According to a US Department of Agriculture study, over 90% of Americans are deficient in 14 essential nutrients. Most of us are well aware that we do not eat properly. Poor dietary habits, busy lifestyles, stress and other pressures often conspire to result in less than ideal nutrition. In addition, modern farming practices and food processing rob the foods we do eat of essential nutrients.
Most nutritionists therefore agree that most of us should be supplementing our diet with select nutritional supplements. This is especially true for those who have chronic medical conditions.
It is important to note, however, that taking vitamins and nutritional supplements is not a substitute for healthy eating. Vitamins and supplements in fact are not foods! They are "co-factors," substances that help your body utilize food more effectively and allow your body's physiology to function better. So, if you're putting garbage in, you'll get garbage out, no matter how many supplements you're taking.
What Supplements Should I Be Taking?
While a complete discussion of what supplements you should be taking is beyond the scope of this site, the following list of the supplements we most commonly recommend for the patients we see in our practice. Please talk to one of our physicians if you have specific questions about which supplement(s) might be appropriate for you.
At the very least, most people can benefit from being on a good multivitamin. Women who are still menstruating may want to choose a multivitamin with iron in it, or take an additional iron supplement. Men should not take iron unless prescribed by a medical provider.
Women should be taking a calcium supplement for most of their life unless instructed otherwise by a medical professional. The teenage years are the most important time for calcium supplementation. In fact, once you reach 25-30 years of age, your bones have absorbed about as much calcium as they ever will. After that time, calcium intake will help prevent bone loss but will not significantly add any additional bone density. However, most teenage girls are getting about 40% less calcium than they require for adequate bone mineralization. A minimum of 1200mg of calcium should be taken a day, preferably with vitamin D3, and this calcium dose should be divided into doses of 600mg at a time.
There are several forms of calcium. Most commonly calcium is found as calcium carbonate. This is acceptable but is more difficult for your body to absorb and may cause some GI side effects such as constipation. Calcium citrate/maleate is an acceptable alternative however, Metagenics compound of Microcrystalline Hydroxyapatite Concentrate (MCHC) found in Cal Apatite, Cal Matrix and other calcium formulations, contains a more bioavailable form of calcium in addition to an active protein matrix and other building blocks of healthy bone. These products are more effective at reversing bone loss and healing fractures than typical over the counter calcium supplements and are better tolerated in the GI tract.
We are finding that vitamin D is important in several functions throughout the body beyond what was originally thought. It is still very critical in the absorption and action of calcium but we are finding correlation between healthy vitamin D levels and reduction in risk of certain cancers, including colon and breast cancer, improvement in immune function, reduction in risk of depression, improvement in energy level and many others. Vitamin D acts as a molecular switch to trigger gene transcription. It targets over 1000 human genes and affects organs, including the heart, lungs, adrenal medulla, neurons, muscle, pituitary, bone and brain.
The principle source of vitamin D is cutaneous production from skin exposure to ultraviolet B (UVB) sun radiation, not from dietary sources. Due to increased awareness of skin cancer, many people are using sunscreen or are covering up when in the sun, therefore reducing sun exposure and vitamin D production. Melanin concentration in darker skinned people also reduces vitamin D production. In Oklahoma, sun exposure is very limited by intense heat during the ideal times of day during the summer and by our latitude and decreased direct sunlight in the winter.
Current recommendations for vitamin D3 intake are 400-800 IU per day but as we are testing serum levels of vitamin D we are finding most people are deficient in vitamin D. We recommend 1000-2000 IU per day as well as a vitamin D blood level testing by your physician. It is possible you could need much higher doses of vitamin D if you are severely deficient. It is also important to know that milk is fortified with vitamin D2 to aid in absorption of calcium. This form of vitamin D is inactive systemically and will not increase your serum vitamin D levels and is therefore inadequate for vitamin D supplementation and replacement.
Omega-3 Fatty Acids (Fish Oil)
The health benefits of Omega-3 oil cannot be overstated. It can help prevent heart disease (including atherosclerosis) and stroke, and it has an anti-inflammatory and anti-oxidant. It has even shown to be helpful in treating chronic conditions such as osteoarthritis, Multiple Sclerosis and more.
A flood of scientific findings on fish oil points to a startling conclusion: Certain omega-3 fatty acids in the oil, consumed either from fish or fish-oil capsules, appear to offer as much protection against dying from coronary heart disease as do cholesterol-lowering drugs. These findings are so strong that the American Heart Association (AHA) now urges everyone to eat at least two small 3-ounce servings of fish per week. The AHA recommends that people that already have heart disease consume about 1 gram per day of the active ingredients in fish oil, omega-3 oils called EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). To follow this would require supplementation with omega-3 capsules or liquid.
When choosing a fish oil or omega-3 oil supplement it is important to find a quality brand. Although the costs may be slightly higher, some of the lower quality products, especially those capsules which require refrigeration, will have high levels of heavy metals, such as mercury and lead or even toxins like PCB's and dioxin.
Flax seed and flax seed oil is not the best source of omega-3. It contains relatively little omega-3 oil. It does have ALA which is weakly metabolized to omega-3 but it is not sufficient. Also, omega-6 oils do not demonstrate the same anti-inflammatory and anti-oxidant qualities of omega-3 oils.
At OSOI, we suggest the average person take 1000-2000 mg a day of omega-3 oils (EPA and DHA). For patients with chronic disease, including arthritis, we recommend 2000-4000 mg per day. Please discuss this with your physician, especially if you take any blood thinners, and consider the quality EPA:DHA supplements produced by Metagenics.
Glucosamine, Chondroitin and MSM
Glucosamine sulfate and chondroitin sulfate are important naturally-occurring components of joint cartilage and connective tissue (such as ligaments and tendons). They are part of the "building block" molecules that help form and maintain cartilage. As we age, our bodies produce less of these substances. Numerous studies have shown the benefits of taking both of these to help with treating the symptoms of arthritis and also possibly to slow down the development of degenerative arthritis.
Contrary to certain reports, both glucosamine and chondroitin molecules get absorbed into joint cartilage. In one study published in a major orthopedics journal, researchers tagged the glucosamine and chondroitin molecules with harmless radioactive labels so they could track where the molecules went in the body. They clearly demonstrated that both molecules became well absorbed into the joint cartilage.
The recommended starting dose is 1500mg of glucosamine and 1200mg of chondroitin for the first month of supplementation. After this first month, you may begin to decrease the dose down to the lowest effective dose.
MSM is another supplement that can help with cartilage and connective tissue and is helpful in combination with glucosamine and chondroitin. The connective tissue fibers are held together by sulfur bridges or links. MSM is a good source of sulfur and therefore helps bind together the fibers that make up the ligaments and tendons. MSM is also a weak natural anti-inflammatory and may help with some of the pain associated with arthritis.
Remember, sulfur is not sulfa. Sulfa is an antibiotic and many people have an allergy to this medication. There is NO cross reaction to sulfur, meaning just because you are allergic to sulfa does not mean you will be allergic to sulfur. Sulfur is found throughout your body and it is impossible to be allergic to it.
The recommended dose of MSM is 3,000mg per day.