Putting it All Together; The Three Roles of Supplementation

Part 6 : supplements

There are three scenarios in which nutritional supplementation make sense.  They are as follows:  

1. Supplementation to make up for dietary deficiency.  

2. Supplementation to restore important factors which have been lost as a result of bleeding or disease.

3. Supplementation with substances proven to move us along the health Continuum in the direction of optimal function and well-being.   


1) Dietary deficiency: The first scenario, dietary deficiency, was the original concept behind nutritional supplementation, and the rationale for it is valid today, even though the incidence of true deficiency-induced disease is less prevalent.  During the great depression vitamin and mineral deficiencies were so common that the federal government created the cartoon ‘Popeye’ to promote the idea of eating more spinach to deal with reports of nearly epidemic levels of iron deficiency among underprivileged children.  (Interestingly, the choice to promote spinach was based on a typo in one of the premiere nutritional textbooks of that time which grossly overvalued the amount of iron contained in spinach!)  Until the middle of the last century, clinical deficiency states like Rickets (softening of the bones due to deficiencies in Vitamin D and calcium), and Scurvy (skin and mucous membrane degeneration due to lack of Vitamin C), were fairly common in medical practice.  Today, these gross clinical deficiency states are rare.  What we see more commonly in modern practice are sub-clinical deficiencies in many of the important vitamins and minerals needed for adequate health, due in large part to lifestyle and farming practices as described earlier.  

The most common deficiencies are in B vitamins, iodine, iron, Vitamin A, zinc, copper, selenium, chromium, and Vitamin D.  For those whose diets are less than ideal, a good quality multivitamin/mineral formula containing these essential nutrients makes sense.  Of all the major vitamins and minerals, perhaps the most clinically relevant today is Vitamin D, which has come to the attention of doctors due to numerous, rather startling reports since 2000, revealing that as many as 80-90% of Americans may be at least sub-clinically deficient in this essential substance.  In one key study in 2008, in the American Journal of Clinical Nutrition, Vitamin D deficiency was recognized as a worldwide pandemic.(3)

Vitamin D is not technically a vitamin; it is a steroid compound manufactured in the skin upon exposure to sunlight, and then processed (first in the liver, then further in the kidneys and by the immune system) into a hormone called calcitriol.  Calcitriol is essential to the formation (in children) and the maintenance (in adults) of strong, healthy bones.  It is also essential to immune function and acts as a major anti-inflammatory.  It is believed that sun-avoidance and the increased use of sunblock have contributed to the reported widespread deficiency, but stress hormones also act to inhibit the production of Vitamin D, and this is undoubtedly playing a role as well.  Natural dietary sources of Vitamin D include fatty fishes, mushrooms, and meat.  In addition, many of our staple foods such as milk, flour, and margarine are routinely artificially fortified with D.  However, as we have seen, despite widespread availability, the pandemic incidence of Vitamin D deficiency points to the need for supplementation in the vast majority of Americans.  A simple blood test can settle the issue.  Ask us about testing for Vitamin D or speak to your primary care provider about it.    

To address the issue of dietary deficiency we recommend Polyphenol Nutrients by Pure Encapsulations.  This supplement starts with organic whole foods, the nutrients of which are isolated and then acted on by special microorganisms to dramatically increase their potency and bioavailability.  PureFood Nutrients contains all the essential vitamins and trace minerals, including Vitamin D, as well as the anti-oxidants and phytonutrients from blueberries, broccoli kelp, kale, cranberries, turmeric, and tomatoes which have led to these special foods being designated as ‘superfoods’ by many of the world’s top experts in clinical nutrition.  For those shown to have Vitamin D deficiency and those who choose not to take this multivatamin formulation, separate supplementation with Vitamin D is recommended.  We recommend Bio-D-Mulsion Forte, by Biotics Research.  This pharmaceutical grade formulation is a liquid emulsion of Vitamin D, delivering 2,000 i.u. in each tiny drop.  I put it in yogurt, salad dressing, or you can just put a drop on your finger and lick it off.  It has the mild flavor of sesame oil.   

2) Supplementation for deficiency due to blood loss or illness: This second scenario is one in which deficiencies exist due to disease or other causes of blood loss.  Malabsorption syndromes, genetic disorders, and the lack of appetite which accompanies both disease and some of the medicines used to treat disease, can all result in vitamin and mineral deficiency states.  Heavy menstrual periods, ulcers, and hemorrhoids have all been known to cause sufficient blood loss to result in iron deficiency.  A drop in hormone levels associated with menopause can interfere with production of Vitamin D and the ability to maintain strong bones resulting in osteopenia or osteoporosis.  These are just some examples of conditions which require specific nutritional supplementation.  Supplementation of this kind is meant as a form of specific therapy and must be diagnosed and carefully prescribed under the supervision of your doctor.  All supplementation should be discussed with your doctor prior to beginning a regimen, but this is especially true when addressing issues surrounding disease and blood loss as supplementation may interfere with medicines being used to treat the condition.      


3) Supplementation to improve function and move us in the direction of optimal health:  This third scenario represents the newest and in many ways the most interesting and exciting area of supplementation.  Increasing inflammation and diminishing circulation is thought to be the norm for people as we age, but is it inevitable?  Can we slow this progression or even reverse it?  And if so, which things move us in the right direction, toward better function and health?  Most of us are well acquainted with the standard formula for improving health: cardiovascular exercise, weight loss, a clean diet, adequate rest, low levels of stress, and avoidance of cigarettes and other toxic addictive substances.  But over the last few decades new information has come to light, adding both to our understanding of aging and to our arsenal of defense against what was once thought to be the inevitable slide down the Continuum in the direction of disease.  What we now know is that certain substances can act to lower inflammation and improve circulation, in other words, to move us toward better health and longer lives.  


As we move from a paradigm of ‘catching’ a cold, to one of cellular stress leading to impaired and/or hyper-immune function resulting in viral illness, we begin to also see that lowering cellular stress through supplementation with Vitamin D can improve immune function and prevent illness.  As we move from the concept of our aging parents ‘getting’ Alzheimer’s Disease, to one of progressively diminished circulation depriving the brain of adequate nutrition ultimately resulting over decades in an inflammatory brain disorder known as Alzheimer’s Disease, so we also begin to see the role for Omega-3 Fatty Acids (fish oil) in improving circulation, and of Alpha Lipoic Acid (ALA), an extremely potent anti-oxidant that is both fat and water soluble and capable of crossing the blood-brain barrier to reduce inflammation in nerve and brain tissue.  As we move away from the concept of a heart attack as a sudden event, and toward the more sophisticated understanding heart disease as progressive inflammation resulting in atherosclerotic plaques which diminish blood flow to the heart and other vital organs, so may we begin to grasp the importance of (again) Omega-3 Fatty Acids (fish oil) with their ability to lower inflammation thereby reducing cholesterol levels, and of Coenzyme Q-10 (Co-Q).  Essential for production of cellular energy (ATP), Co-Q is found in the highest concentrations in heart, liver, and kidney cells, and deficiency of Co-Q has been linked to hypertension, heart disease, and heart failure.  Studies have demonstrated slowing or reversal of atherosclerosis and lowering of blood pressure with the use of Co-Q (17 points drop in systolic pressure and 10 points drop in diastolic pressure). (4)  Used as a prescription medicine in several European countries, Co-Q is available in the U.S. as a supplement.  As we move from the concept of middle age weight gain as normal and inevitable to that of progressive adipose formation as the result of diets loaded in starch and sugar, we begin to see the role of Resveratrol as a potent anti-oxidant and for its unique ability to reduce inflammation by activating a gene which burns excess abdominal fat.  As we move from the paradigm of ‘getting cancer’ to one of chronic cellular oxidative stress leading over time to an abnormal rate of cell division and eventually the development of malignancy, we begin to see the wisdom in high quality Green Tea with its unique catechins (especially EGCG) and their powerful anti-oxidant and cancer-protective qualities.