Category Archives: Supplements

Omega-3 Supplements: Brain Poison or Dementia Preventative?

I recently started taking an omega-3 fish oil supplement with hopes of preserving cognitive function as I age. Cold-water fatty fish are a natural source of omega-3s and I haven’t been eating much lately. My supplement contains 1040 mg of omega-3 fatty acids. It’s a large pill that is difficult to swallow sometimes.

Alaskan Omega-3 Fish Oil by Sports Research

Now I’m starting to wonder if I should continue. From Daily Mail:

The [single observational study] researchers compared 273 people who take omega-3 supplements daily, with 546 similar non-users – and found that those taking fish-oil pills appeared to decline faster on several cognitive scores.

However…

…when it comes to omega 3s and cognitive function, in a major [meta-analysis] review published recently in Scientific Reports, analysis of 58 randomised controlled trials from multiple countries suggested that omega-3 supplements may be associated with slightly better cognitive outcomes – or slower decline in some areas, particularly memory.

Steve Parker, M.D.

Apple Cider Vinegar for Weight Loss?

Photo by Denise Cusack on Pexels.com

Scott Gavura at Science-Based Medicine posted a beautiful article on how science is supposed to work. I don’t understand how the scientific article at hand made it through the peer-review process all the way to publication.

Interest in vinegar as a health remedy is perennial. Apple cider vinegar (ACV) is simply vinegar made from fermented apple cider. Chemically, it is mostly dilute acetic acid, the same ingredient found in ordinary white vinegar. In 2024, a study published in BMJ Nutrition, Prevention & Health reported that a small daily dose of apple cider vinegar produced dramatic weight loss 6–8 kilograms (13-17 pounds) over 12 weeks. The paper was withdrawn more than a year later after substantial criticism. But even before concerns about methodology and reporting were raised, the magnitude of the results should have prompted skepticism: The numbers reported did not align with basic physiology.

RTWT.

—–Steve Parker, M.D.

Which Supplements to Take if You’re Over 65

…..according to Dr. Rhonda Patrick. She’s not a physician. Her Ph.D. is in biomedical science. I’ve listened to several of her podcasts and think that she does a generally good job of keeping her recommendations science-based. Her supplementation recommendations assume you’re generally healthy, eating a healthy diet (e.g., Mediterranean!), and exercising regularly, including some vigorous exercise like HIIT (high intensity interval training.

Here’s the list:

  1. Vitamin D
  2. Omega-3 fatty acid (1.5-3 g/day)
  3. Standard multivitamin (ideally containing lutein and zeaxanthin) (she mentions Centrum Silver)
  4. Lutein (if not in your multivitamin)
  5. Zeaxanthin (if not in your multivitamin)
  6. Magnesium
  7. Melatonin 1.5-3 mg/day, 2-3 hours before bedtime
  8. Creatine monohydrate, at least 5 g/da, 10 g is better
  9. Ubiquinol
  10. Sulforaphane

I’m not very familiar with sulforaphane. Two commenters at YouTube wrote that she likes the Avmacol brand.

PreserVision AREDS 2 formula of multivitamins contains zeaxanthin and lutein. You might want to compare that that product to Centrum Silver. In another video Dr. Patrick said the dose of vitamin D is 4,000 IU. I say the dose may depend on your latitude and amount of sun exposure. I’ve heard for years that magnesium oxide and magnesium chloride are very poorly absorbed; magnesium glycinate, citrate, taurate, and malate are better absorbed. So the latter are the preferred magnesium forms. Dr. Patrick also says magnesium is better absorbed if your total daily dose is divided; e.g., take half your daily dose in the AM, half in the PM.

I’m sure Dr. Patrick goes into details of these items at her YouTube channel (FoundMyFitness) and podcasts (FoundMyFitness and The Aliquot).

On the other hand, neurologist Steven Novella would probably disagree with taking those supplements. He writes at Science-Based Medicine:

Many times in my career I have sat across from a patient who expressed that they are getting serious about their health, and then rattle off a list of things that they are doing to improve their health – all mostly worthless. I do not blame them – they are victims of a self-help, supplement, and wellness industry that has completely mislead them. A typical list might include: eating only organic, avoiding GMOs, taking daily vitamins, eating low-carb, and using a sauna (or perhaps cryochambers). Sometimes they throw in fully magical interventions, like feng shui or reiki. In short, they invest a lot of time and money into interventions that will not make them more healthy, and distract them from the things we know will. 

If you want to improve your health and longevity the data suggests there are five things that are of primary importance (in terms of lifestyle) – eat a well-rounded balanced diet, get sufficient quality sleep, don’t smoke, limit alcohol intake, and exercise regularly. Obviously, getting good medical care is also very important. Get regular checkups (including for dental health), and address any specific health issues you have, including mental health. 

The good news is – there is not mystery to good health. The lifestyle factors I list above are the 99 percenter, meaning that together that have the overwhelming largest effect on your health. So stop worrying about the 1%, there is no magical “superfood” our there, no hack, and no secret.

So, who ya gonna believe? An M.D. neurologist or a Ph.D. in biomedical science?

—–Steve Parker, M.D.

Vitamin Combo Helps Prevent Macular Degeneration

Photo by Dominika Greguu0161ovu00e1 on Pexels.com

I have a particular interest in preventing age-related macular degeneration (ARMD) since it runs in my family. It’s the leading cause of vision loss in adults over 50.

From JAMA Ophthalmology:

Question  What were the long-term findings of Age-Related Eye Disease Study 2 (AREDS2) supplements regarding development of lung cancer or progression to late age-related macular degeneration (AMD)?

Findings  In this epidemiologic follow-up study of the AREDS2 cohort of 3882 participants and 6351 eyes, 10-year follow-up results showed that development of lung cancer nearly doubled in participants assigned to beta carotene among former smokers but not those assigned to lutein/zeaxanthin. Lutein/zeaxanthin was associated with a reduction in the risk of progression to late AMD when compared with beta carotene.

Meaning  These findings suggest that the AREDS2 supplement with lutein/zeaxanthin instead of beta carotene was safe, with no association with developing lung cancer and a potential beneficial association with further reduction in progression to late AMD.

These are the ones I take. In the U.S., your best price may be at Costco or Sam’s Club.

Steve Parker, M.D.

front cover of paleobetic diet

Click to purchase at Amazon.com. E-book also available at Smashwords. com.

High-Dose Vitamin D Supplementation May Be Worse or No Better Than Low-Dose

Lately I’m seeing more patients taking high-dose vitamin D supplements (usually D3, aka cholecalciferol) rather than traditional 400–800 IU/day.

From a recent study:

This randomized trial compares the effects of 400 vs 4000 vs 10 000 IU of vitamin D on total volumetric bone mineral density and bone strength of the radius and tibia.

Conclusion:

Among healthy adults, treatment with vitamin D for 3 years at a dose of 4000 IU per day or 10 000 IU per day, compared with 400 IU per day, resulted in statistically significant lower radial BMD; tibial BMD was significantly lower only with the 10 000 IU per day dose. There were no significant differences in bone strength at either the radius or tibia. These findings do not support a benefit of high-dose vitamin D supplementation for bone health; further research would be needed to determine whether it is harmful.

Source: Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength: A Randomized Clinical Trial | Osteoporosis | JAMA | JAMA Network

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

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Still Taking Fish Oil Supplements? Think Again

Salmon is one the the cold-water fatty fish loaded with omega-3 fatty acids

Salmon is one the the cold-water fatty fish loaded with omega-3 fatty acids

I’ve been sitting on this research report a few years, waiting until I had time to dig into it. That time never came. The full report is free online (thanks, British Medical Journal!). I scanned the full paper to learn that nearly all the studies in this meta-analysis used fish oil supplements, not the cold-water fatty fish the I recommend my patients eat twice a week. If you’re taking fish oil supplements on your doctor’s advice, don’t stop without consulting her.

Here’s the abstract:

Objective: To review systematically the evidence for an effect of long chain and shorter chain omega 3 fatty acids on total mortality, cardiovascular events, and cancer.

Data sources: Electronic databases searched to February 2002; authors contacted and bibliographies of randomised controlled trials (RCTs) checked to locate studies.

Review methods Review of RCTs of omega 3 intake for 3 6 months in adults (with or without risk factors for cardiovascular disease) with data on a relevant outcome. Cohort studies that estimated omega 3 intake and related this to clinical outcome during at least 6 months were also included. Application of inclusion criteria, data extraction, and quality assessments were performed independently in duplicate.

Results: Of 15 159 titles and abstracts assessed, 48 RCTs (36 913 participants) and 41 cohort studies were analysed. The trial results were inconsistent. The pooled estimate showed no strong evidence of reduced risk of total mortality (relative risk 0.87, 95% confidence interval 0.73 to 1.03) or combined cardiovascular events (0.95, 0.82 to 1.12) in participants taking additional omega 3 fats. The few studies at low risk of bias were more consistent, but they showed no effect of omega 3 on total mortality (0.98, 0.70 to 1.36) or cardiovascular events (1.09, 0.87 to 1.37). When data from the subgroup of studies of long chain omega 3 fats were analysed separately, total mortality (0.86, 0.70 to 1.04; 138 events) and cardiovascular events (0.93, 0.79 to 1.11) were not clearly reduced. Neither RCTs nor cohort studies suggested increased risk of cancer with a higher intake of omega 3 (trials: 1.07, 0.88 to 1.30; cohort studies: 1.02, 0.87 to 1.19), but clinically important harm could not be excluded.

Conclusion: Long chain and shorter chain omega 3 fats do not have a clear effect on total mortality, combined cardiovascular events, or cancer.

Steve Parker, M.D.

Reference: Hooper, Lee et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ  2006;332:752-760 (1 April), doi:10.1136/bmj.38755.366331.2F (published 24 March 2006).

Magnesium Supplementation May Enhance Effects of Exercise in Elderly Women

…according to this study published at American Journal of Clinical Nutrition.

Average age of study subjects was 71

Average age of study subjects was 71

Weekly mild exercise sessions were supplemented with 300 mg/day of magnesium. Those taking the supplement showed improved physical performance compared with control subjects. Whether effects are long-lasting is unknown; the study lasted only 12 weeks.

Steve Parker, M.D.

Dr. Oz Discovers the Cure for Overweight….Again

Dr. Harriet Hall writes about it:

Dr. Oz has promoted a series of weight loss supplements on his show.  Raspberry ketones were presented as a fat-busting miracle, thengreen coffee bean extract was touted as “magic,” “staggering,” and “unprecedented.”  And now both of those miracles have apparently been superseded by an even greater miracle: Garcinia cambogia extract.

Dr. Oz calls it “The newest, fastest fat buster.” A way to lose weight without “spending every waking moment exercising and dieting.” “Triples your weight loss.”  “The most exciting breakthrough in natural weight loss to date.”  “The Holy Grail.” Oz claims that “Revolutionary new research says it could be the magic ingredient that lets you lose weight without diet or exercise.”

But does it work? Click for details at Science-Based Medicine.

Omega-3 Fatty Acid Supplements Fail to Stall Age-Related Brain Decline

I like fish, but cold whole dead fish leave me cold

Supplementation with omega-3 fatty acids does not help prevent age-related cognitive decline or dementia, according to an article at MedPage Today.

The respected Cochrane organization did a meta-analysis of three pertinent studies done in several countries (Holland, UK, and ?).

The investigators leave open the possibility that longer-term studies—over three years—may show some benefit.

I leave you with a quote from the MedPage Today article:

And while cognitive benefits were not demonstrated in this review, Sydenham and colleagues emphasized that consumption of two servings of fish each week, with one being an oily fish such as salmon or sardines, is widely recommended for overall health benefits.

Steve Parker, M.D.

Reference:
Sydenham E, et al “Omega 3 fatty acid for the prevention of cognitive decline and dementia” Cochrane Database of Systematic Reviews 2012; DOI: 10.1002/14651858.CD005379.pub3.

Calcium Supplementation Linked to Heart Attacks

A new European study suggests that calcium supplements almost double the risk of having a heart attack, at least in Germans.  You can read the full report in the current issue of Heart.

The medical literature on this issue is a confusing mess.  In other words, lots of conflicting results.

Huge numbers of women in the U.S. are taking calcium supplements either to treat or prevent osteoporosis and the associated broken bones (e.g., hips, wrists, spine).

What I’d like to know, and what nobody knows, is what is the effect of calcium supplementation on average longevity and quality of life.  Maybe I’d accept a higher risk of heart attack if calcium supplementation prolonged lifespan by two years.

In the interest of brevity, I’ll just say that the best way to get your calcium is probably through food rather than supplements.

Shereen Jegtvig has an article at About.com listing foods rich in calcium.

Exercise can also help keep your bones strong and break-resistant.

Steve Parker, M.D.

PS: If your doctor has you on a calcium supplement, you’d best get his blessing before you stop it.