#9: Do Nutritional Supplements Work? If So, Which Ones, And For Whom?

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Jun 17, 2024

Dr. Bobby explores the effectiveness of nutritional supplements, highlighting the difference between preventive and acute use. The podcast addresses the skepticism and industry challenges, emphasizing the importance of rigorous research. Topics include multivitamins for cancer risk reduction and personal supplement use for specific health goals.

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INSIGHT

Supplements: Prevention Vs. Treatment

Nutritional supplements are often taken for lifelong disease prevention, which differs from taking them for known, immediate problems.
The evidence for supplements preventing long-term diseases is mostly unconvincing.

INSIGHT

Supplements Skirt FDA Approval

The supplement industry lacks rigorous FDA oversight compared to pharmaceuticals.
Supplements aren't required to prove safety or efficacy before market release.

INSIGHT

Patent Gap Limits Research

Supplements generally lack patents, so companies have little incentive to fund expensive rigorous clinical trials.
This results in most supplements having weak scientific support despite marketing claims.

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Take-Home Messages

· Lifelong use of supplements to prevent an illness is very different from taking a supplement to treat a known deficiency or a specific symptom

· The evidence does not support the use of most all supplements to prevent illness (with multi-vitamins being the exception where there is some evidence)

· Supplements to treat a particular problem can be very helpful, especially if we do our N of 1 study in ourselves

Part One: Understanding Nutritional Supplements

Various types of supplements: Vitamins, Minerals, Herbals, Probiotics
Most commonly used Supplements: Multivitamins, Omega-3s, Probiotics, Vitamin D, Calcium, Protein Powder, Psyllium
We want to live long and well—taking a supplement may help us feel “agency” or that we are proactive in improving our health---even when the evidence does not support it.

Part Two: the Supplement Industry Differs From Pharmaceuticals

Licensed and prescribed drugs go through extensive testing/FDA oversight to demonstrate that they work and that they are safe
Nutritional supplements are viewed as “food” and don’t have similar regulatory scrutiny
Challenges: traditional drugs receive patents and can afford extensive clinical studies. Nutritional supplements generally don’t have patents and can’t afford to conduct extensive research. For this reason, most supplements have very little scientific evidence to support their benefits, even though their claims may suggest otherwise
Real-Life Example: Critical Evaluation of Broccoli Sprout extract Study

Part Three: Evidence (mostly lacking) for Common Supplements

Omega-3s: studies don’t show a reduction in heart disease or cardiac death; they may have a role for high blood triglycerides or for patients with rheumatoid arthritis (pain control)
Vitamins and Minerals: Minimal Impact on Disease Prevention except for a daily multi-vitamin which has supportive evidence that they may reduce cancer and cognitive decline
Cognitive function: omega 3s and the MIND diet aren’t effective at slowing decline.
Supplements for specific deficiencies or specific symptoms can be very helpful. You can do your own “N of 1 Study” to see if they help you. Step 1: identify the problem (bowel irregularity, sleep…); Step 2: choose a supplement and begin taking it; Step 3: re-assess after a few weeks. If it helps, great. If not, then likely best to stop.

Dr. Bobby’s regimen: a daily multivitamin, colace (for bowel regularity), and recently started Creatine for muscle strength. I don’t take omega 3s, vitamin D calcium, magnesium, or pro-biotics.