“Americans have the world’s most expensive urine.” This was the beginning of a lecture I heard a few years ago, and as I thought about my own oft-fluorescent urine, I had to agree. The lecturer was supporting the conventional Western medical belief that vitamins and supplements are not necessary if one eats a healthy, well-balanced diet. I have been on the fence about this topic and have done my own research. I disagree.

By supplements, I mean vitamins, minerals, herbs, amino acids, phospholipids, enzymes, and the list goes on and on. The argument against supplements states that humans have done just fine for millenia without extra pills or concoctions. But have they? Humans have always had various ailments and just because they existed with these ailments, it does not mean that they fulfilled their potential health and wellness.

My own health journey , and those of many of my patients, has formed my opinion on this topic. For example, I used to have a lot of migraines. These have largely subsided since I take a supplement that combines magnesium, high doses of vitamin B2 and co-enzyme Q10. Why does my body need this when others do not? I don’t know, but a better question is: why do I get migraines when others do not? The simple answer is that our biology makes each of us a unique machine with unique deficiencies and surplusses.

And what about environment? It has become accepted as fact that our food is not as nutrient dense as it once was. From an article in Scientific American (not a woo-woo fringe publication by any means): “it is true that fruits and vegetables grown decades ago were much richer in vitamins and minerals than the varieties most of us get today. The main culprit in this disturbing nutritional trend is soil depletion . . . Sadly, each successive generation of fast-growing, pest-resistant carrot is truly less good for you than the one before.” (April 2011)

I routinely recommend supplements to my patients, depending on their concerns. If they have aches and pains, I will recommend curcumin. If they have anxiety, I will recommend a combination of L-theanine, phosphatidylserine, and/or magnesium. If they are constipated, magnesium. If they want to lose weight, magnesium. (Okay, kidding about that last one, but you can tell that I do love magnesium!)

As I have mentioned in previous posts, a lot of medications are recommended because they have patents and marketing dollars to promote them. No one profits from recommending magnesium. Yes, supplements are a billion dollar industry, but individual manufacturers do not have the financial clout to promote their products compared with the pharmaceutical industry.

Alas, there can be too much of a good thing and more is not better. I frequently have patients bring in their lists of supplements and some of these lists are very, very long. Not too long ago, I had a patient bring in a grocery bag full of supplements that she takes every day. I went through the bag and asked her why she was taking some of these–Why the milk thistle? The mega-dose vitamin E? The selenium? The answer was the same for all of these: “I heard it was good for me.” I suspect that she probably did benefit from some of these, but it is never good to purposely ingest a chemical and have no idea why you are taking it. It is also not good for your bank account.

So where is the happy medium? Can one take supplements without going overboard or going broke? Now if a person feels perfectly fine and has nothing that they feel needs improvement, then great. But if a person has room for improvement, then these are my core recommendations:

(Almost) everyone should take a multivamin, omega-3 fatty acids and vitamin D-3.
If fatigue is a major issue, do some basic blood work. Maybe you are anemic and need iron, or have low B12 levels and need to supplement this.
There is a reason supplements are so popular. They often work. (And if some of this is placebo-effect, is that really so bad?)
If one has gut issues, take a pro-biotic with the caveat that these are not all created equally. My personal preference is for spore-based probiotics, that can survive our acidic stomachs and temperatures. If a probiotic needs to be refrigerated, one has to wonder how it will survive a temp of 98.6F. But this is another topic entirely.
If you are taking more than 3 or 4 supplements, ask yourself why. Was it because you saw a sensationalized article in Women’s Day or a friend of a friend heard this was good to take?
Finally, just because something is “natural” does not mean it is safe. Cyanide is natural. Poison Ivy is natural. You get the picture.

By Cynthia McNally MD 5-27-2021