Supplements

[doodle]

Interesting article...apparently the unregulated supplement market isn't as clean and wholesome as many would like to think.

http://www.nytimes.com/2013/12/15/opini ... inion&_r=0

[Benko]

The main stream media is biased against supplements across the board e.g. 2nd paragraph of the linked article

"Here’s the problem: The Joint Commission, which is responsible for hospital accreditation in the United States, requires that dietary supplements be treated like drugs. It makes sense: Vitamins, amino acids, herbs, minerals and other botanicals have pharmacological effects. So they are drugs."

One could certainly make the case that herbs are drug like (but even this is oversimplified), but vitamins and minerals are not drug like (with a few exceptions in whopping doses). So the writer of the article does not know what they are talking about.

NB: this does not mean that I am suggesting you buy your supplements in the drugstore or take 500 pills worth if you don't know what you are doing.  I would suggest buying from reliable brands e.g. Now brand, or jarrow brand.  There are others, and I have no commercial interest.  Oh and if you need an ayurvedic supplement buy from banyan and a chinese herbal supplement ask me, I have a good brand I can look up. 

I suppose I shouldn't be surprised that there is so much anti-supplement bias.  You can be in charge of your health using your doctor as a consultant, or you can defer to your doctor always do what they say and never question things or research things on your own.  Which do you think the NY times/your doctor (who probably knows little about supplements) would suggest?

How many more people die from approved drugs than supplements?

[Benko]

another biased article against supplements:

http://www.jarrow.com/articles/release/ ... le_on_GMPS

Jarrow's reply:
http://www.jarrow.com/eMarketing/JFI-Tr ... 7-2012.pdf

[Pointedstick]

Goodness gracious, we couldn't have people taking care of their own health, could we? Heavens no. Better call in some expensive experts to help people make the decisions they couldn't possibly make themselves.

Say, would you like some thalidomide? It was approved by all the major government regulatory bodies, after all, so it must be safe!

[Benko]

Goodness gracious, we couldn't have people taking care of their own health, could we? Heavens no. Better call in some expensive experts to help people make the decisions they couldn't possible make themselves.

+1

"Better call in some expensive experts to help people make the decisions they couldn't possible make themselves"

The last half century has been spent convincing people of this, and it has largely worked.  And while no politician you could name (e.g. not Christy, not Rand Paul, etc etc) is a threat to our masters, people thinking for themselves is scary and cannot be tolerated. 

[Coffee]

How about just eating natural, unprocessed, organic, clean food instead? And as a result: Bypass the whole issue.

[Benko]

How about just eating natural, unprocessed, organic, clean food instead? And as a result: Bypass the whole issue.

Good point, but that does not replace the need for EVERYONE taking fish oil and vit D.  Vit K perhaps as well. 

[ns2]

How about just eating natural, unprocessed, organic, clean food instead? And as a result: Bypass the whole issue.

Good point, but that does not replace the need for EVERYONE taking fish oil and vit D.  Vit K perhaps as well.

Wasn't there just a study or two casting doubt on the benefits of fish oil supplements? Same with Vitamin D and it's purported benefits in disease prevention?

I took fish oil for a long time (actually 1000mg krill oil) and the only thing I noticed was easy bruising and frequent purpura's on my forearms.

The only thing I take nowadays is a vitamin B-6 supplement as there seems to be some good science suggesting those over 60 ought to take it.

I'm not for government regulation at all but I think a healthy skepticism about supplements is a very good idea.

[Benko]

How about just eating natural, unprocessed, organic, clean food instead? And as a result: Bypass the whole issue.

Good point, but that does not replace the need for EVERYONE taking fish oil and vit D.  Vit K perhaps as well.

Wasn't there just a study or two casting doubt on the benefits of fish oil supplements? Same with Vitamin D and it's purported benefits in disease prevention?

I took fish oil for a long time (actually 1000mg krill oil) and the only thing I noticed was easy bruising and frequent purpura's on my forearms.

The only thing I take nowadays is a vitamin B-6 supplement as there seems to be some good science suggesting those over 60 ought to take it.

I'm not for government regulation at all but I think a healthy skepticism about supplements is a very good idea.

1.  I believe you mean B12 for those over 50 or 60 years of age. 

2.  My views about supplements have evolved over the years and I am certainly more skeptical about supplements.  I try whenever possible to get as many nutrients from diet and not supplements.  Having said that, I've listed the ones that most people will not get enough of from diet (or sunlight for vit D).  You can and should have your vit D levels tested and if you are not taking any you will very likely be below the levels and even the medical lab will tell you that you are deficient.    Similarly you can get your level of omega 3/omega 6 in your body tested and you'll likely find you have too much omega 6 and not enough omega 3. 

3.  "Wasn't there just a study or two"

There are hundreds of studies on the benefits of fish oil (I'm somewhat skeptical of krill oil).  Now depending on your diet perhaps you get enough omega 3s.  Most people will not.

4.  There are other supplements depending on the situation which you cannot get  from diet and some may want to supplement with e.g. Co Q-10, Lipoic acid.

5. Examine.com  has very good reviews on supplements, chinese and other herbs, etc.  There are very conservative and useful in deciding what to take or not. 

6.  And I never understand statements like this one:

"I took fish oil for a long time (actually 1000mg krill oil) and the only thing I noticed was easy bruising and frequent purpura's on my forearms."

What benefits were you expecting?  For most supplements you will not notice any difference (unless you are treating a problem).  Your omega 3 to omega 6 levels should improve.

Purpura you should not have.  You will bleed easier than before taking fish oil.  There is a spectrum from bleeding too easily to the other end which many people are at.  Clotting too quickly is not a good thing and I would much rather bleed a little too easy than clot too easy.

[Gumby]

I'm not doubting that there are short term benefits to fish oil, but the long term benefits have yet to be established:

Chris Kresser: When it comes to fish oil, more is not better

Article summary

The benefits of fish oil supplementation have been grossly overstated

Most of the studies showing fish oil benefits are short-term, lasting less than one year

The only fish oil study lasting more than four years showed an increase in heart disease and sudden death

Fish oil is highly unstable and vulnerable to oxidative damage

There’s no evidence that healthy people benefit from fish oil supplementation

Taking several grams of fish oil per day may be hazardous to your health

Source: Chris Kresser: When it comes to fish oil, more is not better

It's a pretty detailed article if you want to delve further. He adds a note at the end by saying:

Note: As always, I’m open to discussion and dissenting views. But please don’t link to short-term studies on the efficacy of fish oil, because as I’ve explained in this article, it’s the long-term effects that we’re primarily concerned with. I’d be interested in seeing any studies longer than 2 years showing that 1) fish oil benefits extend beyond reducing arrhythmia in patients with chronic heart failure and patients who have recently survived a heart attack, 2) doses higher than 1g/d produce a larger benefit than doses of 1g/d, and (most importantly) 3) doses of >1g/d or higher do not increase the risk of heart disease or death.

Source: Chris Kresser: When it comes to fish oil, more is not better

In a more recent post, from this year, he adds:

However, while eating cold-water fatty fish is unlikely to cause health problems, I’ve written before about the possible dangers of excessive fish oil supplementation. Most of the studies showing fish oil benefits are short-term, lasting less than one year, and the benefits of fish oil supplementation have been grossly overstated in the media. It’s possible that fish oil supplementation may even cause additional inflammation due to the high concentration of easily oxidized omega-3 polyunsaturated fats when taking a supplement. That’s why the best approach to reduce inflammation is to dramatically reduce intake of omega-6 fat, found in industrial seed oils and processed and refined foods, and then eat a nutrient-dense, whole-foods based diet that includes fatty fish, shellfish and organ meats. This mimics our ancestral diet and is the safest and most sane approach to meeting our omega-3 needs – which as Chris Masterjohn points out, are much lower than commonly assumed.

I still recommend eating fatty fish a couple times per week, and taking cod liver oil daily, presuming your diet is as I described above. What I don’t endorse is taking several grams per day of fish oil, especially for an extended period of time.

Source: http://chriskresser.com/the-roundup-edition-10

[Reub]

And what makes Kresser and Jamimet the final authorities on nutrition, health, and supplements?

[Gumby]

And what makes Kresser and Jamimet the final authorities on nutrition, health, and supplements?

It's not about being final authorities. It's about being skeptical about the supposed "benefits" you hear about in the media and looking for evidence to support long term supplementation of something. Kresser raises some excellent points that are difficult to dispute — the long term evidence is pretty poor for taking grams of fish oil every day for many years.

Read the articles (Kresser's and Masterjohn's) and see if you can dispute them. Are you able to find evidence that supports long term Fish Oil supplementation in healthy people? Just like Kresser, I'm having trouble finding the evidence that everyone thinks is there.

This may come as a surprise to you, with all of the current media hoopla about the benefits of fish oil supplementation. Yet the vast majority of the studies done that have shown a benefit have been short-term, lasting less than one year. The only trial lasting more than four years, the DART 2 trial, showed that fish oil capsules actually increase the risk of heart disease and sudden death.

A 2004 Cochrane meta-analysis of trials lasting longer than six months suggests that the cardiovascular benefits of fish oil have been dramatically over-stated. They analyzed 79 trials overall, and pooled data from 48 trials that met their criteria. The only effect that could be distinguished from chance was a reduced risk of heart failure. Fish oil provided no reduction in total or cardiovascular mortality.

Source: Chris Kresser: When it comes to fish oil, more is not better

I'm aware that the DART 2 trial and the 2004 Cochrane review isn't airtight. But, unless you can find very good evidence for long term Fish Oil supplementation, I'm just not that impressed by it. I'd much rather just eat some fish on a regular basis.

[Reub]

I'm just not sure what "healthy people" means. What if you are slightly overweight? Or have somewhat elevated blood sugar, cholesterol, or CRP/homocysteine markers? Or a little arthritis? Or digestive issues? Or sleeplessness? Or dry skin? Or tinnitus? Or catch colds easily? Or elevated PSA? Or plantar fasciitis? Or depression? Or a sluggish thyroid? Or are a little forgetful? Or you eat a normal American diet? Are you still healthy if you have any of these? Isn't there a place for supplementation for most or many of these unhealthy conditions?

[Gumby]

I'm just not sure what "healthy people" means. What if you are slightly overweight? Or have somewhat elevated blood sugar, cholesterol, or CRP/homocysteine markers? Or a little arthritis? Or digestive issues? Or sleeplessness? Or dry skin? Or tinnitus? Or catch colds easily? Or elevated PSA? Or plantar fasciitis? Or depression? Or a sluggish thyroid? Or are a little forgetful? Or you eat a normal American diet? Are you still healthy if you have any of these? Isn't there a place for supplementation for most or many of these unhealthy conditions?

You should make your own decisions. I'm sure there's nothing wrong with supplementing fish oil for a year or two — it is supposed to be therapeutic over the short term (that's what the studies say, at least). The question is whether or not everyone on the planet should be gulping down fish oil every day for years on end — and I don't think that has been answered yet.

[Reub]

I am sure that there are some perfectly "healthy" people out there somewhere who would not benefit from any supplementation but they might be few and hard to find. And hopefully they would live in a Southern latitude so as not to need a vitamin D supplement either.

[Gumby]

I am sure that there are some perfectly "healthy" people out there somewhere who would not benefit from any supplementation but they might be few and hard to find. And hopefully they would live in a Southern latitude so as not to need a vitamin D supplement either.

No one ever said anything about not supplementing. You figure out what you can't obtain and you supplement accordingly. If you make an effort to reduce Omega 6, and eat some fish, it's not hard to balance your Omega 3/6 ratio.

[Benko]

. If you make an effort to reduce Omega 6, and eat some fish, it's not hard to balance your Omega 3/6 ratio.

Really?  I'd be curious what one has to do dietwise to balance the omega 6/3 ratio.  I just discovered nuts even the good ones have LOTS of omega 6 e.g.

1.  here is the data for raw Macademia nuts:

Total Omega-3 fatty acids
276
mg

Total Omega-6 fatty acids
1737
mg

6:1 omega 6:Omega 3  Walnuts are no better. 
http://nutritiondata.self.com/facts/nut ... cts/3123/2
Again, one does not have to guess, you can have bloodwork and measured.  If you can achieve balance through diet, great.  And I never advocated large doses (for health people with no medical problems).

2. Reub.

I view Kresser as very sane and tend to agree with almost everything of his I've read.

Jaminet, well the perfect health diet is probably wonderful for people with gut issues. 

[Benko]

Even olive oil is very heavy omega 6: omega 3:

Olive oil is on average 10% linoleic acid (an omega-6 oil) and less than 1% linolenic acid (an omega-3 oil), therefore the ratio is 10:1 on average.

[Benko]

From Kresser here:

how-much-omega-3-is-enough
http://chriskresser.com/how-much-omega- ... on-omega-6

"This is why the best approach is to limit n-6 intake as much as possible, ideally to less than 2% of calories, and moderately increase n-3 intake. 0.35g/d of DHA and EPA can easily be obtained by eating a 4 oz. portion of salmon twice a week."

But he points out earlier in the article that limiting omega 6s to that low is difficult:

"imiting n-6 to less than 2% of calories is difficult to do even when vegetable oils are eliminated entirely. Poultry, pork, nuts, avocados and eggs are all significant sources of n-6. I’ve listed the n-6 content per 100g of these foods below:

    Walnuts: 38.1g
    Chicken, with skin: 2.9g
    Avocado: 1.7g
    Pork, with fat: 1.3g
    Eggs: 1.3g

AND GUMBY DO YOU BELIEVE COD LIVER OIL BETTER THAN ANY OTHER FISH OIL AND IF SO, WHY?

[Gumby]

I just discovered nuts even the good ones have LOTS of omega 6

Just discovered? MG and I have been saying that for a long time now!

And, both Jaminet and Kresser have been saying that for years.

Even olive oil is very heavy omega 6: omega 3:

Olive oil is on average 10% linoleic acid (an omega-6 oil) and less than 1% linolenic acid (an omega-3 oil), therefore the ratio is 10:1 on average.

Correct. Again, Kresser and Jaminet have been saying that for years. They recommend coconut oil, butter and beef tallow. Olive oil isn't totally shunned by Kresser/Jaminet — they just tend to use it less often — generally unheated, such as on salads.

From Kresser here:

how-much-omega-3-is-enough
http://chriskresser.com/how-much-omega- ... on-omega-6

"This is why the best approach is to limit n-6 intake as much as possible, ideally to less than 2% of calories, and moderately increase n-3 intake. 0.35g/d of DHA and EPA can easily be obtained by eating a 4 oz. portion of salmon twice a week."

Yep. That's exactly what I try to do.

But he points out earlier in the article that limiting omega 6s to that low is difficult:

"imiting n-6 to less than 2% of calories is difficult to do even when vegetable oils are eliminated entirely. Poultry, pork, nuts, avocados and eggs are all significant sources of n-6. I’ve listed the n-6 content per 100g of these foods below:

    Walnuts: 38.1g
    Chicken, with skin: 2.9g
    Avocado: 1.7g
    Pork, with fat: 1.3g
    Eggs: 1.3g

Correct. But, even Kresser and Jaminet don't shun these foods entirely — they just don't eat them every day. Kresser and Jaminet both recommend eggs (Jaminet recommends 3 yolks per day). They believe the benefit from eggs outweighs the negatives — and they really don't weigh that much to begin with. Kresser gets a whole hog for his family from a local farm and eats bacon and pork — though, again, he says he doesn't consider it to be a major "staple" of his diet (Jaminet doesn't recommend pork). Jaminet recommends avocados (again, not every day). And they both describe chicken as "mediocre" and not something to gorge on.

The Walnuts I think we can all do without as long as we are eating some fish. Jaminet recommends nuts as a "pleasure" food — to be eaten in moderation (see his chart). Kresser agrees with Jaminet there too. The two of them have very similar recommendations.

AND GUMBY DO YOU BELIEVE COD LIVER OIL BETTER THAN ANY OTHER FISH OIL AND IF SO, WHY?

I try to take advice from all spectrums of the ancestral diet community. Fermented Cod Liver Oil (FCLO) is a recommendation from WAPF (which Kresser also follows with his family). So, he mixes Paleo with some WAPF. Kresser recommends FCLO and talks about it here:

Some may ask why I continue to recommend fermented cod liver oil (FCLO), in light of everything I’ve shared in this article. There are a few reasons. First, I view FCLO as primarily a source of fat-soluble vitamins (A, D, K2 and E) – not EPA and DHA. Second, in the context of a nutrient-dense diet that excludes industrial seed oils and refined sugar, and is adequate in vitamin B6, biotin, calcium, magnesium and arachidonic acid, the risk of oxidative damage that may occur with 1g/d of cod liver oils is outweighed by the benefits of the fat-soluble vitamins.

So I still recommend eating fatty fish a couple times per week, and taking cod liver oil daily, presuming your diet is as I described above. What I don’t endorse is taking several grams per day of fish oil, especially for an extended period of time. Unfortunately this advice is becoming more and more common in the nutrition world.

More is not always better, despite our tendency to believe it is.

Source: http://chriskresser.com/when-it-comes-t ... not-better

And it's true. FCLO isn't a huge source of EPA/DHA compared to fish oil. It's sort of like a watered down fish oil that happens to be high in fat soluble vitamins. Many WAPFers take it with High Vitamin Butter Oil (HVBO), but that's just mainly supposed to be a source of K2 (aka "Activator X"), so many people just replace HVBO with a cheaper K2 and then take their FCLO with a fatty meal.

[Gumby]

I had my Omega 3/6 ratio tested last year, following those recommendations, and mine was almost a 1:1 ratio. Even I was shocked — I wasn't expecting it to be that good.

But, I suspect eating at restaurants is where it becomes challenging. Most of the food I eat I cook myself. But, when you go to a restaurant, I think you are typically being served Omega 6 oils. Even restaurant olive oil tends to be doctored with industrial seed oils. So, I suppose that's where it becomes challenging for many people. You can ask for your food to be prepared in butter (that's what Mark Sisson does), but the waiters often seem to make it sound like it's bit of a chore for the kitchen to change their routines — and there's no guarantee that they actually do it.

http://www.marksdailyapple.com/how-to-e ... ining-out/

As Sisson points out, you have to chalk up eating out to your "20" in the 80/20 rule

[Reub]

I'm sorry. I thought that this thread was about the value of supplements in general and not just how one's Omega 3/6 ratio could be altered via eating like a caveman.

[Gumby]

I'm sorry. I thought that this thread was about the value of supplements in general and not just how one's Omega 3/6 ratio could be altered via eating like a caveman.

What's up with the negative attitude? To understand supplementation, you need to understand Pericles's rule, in that the dose makes the poison. Too much of any supplement (Omega-3s included) can be toxic. So, we try to figure out how much of something we really need.

You've said in the past that you regularly take a lot of Fish Oil (I believe you've upped it to 4 grams/day). Well, this is relevant to you.

[Gumby]

By the way, the main reason why Fish Oil is probably inferior to eating fish is that Fish Oil isn't fresh. It's likely gone rancid by the time you've eaten it.

Omega-3 fats are chemically fragile: their carbon double bonds are easily oxidized.  EPA has 5 double bonds and DHA 6 double bonds, so they are the most vulnerable of all dietary fats.  They easily become rancid.

Fish oil capsules often sit on a shelf for months before they are eaten.  If someone offered you the opportunity to eat salmon that had been sitting on a shelf for six months, would you do it?  No? Then why accept the same deal with salmon oil?...

...It’s not possible to make capsules that won’t let molecules of air inside. That’s why capsules usually contain vitamin E or other antioxidants.

There are various papers in Pubmed talking about oxidation of omega-3s in capsules. See e.g. http://pmid.us/20222732, http://pmid.us/11902962, just for a start.

Source: http://perfecthealthdiet.com/2010/06/fi ... -capsules/
and comment

The Japanese turn up their nose at fish that's more than a day old, and they tend to eat a good amount of their fish raw which helps preserve the carbon double bonds and reduces the potential for oxidation. Keep in mind that your stomach is a boiler of sorts, so whatever you put in it tends to oxidize a bit. So, it helps to not feed yourself oils that are already rancid. Fresh fish is just a better way to obtain these fatty acids.

This is not to say that there is no place for Fish Oil supplementation. People who just can't stand to be bothered by eating fish would probably do OK with low doses of fish oil.

[flyingpylon]

I had a doctor tell me to switch from cod liver oil to fish oil because there are more toxins present in the liver (or something along those lines).  Is that just bad advice?  If you compare the labels on a bottle of fish oil vs cod liver oil there is very little to distinguish between them which makes it difficult for consumers to know which to choose.  I'd be interested to know if anyone has more info/opinions on this or could point me to a good resource.