Are Supplements Really Just "Expensive Urine"?

In an ideal world, we’d all be at the pinnacle of health—physically, mentally, emotionally and cognitively. We’d make all our meals from scratch, from whole-food ingredients purchased locally and in season. We would never fall ill, get injured, grow older, or go through anything else that might increase our bodies’ need for vitamins, minerals and other compounds beyond that which we get from food alone or that our bodies synthesize endogenously. But this is a far cry from the world we actually live in, and nutritional supplements can help ensure patients get what their bodies need for both acute healing and long-term health.

Many thousands of words have been written to make the case against supplementation, claiming that it’s “mostly useless” and “a waste of time and money.” The problem with these claims is that they expect supplements to be instant cures for chronic illnesses that result from poor diets and unhealthy lifestyles. Supplements are intended to be exactly that—supplemental to a nutritious diet. They’re not intended to undo or reverse the damage inflicted by daily dietary insult, sleep debt, sedentarism, drug or alcohol misuse, or anything else that can have an adverse impact on physiological function. So when studies assess a supplement—vitamin C, for example, or biotin, or manganese—and it’s determined that the supplement is no more effective than placebo for whatever the intended outcome was, it should come neither as a shock nor as a disappointment. Supplements can be powerful, but they’re not magical. They can facilitate and augment the body’s natural processes, but in the absence of any other dietary and lifestyle changes, they may not have as big an impact as they would if they were used as intended—as supplementary to the positive actions someone is taking for their health. There are numerous other issues that affect the need for and the efficacy of supplementation. Let’s explore a few of these.

Nutrient form and function

Some of the forms of supplements used in research may not be the most effective—for example, vitamin B6 given as pyridoxine, which may be less effective than pyridoxal-5-phosphate for certain applications. Studies looking at inositol for improving polycystic ovarian syndrome (PCOS) may employ only myo-inositol or D-chiro-inositol, when it appears that using both together may be more effective than either one alone. And of course, there’s the very controversial issue of supplementing with synthetic folic acid rather than natural folates. Using forms of nutrients that are less potent or less bioavailable may falsely indicate that the nutrients aren’t effective, but using a different form might have produced more promising outcomes.  

Therapeutic benefits for individuals with specific health conditions

People who are satisfied with their physical, mental and emotional health may not need supplementation, but considering that around 88% of Americans are metabolically unhealthy, most people probably can benefit from strategic supplementation targeted for their individual situation. For example, according to the Centers for Disease Control and Prevention (CDC), more than 100 million Americans have diabetes or pre-diabetes. Type 2 diabetes or insulin resistance may develop in part from deficiencies in specific nutrients needed for healthy glucose metabolism and insulin sensitivity (such as magnesium), but it also may cause increased need for certain nutrients, such as B vitamins and vitamin C. Diabetes may increase the need for essential fatty acids, because hyperglycemia inhibits the enzyme delta-6-desaturase, needed for elongating the essential fatty acids linoleic acid into gamma-linoleic acid (GLA) and alpha-linolenic acid into EPA and DHA. And diabetes is only one among a long list of common conditions that may increase the need for specific nutrients above that which people typically get from their diet, particularly if they have not yet transitioned to a healthier diet and lifestyle.

Pharmaceutical drugs influence nutrient status

Several pharmaceutical medications interfere with nutrient absorption and/or assimilation, resulting in deficiencies that may be correctable via supplementation. Various diuretics may cause increased need for potassium and calcium. Statin drugs are known to reduce synthesis of CoQ10 and vitamin K2, and metformin use results in reduced B12 absorption. These are just a handful of drug-nutrient interactions that affect nutrient status and may indicate that supplementation is warranted. It’s the rare patient these days who visits a doctor and doesn’t have a long list of medications they’ve been taking for years. These can cause clinically relevant deficiencies that should not be ignored, but rather, may be correctable in part by judicious supplementation.    

Dietary preference and aging

People following restrictive diets may benefit from targeted supplementation of nutrients known to be shortfalls on their particular eating plan. For example, vegetarians and especially strict vegans may require supplementation with vitamins D and B12, EPA/DHA, zinc and iron. Those following strict ketogenic diets may need more potassium and magnesium than they typically get from a relatively limited vegetable intake. Older people need more protein than they typically get from their diet in whole food form. For these individuals—especially those with dental problems or who may not be able to stand and cook for a significant length of time—protein powders and meal replacement shakes can be a convenient and effective way for them to get the nutrients they need.  

Nutritional supplements are not a panacea, but clearly, there’s an important role for them in numerous patient populations. From the patient perspective, however, it’s easy to feel like a deer in headlights in the middle of a health food store supplement aisle, totally overwhelmed by the sea of products on display. To ensure that they get the results they seek, rather than ending up with “expensive urine,” patients should work with qualified healthcare professionals to create a supplement regimen that will be effective for their desired goals.

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