- Aloke, we gotta talk two words, vitamin, supplements.

They are everywhere.

- They really are everywhere, I talk to a lot of patients and colleagues who are taking them, Sheena in fact, half of all American adults including 70% of those age 65 and older regularly take a vitamin or mineral supplement.

But here's a potential issue.

About 60 to 70% of people taking these supplements don't report this use to their doctors.

And the reason why that's concerning is because certain supplements can interfere with prescription medications or have adverse side effects.

- In this episode, we're going to break down the science of which supplements actually have scientific backing and which are just a bottle full of lies.

- But it's not that black and white, because certain supplements are actually indicated for certain groups of people or people with certain medical conditions.

So let's dive into the facts which is where we live.

- One thing we need to clear up before moving forward, when we say supplement, we're talking about any dietary ingredient, mineral or extract taken orally to enhance the diet.

Sometimes they're suggested by a doctor to replace a nutrient or vitamin that is missing in your diet or if you have certain health conditions.

- So let's back it up real quick and ask a question, how and when did our obsession with supplements start?

What's up with that?

Well, it all started once upon a time when it was theorized that vitamin C could fend off the common cold.

While this now debunked claim was pushed by renowned researcher, Nobel laureate and molecular biologist, Linus Pauling.

In 1970 he published his claims about vitamin C, and vitamin C sales went through the roof.

- It doesn't stop there.

Linus doubled down and suggested that vitamins could treat all kinds of diseases, including cancer.

Then in 1992, Time Magazine published that year's best selling issue with an article titled "The New Scoop on Vitamins".

Much of the research presented in the article suggested that antioxidants found in a specific group of vitamins, A, C, E and beta-carotene might help fight all the effects of aging and disease by eliminating cellular renegades called free radicals, which come from sunlight, smoking, car exhaust, and pollution.

- Turns out this wasn't entirely true, several studies actually showed a higher mortality rate for people taking these vitamins that were supposed to prevent the diseases we're talking about.

- But that didn't prevent the supplements industry from booming.

In 2021, Americans spent an estimated 50 billion on dietary supplements, and the supplement industry responded in kind by spending approximately $900 million on marketing alone.

According to the CDC, among US adult age, 20 and over, 57.6% use a dietary supplement in the past 30 days and use was higher among women than men.

- So it turns out the demand for vitamins is probably not gonna go anywhere and in many ways it shouldn't, because a lot of people still need supplementation.

But which ones provide the best outcome?

That's the question.

And it all comes down to your individual situation underlying medical conditions, and what outcome somebody wants from taking a supplement For more and all this, we are gonna turn to a panel of experts.

- And since this topic is tough to rate on, yes, take this or no don't take that, we created a fun scale to help us out.

- On the far left X axis we have snake oil, doesn't really work potentially unsafe, on the far right axis, we have backed by research.

- On the top of the Y axis we have safe and on the bottom risky.

- So first up, something that you all have heard about, multivitamins.

- Okay, so I'm saying multivitamins, we are pretty safe not much evidence that they do, that they do much broadly speaking these are gonna be safe as long as they're purchased from a reputable store that that vents these types of things.

But in terms of efficacy, there's really no evidence that a daily multivitamin can extend your life, that's what we call overall mortality.

There's really no evidence that suggests that supplementation with a multivitamin will prevent cardiovascular disease, there's some weak evidence from some parts of the world that a multivitamin might lower the risk of cancer but tends to be parts of the world where nutritional intake of vitamins is a little bit lower.

And so this might be a recurring theme here, but the best way to get those vitamins and minerals is in by eating a healthy diet.

- So I would place it as a safe and backed by research, in the COSMOS trial, COcoa Supplement and Multivitamin Outcomes Study, we saw in 2000 participants that the vitamins reduce the rate of cognitive decline by 60% of those 65 and older.

But we do think that those findings need to be replicated before they're ready for prime time in terms of public health recommendations.

We found no evidence that multivitamins reduce the risk of cardiovascular events, either heart disease or stroke.

And that was true in both the physician's health study too and the COSMOS trial.

- Seems pretty inconclusive.

Some benefits for those in select brackets, but it appears that by modifying your diet, you can get what you need daily from just adding more vegetables to your meals.

So you have the option drop the french fry and maybe just try adding a little bit of carrots.

Next up, collagen peptides.

- And collagen peptides are hot right now, they're going viral like the cool kids say, because I feel like every time I open my social media I see claims that collagen can strengthen your hair, strengthen your nails, your bones, improve joint health, or even reduce the signs of aging, such as those little wrinkles you might notice on your forehead.

Like the ones that I noticed today before we started recording.

- Putting collagen peptides pretty close to multivitamins.

So as someone who wishes his hair was staying a little thicker and discovers new wrinkles every day, I would love this to be highly scientific highly proven and effective, there is some data that suggests that it might increase skin elasticity a little bit in some small studies, and that might be encouraging but we gotta be really careful because those are often quite subjective measures.

And anytime there's a outcome that's relatively subjective like how many wrinkles do you have and how thick do you feel like your hair is today?

They're very much subject to placebo effects.

And so you know the number one way to keep yourself looking young and healthy.

You're gonna make a choice, stay away from cigarettes and smoking and try to avoid that UV damage to your skin.

- Well I'm putting them right above evidence line, what happens with the collagen peptides is they are broken down to their amino acids basically, and so at that point the body will use the amino acids for whatever it needs, it won't necessarily rebuild collagen, but that's why it's controversial you could add protein in other ways and it may be just as beneficial.

- Okay, great.

So you're telling me that I take collagen every day and it may improve the skin on my armpits versus my face.

Great, great, great.

Third on our list, apple cider vinegar or ACV.

ACV claims have swirled for years now, and myths suggest that ACV can be used to treat or reduce high blood pressure, it might even have anti-cancer properties.

- I'm putting the vinegar down here.

I think apple cider vinegar is a really good thing to include in your diet and it has some beneficial properties, it has some phytochemicals, it has polyphenol compounds that are protective and it's generally not bad for you, I think the claims are overblown.

- Apple cider vinegar, actually apple cider or vinegar is gonna edge in here to category two for me.

- Oh, I see a little intellectual debate happening because the panel is split on apple cider vinegar.

- The best evidence is that it tends to lower blood glucose a little bit.

Now, it's not as much as what medications will do for people who have diabetes, but it's enough to be measurable and that could be important.

The safety though is not quite as benign as some of these pills which are just sort of rapidly digested, it is acidic and there are actually some cases of people who have sustained some tooth damage and ammal damage from the acid, from apple cider vinegar.

If you're gonna take it, you wanna chase it with a glass of water, rinse out your mouth, make sure that you know you're getting that acid out where you know into your stomach where it needs to be.

But some modest evidence that there could be some benefit of that.

- Moving on melatonin.

Now melatonin was heavily discussed during the COVID 19 pandemic, because a lot of people had messed up sleep.

It would suggest for people who had conditions like insomnia or poor sleep quality.

But there's some conflicting studies out there, and as a parent in pediatrician, I'm well aware of it.

- We're gonna put melatonin in the quadrant, we're in the realm of science.

We're actually a little bit safer.

One thing is it works quite differently in adults versus kids.

Most of the studies in adults show it doesn't have much effect on promoting onset of sleep which is why people are generally taking it.

And kids just the opposite.

The evidence is fairly strong that it can improve onset of sleep, but you've gotta be careful about a couple of things.

Number one, melatonin supplements are sort of notorious for having the wrong dose on the bottle, people are often quite surprised about this but when studies have looked at those various gummies and measured the actual amount of melatonin in them, in a lot of brands, they don't match up.

Some are are much lower some there's no melatonin in them at all, some there's much more melatonin, and some are adulterated with other substances that could potentially be harmful.

So this is one of those places where you want to know what brand you're getting.

And I generally recommend that people look for a little label on it that says NSP that's this nutraceutical pharmacopeia label which means it has been vetted and measured.

The FDA does not check these things.

So vitamins and supplements get their own carve out, the FDA's not doing spot checks to see if what's in the bottle is what is said on the bottles.

People really want to be careful especially if you're giving things to kid.

- One study on melatonin specifically found that the actual content of melatonin in marketed supplements may be up to 478% higher than the label content low, we gonna be sleeping for days.

- Our last stop, one that a lot of people are familiar with, fish oil and omega-3s.

Now I'm familiar with this one, claims that omega-3s which is found in fish can lower cholesterol and improve heart health.

- I'm putting fish oil right here.

I'm put it there with a caveat that the evidence shows that two fatty fish meals a week are more useful than taking this supplement.

The supplement trials haven't been as convincing although there is some evidence that if you need the omega-3s, which most Americans do, most Americans do not have enough omega-3s, that the fish oil supplement can be helpful, if you can't, particularly if you're a vegetarian and you and you're not eating fish.

- I putting it, you know, further along the scientific axis here for omega-3, some evidence it'll increase the good cholesterol a little bit, decrease the bad cholesterol a little bit.

But in terms of, you know, preventing things like strokes and heart attacks, those things we really care about beyond the numbers, the evidence is much more mixed.

So it's not a panacea but there's some real science there.

I'm not putting in a perfectly safe, these fish oils do tend to thin the blood a little bit make you a little bit more prone to bleeding, and so that for people who might be at risk of falls or who have had bleeding problems in the past, like bleeding from the gastrointestinal tract you wanna really talk to your doctor about this.

Not totally benign like some of the vitamins and supplements are.

- However, a recent trial that looked at high dose EPA, EPA alone, four grams a day did suggest a reduction in both heart disease and stroke and in major cardiovascular events.

But many researchers feel that finding requires a replication and further study.

And for the omega-3s we know that once you get to higher doses, there is such as four grams a day.

There is some increased risk of atrial fibrillation which is an irregular heart rhythm that has been linked to an increased risk of stroke.

However, it's more effective for reducing cardiovascular disease in the higher doses.

So it's a trade off, but the higher doses need more research because there is a risk side to the equation.

- So that's a yes to lowering certain cholesterol, but the jury is still out about heart health.

The science isn't perfect here and we are still learning more and more about the impact of vitamins and supplements.

But what we do know is please consult your doctor before taking any vitamin or supplement.

- I cannot echo this enough, talk to us, talk to a healthcare professional.

Certain situations do call for a certain supplement but unless you're honest with your healthcare provider we can't give you the best advice or the best course of action.

And that's it for us on this episode of Vitals.

You want us to talk about another supplement?

Hit us up in the comments, we love a good spirited chat about help and wellness.

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