Since the beginning of the COVID-19 pandemic in March 2020, the conversation around nutrients to support immunity and overall health has been on the rise.  Friends and clients are asking me more frequently whether they should be taking supplements, how much they should take, and what brands are quality brands of supplements to invest in.  Before we jump into all of that, let’s first take a look at supplements in general.

What Are Supplements?

According to Cambridge Dictionary, the meaning of supplement is something that is added to something else in order to improve it or complete it; something extra¹.

In the case of dietary supplements, the goal is to bridge the gap between where your body is and where it should be in nutritional status.

Do I need supplements if I eat a healthy diet?

Unfortunately, our food is only as nutritious as the land and environment where that it was grown or raised.  Poor farming and overfarming practices have led to a decrease in soil quality.  Pesticides can accumulate in the soil, depleting the nutrient quality of the soil.  Pesticides can also accumulate in the body if the rate of intake is greater than the excretion.  This is greatly impacted by if the detox pathways are compromised or overburdened due to the number of toxins one is exposing themself to.  

Animals that are raised in environments where they have access to the outdoors to graze and roam contain significantly more nutrients than those raised in confinement. Confined Animal Feeding Operations (CAFO) animals are confined to a lot or facility and fed unnatural diets, typically grains, which can compromise their microbiome.  Due to their close living quarters, disease is more prevalent (especially if their microbiome is compromised) so antibiotic use is common.  Hormones usage is also common to “speed up” the growing process of animals.  These antibiotics and hormones are then transferred to humans when we consume these products.  You can learn more about CAFOs and their impact on health according to the CDC here.  You can read more about conventional vs. organic produce and farming practices here. 

On top of that storing, transporting, processing, and refining foods all deplete the nutrients that are available in the food.  When a fruit or vegetable is harvested, it begins to degrade in nutritional quality.  Eating in-season, locally sourced foods whenever possible will be the most nutrient-dense.  Have you ever noticed how delicious tropical fruits taste when you are vacationing in tropical locations?  It’s not just a coincidence!

Food quality and nutrients are also affected by what you choose to eat.  Processed foods - aka packaged foods - do not contain as many nutrients as whole foods.  It is also important to eat a variety of food every day.  We all have our favorite foods but rotating in various fruits, vegetables, fats, and proteins will ensure that you are receiving the various nutrients that your body needs.

Nutritional Deficiency Factors

While the environment and choice of foods can definitely impact your nutritional status, there are other factors that play a role in this as well.

• Lifestyle Factors:
• Smoking and drinking alcohol can contribute the nutrient depletion.  Alcohol inhibits the breakdown of nutrients into usable molecules by decreasing the secretion of digestive enzymes from the pancreas. It also impairs nutrient absorption by damaging the cells lining the stomach and intestines and disabling the transport of some nutrients into the blood.²
• Inadequate sleep tends to affect the way we eat as well.  Unrested individuals tend to consume more convenient foods.  One study found an association between short sleep and a higher prevalence of inadequate intake for calcium, magnesium, and vitamins A, C, D, E, and K.³
• Stress
• The effects of psychological stress, sleep deprivation, and physical exercise on micronutrient concentrations and micronutrient excretion include magnesium, zinc, calcium, iron, and niacin. Overall, the bulk of evidence suggests stress can affect micronutrient concentrations, often leading to micronutrient depletion.⁴
• The adrenal glands have a high concentration of vitamin C. When stress levels are elevated, you burn through this powerful antioxidant that plays a role in immunity faster.
• Medications
• There may be a pill for every ill.  However, it does not necessarily come without sacrifice.  Many medications can deplete the body of key nutrients.
• In particular, oral contraceptives can negatively affect nutritional status.  It has been shown that the key nutrient depletions concern folic acid, vitamins B2, B6, B12, vitamin C, and E, and the minerals magnesium, selenium, and zinc.⁵
• Gut Dysbiosis
• Impaired digestion impairs the absorption of nutrients in food.  This is usually linked to an underlying root cause affecting gut health.  You can read more about my gut health-related blogs here.

Are Supplements Important?

As you can see, there are many factors that can negatively affect our nutritional status.  By taking supplements, you are bridging the gap between where your body is and where it needs to be.  By adding supplements, you can enhance your overall wellness status.  The micro- and phyto- nutrients you are adding into your diet affect many aspects of your health including:

• Enzyme reactions
• Hormone creation
• Metabolism and energy production
• Cell division and DNA replication
• Antioxidants
• Epigenetics

But before you just go online and order a bunch of supplements, there are a couple of important things I want you to know.  

1. You cannot out-supplement a diet or lifestyle!  There is no magic pill to solve all of your issues.  You must approach health from a holistic point and make a few tweaks to have optimal health.
2. Too much of a good thing can be a bad thing!  Yes even with supplements.  For example, if you take too much vitamin C, you may end up with diarrhea, which can lead to nutritional deficiencies.  You will want to work with a qualified provider for specific needs
3. Quality matters!  Keep reading for more info on this!
4. Some supplements could interfere with prescription medications.  Have a conversation with your practitioner for more guidance and/or refer to the medication information included with your prescription.

Are Supplements FDA Approved?

The FDA regulates pharmaceuticals but it does not regulate supplements by the same standards.  The FDA regulates the ingredients in a supplement and the finished product, FDA approval is not required for supplements prior to being sold.⁶  The FDA can only take action against the company that has misrepresented a supplement after it hit the market.  

Since 2007, the FDA has created a minimum standard for supplements by creating the Current Good Manufacturing Practice. According to the FDA

“The Dietary Supplement (DS) CGMP rule in 21 CFR part 111 (“the DS CGMP rule”) requires persons who manufacture, package, label, or hold a dietary supplement to establish and follow current good manufacturing practice to ensure the quality of the dietary supplement and to ensure that the dietary supplement is packaged and labeled as specified in the master manufacturing record.”⁷

The CGMP provides a minimum level of safety with supplements including manufacturing, sanitation, processing, warehousing, distribution, and personnel training.  However, while the CGMP is in place, it's difficult to regulate and ensure that all companies are following good standards.

Supplement Quality

When contemplating supplements to support your needs, it’s easy to just look at the price and go with what is the cheapest.  However, I want to caution you on that game plan.  Price does matter but so does quality.  Here are something to consider when purchasing supplements.

Synthetic vs Natural Supplement Ingredients

Ingredients should be the biggest factor concerning the supplements you purchase.  The nutrients should be in the most bioavailable form.  Bioavailability refers to the amount of a nutrient that is absorbed and available for the metabolic processes in the body.  

While the constituents of natural and synthetic supplements are the same, the molecular structure is different.  Natural ingredients are going to be more bioavailable because they contain cofactors, enzymes, and phytonutrients that affect absorption and efficacy. 

Here are some terms you may notice on your supplement label and what they mean.

• Food-based - This is a marketing term to make products appear more natural.  Food extracts are added to products containing synthetic nutrients.  
• The supplements facts will have synthetic ingredients listed separately and food extracts grouped
• Food Derived -These ingredients are the most bioavailable because they are made from whole food concentrates.  You should see ingredients like vegetables, fruits, juices, and whole foods extracts. Flash or low heat processing guarantees nutrients are preserved. 
• The supplement facts will list the food of origination in parenthesis next to nutrient.
• Food Grown - Some nutrients occur naturally in very small quantities that are not able to derive from food.  Synthetic nutrients are used to feed or fertilize a growth matrix.  The growth matrix consumes the synthetic nutrient and converts it to the form naturally occurring in nature with the correct molecular structure.  
• The supplement facts will list the synthetic form in tandem with the growth matrix in parenthesis. For example, biotin (with organic brown rice)

Excipients

Excipients are the inactive ingredients added to supplements to maintain or improve safety and freshness, improve or maintain nutritional value, improve taste, texture, or appearance, aid in manufacturing/production.^₈  These are listed under "Other Ingredients".  However, manufacturers are not required to list ingredients that may have been added to the raw materials.  While often excipients can enhance the product, some can negatively impact individuals, especially if an allergy exists.  Reading the full label is important to ensure the safety of each ingredient for individual use.

Supplement Delivery Form

Capsule, tablet, powder, liquid, spray…….There can be a lot of options as to how to take your supplements.  The form a supplement is delivered should optimize the delivery of nutrients as well as absorption.  Again, you must take into consideration the excipients, especially sugar.  I know that gummy supplements are more fun but they may also come with additional, unnecessary sugar.  

GI status should also be considered when choosing your delivery method.  Those with a compromised GI system may not be able to fully digest and extract the nutrient in supplements.  Optimizing GI functions should be a priority.  Below you will find some different delivery methods as well as considerations for each.

• Liposomal, Sprays, & Sublingual Tablets, Transdermal
• By-passes digestion process but may put an additional burden on the liver
• Take the longest to breakdown
• Capsules
• Dissolve and release ingredients quickly
• Powder
• Fast absorbing and can give a large number of nutrients at one time

Guide for Buying Supplements

High-quality products will also list as much info about the nutrients that they can fit on the bottle while low-quality supplements will not very descriptive or provide much information.  

Here are a few other guidelines to keep in mind when shopping for supplements.

• Meet or Exceed Good Manufacturing Practices
• High-quality companies conduct audits to ensure quality control
• Preservatives & Shelf Life
• Maintain maximum purity and potency through the expiration date
• High-Quality, Raw Materials
• Carefully sourced and tested for quality and impurities
• Proper Labeling
• Avoid supplements that make health claims regarding a cure, treatment, or disease prevention. 
• A supplement can allow for instruction and functional claim of nutrients in the supplement.  For example, “helps balance hormones” is allowed whereas “cures hormonal imbalances” is not allowed.

The bottom line is, you want to ensure you are getting quality supplements that will help support and nourish your body.

Ready to try a few supplements?  Check out my recommendations here for men, women, GI health, immune support, and travel support.  These quality supplements are delivered to you via my professional online dispensary, Fullscript.  Email me with any questions or specific supplement requests.

Resources:

¹https://dictionary.cambridge.org/us/dictionary/english/supplement

²https://pubs.niaaa.nih.gov/publications/aa22.htm

³https://pubmed.ncbi.nlm.nih.gov/31581561/

⁴https://pubmed.ncbi.nlm.nih.gov/31504084/

⁵https://pubmed.ncbi.nlm.nih.gov/23852908/

⁶https://www.fda.gov/food/dietary-supplements 

⁷https://www.fda.gov/regulatory-information/search-fda-guidance-documents/small-entity-compliance-guide-current-good-manufacturing-practice-manufacturing-packaging-labeling

⁸https://www.fda.gov/food/food-ingredients-packaging/overview-food-ingredients-additives-colors