SUPPLEMENTS AND MEDICATIONS

Medications, supplements, vitamins—there are a lot of pills and doses out there that can have a pretty profound impact on how our bodies function (or don’t). I’m going to focus in this blog on supplements that we can use to support our overall health, because they are widely available, often much cheaper than drugs, and there isn’t a lot of good information about them out there.

I am not anti-medication. Not even a little bit. I am, however, anti over-medication. For one thing, we have a toxic history with using medications as mechanisms of chemical restraint (disproportionately so within institutional settings and child-serving systems like foster care, and disproportionately of individuals of color within these settings and systems) which many of y’all who are reading this may have been subjected to.

But even for the rest of us, medications are often the first and only line of defense. And they are typically not considered within the context of other treatment interventions. One of my clinical nutrition professors offered this hierarchy as the ideal alternative to over-medication and I’m all for it. When there’s a problem, we should start at the top of this list and work our way down :

Hierarchy of Interventions

  1. Lifestyle
  2. Food
  3. Supplements
  4. Drugs
  5. Surgery

See how far down that list supplements and drugs come? I worry about the fact that those of us in the US are on a lot of medications. 50% of U.S. American adults take at least one prescription drug every month, and one in four of us are taking three or more. 73.9% of doctors visits end with a prescription being written and 80.4% of hospital visits end with a prescription being written. From 2008 to 2018 the use of opioids went up 22%, but antidepressants went up 97% anti-anxiety and anti-epilepsy meds went up 661% (Not a typo. Six hundred. And sixty-one.). Medication being the first thing we go to is a really worrisome habit.

And the medicines we’re given generally do not work as universally as we are led to believe. Nor are they typically designed for longer term use. Pain medications are a good example. The two medications we use most for chronic pain are opioids (and the opioid crisis is something we all know about) and over the counter NSAIDs (nonsteroidal anti-inflammatory drugs). These include aspirin, ibuprofen, and naproxen. Opioids do block pain, but only for about a month, then your body reacts by increasing the number of receptors to allow the pain signal to get through again. Additionally, they reduce the body’s ability to release endorphins, letting us manage pain independently. And opioid use reduces gut motility and interferes with the secretion of digestive enzymes from the gallbladder and pancreas resulting in impaired nutrient absorption.

But over the counter (OTC) pain medications aren’t a real, long term pain solution either. NSAIDs (like ibuprofen) account for 3200 deaths per year, and 32,000 hospitalizations. An OTC drug doesn’t mean it’s a benign drug, and these can cause hypertension, heart disease, kidney damage, and gastrointestinal bleeding. Even more common is that NSAIDs inflame the intestinal tract, which can lead to leaky gut. The intestinal lining is repaired and replaced every 3-5 days, and NSAIDs interrupt and block that process. Intestinal permeability occurs within 24 hours for 60-80% of the people who take an NSAID With long term use, 50-70% of people develop chronic intestinal inflammation. NSAIDs reduce pain but prevent healing.

Almost all analgesics (Tylenol as well as the NSAIDs) cause hypersensitization to our pain receptors, just like opioids. We end up with increased pain over time by using them. A study of people with episodic migraines who took NSAIDs 10-15 times a month found that many of them ended up having chronic daily headaches. Our own pain relief system (endorphins) shuts down when we take pain medicine, and it takes time to get that system to kick back in.

I have had significant success helping clients avoid needing prescription medications or minimize the number of prescriptions they need to use (under their prescriber’s watchful eye—I always work in conjunction with the prescriber!). I’ve also had clients increase their prescription medication usage, just like I did in 2020, to better manage their symptoms during an unprecedented crisis. Doing so isn’t a sign of failure or an over-reliance, so long as it is done thoughtfully and with an eye to the other mechanisms of supporting a healthy body.

I’m saying all this because I am passionate about finding alternative methods to support health beyond the current medical model. Whether we are talking about penicillin or lavender oil, anything we use should be done thoughtfully and holistically (using the true sense of the word). And if you do take allopathic drugs, they’ll be most effective when supported with everything else further up the hierarchy.

All that being said, let’s talk about how using supplements to support your health might benefit you.

What Are Supplements?

A supplement is something that completes or enhances something else when added to it. The idea is that there is something missing from our bodies and we are trying to complete or enhance our intake of food and prescription medications with other nutrients and bodily support.

According to the World Health Organization, 80% of the medications taken world-wide are naturally derived formulations rather than things grown in a lab. Our history of medication is based on the natural world. Animal, mineral, and herbal products have been used for over 5000 years. As late as the 1890s, 59% of the products in the US Pharmacopoeia were based on herbs or herbal combinations. The WHO reports that in the United States, a third of people are taking some form of supplements. And interestingly, the higher someone’s level of education, the more likely they are to use a supplement. (And that one-third number doesn’t include individuals taking something like Lovaza, which is a prescription formulary of fish oil).

A lot of times you will see the word “vitamins,” which I tend to shy away from since most vitamin products on the market are synthetic isolates and that’s exactly the thing we are trying to avoid. Instead, I recommend in my practice (and use in my personal life) a variety of whole food supplements and good quality herbs.

Whole food supplements are literally just food. Or rather, they’re pills, but pills that are condensed versions of food, like vitamin C where the C comes from constituted buckwheat juice, not ascorbic acid. You’re piling on the nutrition you need for healing. My motto is, you have to either eat it or take it. And honestly, getting enough of the nutrients we need through diet alone is nearly impossible. For example, depleted soil means we may not be getting enough trace minerals in our diet from the veggies we eat, even if they are local and organically raised. And there’s less and less biodiversity available in supermarket produce. So we supplement. While I already cook with garlic, I still add a whole food garlic supplement to support my immune system during flu season. And since finding spanish black radish in a grocery store is pretty impossible, I take them as a whole food supplement to help support my digestion as well. Whole food supplements can help bridge that gap without the side effects of the synthetic isolates found in allopathic meds and most over-the-counter vitamins.

Herbal supplements work far more like medications do, but also more like whole food supplements than you would first guess. Instead of treating a symptom, they are also operating to promote the body’s own healing and ability to balance itself. That’s why so many of the herbal remedies that are most effective for mood disorders are adaptogenic ones, meaning that instead of being just an upper or downer, they function as all-arounders. They’re like the thermostat on the wall that is going to kick in heat when it’s cold or the a/c when it’s hot as balls. They work by promoting the stabilization of physiological processes.

Do I Need Supplements?

Maybe you don’t need to supplement your diet. If you are getting all you need through your food—especially if you are getting organically grown veggies, eggs and meat from pasture raised chickens, beef from grass-fed and grass-finished cattle, on land that has been tended carefully for generations.

I’m not saying all this to be snarky or up-sell you on nutritional support but to point out that almost everyone in this day and age are dealing with numerous barriers to getting adequate nutrition from the foods they eat.

And speaking of that toxic environment? I know, we already did because I am such a joyful person to hang out with. But we have been absorbing way more crap into our systems since WWII. We come into contact with products and byproducts every day that are inflammatory, cancer-causing and the like.

And if we are taking prescription medications? There are side effects to those. Medications can disrupt our nutrient absorption in a multitude of ways. A 2018 study published in the Journal of The American Medical Association found that one-third of U.S. Americans are taking a prescription medication that can cause a mood disorder, stating there are over 200 different prescription medications that can have this effect, including super common medications like proton pump inhibitors that treat acid reflux and beta-blockers that treat hypertension. Anything we put in our body affects the whole system, something that helps our blood pressure may decrease absorption of other nutrients which cause a biochemical issue that presents as depression, anxiety, and the like. And the more of them we are taking, the higher our risk: going from one medication to three more than doubles our risk of developing clinical depression.

This is true of physical health as well—our prescription meds can cause a multitude of long term issues. For example, someone on corticosteroids for rheumatoid arthritis will need calcium supplementation to manage the decrease in calcium absorption. And an individual on angiotensin converting enzyme (ACE) inhibitors for more than 3 months will likely need zinc supplementation.

How Do I Know What Supplements to Take?

So how do we figure out what supplements would benefit us most? Lab work is ideal, so we can look at what your white blood cell count and the like are actually doing, and also look for patterns of issues. You may not be completely out of range by lab standards, but have decreased levels in a few areas that bear looking at. Alternatively, looking at clusters of the symptoms you are experiencing can help find patterns of bodily responses. Nutritionists and functional medicine docs will ask about all the weird symptoms you might be experiencing (not just the ones you came in with) with some kind of questionnaire, and many more traditional MDs are starting to do the same. I do love the smell of a good paradigm shift in the morning, don’t you?

If you are on prescription medications, look at what you are taking, check out the pharmacy fact sheet on side effects (or if you are like me and throw those away pretty quickly, log onto drugs.com) and see if any of your current health complaints overlap with the side effects listed. There is tons of information online about which medications and classes of medications can cause issues.

Watch carefully with new meds. Doctors and pharmacists are way overworked in our healthcare system, but they do give a shit and do know these are issues to watch out for so request a consult with them. It is also really helpful to do a “brown-bag” yearly update on your medications. Bring in everything you are taking to your annual check up to review with your doctor or their clinic staff. I have clients who keep spreadsheets of what they are on, what they have been on and when they stopped, etc. It’s a ton of work on their part but it makes it way easier to review and go “Oh! This might be the problem!”

Another way to figure out what supplements might help is to keep track of your health and habits daily. If you are trying to figure out how your body responds to all of the input it receives, a health journal is your best tool. Now that there is an app for everything, you can make this as easy and digitized as possible if that is your preference. If you are old school, you can just jot down the following every day:

• The meds you are taking, the dosage, and the time (both prescription and OTC).

• Same for any supplements.

• What you ate.

• What you drank.

• Other substances ingested (ahem).

• Vaccines received.

• Exercise/movement engaged in.

• Any physical ailments and whatever you used to manage them (asthma attack, back pain).

• Any accidents or injuries.

A lot of docs love if your health journal includes your medical history and your family history as well, so if you are sharing it with them you have it all in one place.

There are a lot of benefits to keeping a health journal. You’ll be more organized and streamlined for doctor’s appointments and your own personal tracking. You’ll save money because you can see your history treatment at a glance. For example, you can go “oh yeah tried that two years ago and it gave me a horrible headache, no thanks.” You’ll be more likely to figure out food triggers. You’ll notice how stressors (lack of sleep, crappy work schedule, people around you being all people-y) are influencing symptoms. And you’ll be more likely to figure out what meds/supplements are helping or hindering.

Supplement Safety

You may have heard something along the lines of “supplements don’t work,” or “supplements are dangerous.” It’s true that a lot of them are crap.

Part of the reason that dietary supplements get a bad rap is because many of the ones on the market are just bullshit in a bottle. The New York Attorney General tested and sent a multitude of cease and desist letters to herbal supplement companies based on the fact that much of what they tested had no active ingredient. University of Guelph in Canada studied a bunch of supplements and found many unlisted ingredients within them, including things that could encourage an allergic response in someone taking them. And synthetic versions of the product, rather than the actual extracted herb or whole food, are generally going to have more side effects because the human body struggles to recognize them for what they are.

So we read about the amazingness of using St. John’s Wort for depression, then we feel stupid and/or ripped off when it doesn’t work for us. I had that experience with a cheap kava I tried years ago. It made me seriously irritable and more than a little batshit. I was afraid to try kava again until I learned more about finding and using quality products. I was great about educating myself on prescription meds, but it somehow never occurred to me that I should treat supplements just as seriously.

Additionally, supplements aren’t magical fixes anymore than an allopathic medication is. Nothing is a magical remedy, but you can’t convince social media of that. While I was writing this chapter, I saw a well-known herbal store post wild claims about bay leaf. Claims that included if you have bay leaf (which they sell!) you have no need for a pharmacy. That a bay leaf added to your meat will convert triglycerides to monounsaturated fats and allows the body to produce insulin (among many other magical things).

This particular meme has been going around since 2019 and it easily fact checked. But this company didn’t bother to do so. While I am the queen of ignoring stupidity on the internet because it’s bad for my mental health, this is the kind of thing that gets my nutritionist knickers riled up. So I did the research and found out that bay leaf impacts circulating blood lipids, metabolism, and glucose by the same mechanisms that certain forms of cinnamon do. Meaning both are helpful in promoting managing metabolic stability. One leaf added to your pot of beans doesn’t do anything but flavor the beans. But in supplement form (which this company did not sell), it works great. Fresh bay leaf can be encapsulated to about 500mg per capsule. Two to six of those (3mg) taken daily for thirty days has been shown to reduce blood glucose by 20%. And yes, that is phenomenal. Especially considering that there would be no accompanying side effects (unless you are allergic). This could be used in conjunction with other treatments and lifestyle changes to help manage blood sugar. And maybe help minimize the amount of insulin or metformin someone needs to take. But telling people adding a leaf to their food means they can throw away their meds? Those are the types of “alternative facts” that kill people.

A new supplement also has to be the right thing for your specific circumstances. I have colleagues message me on the regular because they have a client who wants to try supplementation for their depression and what should they take? I’m not being snarky when I say I have no idea. I don’t know their history, their other medications, all their symptoms, I haven’t seen their lab work etc. An ethical nutritionist is going to be as careful and considered as an ethical allopathic doc. If you tell an MD buddy you’ve been moody lately, and ask what would be helpful, they aren’t gonna say “Abilify, LMAO, bet,” they are gonna tell you to go get a workup. (At least they should. Run like the wind if they throw pills at you like confetti.)

So, takeaway? There is no magical plant to chew on, research matters as much as anything else you are putting in your body. If the claims seem over the top they probably are.

If you are using supplements (either herbal or whole food), research as much as you can. ConsumerLab.com is a third party lab that rates for purity and truth for labeling. Look for brands that go through third party testing (NSF International, NSF GMP, US Pharmacopeia (USP), TGA, IFOS & IKOS, Consumer Lab…my favorite brand is TGA tested and approved) or if it’s a cottage industry maker, ask them about how they source, process, store, and the like. You’re looking for them having mechanisms in place to make sure you are getting quality product in the dosage amount it claims on the bottle.

If you can afford to, work with a provider who knows their shit, like an herbalist, Chinese medicine practitioner, or clinical nutrition professional. Most of those who do work with supplements professionally are brand-loyal based on experiences, but will also discuss different brand options with you. I always give people a couple of brand recommendations and discuss what to look for if they are exploring other brands (e.g., you want a kava that has been water extracted and you want a fish oil that hasn’t been sitting on a pallet in an unheated storage facility behind a club warehouse).

But most important? Trust your body more than you trust me. A whole food supplement or herb will likely have fewer side effects for you than a prescription medication (and research continues to back this up). If your body recognizes something as food, it will metabolize it differently. But not all bodies respond the same way to food, right? Even healthy foods.

Every body is different and your body will be the best tell of whether or not something is helpful. If you start a new supplement, and have a poor reaction to it, believe your reaction. Stop taking it for a few days then try again. Same reaction? That’s a nope from the judges. If you notice any weird “new” problem after a period of time, take a “supplement holiday” and see how you feel. Gradually add them back in one at a time and see what happens. FWIW, this can also be a good idea for some prescription medications, but those can come with serious side effects from withdrawal, so only do so with your doc knowing what’s going on.

The Obligatory Disclaimer About Supplements

I am about to talk about some specific supplements. But please don’t just go out and try them on your own. It is super important to discuss these things with your treatment provider before embarking on any of them. I have a postdoc in clinical nutrition, but if I have a client on prescription meds I always talk to their prescriber before adding anything else. Interactions are no joke and it’s important to be careful. Anything you take can also be of concern if you are pregnant, if you are drinking, or if you are using drugs or even over the counter medications. A prime example? I went to a tea making class last year and the person teaching it, a very skilled herbalist, discussed a calming blend that contained St. John’s Wort. She failed to mention that St John’s Wort can interact badly with antidepressant medications and HIV medications.

You also need to consider the following statement to hold true to everything I’m discussing in terms of supplemental treatments:

“This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

The FDA does not review claims related to structure and function of supplements, which is what we are discussing here. I’m going to discuss the structure of different supplements and what research is out there regarding how they function in the human body to help the human body gain equilibrium. And that’s not the same as a treatment, right? We are all smart cookies and we got that. I’ve cited my ass off in terms of the studies related to structure and function but also encourage you to do your own reading and thinking and talking to your treatment peeps before you start mixing the red and blue pills.

Some Supplements to Consider

Ok, I know I just spent pages flapping around saying don’t pop supplements like they’re Pez because you will kill youself dead. While that’s overall true, there are some generally safe things that are helpful for most people. So here is my top 5 for most-everybody list (though keep in mind that if your tummy doesn’t like it, your tummy is in charge).

And, as always, a supplement is not intended (nor FDA approved to) diagnose, treat, cure or prevent any disease. Supplements are designed to support your body’s best health and functioning. Even with the most generally safe stuff, your doc may have concerns about what you’re taking and at what dosage you are taking. Consult the nice person who is trying to keep you healthy, yeah?

Probiotics

Our chronic exposure to toxins and our overexposure to antibiotics has done a lot of damage to our gut microbiome. There is a lot of promising research out there that probiotics can help heal gut lining damage and rebalance that biome.

Probiotics are just beneficial bacterial cultures that research demonstrates reduces the severity and the incidence of gut infections (both chronic and acute) thereby reducing inflammation in the body. Other research has found them to be of benefit to managing cancer and allergies as well.

We don’t know the magical cocktail to use (and indeed, how it would vary from person to person), so you may need to experiment with different formulations and brands. A brand with a higher count of strains is generally a good bet.

Something it might be helpful to take along with probiotics is prebiotics, which are a type of indigestible fiber that operates as food for the probiotics. Their job is to keep the good bacteria active in your system. And then, you may also find it helpful to add digestive enzymes which are the proteins that speed up the chemical soup reaction in our body allowing our food to be broken into substances that our digestive tract can absorb. I say all this within the probiotics section because you can get probiotic supplements that also have prebiotics and digestive enzymes in the same compound.

There aren’t any contraindications for probiotics. You might get a little gassy from them, but that is about the extent of side effects.

Omega 3s

Omega 3s are on the list of supplements everyone should take because of how efficiently they decrease inflammation and oxidation that is associated with so much disease, from heart disease to depression.

Omega 3 fatty acids consist of alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Most fatty acids are produced within the body. ALA is not, so we must get it from food or food-based supplements. ALA combines with enzymes to create EPA and DHA.

You can get Omega 3s from foods like fatty fish, flax seed, chia seed, and walnuts. Or you can take them in supplement form as fish oil, plant-based blue-green algae, or ahiflower oil. I take cod liver oil because it also has vitamins D and A. Fun fact, cod liver oil was given to children regularly to fight rickets and obviously had a lot of other health benefits we weren’t aware of. I know there’s a lot of info out there about Omega 6 and Omega 3 ratios. We don’t know what is optimal, but all the research shows that focusing on raising Omega 3s is plenty beneficial rather than worrying about lowering Omega 6s or monitoring them in accordance with each other.

Omega 3s can be contraindicated with a host of bowel conditions, as well as liver conditions, appendicitis, and schizophrenia. Check with your doctor first if any of these issues apply to you.

L-Tryptophan

You read about this one in the Sleep chapter. L-Tryptophan is the sole precursor of serotonin, and experimental research has shown that L-Tryptophan’s role in brain serotonin synthesis is an important factor involved in mood, behavior, and cognition. Tryptophan also increases serum melatonin levels and decreases cytokine production. It’s kinda a 20 dollar wonder drug. While L-Tryptophan is in food, we don’t absorb it as well because of amino acid competition in the transport system, so taking it as a pill will get you more benefit than eating a lot of turkey will. If quality sleep is an ongoing issue, take it at night as one larger dose instead of throughout the day.

L-Tryptophan is contraindicated with eosinophilia myalgia syndrome. It’s also something to discuss with your doctor if you are taking an antidepressant. While there is less interaction between antidepressants and L-Tryptophan versus a strong nervine herb like St John’s Wort, there can still be an issue if you are taking a prescription antidepressant.

Magnesium

Odds are literally even that you are magnesium deficient. 50% of Americans (and up to 80% of older Americans) are. Magnesium is the fourth most abundant mineral and the second most abundant positively charged ion in a human cell. It’s fundamental to human wellness for a multitude of reasons, including being responsible for cellular function (the importance of which we talked about earlier in the book), and been shown to directly impact depression in human beings (with demonstrable difference in symptoms in as quickly as one week).

Fun fact? Because magnesium is so good at preventing lactic acid build up, I like to suggest taking it before and after a workout or a massage (it also increases the available glucose to energize your muscles)!

Contraindications for magnesium include renal disease (big one!) but you should also check with your doctor if you have heart disease, intestinal issues, or diabetes.

Zinc

One-third of the population worldwide is zinc deficient (and deficiency rates are even higher in low- and lower-middle-income countries). Zinc is an essential nutrient for humans. It is extensively involved in pretty much every groovy thing the body does and is therefore considered an antioxidant. Its ability to alleviate depression is related to many mechanisms in the body (supporting immunity, decreasing inflammation, helping manage oxidative/nitrosative stress, mitigating the stress response, supporting recovery from neurotrophic deficits, and regulating transcriptional/epigenetic neutral networks).

The body needs to take in zinc regularly, since it doesn’t have a way to store zinc “for later.” It’s found in multiple food groups, like shellfish, legumes, seeds, and nuts, so malnutrition can lead to decreased zinc intake. Zinc deficiency can also be inherited—some people just don’t absorb it well.

Zinc deficiency is identified through lab work, though research shows that a zinc assay test (which you can purchase online for like fifteen bucks) is about 70% accurate if you are looking for a cheaper option.

Zinc may be contraindicated if you have a disorder that leaves you with an inadequate amount of copper in your system.

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