We receive many questions about supplements at our center, as you can imagine. Alex Vasquez, ND, DC, who is the editor of the Naturopathy Digest, addresses a number of these questions concerning why nutritional interventions often do not perform at the level naturopathic physicians and their patients would like. Here is a brief summary of some of his points:
1. Inadequate dosing: one reason that nutritional interventions or supplements do not work as expected is because they are not taken at the proper dose. I commonly see this with supplements that require dosing three times a day, for example. Often, one of those three doses is missed. In terms of conventional medicine, Dr. Vasquez gives the example of researchers doing studies in which they dose patients with vitamin D at 400-800 IU per day and then concluding that it is ineffective, when the physiologic requirement for vitamin D in adults is approximately 3,000 to 5,000 IU per day. Clearly a dose that is only 10 to 20 percent of the adequate dose is not going to work.
2. Dosing duration: unlike pharmacological interventions that act in a matter of days, reversing long-term nutritional deficiencies can take months or years. This leads to at least two potential problems. The first is that many scientific studies are of short duration and therefore underestimate the positive impact nutritional interventions or supplements could have if given enough time. The second is that many patients become discouraged when result are not rapid and give up on the intervention too quickly.
3. Failure to use the right form: this is a big topic that is touched on elsewhere (see Challenges of Supplementation: Effectiveness). In a nutshell, the issue here is being sure to purchase the correct form of the supplement that has been recommended to you. A good example is popular supplement glucosamine, which comes in two forms. Glucosamine sulfate (GS) is the form that has been shown to be beneficial in various studies. Glucosamine hydrochloride (G HCL), however, appears to be useless. Unfortunately, this does not stop stores and Internet sites from selling it.A very unfortunate aspect of this occurs when researchers fail to use the correct form of a supplement, come to the wrong conclusions, and then misinform the public. This actually occurred with the infamous Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) that was published in the New England Journal of Medicine. In addition to other design problems with this study, the researchers used the G HCL form, rather then the more clinically useful GS form. Was this simply sloppy research procedure or was there a more Machiavellian motive? Predictably, headlines appeared claiming glucosamine was not helpful. What is truly not helpful is “scientists” who do not do their homework.
4. Failure to ensure adequacy of co-nutrients: the positive impact of nutrition or supplementation does not occur in isolation. The components of food and supplements often require certain metabolic conditions in order to be utilized properly. Critical metabolic reactions in your body require co-nutrients such as vitamins and/or minerals in order to successfully move forward. If one of these co-nutrients is missing, the success you are looking for from your nutritional intervention or supplement(s) may not happen.One example of this can be found in supplementing with flaxseed oil, a good source of omega 3 fatty acids. What is often not appreciated is that turning flaxseed oil into its useful counterparts (EPA, DHA) requires B vitamins, vitamin C, zinc, and magnesium. If you are deficient in any of these, you will not reap the maximum benefits of taking flax seed oil. This is why using a high-quality multivitamin or eating a nutrient-dense, high-quality diet can assist in increasing the effectiveness of other interventions.
5. Use of mislabeled supplements: as I have discussed elsewhere (see Challenges of Supplementation: Purity & Safety), there are some supplement vendors who are dishonest in the labeling of their products. This is a systemic problem that is difficult to address. Two ways we do this is by working with vendors with a proven record for integrity and safety, as well as using a Quality Control audit.
6. Taking supplements with food or away from food: it is fairly well known that some drugs should be taken with food and some away from food. The same is true with supplements. Multivitamins, for example, should be taken with food, while proteolytic enzymes like Wobenzym should be taken away from food for optimal effectiveness.