Many of my clients want to know if they should take supplements. My answer is, it depends.
It depends on your level of health, how physically fit you are, your understanding of nutrition, your age, gender, if you have any medical conditions, and if you are taking any medications.
There are a variety of supplements on the market. The pressing question is are they necessary or useful, and which ones truly benefit your health. Another important consideration is supplement quality, but that will be content for a future article.
For the purpose of this article let’s consider nutritional supplements to be those supplements that can improve various health markers, for example probiotics, omega-3 fatty acids, and some supplemental vitamins.
“Can’t I get everything I need from food?”
Again that depends on how and what you eat, your nutritional knowledge and how well you apply that to your daily eating choices, your level of stress, or if you have any health conditions (like IBS of type II diabetes). In general, I would say, “No, you can’t get everything you need from food.” One example is how some food preservatives negatively affect gut flora, providing a valid reason for supplementing with probiotics.
A quick note before I go any further. I have adapted this article from a case study I wrote earlier this month as part of my involvement in the Precision Nutrition (PN) Level 2 Certification program. The case study required that I consider the PN demographic that partakes in the year-long PN Men and Women’s Coaching Programs and to justify their recommendation that participants in the program supplement with probiotics and omega-3 fish oils. I was also required to cite scientific research papers to substantiate my claim for or against.
This article is not a pitch for you to buy supplements, nor is this article associated with any particular products. My sole purpose with this article is to educate you on why certain supplements can play a role in improving your health.
The Biggest Health Problem Today
One of the biggest health issues in North America today is obesity. According to the Centres for Disease Control and Prevention, “More than one-third (34.9% or 78.6 million) of U.S. adults are obese.” As well, “Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death” (“Adult Obesity Facts”).
Note that obesity if on the rise and an even scarier condition for children, but for the sake of this article I will be addressing the health of adults.
We can also make some general assumptions based on widely available research. For example, one study (Zhong et al.) found that nearly 70% of Americans take at least one medication, with antibiotics, antidepressants and opioids being the top three.
Add to that one more frightening statistic from the CDC: “The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight” (“Adult Obesity Facts”).
It’s worth repeating: 35% of U.S. Adults are obese and 70% of Americans take at least one medication.
Given the high number of adults taking medication and with medical conditions, consideration should be given to long-term health improvement, as well as more immediate actions that are easy to administer and offer exceptional health benefits.
How does medication affect gut health?
Medications negatively affect healthy bacteria and gut flora balance in the body. Taking any kind of medication can have many side effects that will depend on many other factors including pre-existing health conditions, gender, age, and if the person is taking any other medications.
Some of the problems with digestion related to taking medication include stomach irritation, esophageal reflux, constipation and diarrhea.
For example, anti-inflammatories (NSAIDs) like ibuprofen weaken the ability of the stomach lining to resist acid made in the stomach. Overuse can lead to inflammation of the stomach lining, ulcers, bleeding, or perforation of the lining.
Diarrhea is most often caused by antibiotics, which affect the healthy bacteria normally present in the large intestine (“Medications and the Digestive System”).
How to counteract the effects of medication on gut health
Long-term, the best solution is to improve as many health markers as possible for the client so that they might be able to reduce or eliminate taking their medication. A diet, nutrition and exercise plan are essential strategies for improving health.
In the short to long-term, to protect and improve gut health and gut flora, supplementing with probiotics is a sensible recommendation. Given the percentage of U.S. adults taking medication or with a medical condition, making a blanket recommendation for most adults to take probiotics is prudent.
Should You Take Probiotic Supplements?
According to Didari et al. “… the overwhelming existing evidence suggests that probiotics are safe.” At risk individuals included “critically ill patients in intensive care units, critically sick infants, postoperative and hospitalized patients and patients with immune-compromised complexity” (e.g. HIV).
Make sure you check with your doctor first if you have any pre-existing medical conditions before taking any supplements, or consider working with a qualified Nutrition Coach.
What will probiotics do and how do they work in the body?
Supplementing with probiotics will:
- Help digest and absorb nutrients, which may be affected by medication & help to metabolize those same medications.
- Assist in the reduction of antibiotic-associated diarrhea (“Probiotics for the Prevention and Treatment of Antibiotic-Associated Diarrhea”).
- Keep “bad bacteria” and other pathogens from settling in and growing. If some medications kill healthy bacteria and gut flora, clients could be more prone to illness, thus supplementing with probiotics will help to support and stimulate the innate immune system of the gut (“Probiotics promote gut health through stimulation of epithelial innate immunity”).
- “Artificial preservatives used in many processed foods could increase the risk of inflammatory bowel diseases and metabolic disorders (“Food preservatives linked to obesity and gut disease”). Given that many adults are eating a diet high in processed foods, probiotic supplementation may also help strengthen gut health against the harmful effects of artificial preservatives.
- One study indicates “that the fungal gut mycobiome seems to be disturbed in obese patients, in association with alterations in lipid and glucose metabolism.” Thus if the obese client shows less biodiversity in their bacterial and fungal flora, and if this is a correlation with their obesity, supplementing with probiotics could help re-populate normal gut flora health and promote weight loss (“Obesity changes the human gut mycobiome”).
There is further research that suggests probiotic supplementation can help with IBS and improve mental health and wellness. However, in my opinion the above list offers sufficient grounds for suggesting that most adults should supplement with probiotics.
We’re Eating Too Many of the Wrong Fats
Given the horrible statistics (35% obesity) of the U.S. population, not only is lack of exercise an issue, but most adults are probably eating a diet high in saturated fats (butter, trans fats, animal fats, lard) and low in omega-3 and other healthy fats, as well as processed food.
Historically our bodies “evolved with a fat intake ratio of about 1:1 omega-3 to omega-6 fatty acids. Now, it’s closer to 1:20” (“All About Fish Oil”). Our modern diet has changed in Western countries due to the amount of processed food we eat, as well as less wild game, fresh fish and plants.
Another important factor to consider is that we cannot manufacture the so-called “essential” fatty acids in our bodies:
“The polyunsaturated fatty acids alpha-linolenic acid (ALA) and linoleic acid (LA) must come from the diet because they cannot be made by the body. ALA, an omega-3 fatty acid, is converted in the body to the fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). LA, an omega-6 fatty acid, is converted to the fatty acid arachidonic acid (AA)” (“Omega-3 Fatty Acids and Health”).
What are the health benefits of omega-3s?
Omega-3 fatty acids,
- Have anti-inflammatory properties, “specifically DHA and EPA, work because they block inflammation pathways in the cell. They block not one but multiple pathways. Immune cells (macrophages) seem to be particularly sensitive to omega-3’s anti-inflammatory effects” (“Research Review: How do omega-3 fatty acids work?”).
- Are important for brain cells — they provide energy and make up membranes of the cells
- Can improve insulin sensitivity and make our bodies better at using stored body fat for energy.
Short of going back to “ancestral eating”, a good Exercise & Nutrition Coach can educate their clients about nutrition and various ways to improve eating choices that will improve health markers. One thing I do with my nutrition clients is to help them develop health new habits. That could be eating a healthy breakfast, preparing snacks in advance, or supplementing with omega-3 fish oil as a way to improve their health.
As the client becomes more educated and their “nutritional age” matures, their eating habits may also evolve to reflect a better mega 3:6 balance. Thus they may reduce or eliminate taking essential fatty acid supplements, depending on their needs.
Why recommend taking omega-3s from fish sources?
EPA and DHA are more easily found in greater amounts in fatty fish, like salmon, trout, herring, mackerel, krill and shellfish. Vegetarians can choose algae oils. Flax oil, which provides ALA, only minimally converts to EPA and DHA in the body (“Omega-3 Supplements: An Introduction”).
Andrews suggests supplementing with “small-fish-based formulations (e.g. herring, mackerel). Small fish are lower on the food chain and less likely to accumulate environmental toxins. Or choose krill oil or algae oil.”
Should you supplement with omega-3?
Precision Nutrition (PN) recommends that their clients aim for 3–9 daily grams of total fish oil (about 1–3 grams of EPA + DHA) per day. Why?
The Mayo Clinic offers an extensive dosing schedule for a large list of conditions “based on scientific research, publications, traditional use, or expert opinion” (“Omega-3 fatty acids, fish oil, alpha-linolenic acid dosing”). For example,
“To treat weight loss in people with illness, 30 millilitres of fish oil has been taken by mouth daily, providing 4.9 grams of EPA and 3.2 grams of DHA for four weeks. A dose of 2–2.2 grams of EPA plus 0.96–1 gram of DHA have been taken by mouth daily for 3–7 weeks. A dose of 2–16 grams of fish oil has been taken by mouth daily for three months.”
The Mayo Clinic offers a few more treatment examples of high dose fish oil intake. What I take from the cited example above (but not knowing what “illness” they are referring to) is that PN can safely suggest a dose of 3–9 daily grams of total fish oil (possibly determined by the client’s body weight and bodyfat %) to facilitate weight loss, as well as offering other health benefits.
Fish oil precautions
There are more serious precautions with taking fish oil supplements vs. probiotics. These include,
- People who bruise easily, have a bleeding disorder, or take blood-thinning medications.
- “People with either diabetes or schizophrenia may lack the ability to convert alpha-linolenic acid (ALA) to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the forms more readily absorbed by the body. People with these conditions should be sure to get enough EPA and DHA from their diets. Also, people with type 2 diabetes may experience increases in fasting blood sugar levels while taking fish oil supplements” (“Omega-3 fatty acids”).
Once again, consult with your doctor first before taking any supplements.
There appears to be enough research, in particular research summaries and advocacy from trusted sources (like the Mayo Clinic) that suggest supplementing with probiotics and fish oil are safe and prudent.
Given the high percentage of obesity in the U.S., the percentage of adults taking medications, and those with a medical condition, supplementing with both probiotics and omega-3 fish oil may improve various health markers and help to stimulate weight-loss. Finally these supplements can be a useful tool in the formation of healthy habits, which may or may not be later replaced with real food sources.
Eat well to be well!