Mom was going through a “phase.”
At that time, we lived in Northern California, transferred there courtesy of my father’s naval career. It was the late 1960s. I was 7 years old, and my older brother Robert was 8 and a half. My younger brother Michael was exempt, only being 2.
Exempt from what?
Mom had heard about supplementing the diet for health. I don’t know what her sources were, back in days of yore before internet—perhaps some ladies’ magazine. However, she decided that both she and we needed a supplement drink in the mornings before leaving for school.
What was her dire concoction? All whirled up in our family’s avocado green Oster blender was a combination of whole milk, a raw egg, a large dollop of orange juice concentrate from the can, a heaping scoop of Brewer’s yeast, and scoops of various other powders—dunno what. Robert and I would have to drink about a cup of the vile and retch-inducing blend before being released to go to school.
Our torture ended when Dad took up arms on our behalf, arguing that Mom could drink anything she wanted, but that we kids should be liberated from drinking the brew if we wanted to quit.
Spoiler alert: We quit.
Flip forward to today, when the internet abounds with pro-proprietary capsule- and shake-supplement blends with limited science to support their use. Although not near as gag-worthy as Mom’s blend, it’s hard for the average person to figure out which claims are worthy of belief and one’s cash. I understand the dilemma; with aging, disease, aches and pains, I take three mainstream pharmaceuticals and 11 (!) nutraceuticals—it’s quite the laughable mountain of multicolored capsules and tab- lets that emerges from my extra-large pill sorter each morning. But are the supplements science-worthy?
I did a second-opinion consultation a couple months ago for a “young” man (early 30s) who was consulting for cryptic elevation in liver tests of recent onset that had stymied his local gastroenterologist. Negative liver serologies, celiac testing, and ultrasound imaging left his physicians shrugging.
At our video chat, he disclosed that he had been fatigued recently; could it be his liver? Digging deeper, it turned out that he had been taking four to five various supplements that were “guaranteed” to give him more energy. The time of onset of his fatigue? Eight months—the age of his first son. Hmmm. I suggested he stop the supplements, and, why yes, his liver enzymes normalized on repeat testing. His new-father fatigue will likely improve when his son deigns to sleep through the night.
So, how do I choose what supplements to take?
- The supplement in question needs to have peer-reviewed and published clinical
- I add only one new supplement at a
- I reassess in one month/bottle. If questionable improvement in symptoms, I stop the supplement and see if symptoms If asymptomatic, are there possible lab tests to verify improvement?
- I review supplements every six months, because science changes.
Here is a list of what I choose to take daily, minus the prescriptions:
Women’s MVI, Vitafusion 2 qD
Biotin, 5000 mcg qD
Turmeric, 2 grams qD
Omega 3, 2000 mg (vegan, not fish oil)
CoQ10, 100 mg qD
Amla fruit, 1 gram qD
B12, 1000 mcg qD
Magnesium oxide, 300 mg qD
Vitamin D3, 5000 IU gelcap qD
Boswellia serrata, 500 mg qD
Quercetin, 500 mg with Bromelain, 100 mg qD
So let’s take my semi-annual, objective, virtual hike up my pill mountain together.
Vitamins: MVI, B12, Vitamin D3
Growing evidence supports that a daily multivitamin may not be very useful for good health. Unless you have a documented vitamin deficiency, or risks of one (like being vegan or over 60 years old), a daily multivitamin while consuming a healthy diet is unnecessary. There is a study that supports use of multivitamins in women reducing cardiovascular mortality (HR: 0.65), although no such benefits are seen in men.
Although a meta-analysis on multivitamin use demonstrated reduction in cancer was observed in men, no such reduction was observed in women; meta-analysis concluded, “Evidence is insufficient to prove the presence or absence of benefits from use of multivitamin and mineral supplements to prevent cancer and chronic disease.” So, while I have enjoyed the daily “snack” of the two tasty gummies, I will not be reordering when I complete my current bottle(s).
However, being (mostly) vegan and over 60, the daily B12 is important, since 10-15% of the over-60 population is low in B12.
As for vitamin D, I have a documented moderate vitamin D deficiency despite my gardening sun exposure. Standard replacement doses of 2000 IU didn’t normalize my levels, but 5000 IU daily did. As it is one of the fat-soluble vitamins, I have a vitamin D level checked annually to ensure that I don’t overshoot this potentially accumulating substance. Up to 35% of the population is low in vitamin D, even though the recommended dosage is a mere 600 IU daily. And there is a modest statistical reduction in overall mortality with vitamin D supplement (RR=0.93). The algorithm has changed for dosing, so if you are replacing vitamin D, make sure to check your levels annually and adjust accordingly.
However—and a reason to assess my supplement use intermittently—an August 2024 clinical practice guideline change by the Endocrine Society advocates against routine vitamin D screening or replacement in most populations. Conclusions included “no significant effect on select out-comes in healthy adults aged 19 to 74 years,” “a very small reduction in mortality among adults older than 75 years,” in pregnant women a “possible benefit on various maternal, fetal, and neonatal outcomes,” and in adults with prediabetes, “moderate certainty of evidence suggested reduction in the rate of progression to diabetes.”
Administration of high-dose intermittent vitamin D may increase falls, compared to lower-dose daily dosing. So, should I continue my vitamin D? A conversation for my internist appointment this November. Oh, how much she must enjoy my appointments!
Joint and Muscle Relief: Boswellia, Turmeric, CoQ10, Magnesium
I have knee osteoarthritis, and residual muscle weakness I attribute to long Covid. To reduce my exposure to NSAIAs for the knee osteoarthritis, I have long advocated the use of boswellia. (You’d have to pry it away from me.)
Same with turmeric; in addition to reducing OA pain, benefits include any number of health conditions, so I’ll be keeping that too.
The CoQ10 is useful in reducing statin-induced myopathy which includes pain, weakness, cramping and fatigue. As both my dad and I have experienced this myopathy, and I’m on Pravastatin (with supposedly “less” myopathy), I’ll be keeping this one. There are various mitochondrial associated benefits as well—actually too many for inclusion here.
The magnesium is to aid muscle recovery from exercise and reduce cramps. Giving myself credit here: I’m currently doing Pilates twice per week, core and balance class twice per week, water aerobics twice per week, and yoga weekly, in addition to gardening. (Yes, retirement is da bomb!) I’ll keep my magnesium, please and thank you. Hmm, I’ve run through my word allotment and have too many remaining supplements to go, so tune in next issue for T2D and dyslipidemia.
So, what has this shared semiannual review done with my supplement list? I’m dumping the multivitamin (and probably the biotin, foreshadowing the next article installment…), and continuing the turmeric, CoQ10, B12, magnesium, and boswellia. I’ll give some consideration to releasing the high-dose vitamin D with the input of my physician.
Women’s MVI Vitafusion 2 qD
Biotin 5000 mcg qD pending
Turmeric 2 grams qD
Omega 3 2000 mg (vegan, not fish oil): Pending
CoQ10 100 mg qD: Yes!
Amla fruit 1 gram qD: Pending
B12 1000 mcg qD: Yes!
Magnesium oxide 300 mg qD: Yes!
Vitamin D3 5000 IU gelcap qD: Discussion with internist, possible discontinuation and recheck levels
Boswellia serrata 500 mg qD: Yes!
Quercetin 500 mg with bromelain 100 mg qD: Pending
I believe that I, too, am going through a phase.
