The allure of supplements is clear. This pill or powder claims to be able to improve your energy, smooth the functioning of your digestion, resolve those aching joint pains.  Why would you not choose to take it? Well, like most things it’s complicated.  There are many reasons why you might choose to take supplements at one time or another and several other reasons why you might choose to limit or not include supplements in your regular routine. 

‘Efforts to facilitate healing are dominated by our contemporary culture's Magic Potion story: that the right external substance can solve our problems quickly and effortlessly’

– Lewis Mehl Madrona Remapping the Brain with Story

Nutritional supplements are big business. They are also often a significant element in the treatment recommendations in many Functional and Integrative Medicine clinics. While I will make  supplement recommendations to those I work with, I endeavor not to make these the central part of the treatment plan. 

Some of the potential benefits of supplements:

• Addressing nutritional deficiencies. Many of the fruits and vegetables we eat contain far lower amounts of various essential minerals and vitamins than the same foods did a mere 40 or 50 years ago.  Taking nutritional supplements have been proposed as a way to make up for this difference. In some instances supplementing certain nutrients is associated with improvement in certain health conditions - for instance, selenium supplementation for some forms of thyroid disease.  Also, taking nutritional supplements to make up for nutrient deficiencies that are actually induced by certain medications.  For instance, vitamin B12 when people are on long term acid blocking medications and coQ10 for those on statin medications to lower cholesterol. 

• Supplements may also provide potentially effective treatment or support for some conditions such as depression and menopausal hot flashes, preventing the need for taking a prescription medication, something that many people would prefer to avoid if possible. 

• Some people take nutritional supplements to provide a level of nutritional support or “cushion” during times of increased vulnerability - for instance, taking probiotics while taking antibiotics to prevent antibiotic associated diarrhea.  There is pretty clear evidence of benefit for this indication.

• Many herbal supplements have the ability to be homeostatic in their effect. This means that they have  a more modulating impact on biology rather than a unidirectional one.  For instance, triphala is a supplement that can be helpful for bowel regulation in the setting of both constipation and loose stools and maca an herbal supplement that can support people who menstruate with a range of hormonal imbalances that can occur during their perimenopausal transition.  

Some of the potential concerns about supplements

• Environmental concerns. The supplement industry is under increasing scrutiny for concerns about a lack of environmental sustainability.  Some of this is just baked into the very nature of the products and business model - decontextualized nutrients that are often extracted from natural food products or possibly created in a lab. The large amounts of waste produced, shifting land use in the places where supplements are produced and the large amounts of packaging and carbon footprint to ship these products are additional concerns.  Fish oil supplements, whose use has grown substantially over the past decade, pose many threats to aquatic ecosystems with overfishing of the small fish used to produce these supplements. 

• Lack of transparency and variable quality control. There remains a lack of transparency in the supplement industry with many supplements produced with proprietary processes and raw materials that are obtained from international suppliers who may have variable oversight and quality control. While there are many high quality supplement manufacturers out there, there are still concerns with quality.  It is not uncommon for independent evaluators to find discrepancies in the amount of active ingredients in the actual supplement vs. what is listed on the package. Many supplement formulations can be very sensitive to temperature, light etc. Shipping conditions and time on the shelf can often negatively impact their potency. 

• Cost.  Supplements can be quite costly, especially if they become a regular and ongoing part of one’s routine.  I have known people and participated in the care of individuals who were often paying several hundreds of dollars per month for supplements.  Often these supplements had become such a part of their routine, that they became habituated to taking them and felt anxious with the prospect of making changes to their regimen. 

My approach and recommendations 

So, taking this all into account. What is one supposed to do? My approach is to first start by prioritizing those approaches and actions that can be taken that do not rely on nutritional supplements.  Often, there are many.  In those instances where supplements are considered some key questions to ask:

• What is the intent of adding this supplement? 

• How will we discern the impact, potential benefit of this addition?

• What is the timeline for use or reassessment of benefit?

If you are already taking some nutritional supplements, I encourage you to ask these questions about your regimen.  Taking breaks from nutritional supplements or rotating their use can be helpful in discerning the impacts of certain supplements. It can also be worthwhile to reflect on the ways in which we may be taking supplements to avoid addressing other issues in our life. For instance, high numbers of sleep aids or stress support supplements because there are aspects of our life (work, relationships, etc.) that are a significant source of stress, but we are avoiding engaging with the real root cause(s). 

All of this said, there can be compelling reasons to take some nutritional supplements potentially on an ongoing basis.  My goal is to make sure that you are clear on the reasons, the benefits and the alternatives. 

What are your thoughts about and experience with nutritional supplements?  Leave a comment below.