Top 10 Things to Know about Supplements

At this point I’ve worked for two Chinese herbal pharmacies, one integrative pharmacy (providing a mixed offering of over-the-counter supplements and prescription pharmaceuticals) and have helped to market a US-based Chinese herbal distributor as well as a Western nutritional supplement manufacturer. Over this time, I’ve received a lot of questions about how to choose the right supplement and also seen a fair number of people randomly purchase and try supplements. In an attempt to address some of these questions, and also to explain why I don’t suggest buying and trying supplements without a practitioner recommendation, I’ve put together my…

Top Ten Things to Know about Supplements

1. Isolates are not whole foods.

One of the biggest differentiators within nutritional supplements is whether it is a whole-food product or not. What does this mean? Well, a nutrient, such as vitamin C, can be lab made and or isolated and concentrated – this would be considered an isolate. Or, a nutrient can be found in a whole food, such as the vitamin C found in an orange. In the case of a whole-food supplement, they’d take this natural source, extract it (for example, juice and dry) and then blend it into its final supplement that starts with an isolate (see #2). To supplement with a whole food, well that would mean simply eating the orange.

Obviously, eating an orange is the most natural form of nutrition; however eating a whole food also provides the lowest dose of any given nutrient. With an isolate, you can pack in much higher quantities of desired nutrients. A whole-food supplement is a pretty good go-between, providing slightly higher quantities of desired nutrients, while also getting all the beneficial cofactors (read: everything else that’s helpful and nutritious) in the food. Is one better than another? Not necessarily – it really depends on what’s needed.

2. Supplement Facts are different from Nutrition Facts.

Remember that bit where I said a whole-food supplement starts with an isolate? That’s because if a company is going to put a supplement on the market the FDA wants to be sure the public knows what they’re getting. Makes sense, right? But… two foods are never going to provide exactly the same amount of nutrients, right? So, a company has to start with a given amount of isolates so that they can guarantee there will be at least that much of a certain nutrient in the final product; the whole-food addition is just that, additional goodness. One of my favorite ‘supplement’ lines is HealthForce Nutritionals. What I love about their products is under their Nutrition Facts label I don’t see a list of nutrients; I see a list of foods– a sure sign I’m eating as naturally as possible. (Still would be nice to have an idea of how much of what was in a ‘supplement’– too bad they can’t test and list a random batch’s profile!)

3. Supplements come from various medical paradigms.

Just because you’re in the ‘Supplements’ section doesn’t mean they all work for the same reasons. You’ve got nutritional supplements, glandulars, Chinese herbs, Western herbs, homeopathic remedies, etc. I once had a customer question about hot flashes and what causes them. I explained how in Chinese medicine we understand that as the body ages, Kidney yin naturally declines, allowing yang to escape, which can result in hot flashes. A colleague who had been standing by then leaned into the conversation to say, “Yes, but I think she was asking what causes hot flashes?”

(my pained, inside voice….)

Yes, it’s important to understand there is more than one theory on what causes illness and how to treat it. This difference will roll over to available treatment. Homeopathics can be very powerful medicine when prescribed appropriately; Chinese herbal medicine can be wonderful with the right diagnosis; Western supplements and herbs can be just what the doctor ordered when the whole picture is taken into consideration. One ‘sleep aid’ is not the same as another….

4. Homeopathics are energetic medicine.

I find homeopathic remedies so interesting! My first introduction to this medicine was with flower essences. In working with patients and customers, I’ve found many people don’t know how they’re made, but almost always are fascinated when I tell them. So, I thought I’d tell you, too!

Homeopathics are generally considered super safe because they’re a type of energetic medicine. They start off with a material–let’s say in the case of flower essences, a flower–from which they make a tincture by letting the crude material soak in an alcohol-water solution. Then they dilute it down, by taking only one drop of that solution and adding it to let’s say 9 parts alcohol-water solution. Then they take one drop of that diluted solution and add it to another 9 parts diluting material, etc. In the end you might be taking a remedy that has only one drop of the original tincture to 1,000,000,000,000,000,000,000,000,000,000 parts diluting material. (Seriously!) So, remember – the number on the side of the vial actually means something — it speaks to the concentration of the medicine, which is different than you’d think. The higher the number does not mean stronger medicine! Remember just then I said different supplements come from different medical paradigms? Well, in homeopathic remedies, a 6C, for example, targets something different than a 30C of the same remedy. The best part of homeopathics is that you don’t have to worry about drug interactions.

5. Homeopathics can work differently on different people.

Just an important side note about homeopathics–some people can have an opposite reaction to the remedy than intended. So, for example, a person taking a ‘calming’ homeopathic remedy might actually feel more anxious or excited after taking it. More reason to work with a homeopath before haphazardly pulling these off the shelves….

6. Vegans and vegetarians, check your sources.

And a last note on homeopathic remedies: They’re not necessarily going to tell you on the label if the remedy is vegetarian or vegan. A good example is extremely popular Oscillococcinum used by folks to treat flu symptoms. It would be great if anywhere on the packaging it indicated it was made with duck liver….

7. Nutritional supplements affect the body.

This one is hard for people to understand because supplements are so readily sold without question. It should be a no-brainer – but I mean nutritional supplements can affect the body in ways you were not expecting. Let me grab a bit on adverse reactions from a sample supplement, taken from Natural Medicines Comprehensive Database, an unbiased source for clinical information on the subject:

Orally, [supplement name] is generally well tolerated. Side effects are more common with higher doses and include flatulence, nausea, vomiting, diarrhea, constipation, dry mouth, headache, mild insomnia, anorexia, sweating, dizziness, and nervousness (5231,9113,12231,14840,17123). Anxiety and tiredness have occurred in people with depression (5231,14841), and hypomania in people with bipolar disorder (5231). A case of mania with suicidal ideation has also been reported in an otherwise healthy patient (12231).

It’s true – a lot of people safely take this particular supplement, and they’re very happy with the positive effects. But as you can see, it would be extremely wise to only take it under the supervision and suggestion of an educated practitioner. For the right person, this supplement could really be the wrong choice.

8. Nutritional supplements can interfere with medication.

Another reason you want to make sure a healthcare professional is managing what you’re taking! And not just like… things get wonky. Women taking oral contraceptives and St. John’s Wort can find themselves getting pregnant–that kind of surprising ‘interference.’ Let’s not even get into drugs that affect the heart or mood….

9. Vitamins and minerals need their friends, too.

In Chinese herbal medicine, we break down a formula into parts of (my terms) who’s in charge, who’s their wingman, who’s their flanking support, and who gets them through the door into the party. Nutrition isn’t much different–let’s take calcium for example. We know we want calcium for the bones, and many agree 1200 mg is the lucky number. But, they found folks taking elemental calcium at higher doses showed increased risk for heart attack–the calcium was going to the blood vessels, not necessarily the bones. In contrast, when vitamin D is added, they find there doesn’t seem to be a significant problem with calcium going to the vessels. The take-home point? Food is always best. Next best, might be finding a synergistic formula in which the chief has a checks-and-balance system.

10. Citrate, glycinate, gluconate, carbonate, oh my!

This one is tough – you’ll find you can buy the same mineral in many different chelated forms: ~ citrate, ~ glycinate, etc. A chelated mineral is when they bind the mineral to an amino acid for the purpose of (supposedly) increasing bioavailability. It’s never clearly indicated what the difference is and/or which one to get. Again, there’s no right answer; and it’s different for each mineral. However, generally speaking when choosing between these you’re really choosing between digest-ability and absorb-ability. Some are easier on the digestion than others–remember these are rocks; and rocks aren’t the easiest to digest. So, depending on the strength of your gut, and the level of supplementation needed, you might choose one over another. Yet one more reason to leave it to the professionals….

Conclusion

Well, I hope this piece leaves you with a little more respect for what’s readily available to you in supporting your health, and a little more inspired to talk with a healthcare provider before trying to tackle it on your own. Concerned? Come on in for appointment!

Medicinal Herbs Not All the Same

How many plants are in your backyard? How many different types of rock? How many animals come through? Is it possible to imagine how many more exist in your state, region, or country? It is almost unfathomable to consider all the species of plant, animal and mineral that exist across the globe when just under 2.5 acres of the Amazon alone contain 750 different types of trees and 1500 different plants! (Who’s ever counted anything above 100?) And yet, despite the challenges, some brave folks have made great leaps and bounds in identifying what they find, what may be dangerous, and what may be potentially medicinal. You can imagine that even being able to do this for your own backyard would be challenging enough – but for an entire state, country? You’d need time– a few lifetimes!

It makes sense given the context of possibility, that natural medicinals are largely split into subsections. It’s the only reasonable way to know these medicinal well and to learn how they interact with other medicinals in preparation. Here in Washington, many folks see Naturopaths and are taking what we call, “Western herbs;” and anyone seeing a Chinese herbalist is likely taking “Chinese herbs.” You can imagine these were the medicinals people originally found in their backyards on either sides of the globe; and as they started to record what they found and talked to other folks in their area their findings began to expand. Truth be told, what we call “herbs” in Chinese medicine is actually quite a bit more expansive than just plants; it also includes minerals and animal by-/products. For simplicity’s sake I will use the words interchangeably.

Within the Chinese pharmacopeia [of traditional medicines] alone there are  close to 13000 medicinals. Multiply that number by about 7600 and you start to see the number of ways recorded in historical text that these herbs have been combined in formula to treat illness and prevent disease. (My mind already blew at the first paragraph.) In most TCM (Traditional Chinese Medicine) schools in the US a student is trained to know about 300 – 400 medicinals. What does it mean to know an herb?

Each medicinal in Chinese medicine has certain properties that affects the what, how, and where of its function. For example, let’s look at chrysanthemum flower, first mentioned in medical texts around 200 CE in the Shen Nong Ben Cao Jing. Remembering that even the same plant has many different species, we’re talking about Chrysanthemum morifolium Ramat here. We consider this herb to be slightly cold in nature, sweet and bitter, entering the Lung and Liver channels. (No, this isn’t Greek!) Let’s break it down:

TEMPERATURE: We need to know the temperature to see if it is warming or cooling to the body system. Can you imagine you’re sweating under the hot summer sun – what would you prefer, a cooling, refreshing watermelon or a piping hot, pungent curry dish? (I think of my father saying if you were in the desert, you should wear a black wool sweater to stay cool – but that’s cheating! Of course the hot wool sweater will make you sweat–but it’s the sweating that keeps you cool, not the wool! So, let’s stick to the basic principle that certain things warm us us inherently, and others cool inherently.) Here, we can expect where there is heat, there may be cooling with this herb.

NATURE: The nature, in this case sweet and bitter, helps us know how it affects function in the body. For instance, everyone’s seen a child on sugary candy – all that sweetness has a tonic effect. Similarly, each taste has a certain action. Here, we can see Chrysanthemum, because it is sweet and bitter, may drain (bitter) and protect (sweet tonic) at the same time.

PROPENSITY: Lastly, what channels an herb enters tell us what aspect in the body may be affected. Channels connect organs all the way through to the outside skin. Each organ is like an umbrella for physiological functions in the body. Here, Chrysanthemum enters the Lung and Liver channels – so we can expect it treats symptoms associated with these pathways.

THE MORE IMPORTANT STUFF: Dosing. What amount of this herb is safe? Therapeutic? Too much? How does this herb interact with other herbs? Drugs?

AND THEN THE EVEN MORE IMPORTANT STUFF: What farm did the herb come from – what are their growing and processing practices (i.e. was anything added to this herb)? What testing has been done to ensure this herb is what we think it is?

I’ve tried to keep the example relatively vague just to give you an idea that for us herbalists, there’s a lot more to choosing an herb and building a formula than meets the eye. It’s really not safe for you to self-diagnose and self-treat! It’s an art that requires years of education and an appreciation of a person’s constitution, present condition, other contributing factors, and tolerability for an herb. Multiply this by usually 5 to anywhere up to 30 different medicinals and you get a formula that may be of some great use.

So, next time you think you’ll try something – try calling your herbalist first. I’m around on Tuesdays and Thursdays for consultation. ; )