In our search for answers to questions of how to regain our health and vitality, we are inevitably inundated with supplement advertisements and marketing claims that make every kind of promise. For every malady, there is a supplement - or fifty - claiming to have cured someone with the same malady. We invest a great deal of emotional and financial capital in our hope for equivalent success, pouring a lot of faith and money into supplements that we believe will help us. Whether we seek to boost energy, lift mood, sleep better, burn off unwanted weight, treat stubborn skin conditions, heal an ailing gut, or restore optimal function to another ailing vital organ, supplements offer us an endless line of options. Sometimes we even get lucky and one of the many supplements we've taken a chance on does end up making us feel better for a little while. This fuels our hope.
We think, "Perhaps if a little helped, I should take more!" or " Perhaps if I took it for a week and saw improvement, I will feel even better after taking it for a month or longer".
For many people, this strategy backfires.
Supplements that may have worked for a little while at one point now fail to generate the same result. In fact, often the supplements that seemed to help earlier may even produce pronounced negative reactions eventually. But why? How can something that helps become something that harms? What changed? To answer these questions and to understand the key to harnessing the benefit of certain supplements while avoiding the potential detriment, we must first understand how a supplement acts on the body.
Supplements take many forms. Here, we will explore the following broad categories of supplements: nutritional supplements such as concentrated macro- and micro- nutrients (amino acids, fatty acids, vitamins, minerals as well as endogenous antioxidants made from those nutrients such as glutathione, and alpha lipoic acid), herbs (including adaptogenic herbs) and bioactive compounds such as pre/probiotics and other compounds from isolated food-stuffs such as indole -3 carbinol and sulforaphane, glandular supplements, and hormonal supplements such as DHEA, testosterone, progesterone, estrogen, and pregnenolone.
A nutritional supplement is a term here meant to denote components considered nutrients. These include macronutrients (fats, carbohydrates, and protein) and micronutrients (vitamins, minerals). For the sake of consolidation, we will also include some of the important antioxidant compounds our bodies make from these macro- and micro- nutrients such as the powerful antioxidants glutathione and alpha lipoic acid. On the face of it, the logic behind using nutritional supplements seems simple and highly rational: If your diet lacks in any of these components, good nutrition science tells us that many metabolic pathways needed to perform the vital daily functions required by tissues, organs, and cells, will fail to be optimal and can even lead directly to disease.
So, nutritional supplementation seems to be a reasonable substitute for an insufficient diet, right? Not always true. In fact, often not true.
Let's set aside for now the very valid cautions voiced against unregulated supplement manufacturing and the possible quality control problems inherent in the supplement industry at large. While this is an important discussion to have, it is not intended to be the main focus here. For our purposes in this piece, we are granting the existence of valid GMP (good manufacturing practices) approval and the existence of some supplement manufacturing companies that do indeed do an excellent job of maintaining integrity and consistency of product content claims and quality production. Our purpose here is to evaluate the intended use of the products themselves, assuming they are already in excellent GMP standing.
Not only are many nutritional supplements isolated in a way that removes them from the synergistic matrix inherent in the whole food form, but doing so may render them less likely to be absorbed or assimilated as efficiently. An important side note: don't be tricked by "whole food-based" nutritional supplements, as this is a misleading marketing ploy that allows manufacturers to classify a supplement as "whole food-based" simply if it contains a yeast culture. Not all forms of isolated nutrients are absorbed equally. For example, magnesium amino acid chelate is more well-absorbed than magnesium oxide, though both are marketed as a magnesium nutritional supplement.
Furthermore, and perhaps most importantly, even if you are able to obtain highly bioavailable forms of nutrients in high quality nutritional supplements, the true clinical challenge will be in matching the dosage and frequency/timing to the level of individual need - which can vary widely. This will be extremely critical for success. This is one of the most commonly overlooked elements of clinical or self-guided protocols intended to restore health through supplementation and one of the most common reasons that supplementation can fail or begin to initiate negative or harmful reactions.
Since the body is dynamic and the recovery process especially so, the need the body has for different concentrated nutrients in supplemental form may vary throughout a day, week, or a month or even over years. It becomes very difficult for many doctors and patients not versed in assessing the complex variable landscape of individual metabolic needs to ascertain what is the appropriate nutrient supplement(s), dosage, and timing for each person. And even in the hands of the most experienced clinicians, there can be a short period of necessary trial-and-error.
It is also very important that nutritional supplements are not used as a foundational substitute for a whole-food based diet. The science of nutritional supplementation, while life-saving for some people (inarguable in severe cases such as Wernicke-Korsakoff syndrome or advanced pellagra), is far from being sophisticated enough to sufficiently replace whole food as a foundational nutrition plan. Whole food contains hundreds if not thousands of compounds that we have yet to sufficiently identify the depth of metabolic importance of. We need real food.
Additionally, due to the fact that nutritional supplements are isolated and concentrated de-contextualized entities, it is possible for them to behave very differently in the body when compared to their whole food counterparts. A great example of this is calcium. A 2013 National Institutes of Health study found that there was an increased risk for cardiovascular disease, stroke, and heart attack for those taking supplemental calcium. Consuming calcium-rich foods did not seem to pose the same risk.
The most successful recovery plan, especially for those who have had multiple failed recovery attempts and find themselves with increasing loss of function, must start with a comprehensive whole food based plan first and only seek to add nutritional supplements judiciously under the guidance of a clinician trained in metabolic science and nutrition who can help to determine proper individualized protocols.
For many people who have long lists of food allergies or sensitivities and digestive disturbances, it will be even more urgent that they work with a trained dietitian nutritionist who can collaborate closely with the patient to customize a whole food based plan that works for their needs.
With the growing advances in nutrigenomics (how nutrients interact with gene expression) and increasing capacity to diagnose individual genetic mutations that may place "kinks" in the metabolic hose such as the MTHFR (methylenetetrahydrofolate reductase) mutation that increases the demand for methylfolate (methylated form of folate), more emphasis may be placed on the importance of nutritional supplementation. This is also true in the case of those diagnosed with pyroluria, which can increase the need for B6 and zinc. However, any treatment protocol that focuses only on high-dose isolated nutrient supplementation for these individuals, without appreciation for the bigger metabolic picture of the individual, as well as the current status of the neuroendocrine system (or stress-response system), will ultimately be more likely to induce negative reactions or fail.
One final and very important consideration when determining dosage and proper use of nutritional supplementation is the existence of metabolic feedback inhibitions. To imagine what feedback inhibition is and how important it is to our health, think of a conveyor belt that manufactures Product Z. Product Z is built from the hands of two factory workers we'll call Jack and Jill. Jill stands at the very front of the assembly conveyor belt, Jack a little further down the belt, and Product Z follows after Jack at the end of the belt. When Product Z gets produced in high enough amounts, it will send a signal to Jack and/or Jill, that says "slow down production of Product Z! We have enough!!" and Jack and Jill will obey by slowing down production. Similarly, we have a number of ways our body regulates the production of hormones, neurotransmitters, antioxidants like glutathione, and countless other products of metabolism crucial for health. Feedback inhibition is one of these ways. When we are diagnosed as being low in the neurotransmitter serotonin, for example, we may decide to supplement with something like 5-HTP (a precursor amino acid for serotonin) in attempt to boost serotonin. While this seems reasonable, it may fail to appreciate the mechanism of feedback inhibition. 5-HTP can build up to the point where it will trigger a feedback inhibition and effectively turn down serotonin production. How do we determine the "right" dosage then? Again, we must first be familiar with the metabolic pathways of regulation themselves, know how to address metabolic deficiencies with comprehensive dietary plans and only then proceed cautiously with small, titrated dosages of supplemental precursors such as 5-HTP.
When we supplement with Product Z (in this case, 5-HTP) without understanding the full picture of metabolic dysfunction in an individual with low serotonin levels, it is more likely we will take a dose inappropriate for our needs. In the case of serotonin, by supplementing 5-HTP in an attempt to correct apparent serotonin deficiency, we may in fact reach a point where our supplementation triggers feedback inhibition of serotonin production and tells the body to turn down serotonin production - the very thing we are trying NOT to do!
Hopefully now you are beginning to appreciate the delicate balance of metabolic regulation that is taking place at every second of our lives and how nutritional supplementation is best treated with caution and care to avoid excess.
When we switch gears from talking about nutritional supplements to talking about supplementing herbs, glandulars, some bioactive compounds, and hormones, we largely move beyond the realm of nutritive compounds and into the realm of what we can call "regulatory compounds". Regulatory compounds do not provide fundamental nutritional building blocks such as supplied by nutritional supplements, though they may influence the way certain nutrients are utilized. Hypothyroidism, for example, can impair conversion of riboflavin (B2) to an active form the body can utilize. Another example many of us are very familiar with is the way estrogen affects calcium/vitamin D absorption and utilization.
More broadly speaking, though, the regulatory compounds and supplements containing them do their job best when there is a pool of nutritional building blocks (the macro- and micro-nutrients listed earlier) available, since many of the enzymes the regulatory compounds act upon will require these nutrient cofactors for function.
Adding in supplemental regulatory compounds such as herbs, bioactives, and hormones may fail to yield good results without first ensuring nutritional status is more adequate. At worst, adding in the regulatory compounds before restoring nutrition to a higher level can lead to further exhaustion of nutrient reserves and ultimate recovery failure and worsening of symptoms.
Without first attending to the nutritional imbalances and nutritional reserves of the body, regulatory supplements will not act optimally. Once the nutrition status of the patient begins to replete, often the response to regulatory supplements previously not tolerated is improved. Patients become more tolerant and responsive to the healing herbal and bioactive stimulatory compounds and may even benefit from proper individualized use of careful hormonal therapy.
Supplements can have powerful beneficial effects and may possess the capacity to elevate health and enhance healing. However, when employed with a broad brush, merely following label directions or mimicking protocols that may have worked for another individual, without a more in-depth personalized medical evaluation or full appreciation for the unique needs of each individual, their level of disease progression/ metabolic dysregulation, and their clinical symptomatology, supplements can impede recovery and even advance disease progression. Knowing how to construct a nourishing foundational whole foods-based and appropriately individualized nutrition and metabolic healing strategy - which may or may not include some beneficial supplements judiciously timed and dosed - is the core of any protocol for a sustainable recovery of health.
About the Author
Heather Davis, MS, RDN, LDN, holds a master's degree in nutrition science and is accredited by the Academy of Nutrition and Dietetics as a registered dietitian nutritionist (RDN). She works as a clinical dietitian, educator, and medical writer specializing in neuroendocrine nutrition and advanced chronic disease medical nutrition therapy