammatory, great for allergies, and a mild diuretic that can be helpful for kidney stones and UTIs. The root is useful for prostate issues. This is a case where you would definitely want to be educated on which part to use! Chamomile flower tea is a nice, gentle way to manage anxiety and it can help with abdominal cramping, but the flowers must be used. I often see lesser quality and less expensive teas containing the entire plant, which would not be nearly as effective.
This can be of particular concern for patients with food allergies and sensitivities. As mentioned earlier, many over the counter supplements contain fillers, and the study found that often the fillers were not listed on the label. The best way to avoid unknown fillers is to buy supplements from a reputable brand.
Final Word from Dr Lang
I am hoping that this article is helpful to our patients (and non-patients) out there. Some of this information can be disheartening, but there are good brands out there. One of my personal favorites is Thorne (no affiliation), they have been long time advocates for supplement quality. I am very careful about which brands I recommend and Specialty Natural Medicine is extremely picky when it comes to herbal and nutritional supplements that we stock. The conversation around supplements can be a difficult one, especially when I suggest a patient swap out a supplement they already have for one that I recommend that may cost more. But if you think about it, which is going to “cost” more- a supplement that cost $10 that does little to nothing or one that costs $20 and helps my patients feel better? If you have questions about the supplements you are taking, please ask us! We are here to help you navigate and understand this complex subject!