Dr Rupy: In today's episode, I'm talking about supplements that I think are not as useful as the claims make out. They're pretty ubiquitous in supermarkets and health food stores, and I'm also going to talk about the ones that I think may have use. It warrants a bit more attention on the podcast, considering I get asked about them so much. I'm a user of supplements myself. We should do deep dives into individual ones, but I thought I'd test the waters by doing a broad overview of supplements that I think are worth it, not worth it, get your reaction. If you want me to do more episodes like this, I'm very happy to, and we're going to do a lot more dives like this on the newsletter, the seasonal Sundays newsletter, and of course, all the other content that we put out on the podcast as well. So if you're interested, hit me up on Twitter, send us some feedback via the newsletter. I look through all the feedback that we get on the newsletter feedback page via Google, and I hope you enjoy this podcast. Remember, you can download the Doctor's Kitchen app for free to get access to all of our recipes and specific suggestions tailored to your health needs, and you can watch this on YouTube right now. It's a really easy way to support the podcast. Go to YouTube, subscribe, check out the other videos that we've got. We're going to be doing some bespoke and only YouTube available videos as well, and tons more content on recipes that you're going to absolutely dig. So thanks so much and on to the podcast.
Dr Rupy: Today we are talking about supplements that I think are not worth your money and some supplements that I think might be worth an investment. The reason why I'm talking about this today is because everybody always asks me, whether I'm doing a chef demo or I'm in clinic with patients, what supplements they should be taking and whether the supplements that they are taking are actually worth it or not. So today we're going to dive into some of the things that I think are not worth it and are overhyped and some that may have a bit of evidence depending on the person. And that's rule number one. The first thing I want to say is that every supplement could have a use, but it needs to be personalised to the individual and it really depends on your physiological state. So a supplement that I might be ragging on today may have benefits for you. And when in doubt, number two, please refer to your health professional for any further guidance if you've been told to take one of these supplements, because you may be in the small category of people that would require said supplement and it might be beneficial for you, depending again on your disease state, condition, etc. So, with that being said, let's start off with number one, the darling of all supplements, the multivitamin. I really don't think the majority of people should be taking a multivitamin. The reason why is because first, most multivitamins are just concoctions of synthetic chemicals that won't actually do anything in your body. And the worst outcome is that they could actually be doing harm. Multivitamins are sort of the general foundational supplement that most people think that they should be taking to support a healthy balanced diet. When in reality, you should be able to get most of your nutrition from a healthy balanced diet, one that is diverse, colourful, largely plants, has lots of fibre. You should be getting adequate amounts of all the different recommended daily intakes for vitamins and minerals. There may be some circumstances where it is beneficial. For children, particularly younger children who might not be having the best diet, there may be a role. In adults, for certain people who have disease states that lack the that do not enable them to absorb as much from their food, so a digestive issue, for example, they may benefit from having a multivitamin. Outside of that, and I think there's quite a broad category here of people that are taking it outside of those two unique conditions, or the number of conditions that there could be for a multivitamin, I don't think it has benefits and I don't think we should be spending money on it, including some of the powdered forms of multivitamins that quote unquote give you foundational support. I just don't think there's any use for those at all. In the best scenario, you're just wasting your money. In the worst scenario, you're actually doing harm. And there are actually a number of studies that have shown that multivitamins or collections of key vitamins like vitamin A, C and E, for example, have been harmful for those who have precancerous or cancerous lesions because what you're essentially doing is giving unfiltered amounts of what are promoters of cell growth and those elements can be hijacked by cancerous cells to promote growth. So in certain large trials, some of which I'll link in the show notes, they've been shown to actually have worse cancer outcomes. So multivitamins are not necessarily inert and I really don't think we should be spending any money on them whatsoever unless there is a clear clinical indication. Number two, calcium. So again, unless you're being prescribed this for a very specific reason, calcium is something that I would be very careful about. And the reason why is because unopposed calcium supplementation can lead to a number of different issues. There is evidence that it can be worsening calcification of your arteries. So calcium and the calcification of your arteries is actually quite a late stage of cardiovascular disease. It's essentially where there is fossilification of your arteries. You're getting actual clogging of the arteries and it's quite a late stage and we even do CT calcium scores to determine just how progressed atherosclerosis is. Even in combination, there may be some issues with these as well. So Adcal-D3 is a very popular supplement that is given on the NHS. Again, please refer to your doctor or your GP if you are on one of these medications to ensure that you're on it for the right reason. There are positive effects on skeletal health with adequate calcium and vitamin D3 supplementation. That is very, very well established. However, there may be some negative impacts as well for unopposed, particularly unopposed calcium. Vitamin D3, again, is very popular. I am a proponent for vitamin D3. That's actually one of the supplements that I'm going to come to a little bit later on in terms of one of the supplements that may be worth it. And there's a whole host of reasons as to why somebody would be on vitamin D3 and benefit from vitamin D3. There's a reduced incidence of autoimmune conditions potentially, maybe even heart attacks. Looking at something called the VITAL study, V I T A L, the studies always have abbreviations. They showed that a combination of vitamin D3 and omega-3 of varying doses actually had beneficial effects on the cardiovascular outcomes. Vitamin D is also responsible and required for the synthesis of calcium transport protein calbindin, which actually facilitates the uptake of calcium through the intestinal mucosa. So it's again, something that has a multitude of effects, but certainly on calcium metabolism is very important. However, if you're just taking vitamin D3 or you're just taking calcium supplementation, both of which will be beneficial for certain things, it may lead to the risk of something called hypercalcaemia, which is a fancy word for saying high calcium levels in your blood. In fact, in a systematic review and meta-analysis that was published in 2016 in the American Journal of Clinical Nutrition, they stated long-term vitamin D supplementation resulted in an increased risk of hypercalcaemia, calcium in your blood, and hypercalciuria, which is calcium in your urine. Now that didn't necessarily result in excess amounts of renal stones, at least not significantly anyway, but their suggestion was, look, this is good. It is calcium and D3 is great at improving bone mineral density, but it needs something else. And the extra thing is vitamin K2. The combination effect of vitamin K and vitamin D on human bone quality was shown in another meta-analysis of randomised control trials. I believe this one was published in nutrients, and their conclusion was that the combination of vitamin K and D can significantly increase the total bone mineral density and significantly decrease undercarboxylated osteocalcin and a more favourable effect is expected when vitamin K2 is used. This is all a fancy way of saying we can improve bone quality whilst reducing the risks of excess calcium in the body that can contribute to an increased risk of cardiovascular disease. The reason why K2 is important is because, and it has an important role specifically in cardiovascular health, is through the regulation of calcium homeostasis, fancy way of saying calcium balance. And what K2 does is it helps regulate soft tissue calcification through the activation of anti-calcific proteins known as matrix GLA proteins. Again, all a fancy way of saying K2 is responsible for ensuring that calcium does not result in the arteries, particularly those surrounding the heart, that can lead to, obviously, stenosis of those, so narrowing of those arteries and cardiovascular disease and heart attacks ultimately. And that was actually a direct quote from a paper that was published in openheart.bmj.com. I'll leave the links in the show notes as well. So my suggestion would be not to supplement in isolation. And this is going to be a common theme in today's episode. Not to have vitamin D3 and calcium, not to have calcium alone, specifically, not even to have D3 alone either for these reasons, but it needs to be in combination with something called MK7. That is vitamin K2, specifically vitamin K2 menaquinone, sorry, 7. And that this is something that's very important and it isn't really well recognised, but today you are seeing vitamin D3 in combination with K2 more, more commonly. And it's for this reason, it's because people are getting wise to the fact that when you're supplementing in isolation, you are throwing out some balance. And that'll be a, like I said, a common theme. Okay. So that's, that's calcium and vitamin D3, I guess. Zinc. So zinc gained a lot of popularity because it was shown in some ways to reduce the severity and duration of viral illnesses. It can have an impact on viruses and lessen the stronghold of viruses, particularly things like respiratory syncytial virus or common cold viruses. However, copper and zinc compete for absorption sites in the small intestine. So if you're having a lot of zinc around, then your copper tends to lose out. And as a result, copper deficiency may develop. Now the reason why I'm specifically calling out zinc rather than other minerals is because I feel that zinc is quite heavily promoted, particularly in a post-pandemic world where everyone's quite understandably concerned about respiratory viruses. And if you're high dosing with zinc, you could be causing copper deficiencies because of the fact that these minerals work in antagonistic and synergistic pairs. So in certain cases, when you have a high amount of a mineral, it can reduce the availability of other minerals. In this case, zinc and copper. These are things to really think about because unless you have a specific, determined nutrient deficiency, I think you should really steer clear of individual supplementation unless directed so for a very, very clear reason and in cognizance of the fact that if you are supplementing with one thing, you are disturbing the balance and you may need to supplement with other things or lower said supplementation or change other things in your lifestyle. So this is, this is something that I think not a lot of people are aware of. So in, in, in conclusion for the things that I really don't think are worth it, multivitamins, single supplementation of calcium, single supplementation of vitamin D3, zinc. What things do I look at that I think are potentially worth it? Omega-3. Now I've, I've talked about omega-3 already on the pod. So there was the study, the VITAL study, looking at omega-3 supplementation with vitamin D3. Now, discarding everything that I've just said about single vitamin D3 supplementation, what did they show? So they showed that with the combination of D3 and omega-3, there was a reduction in the incidence of autoimmune conditions, maybe even heart attacks as well, looking at the same data. And the doses that they used were variable, which is why it's not, not the best study. They used vitamin D 2,000 international units per day, and they also used on average 1,000 milligrams per day of omega-3. And that was split between eicosapentaenoic acid, also abbreviated to EPA, and docosahexaenoic acid, which is also known as DHA. And the the relative concentration or the the difference between those two were 460 milligrams for EPA and 380 DHA, but there was variation in in the amounts of those because this was a combined study looking at a whole bunch of of of studies. That does appear to have some benefits. So omega-3, I think, does have some cardiovascular benefits for sure. It appears to have an anti-inflammatory effect as well. We tend not to be able to consume enough omega-3 in those doses from food. We'd have to be eating quite a bit of small oily fish to achieve that. Now, I love my oily fish. I'll have anchovies and herring and sardines. I love small fish, and it's very easy for me to consume a large amount, but even with the amounts that I consume, it's quite difficult to get to those EPA and DHA levels that have been shown to be beneficial. And actually, the amount that they use in that VITAL study is not as high as actually how much we should be consuming to have the potential best benefits. So despite the inconclusive nature of cardiovascular benefits, I still think that a good quality EPA and DHA supplement of at least a gram across the EPA and DHA is is worth it. But it may it may need even more than that, to be honest. It may need more than the gram. And and there are pharmaceutical doses of omega-3 that are being used, particularly in the States and being prescribed by cardiologists that may have even more benefits that I'm that I'm aware of. Pulling in the the sort of plant-based community here, algae supplements are an option. And actually, there may even be a cleaner option as well, because fish oils, due to the fact that they're highly processed, they have to be extracted using certain techniques that can actually destroy some of those omega-3 fats. The way they're stored has to be quite strict to ensure that there's no effect on the quality of the oil that can cause rancidity. A lot of the omega-3 supplements that you find, particularly the cheap sources, are not great quality and actually might be having a pro-inflammatory effect. This is where it gets very, very complicated. So an algae source could actually be a better source of EPA and DHA. The issue with algae sources is that they tend to be a lot more expensive and they tend to be in lower doses. You'd have to buy quite a bit and consume quite a bit of these algae-based omega-3 sources to have the same effects. And I'm not aware as of yet of any particular study specifically looking at algae-sourced omega-3 when looking at cardiovascular outcomes and inflammation outcomes as well. So I would, I would say omega-3 is probably worth your money, but I would really go for a decent source as well. The other thing, just to reiterate that I said earlier, D3 and K2. I am a big vitamin D3 fan. I think most people are deficient in vitamin D3. D3 acts like a steroid hormone, so it's not just a vitamin. In fact, it doesn't act like a vitamin, it acts more like a steroid hormone. It's a master gene regulator. So it has an impact on multiple things, not just calcium metabolism, but also inflammation metabolism. It has an impact on your weight and cardiovascular health as well, as evidenced by the study that I mentioned earlier. So I think a decent vitamin D3 plus K2 is useful as well. Food-based supplements, that's the third thing I want to talk about. So the the beauty of food-based supplements is that you're not just getting a single nutrient or a single mineral or vitamin, you're getting a combination of elements that nature has perfected. So the things that I include in my daily repertoire of ingredients that I want to consume include dehydrated berries that you can get in powdered form, cacao, which is raw chocolate that has a beautiful array of flavonoids and lots of protein in as well, hemp seeds, I know that's not a particular supplement, but hemp seeds that are shelled because of again, the protein value and the good quality fats. You can also get oat bran that has a cholesterol lowering effect. So that's not the same as oats per se, but you're just specifically getting the bran. So again, a whole food-based supplement. Those are the kind of food-based supplements that I think could be easy additions to your porridge, your smoothie, your salad, however you want to take them. I personally do it old school. I whack it in some water and I just down it myself. It doesn't taste particularly nice, and I do that with my my green supplement. But yeah, that's that those are the kind of supplements that I think are going to become a lot more popular in the future as people get wise to the fact that single nutrient isolated supplementation is not a good thing unless there is a very, very specific clinical reason as to why you're doing it. That being said, most greens supplements, including the OG of green supplements, everyone knows what I'm talking about, that brand, I think is mainly a multivitamin. If you look at the back of the packet, it's just multivitamins, and the inclusion of something like 70 different ingredients. And if you tot everything up, there is no way that you can get a decent dose of each of those individual ingredients in a single scoop that is what is being advertised. I don't think those have any benefits whatsoever. I haven't seen any evidence to suggest that they have beneficial impacts. I don't think they need to because their marketing campaign is amazing, and they've got incredible people promoting the brand, which is great. But purely from like a recommendation point of view, I really don't think I could recommend any of those green food supplements as they are today, anyway. The mushrooms, the chlorophyll, the spirulina, all the different ingredients that they've packed into one single scoop are surely not going to be in a big enough dose to have any measurable impact. So I don't spend my money on those and I don't think you should either. The other thing that I think potentially could be worth spending money on is turmeric. And whether you want to put it in your coffee or oat latte or whatever you want, or put it in food, which is the way I take it, two grams of turmeric, whole turmeric powder with a bit of black pepper to increase the availability because black pepper has piperine that causes mild irritation to your gut lining and that increases the absorption of turmeric, which is why it has this amazing increase in bioavailability. I think it's a great addition. Again, another whole food-based supplement that I think is worth the extra, what is it, three, four pounds per month if you actually go through a whole bottle of turmeric every day. I think it's a great addition to the diet and one that has benefits on inflammation, benefits on cognition, benefits on metabolism. There is a whole host of reasons as to why turmeric could be beneficial. And we've talked about it on the podcast as well with a number of different herbalists, and I'm very bullish on turmeric. And I'm not just saying that because I'm Indian and I want it to be, but I just think those beautiful, accessible ingredients that we all have access to should definitely be included into the diet because it has those potential anti-inflammation benefits. A new one that I think may be beneficial, but I need to do a little bit more research on, is actually creatine. Now, creatine may come as a surprise to people because I'm not your typical gym bro, I'm not doing content online around exercise sets and improving my benching number, but creatine actually may have some benefits, particularly for vegetarians and plant-based eaters. The reason why is because it appears to improve your muscle contractility, which is why it's very popular amongst gym goers. But as we age and we have degradation of muscle fibres, this could be something in combination with exercise that could have benefits in terms of muscle preservation and the prevention of sarcopenia, which is the essentially where your muscles dissolve and your fat to muscle ratio increases in a negative way, i.e. you're getting a lot more fat and less and less muscle, which which is unfortunately leading to a pro-inflammatory effect, which can accelerate other diseases of aging as well, as well as reducing your ability to to keep core stability. So creatine may have some benefits in that respect, as long as it's combined with exercise. The other potential lesser known effects may be on brain health and depression. Now, there isn't too much evidence around the impact of of creatine on on these effects on on cognitive effects, but I am very bullish on the fact that creatine is very, very well studied. It has a very low side effect profile. You don't need too much and actually it's very, very cheap. So I think this potentially could be worth it as well. And it's not just for men, it's for women as well. So creatine is a new one that I'm experimenting with personally and I think it could have legs as well. What my take-home messages are is number one, be supplement wary. There are a lot of supplements online and not every single supplement is relevant for you. Number two, if you are going to supplement, do discuss it with your doctor, specifically if you have a deficiency in key minerals or nutrients, because these supplements work in antagonistic pairs. You could be supplementing one and it could be counterproductive to another. And that's a very, very important point. Calcium supplementation can reduce your magnesium, for example. Zinc supplementation can reduce your copper. And there are multiple antagonistic pairs for every single vitamin and mineral as well. More more minerals rather than vitamins, but certainly these work in synergistic, i.e. complementary, and antagonistic, i.e. not complementary and and they they force off each other. And this essentially is the reason why I'm a big fan of the synergism in nature. Now it sounds a little bit hippie, but I'm much more of a fan of obtaining your vitamins and minerals from diet because in nature, these vitamins and minerals are presented alongside each other in their synergistic partners. So you know you're able to absorb a lot of them, particularly through mild processing and cooking techniques that can exacerbate the absorption of those individual nutrients as well. So unless you're literally eating bucket loads of a particular vegetable or fruit, you're unlikely to cause toxicity of these vitamins or minerals that can happen with supplementation, and you're unlikely to cause that imbalance as well, which is why I think certain people are not big fans of kale because it has oxalates, because it has tannins and that can offset absorption of other things like calcium, for example. When in reality, we're not really eating or we shouldn't be eating in such large amounts that it can be counterproductive to other individual micronutrients in your diet.
