Most of us are well aware that we do not eat properly. Poor dietary habits, busy lifestyles, stress, and other pressures often conspire to result in less than ideal nutrition. In addition, modern farming practices and food processing rob the foods we eat of essential nutrients.
Most nutritionists therefore agree that most of us should be supplementing our diet with select nutritional supplements. This is especially true for those who have chronic medical conditions.
It is important to note, however, that taking vitamins and nutritional supplements is not a substitute for healthy eating. Vitamins and supplements in fact are not foods! They are “co-factors,” substances that help your body utilize food more effectively and allow your body’s physiology to function better. So if you’re putting garbage in, you’ll get garbage out, no matter how many supplements you’re taking.
What supplements should I be taking?
While a complete discussion of what supplements you should be taking is beyond the scope of this site, the following is a list of the supplements we most commonly recommend for the patients we see in our practice. Please talk to our physician if you have specific questions about which supplement(s) might be appropriate for you.
Multivitamin
At the very least, most people can benefit from being on a good multivitamin. Women who are still menstruating may want to choose a multivitamin that has iron, or take an additional iron supplement.
Calcium
Women should be taking a calcium supplement, preferably one with Vitamin D in it. The teenage years are the most important for calcium intake. In fact, once you reach the age of about 25, your body has laid down about as much calcium in the bones as it ever will. After that, calcium supplementation will prevent bone loss, but will not significantly add any additional bone density. However, most teenage girls are getting about 40% less calcium than they require for adequate bone mineralization. Therefore, every teenage girl should be taking calcium supplements, as well as every adult woman. Generally, calcium citrate/malate is preferred to calcium carbonate, since it is more easily absorbed and bioavailable.
Omega-3 Fatty Acids (Fish Oil)
The health benefits of Omega-3 oil cannot be overstated. It can help prevent heart disease (including atherosclerosis) and stroke, and it is an anti-inflammatory and anti-oxidant. It has even shown to be helpful in treating chronic conditions such as osteoarthritis, Multiple Sclerosis, and other chronic conditions.
A flood of scientific findings on fish oil points to a startling conclusion: Certain omega-3 fatty acids in the oil, consumed either from fish or fish-oil capsules, appear to offer as much protection against dying from coronary heart disease as do cholesterol-lowering drugs.
The evidence of fish oil's protective powers is so strong that the American Heart Association now urges everyone to eat at least two small 3-ounce servings of fish a week (http://www.americanheart.org/presenter.jhtml?identifier=4632). That's particularly important after menopause in women and after age 45 or so in men, when coronary risk starts to rise.
Last fall the heart association advised people who already have heart disease to consume about 1 gram a day of the active ingredients in fish oil--omega-3s called EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). To follow that recommendation, the average person would have to take at least some fish-oil pills or liquid. This is one of the few times that a major health organization has endorsed any dietary supplement for treating or preventing disease.
In order to consume the suggested amount of fish oil, most people need to take fish oil supplements. The danger is that fish, and therefore fish oil, is potentially contaminated with mercury, and even with other toxins such as PCB’s, dioxin and lead. If not properly manufactured and stored, fish oil also can become rancid. Therefore, it’s critical to obtain your supplements from reputable manufacturers who have filtered their fish oil to remove these toxins and who can guarantee their product’s purity and potency. (See “How do I know what’s a good vitamin product?”)
Flax seed and flax seed oil, by the way, is not the best source of omega-3. It contains relatively little omega-3 oil. It does contain alpha-linolenic acid (ALA), which gets weakly metabolized in the body to omega-3 fatty acid, but it requires a profound amount of ALA in order to get the suggested amount of EPA/DHA, so flax seed is not recommended as a primary source of omega-3.
At Lehigh Valley Institute for Sports & Musculoskeletal Medicine, we suggest the average person take 1000-1500 mg a day of fish oil. For patients with arthritis or chronic diseases, we recommend at least 3000 mg/day, typically in the form of liquid, rather than capsules.
Glucosamine & Chrondroitin
Glucosamine sulfate and chondroitin sulfate are important naturally-occurring components of joint cartilage and connective tissue (such as ligaments and tendons). They are part of the “building block” molecules that help form and maintain cartilage. As we age, our bodies produce less of these substances. Numerous studies have shown the benefits of taking G/C both to help with treating the symptoms of arthritis and also possibly to slow down the development of arthritis.
Contrary to certain reports, both glucosamine and chondroitin molecules get absorbed into joint cartilage. In one study published in a major orthopedics journal, researchers tagged the glucosamine and chondroitin molecules with harmless radioactive labels so they could track where the molecules went in the body. They clearly demonstrated that both molecules became well absorbed into the joint cartilage.
The recommended amount is a starting dose of 1500 mg a day of glucosamine and 1200 mg a day of chondroitin for the first month. Then you may try decreasing to 1000 mg and 800 mg of glucosamine and chondroitin respectively a day.
As with all other nutritional supplements, brand matters. There is no government oversight over the health food industry, and there are some glucosamine and chondroitin products on the market that are not even worth the bottles in which they are packaged. The absolute best product on the market currently is Cosamin-DS®, made by Nutramax Laboratories. It is available through most pharmacies, health food stores, and the internet.
MSM
MSM (methyl sulfonyl methane) is another supplement that can help support connective tissue. It can be useful in treating arthritis, especially when used in combination with glucosamine and chondroitin. The connective tissue fibers (ligaments and tendons) are held together by sulfur bridges or links. MSM is good source of sulfur and therefore helps bind together the fibers that make up the ligaments and tendons. MSM is also a weak natural anti-inflammatory and may help with some of the pain associated with arthritis.
Sulfur is not sulfa. Sulfa is an antibiotic to which some people are allergic. Since your body contains large amounts of sulfur, it is impossible to be allergic to it.
The suggested dose of MSM is 3000 mg/day.
Other Supplements
Lehigh Valley Institute for Sports & Musculoskeletal Medicine carries a complete line of nutritional support products at our office, and others can be ordered and received usually within about a week.
Can I take too many vitamins?
When it comes to vitamin and mineral supplementation, more is not necessarily better. In fact, fat-soluble vitamins, such as vitamin A, can reach toxic and dangerous levels if doses are too high. In addition, many people take multiple nutritional products, many of which may have the same ingredients, leading to doses that are too high. It is critical that you read labels carefully and that you discuss everything that you’re taking with your physician. This is why companies that manufacture professional-grade supplements do not sell their products through health food stores. They want to insure that patients are using their products correctly and under physician supervision.
How do I know what’s a good vitamin product?
Deceptive Claims
Most vitamin and nutritional product suppliers assure you they are giving you the best quality in the marketplace. In our experience they often don’t deliver the quality that they claim. Most manufacturers do little or no testing of their products. And many natural product testing laboratories use unethical practices and poor science to test the validity of raw materials and finished products. The bottom line is that you have no guarantee that what’s on the label is what’s in the bottle.
While all nutritional product companies claim to have the best quality, almost none are completing all the steps that are required to insure comprehensively that quality and purity are consistently produced time after time. And there is no government mandate that dictates they should!
What should I know about sports nutrition?
Athletes often ask us what they should be taking to improve performance. As with many such questions, the answers depend on the athlete’s age, the sport, co-existing medical conditions, and dietary habits.
At the very least, most supplements marketed to athletes to improve performance essentially are worthless! The only supplements proven to enhance performance are caffeine and creatine, but each of these has its own problems and dangers.
Caffeine
Caffeine is a legal stimulant and can enhance performance in certain sports involving speed. But it can hinder performance in sports such as archery and shooting where fine motor control and a steady hand are essential.
Creatine
Creatine can boost strength and power, but it does so at the expense of increased weight gain. Creatine may be helpful for sports such as weight lifting, body building, baseball, and for football linemen. But because it increases body weight, it can hinder performance in sports where maintaining lean body weight is critical. Creatine should also be avoided in teenagers and younger athletes because of the increased physiologic load placed on the kidneys and the lack of long-term studies investigating its safety in these age groups.
Make sure you buy your creatine from a reputable supplier. Many companies either “cut” their creatine with other powders, or they add other supplements to the creatine, some of which may be banned substances by the NCAA or U.S. Anti-Doping Agency, or may be downright harmful. You should only use pure creatine monohydrate.
The correct way to take Creatine is by “cycling.” Mix 5 grams (one rounded teaspoon) of pure creatine monohydrate in juice, and take it once daily for one month. Then stop for at least a month to allow a “washout” period. Higher loading doses used to be recommended, but that approach has fallen out of favor since it does not appear to be necessary and puts an unnecessary load on the kidneys.
Protein Supplements
Proteins are the building blocks of the body, and amino acids are the building blocks pf proteins. There are 9 “essential” amino acids—amino acids that are not synthesized in the body and need to be obtained through the diet. Protein builds muscle and it rebuilds and repairs muscle after exercise. During exercise up to 15% of the energy needs are generated from protein breakdown into glucose.
Protein supplements have long been used by athletes to improve performance. However, there is no scientific support for protein supplementation as a performance enhancer. Protein shakes and bars have gained popularity with the rise of high protein-low carbohydrate diets. Most athletes need less protein then they think, and they need more carbohydrates than they believe. A healthy balanced diet provides the protein needs for most athletes. Athletes in certain sports, such as weight training, and field events, such as shot put and hammer throw, may benefit from a small amount of protein supplementation. But too much protein puts a large burden on the kidneys, which have to filter the excess protein and amino acids from the blood.
According to the American Society of Exercise Physiologists (ASEP), the protein requirement for general fitness/nutrition is about 1.0 gram of protein per kilogram of body weight per day. For moderate-to-high intensity athletic training, recommended protein requirements are 1.0-1.5 grams per kilogram of body weight per day. For intense athletic training, approximately 2.1 grams of protein per kilogram of body weight per day of protein is suggested.
Be careful when choosing “protein bars.” Many bars are nothing more than glorified candy bars, high in fat and carbohydrate. So read the labels carefully.
Carbohydrates & Fats
The advent of low-carb diets has cast an undeserved bad shadow on carbs. But carbs are in fact the mainstay of sports nutrition. These are not the enemy! Carbs provide the necessary quick fuel and energy for actively contracting muscles. They also provide a sort of “flame” that helps break down fats more efficiently, providing energy for endurance events. Stored carbohydrate is referred to as “muscle glycogen” (MG). During aerobic exercise, it is important to have sufficient MG stores in order to reduce the amount of protein breakdown occurring during activity.
The key is carb selection. Avoid simple carbs and instead choose complex carbs such as fruits and vegetables. Certain pasta manufacturers (such as Barilla and Hodgson Mills) are now selling high-protein whole grain pastas that are quite tasty. During endurance exercise, however, simple carbs may help provide immediate fuel for sustained activity. Sports drinks such as Gatorade® or Cytomax®, or easy-to-carry fruits such as bananas or orange slices, can provide quick carbohydrates.
Likewise, fats are necessary and can provide a source of energy for sustained endurance activities. Fat is also essential for the utilization of fat-soluble vitamins. Unsaturated fats, such as olive and canola oil, preferred over saturated fats such as butter. Approximately 30% of dietary calories should be in the form of fat, with most of that being mono-unsaturated fats.
Growth Hormone Promoters
Numerous manufacturers have been marketing products claiming to stimulate release of growth hormone within the body. Such claims are completely unfounded. These products break down in the stomach and have no proven effect on growth hormone production. Growth hormone levels need to be measured by blood tests, and the only way to increase growth hormone levels is by injection.
Vitamin Supplements
Because of the increased risk of oxidative stress and the formation of free radical molecules, athletes should at least be taking a multivitamin, and women should add iron. Additional antioxidants, such as vitamin C, coenzyme Q-10, and omega-3 fish oil should be added. |
