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9 Steps to Perfect Health – #4: Supplement Wisely

February 18, 2011 in Perfect Health | 77 comments

picture of man made by supplementsIn the first three articles in this series, we discussed which foods to eat and which foods to avoid. In this article we’re going to talk about when to supplement and how to do it wisely. We’ve got a lot of material to cover, so you might want to grab a cup of tea and get comfortable!

There are three principles to supplementing wisely:

  • Get nutrients from food whenever possible.
  • Take nutrients in their naturally occurring form whenever possible.
  • Be selective with your supplementation.

Get nutrients from food whenever possible

Humans are adapted to getting nutrients from whole foods. Most nutrients require enzymes, synergistic co-factors and organic mineral-activators to be properly absorbed. While these are naturally present in foods, they are often not included in synthetic vitamins with isolated nutrients.

In a paper published in the American Journal of Clinical Nutrition called Food Synergy: An Operational Concept For Understanding Nutrition emphasizing the importance of obtaining nutrients from whole foods, the authors concluded:

A person or animal eating a diet consisting solely of purified nutrients in their Dietary Reference Intake amounts, without benefit of the coordination inherent in food, may not thrive and probably would not have optimal health. This review argues for the primacy of food over supplements in meeting nutritional requirements of the population.

They cautioned against the risk of reductionist thinking, which is common in conventional medicine and nutritional supplementation. Instead, they urge us to consider the importance of what they call “food synergy”:

The concept of food synergy is based on the proposition that the interrelations between constituents in foods are significant. This significance is dependent on the balance between constituents within the food, how well the constituents survive digestion, and the extent to which they appear biologically active at the cellular level.

They go on to provide evidence that whole foods are more effective than supplements in meeting nutrient needs:

  • Tomato consumption has a greater effect on human prostrate tissue than an equivalent amount of lycopene.
  • Whole pomegranates and broccoli had greater antiproliferative and in vitro chemical effects than did some of their individual constituents.
  • Free radicals were reduced by consumption of brassica vegetables, independent of micronutrient mix.

In short: get nutrients from food, not supplements, whenever you can.

Take nutrients in their naturally occurring form whenever possible

Synthetic, isolated nutrients don’t always have the same effect on the body. It matters whether the nutrients have been produced by technologic or biological processes, because industrial processing sometimes creates an entirely new compound with different physiological actions. Trans fat produced in ruminant animals (such as conjugated linoleic acids in dairy products) are beneficial to health, whereas trans fats produced in the processing of industrial seed oils are highly toxic.

Folic acid is another example. The naturally occurring form of folate is not folic acid, a compound not normally found in food or nature, but tetrahydrofolate. While folic acid can be converted into folate, that conversion is poor in humans. It’s also important to note that unlike natural folate, folic acid does not cross the placenta. This is significant because folate is a crucial nutrient for pregnancy, and while folic acid can prevent neural tube defects it doesn’t have the other beneficial effects of folate. What’s more, several studies have shown that folic acid – but not natural folate – increases cancer risk. Unfortunately, folic acid is what’s often used in multivitamins, because it’s significantly cheaper than natural folate.

Be selective with your supplementation.

Multivitamins have become increasingly popular: half of Americans currently take one. But is this a good idea? Most studies show that multivitamins either provide no benefit, or may even cause harm. A study in the Archives of Internal Medicine showed that multivitamins have little to no influence on the risk of common cancers, CVD or total mortality in postmenopausal women. A now infamous meta-analysis in the Journal of American Medical Association, which looked at over 68 trials with 230,000 pooled participants, found that treatment with synthetic beta carotene, vitamin A and vitamin E may increase mortality.

The problem with multivitamins is that they contain too little of beneficial nutrients like magnesium, vitamin D and vitamin K2, and too much of potentially toxic nutrients like folic acid, calcium, iron and vitamin E. This means that multivitamins can actually cause nutrient imbalances that contribute to disease. Another problem is that multivitamin manufacturers often use the cheapest possible ingredients, such as folic acid instead of natural folate – the consequences of which we discussed above.

Which supplements may be necessary?

At this point you might be thinking I’m against supplementation entirely. Not so. No matter how well we eat, some nutrients are difficult to obtain enough of from food alone. There are also circumstances where are need for certain nutrients may increase, such as vitamin C during infections and magnesium with blood sugar imbalances or metabolic problems. In these cases, it makes sense to supplement selectively with beneficial nutrients.

The five nutrients I recommend most people supplement with are:

  • Vitamin A
  • Vitamin D
  • Vitamin K2
  • Magnesium
  • Vitamin C

Vitamin A (Retinol)

Vitamin A is important catalyst for a variety of biochemical processes in the body. It’s required for assimilation of protein, minerals and water-soluble vitamins, and it also acts as antioxidant > protecting body against free-radical damage and diseases like cancer. Vitamin A plays a crucial role in reproduction, promoting full-term pregnancy and proper development of face (eyes, nose, dental arches & lips).

The RDA for vitamin A (2,600 IU) is woefully inadequate, and even then, over 25% of American consume less than half of the recommended amount. Native populations such as the traditional Inuit – which were free of modern, degenerative disease – got much more vitamin A than the average American. The Greenland Inuit of 1953, prior to much contact with the Western world, got about 35,000 IU of vitamin A per day.

Vitamin A (retinol) is only found in significant amounts in organ meats, which explains why many Americans don’t get enough of it. If you follow my recommendations in #2: Nourish Your Body, and you do eat organ meats (especially liver), you’re probably getting enough vitamin A and thus don’t need to supplement. However, if you’re like most Americans and you’ve never eaten liver in your life, you would benefit from supplementing with A.

There’s been a lot of discussion in the media about the toxicity of vitamin A. Some researchers and doctors now recommend avoiding cod liver oil because of this concern. Even Dr. Mercola has jumped on the “vitamin A is toxic” bandwagon. But is this true?

It is true that vitamin A is potentially toxic. Some evidence suggests that excess vitamin A increases the risk of osteoporosis. For example, this study showed both low and high serum A carried double risk of fractures as did optimal levels.

But if we dig deeper we find that excess vitamin A only causes problems against a backdrop of vitamin D deficiency. In his excellent article Vitamin A on Trial: Does Vitamin A Cause Osteoporosis, researcher Chris Masterjohn summarizes evidence demonstrating that vitamin D decreases the toxicity of and increases the dietary requirement for vitamin A. Studies show that supplementing with vitamin D radically increases the toxicity threshold of vitamin A. In a hypothetical 160 lb. person, vitamin D supplementation increases the toxicity threshold of vitamin A to more than 200,000 IU/d. You’d have to eat 22 ounces of beef liver or take 5 TBS of high vitamin CLO each day to get this amount. Not likely!

To meet vitamin A needs (assuming you’re not up for eating organ meats), I recommend taking high vitamin cod liver oil (CLO) to provide a dose of 10-15,000 IU per day. Cod liver oil is really more of a food than a supplement, but since it’s not a normal part of people’s diet we’ll consider it as a supplement. CLO is an ideal vitamin A source because it also contains vitamin D, which as we just learned, protects against the toxicity of A.

Vitamin D

Much has been written about the need for and benefits of vitamin D supplementation over the past several years – and with good reason. It’s absolutely critical for health, and up to 50% of Americans are deficient.

We can get vitamin D from two sources: food, and sunshine. Seafood is the only significant source of vitamin D, but you’d still have to eat a lot of it to get enough. 8-9 ounces of herring provides about 2,000 IU of vitamin D, which is a minimum daily requirement for most people to maintain adequate blood levels.

Sunlight converts a precursor called 7-dehydro-cholesterol in our skin to vitamin D3. This D3, along with the D3 we get from food, gets converted by the liver into 25-hyrdroxy-vitamin D (25D), which is what typically gets measured when you have a vitamin D test. The optimal 25D level is somewhere between 35 and 50 ng/mL.

Contrary to what some researchers and doctors have recommended, there’s no evidence that raising blood levels of 25D above 50 ng/mL is beneficial, and there’s some evidence that it may cause harm. Studies show that bone mineral density peaks at 45 ng/mL and then falls again as 25D levels rise above 45. Other studies have shown that the risk of kidney stones and CVD increase with high 25D levels, due to elevated serum calcium levels that accompany excess vitamin D.

However, we also know that vitamin A and vitamin K2 protect against vitamin D toxicity, and vice versa. As I explained in the vitamin A section, fat soluble vitamins exist in a synergistic relationship. It’s possible that the people in the studies above that experienced problems with excess 25D levels were deficient in vitamin A or K2, or both. This is why it’s so important to supplement with all of the fat-soluble vitamins together.

What about sunlight? Well, in summer mid-day sun with pale skin, 30 minutes of direct sunlight will produce 10-20,000 IU of vitamin D. But this is a best case scenario. With darker skin, or different times of year, or buildings that block the sunlight, or increased time spent indoors, we won’t be producing that much. It’s also true that aging, overweight and inflammation reduce our conversion of sunlight to vitamin D. This is why sunlight alone isn’t normally a sufficient source of vitamin D.

With this in mind, most people should supplement with D. The amount needed to maintain blood levels of 35-50 ng/mL varies depending on some of the factors I’ve listed above, but in my clinical experience it’s usually somewhere between 2,000 – 5,000 IU. With vitamin D, it’s important to test your levels, begin supplementation, and then re-test a few months later to determine the correct maintenance dose.

As with vitamin A, the best source of vitamin D is high-vitamin cod liver oil. It contains not only vitamins A & D, but also natural vitamin E and other quinones.

Vitamin K2

Vitamin K2 may be the most important vitamin most people have never heard of. It’s needed to activate proteins and it also regulates calcium metabolism (keeping it in the bones and teeth where it belongs, and out of the soft tissue where it doesn’t belong). Elevated blood calcium significantly increases the risk of cardiovascular disease (CVD), which explains why vitamin K2 has been shown to prevent atherosclerosis and heart attacks. It also strengthens bones.

Unfortunately, many (if not most) of Americans are deficient in vitamin K2. It’s important to point out that vitamin K2 is not the same as vitamin K1, which is found in green, leafy vegetables like kale and collards. Some K1 is converted into K2 in our bodies, but that conversion is inefficient in humans. It is efficient, however, in ruminant animals – which is why grass-fed dairy is the most convenient source of vitamin K2 in the diet. This is only true in animals raised on pasture, because it is eating the K1-rich grass that allows them to convert it into K2.

Most people should aim for at least 100 mcg/d from a combination of food and supplements. If you eat a large amount of cheese from grass-fed cows and pastured egg yolks, you may be able to get this amount from food alone. 100 g of hard cheese contains 67 mcg, and 6 pastured egg yolks contain about 32 mcg. Otherwise, supplementation is probably beneficial. I recommend a dosage of 1 mg/d in the MK-4 form, which is the form of vitamin K2 found in pastured dairy and the one shown to have the most benefit in clinical studies. There is another form, MK-7, that is found in fermented foods like natto, but it has not demonstrated the same properties as MK-4 in clinical studies.

Magnesium

There are few compounds in the body more important to overall health than magnesium. Over 300 enzymes need it, including every enzyme associated with ATP, and enzymes required to synthesize DNA, RNA and proteins. Magnesium also plays an important role in bone and cell membranes, as it helps to transport ions across the membrane surface.

Studies show that most Americans are deficient in magnesium. The median intake across all racial groups is far below the RDA, which is 420 mg/d for men and 320-400 mg/d for women. Although half of Americans take a multivitamin daily, most don’t contain enough magnesium to prevent deficiency.

Magnesium is also difficult to obtain from food. Nuts and seeds are the highest source, but it’s difficult to eat enough of them to meet magnesium needs without getting too much polyunsaturated fat. Another issue is that magnesium levels in food have dropped as modern soils have become increasingly depleted. What this means is that if you’re not supplementing with magnesium, you’re probably not getting enough.

And magnesium deficiency is no small thing. It has serious – even fatal – consequences. It produces symptoms like muscle cramps, heart arrhythmias, tremor, headaches & acid reflux, and it’s associated with CVD, hypertension, metabolic syndrome, diabetes, migraines, PMS, asthma, hypothyroidism. In fact, it’s hard to find a modern disease magnesium deficiency isn’t associated with.

Because of this, I think everyone should supplement with magnesium. Intake of 400 – 800 mg/d from a combination of food and supplements is an optimal range to shoot for. Since most people get less than 250 mg/d from food, a dose of 400 – 600 mg/d in supplement form is ideal. I recommend using chelated forms of magnesium like glycinate and malate, because they’re better absorbed and tend to have fewer side effects.

Vitamin C

Vitamin C is needed for building the structural components of the body, and for maintaining levels of glutathione, the master antioxidant in the body. But vitamin C deficiency is also common: studies suggest that 34% of men and 27% of women don’t get enough. This is especially true for the elderly and those struggling with chronic illness.

400 mg/d is the saturation range in healthy people, and that number is probably higher in the elderly and the sick. As with the other micronutrients in this article, it’s difficult to obtain adequate levels of vitamin C from the diet. Acerola cherries are the highest food source, with 1677 mg per 100g. A cup of cooked red peppers has 235 mg, which is one of the highest dietary sources.

I’m somewhat less certain about the need to supplement with vitamin C, but in general I recommend approximately 500 mg to 1 g of vitamin C each day. If you’re dealing with a chronic health challenge, or fighting an infection, you can take several grams a day with no toxic effects. It’s best to space the doses out to avoid diarrhea, however.

Other contenders

In addition to the fat-soluble vitamins A, D & K2, and magnesium and vitamin C, some may want to consider supplementing with selenium and iodine. Selenium plays important role in thyroid function, which affects every aspect of physiology. The recommended dose is approximately 200 mcg/d.

Selenium is plentiful in organ meats, ocean fish, and in brazil nuts. One brazil nut contains 100 mcg of selenium, but it also contains a whopping 1 g of omega-6 linoleic acid, which as you know from previous articles in the series, we want to limit significantly. This is why I don’t recommend brazil nuts as a source of selenium. Ocean fish are also good sources of selenium. 100 g of cod contains about 150 mcg.

Iodine also plays a crucial role in thyroid function, and it prevents brain damage and strengthens the immune system. The amount iodine needed for thyroid function is incredibly small: we need about a teaspoon of iodine over a lifetime to avoid deficiency. I’m not convinced humans need to supplement with iodine above what can be obtained from seafood, but some research does suggest that increased intake of iodine is beneficial. This is especially true if you’re fighting a chronic infection or dealing with a hypothyroidism caused by iodine deficiency.

But be careful: iodine can trigger and flare autoimmune diseases, especially Hashimoto’s and Graves’(autoimmune thyroid disease). In the U.S., 9 out of 10 women with hypothyroidism actually have Hashimoto’s, so the typical advice to supplement with iodine if you are hypothyroid is dangerous. I’ve written extensively about this in my special report on thyroid disease.

For those without autoimmune disease, a dose of 12.5 mg – 50 mg per day may be beneficial, but it’s best to work up slowly over time, beginning at a much lower dose.

Chris Kresser

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{ 77 comments }

Jenn February 18, 2011 at 9:35 am

Great post…what are your thoughts on Vitamin B (I currently supplement B12, but am moving towards a B-complex to include 1, 2, & 6) -

In searching for an answer to my chronic headaches – bloodwork indicated that I was low on Vit D (even after supplementing 4-8k daily) – and it was suggested that I supplement with B12 (I was normal range, but low end of normal). I’ve been taking 40k Vit D and 5k mcg of B12 daily for the last two months – and my headaches have greatly improved. I’m getting ready to have more bloodwork – so I can see how the Vit D levels are this time around.

Also – how would you adjust these recommendations for children? I currently give them a probiotic and vitamin D, in addition to a multi…I’d like to see how their multi stacks up…

Thanks -

Monte Diaz February 18, 2011 at 9:53 am

Excellent article Chris.

DaninIdaho February 18, 2011 at 9:54 am

HI Chris. Wondering about V-A in sweet potatoes. I don’t eat lots of organ meats, but do eat tons of yams and sweet potatoes. Would you consider these ok sources or are they in the beta-carotene form which is different? Great series. Thanks.

Chris February 18, 2011 at 9:59 am

Hi Chris:

Excellent post. I was wondering what your opinion was of ALCAR + r-ALA + ubiquinol. I’ve read some pretty convincing research on this stack, but am unsure if it’s necessary for a 25 year old consuming mostly grass-fed beef, wild-caught fish, pastured butter & cream, coconut products, pastured eggs, and fermented veggies, with the inclusion of sweet potatos post-workout, and 1 “cheat window” per week – usually Saturday afternoons-evenings where the worst of the worst is indulged in with friends or family.

Thanks!

Monte Diaz February 18, 2011 at 10:48 am

Chris, do you think its okay to consume a bottle of FCLO along with a bottle of HVBO every 30 days?

It works out to about 8ml of both FCLO and HVBO. In your experience what is a minimum effective dosage?

I’ve already ordered both of them in preparation for an “orthodox” paleo diet I’m starting.

Thank you.

michelle February 18, 2011 at 11:12 am

Hi , what brand of supplements you recommend ?

Tanya Lopez February 18, 2011 at 11:22 am

Thank you for discussing the difference between folic acid and folate, articles like yours will help this become a bit more widely known.

Chris Kresser February 18, 2011 at 11:49 am

DaninIdaho: no vitamin A in plant foods. That would be beta-carotene.

Chris: it’s certainly not necessary. Whether it’s beneficial for you is impossible for me to say, but your diet seems great.

Monte: yes, that’s a good dose of both. I recommend 5mL of each as a maintenance dose.

Michelle: it depends on the supplement. I like Green Pasture fermented cod liver oil for A & D, and their butter oil for K2. Magnesium and Vitamin C I usually use Pure Prescriptions.

Daina White April 18, 2011 at 4:11 pm

What flavor of Green Pastures Cod Liver oil do you recommend? I think you said Arctic Mint in another post, but what flavor butter oil do you like then? And if you get the combined kind, what flavor? Thank you.

Chris Kresser April 18, 2011 at 4:28 pm

Arctic Mint.

Chris Kresser April 18, 2011 at 4:28 pm

Arctic Mint.

Bryan Opfer February 18, 2011 at 11:55 am

Hey Chris. Another great article. Any recommendations on the timing of supplements? Should we take them all with breakfast? Spread them out over the day? or doesn’t really matter?

Chris Kresser February 18, 2011 at 11:56 am

Bryan: in the case of these supplements, it doesn’t matter much. Magnesium and vitamin C may be better tolerated with food.

ben February 18, 2011 at 12:46 pm

You say Vitamin E is toxic, but I think you’re just referring to the alpha-tocopherol. Would supplementing with a mixed tocopherol provide any benefit? It seems strange to me that you would recommend the other fat soluble vitamins and not Vitamin E.

Julie February 18, 2011 at 12:47 pm

What about Epsom salt baths? Will those help a Magnesium deficiency?

Mike February 18, 2011 at 1:08 pm

Jenn, my understanding of B12 is that most animal foods have a good supply as long as not everything you eat is horribly overcooked. But many people seem to have an absorption problem due to low stomach acid or lack of intrinsic factor. For that reason I’ve heard that the most effective B12 supplements are the sublingual lozenges.

I’ve also heard that methyl B12 and dibencozide (adenosylcobalamin) are the only usable forms. I’d be interested to hear what Chris has to say about it.

Angela February 18, 2011 at 1:41 pm

Chris
What do you think about the fermented CLO and high vitamin butter oil combo offered by Green Pastures. The cod liver oil and the butter oil separately are quite expensive so I wondered if the combo would be effective. Also I know there’s this synergy between vitamin A & D in CLO and K2 in butter oil.

Thanks for another really informative article.

Anglea

Chris Kresser February 18, 2011 at 2:27 pm

Angela: the blend is great.

Mathias February 18, 2011 at 3:04 pm

Hi Chris,

Many thanks for these educational posts! Here in Sweden there aren’t alot of alternatives when it comes to cod liver oil. Across the border in Norway, however, the state department of health recommends something called Möller’s tran for all citizens. Its content per 5 ml:
Vitamin D 10 mcg
Vitamin A 250 mcg
Vitamin E 10 mg
Omega-3 fatty acids 1.2 g
– of which 0.6 g DHA
– of which 0.4 g EPA

As you can see, the dosage here (5 ml/day) is quite below your recomendations. What would be a reasonable ml/day in your opinon?

Beth@WeightMaven February 18, 2011 at 5:17 pm

Read an article a while ago that suggested that some (many?) commercial cod liver oils strip the natural A & D vitamins out in processing and then add synthetic back in, sometimes at not healthy ratios. The recommendation, as I recall, was to be very picky about your choice of CLO supplement.

Tracee February 18, 2011 at 6:02 pm

I love this series. Would butter from grass fed cows have K2? My five year old loves to eat butter.

Chris Kresser February 18, 2011 at 6:18 pm

Beth: that’s exactly right. To my knowledge, all commercial CLO manufacturers remove the natural vitamins before processing, with one exception: Green Pasture fermented cod liver oil. Because it’s processed by fermentation rather than heat, they leave the natural vitamins intact. It’s the product I take myself and recommend.

Tracee: yes, grass-fed butter definitely has K2. It’s one of the best sources.

Mathias February 18, 2011 at 6:36 pm

Oh man, looking at green pastures – shipping alone is around 80 USD. Purchasing CLD from there will probably negate the intended effect since being poor is also bad for your health, right? Seems us northerners are out of luck.

Matthew February 18, 2011 at 6:36 pm

I’d like to make a comment on Vitamin C. I agree its a very important nutrient, but I think its interactions with other nutrients themselves have been overlooked by you and the Jaminets :-) . Vitamin C seems to increase iron absorption and mobilization above normal levels, which can be harmful in just about anyone with normal ferritin. In addition, Vitamin C works as a copper antagonist in the body at doses above 500mg (don’t have time to find the paper right now). Copper, as the Jaminet’s note, is very important for healthy collagen and heart structure, so excess Vitamin C here again might be harmful. Whadya think?

Chris Kresser February 18, 2011 at 6:41 pm

I agree that there may be issues with too much C. That’s one reason I said I felt less certain about it. On the other hand, there’s a lot of data suggesting it’s safe at higher doses. Personally, I don’t supplement with it on a regular basis, but I do use it if I feel I’m fighting a cold or infection of some sort.

Matthew February 18, 2011 at 6:50 pm

Sounds like a game plan, and the Pure Encapsulations product looks high quality. Thanks for the series and keep it up.

Dana February 18, 2011 at 9:36 pm

Ironically, vitamin C is also important for collagen formation. That’s why when you get scurvy, your body kind of falls apart. It’s also one reason smokers age more quickly. Tobacco smoke destroys collagen.

Chris K., do you use the acerola capsules from Pure Prescriptions? I see they’ve got straight-up ascorbic acid but it seems to me the acerola might work better. Not that I’m all out to consume as much C as possible but, like you, I could see times I might want more of an intake.

Matthew February 18, 2011 at 9:50 pm

Yup, cooper and vitamin c seem both to be part of healthy collagen!

Jenn February 19, 2011 at 6:49 am

@Mike- thanks…I get plenty of animal foods, but I think I might have had an absorption problem. My current B12 is methyl, it dissolves under the tongue. The B complex that I’m moving to has 1.7 mg of Riboflavin (B2), 20 mg of niacin, 2 mg of B6, 1,200 mcg of B12 and 30 mg of pantothenic acid.

The B12 in this new formula is cyanocobalamin, though – I’ll have to look into that as far as a usable form…

I’ve been trying to find a multi-vitamin that covers the bulk of these vitamins/minerals – can anyone recommend a particular brand that they love?

Laura in Arizona February 19, 2011 at 8:06 am

Hi Chris,
Love your site and your ability to convey your information. I have a question about the Green Pastures products. I am interested in trying the FCLO and HVBO or their combo. I can’t really make sense on their site about dosages. How much do you take per day to get your recommended amounts? I understand that as a real food there will be fluctuations in each batch and I am fine with that. I would rather take a whole real food but would like your guidance as to dosage. Thanks!

Monte Diaz February 19, 2011 at 9:27 am

@Laura

They are both 8oz bottles (237ml) and the dosages they recommend are fairly low in my opinion. (2ml)

In a post above Chris states, “I recommend 5mL of each as a maintenance dose.” I take 8ml of each one per day because that works out to a 30 day supply. Chris’s recommendation makes each one last 45 days.

Chris Kresser February 19, 2011 at 9:52 am

For Green Pasture FCLO, I suggest 5mL as a maintenance dose, but up to 15mL for short-term therapeutic benefits.

I don’t recommend supplementing with B12 unless you’re deficient or have an absorption problem like pernicious anemia. Deficiency should be confirmed by testing methylmalonic acid, which is a more accurate marker than serum B12.

I like the Pure acerola better than the ascorbic acid.

Matthew February 19, 2011 at 10:50 am

The acerola product seems to have some ascorbic acid in it in addition to the acerola extract. Another option is the buffered ascorbic acid, which can be taken on an empty stomach.

Matthew February 19, 2011 at 10:53 am

Just another question for Chris. I’ve been taking 2000IU D3 for a blood level of 45 ng/ml. If it started taking 5mL FCLO, should I drop this down or??

megan February 19, 2011 at 1:21 pm

What do you think about Apex Energetics products, in context of this article that you posted?

Chris Kresser February 19, 2011 at 1:43 pm

I use Apex supplements in my practice, but not for any of the nutrients I discussed in the article. I use them for more specific therapeutic goals.

Megan February 19, 2011 at 2:07 pm

Okay, thanks!

Jack Kronk February 19, 2011 at 4:42 pm

Chris,

Excellent article. Supplementation is a tricky subject with a lot of questionables. You really covered a broad spectrum here.

Regarding Magnesium, I get 3 sources from natural foods:
1. I eat wild sardines from Wild Planet brand about once per week.
2. I eat raw almonds/pecans (the whole nuts or a spoonful of nut butter) pretty much daily. I know you recommend a watchful eye on too much nut consumption for their omega6, but I do have a very healthy diet full of omega3. Also, I soak/sprout/dehydrate the nuts first, then make homemade nut butter. At any rate, whether that’s too much O6 from nuts or not, this is what I’m doing.
3. I take a spoonful of raw cacao powder regularly, either for a nice cup of hot cocoa or chocolate raw milk, or sometimes I add it to my post workout drink for flavor. Raw cacao is exceptionally high in magnesium.

Do you think these 3 sources would mean that I am getting sufficient magnesium in an otherwise nutrient rich diet full of other items like pastured dairy (butter, cream, raw milk, ghee) and grass fed beef?

Also, I take the Green Pastures blend daily (just the half tsp recommended dose at this time). I’m wondering if eating a tablespoon per day of virgin red palm oil is a good idea for vitamin A and natural vitamin E. I am not fond of the flavor, but I’ve read so much positive about it, I am willing to learn to tolerate it if I know it’s beneficial enough.

Thanks Chris. Really appreciate all of your hard work in compiling these write ups. Your efforts carry great value.

-Jack Kronk

magnesium, raw caco powder, sadines, almonds/pecans

vit a/e in palm oil

Jack Kronk February 19, 2011 at 4:46 pm

sorry. please ignore the gibberish below my name above. that got copied/pasted by accident.

Chris Kresser February 19, 2011 at 7:20 pm

Jack: you’re probably in good shape unless you’re dealing with a chronic illness that might benefit from increased Mg supplementation. Red palm oil is an excellent source of E. I know what you mean – it does have a strong taste.

mayo February 20, 2011 at 12:21 am

In japan, there is a condition known as ‘wakiga’… which we refer to as a disorder that causes an unusual body odor that is not associated with uncleanliness. By all accounts it is a personal (unpleasant) scent that is not localized and cannot be washed/scrubbed or masked away.. There is even experimental surgery for it, but it has been received with limited success.

My spouse has this condition and I’m curious in your study of Chinese medicine, if you’ve ever heard of this rare disease. We’ve noticed at least one supplement, choline, that makes it worse, but perhaps there’s others that can make it more tolerable.

Thanks So Much ,
Mayo

Chad February 20, 2011 at 3:01 pm

For Magnesium supplementation, I’ve been using Ancient Minerals Magnesium Oil. It’s a transdermal magnesium. The benefit is you can use a ton of it to replenish your levels, and you won’t get the laxative effect associated with oral magnesium.

Alex February 20, 2011 at 3:25 pm

Hey Chris,

Thanks for the excellent post. Do you think Natural Calm is a good source of magnesium? Also, if so is it okay to take the flavored kind, sweetened with stevia?

As far blue ice royal, do any of the flavors taste good? Or do you take the capsules?

Do you think most people can benefit from digestive enzymes and probiotics?

Thanks!

Jack Kronk February 20, 2011 at 4:51 pm

Alex,

Blue Ice Royal… chocolate cream is awful, but the cinnamon tingle taste like cinnamon gummy bears or hot tamales, seriously. It’s not unpleasant at all.

But lemme tell you, I took the Olso Orange flavor of FCLO (the liquid). It was positively disgusting. I might rather take a spoon of sewage. Maybe I got a bad bottle or something, but switching to the cinnamon tingle combo gel was a very welcomed change for me.

Chris Kresser February 20, 2011 at 4:54 pm

Arctic mint is by far my favorite, and most of my patients agree.

Alex February 20, 2011 at 6:04 pm

Thanks Chris and Jack for the info. Would you mind addressing the rest of my questions when you get a chance?

ben February 21, 2011 at 12:03 am

Anyone know a supplement that contains all the protection from Advanced Glycation End-products, or AGEs?

Namely one that contains all the amino acids:
Carnosine
Histidine
N-Acetyl Cysteine (NAC)
L-Arginine—

megan February 21, 2011 at 3:19 am

Ben,
Lypospheric AGE – Blocker from LivOn Labs.

Aravind February 21, 2011 at 12:07 pm

Chris –

Love this series so far. Thanks!

I cannot consume fish due to allergy issues. I am eating an “adequate” quantity of pastured eggs and full fat dairy, and also taking 2000 IU Vitamin D supplement (since I drink milk that is not Vitamin D fortified). Is that an acceptable alternative to Cod Liver Oil?

Thanks,
Aravind

Danny February 21, 2011 at 12:23 pm

Is it safe to be taking a magnesium supplement without calcium?

Aaron Ashmann (halotek) February 21, 2011 at 6:08 pm

Chris, I’m a little bit surprised that you recommend such a high dose of iodine. There has been a lot of conflicting literature on optimal dose. Many people have actually inhibited their thyroid hormones at large doses. Recommending 12.5mg to 50mg when the RDA is 150mcg doesn’t seem that prudent without a lot of explanation. I know you could probably give an explanation — but a disclaimer might be warranted.

Also, I see you recommend 1mg of MK-4 a day, but say you take butter oil for your K2– do you supplement both or what is your dose of the butter oil?

Do you have an optimum form of vitamin c?

Thanks for your articles!

Conscious Life February 21, 2011 at 7:38 pm

Thanks for another useful post, Chris. Personally, I eat sweet potatoes 2 to 3 times a week, and get regular sunshine each day (I’m live in the Equator — Singapore), so I guess I’m probably not in urgent need of vitamin A and D. My daily cabbage kimchi fix may also be a sufficient source of vitamin C. But, I’m not so sure about K2 and magnesium. I’d have to look for some ways to fill the gaps. I’ve heard a few people talked about fermented cod liver oil and butter oil. Seems like Green Pasture is the brand to go with. Is taking butter oil the same as taking butter itself? Since I seem to have a thing for fermented foods (love my kimchi and natto), I may just give Green Pasture’s fermented CLO/butter oil blend a try one day. The only show stopper is the cost. Since it’s not available where I live, the cost, including overseas shipping, is jaw-dropping for a bottle of oil.

Aaron Ashmann (halotek) February 21, 2011 at 7:56 pm

I must be a little out of it at work because I see that you do have a disclaimer now.

Angela February 22, 2011 at 3:19 pm

Chris
Are you familiar with Yes EFA oil? I’m taking Green Pastures FCLO, but the GAPs protocol also recommends a EFA nut/seed oil blend. My holistic doctor recommends this brand. What do you think?
http://www.yes-supplements.com/yes-efas.html

Kimberli February 24, 2011 at 10:20 am

Could you link the studies showing the ineffectiveness and danger of multivitamins? I am hypothyroid and after seeing a better qualified doctor we discovered that I was deficient in several nutrients. I started taking the Metagenics w/o iron twice a day, Vit D and Iron in the evening so this did not bind to my dose of Armour. I saw nice improvements after a few months and since going 100% Paleo I’m hoping to see even bigger improvements when I get my results next week. I’m curious as to why the individual supplements would work but not the multivitamins with the same nutrients. I also found it interesting that the study on folic acid was with people receiving the folic acid with gluten. Thanks!

Mike February 24, 2011 at 11:12 am

I’ve been thinking about getting butter oil, but I wanted to check with you about dairy intolerance. We seem to tolerate ghee in moderate amounts, and I assume that butter oil is at least as safe as ghee, but it would be nice to make sure. Is butter oil really casein-free?

Chris Kresser February 24, 2011 at 11:18 am

Mike: neither ghee or butter oil are caesin free, but they are lactose free. Casein is the protein, lactose the sugar. Different people react to different things. If you react to casein, you may (or may not) react to B.O. If you tolerate ghee, you’d be even less likely to react to B.O. I think.

DJ February 24, 2011 at 10:42 pm

Hi Chris,

Loving this series! A few comments:
You mentioned how trans-fats from grass-fed dairy and trans-fats from processed foods are not the same… you also discuss the concept of “food synergy” and avoiding reductionist thinking… but then it seems like you’re ignoring those two points when you recommend avoiding Brazil Nuts because of their PUFAs?? Maybe the PUFAs when consumed with selenium and other undiscovered nutrients/compounds in Brazil Nuts would not have the same negative effect as the nasty, oxidized PUFAs in processed oils?

Also, with all the players in bone density (physical activity, acid load, vitamin K, calcium, vitamin D, vitamin A, etc), I doubt we have good studies that have looked at all these factors, and I highly doubt that we have enough evidence to say that “bone density peaks at 25(OH)D level 45 ng/mL.”

Finally, thank you for bringing up the elevated serum calcium issue. With so many people supplementing with vitamin D, I think there needs to be more discussion about the cofactors needed to ensure vitamin D can do its work, and also how to avoid possible negative effects (e.g. elevated serum calcium).

Thanks for your excellent work!

Mark Gaw February 25, 2011 at 8:37 am

Hi Chris: What do you think about using Brewers Yeast as a supplement? I’ve read that this is considered a nutrient dense food. Thank you, Mark

elhnad February 26, 2011 at 1:29 pm

HI Chris,
i was at this post
http://nephropal.blogspot.com/2009/07/magnesium.html#comment-form

and the Pal suggests gluconate and citrate forms of magnesium which are different from the two forms you mentioned. Do you have any opinions on this? thanks!

Chris Kresser February 26, 2011 at 1:49 pm

Gluconate is good too.

elhnad February 27, 2011 at 10:18 pm

thanks, Chris. what are your thoughts on capsules vs. tablets?

Carolyn February 28, 2011 at 10:26 am

Really enjoying this series, Chris. I’m a little confused about magnesium supplementation. The brand I use says ” Magnesium Malate, 1000 mg 150mg of Elemental Magnesium ” on the label. Looking at the ingredients list, it states “Calcium, 100mg and Magnesium, 150mg from 1000 mg Magnesium Malate.” So which amount do I use to measure my intake of this? Using the elemental amount, a person would take 3-4 of these daily to achieve 450-600 mg range?

Thanks

Chris Kresser February 28, 2011 at 10:39 am

Yes, you use the elemental magnesium number for dosing.

Jack Kronk March 1, 2011 at 10:02 am

Chris,

Some Paleo folk report improved skin hydration after choosing to supplement with Iodine. Do you see any particular possible reason for this, perhaps related to thyroid function?

Yesterday, I ordered this bottle of Kelp tablets from KAL. It provides 225mg of iodine in the form of Kelp. Is this a decent choice? I tried to get one without a bunch of weirdo ingredients and this was one of the more pure choices.

http://www.vitacost.com/Kal-Kelp-Iodine/?csrc=GPF-021245754138&ci_src=14110944&ci_sku=021245754138

Thanks!
Jack Kronk

Chris Kresser March 1, 2011 at 11:07 am

Dry skin is a symptom of hypothyroidism, so I imagine your guess is correct. I think you mean 225 mcg, but that’s probably a good choice.

Jack Kronk March 1, 2011 at 2:03 pm

Wow. I just found and read your articles from mid 2010 on Iodine and Hypothyroidism. I didn’t know you had done so much work on that topic. I hope I am not making a mistake by beginning iodine supplemenation with the kelp tablets. I have seen on multiple sites that iodine supplementation is probably a good idea for most people, and that the vast majority of folks are deficient from their diet. So I finally took the leap. From what I understand, it takes quite a while to see any differences if I am even going to at all, like 6 months or something.

Chris March 7, 2011 at 5:58 am

Chris,

I’m really enjoying this series and I really appreciate you sharing this information. My question is about Vitamin D. I’ve always heard that 30 minutes in the sunlight produces so much Vitamin D but I’ve always wondered how much skin exposure is normally tested. In other words, you mentioned with pale skin, 30 minutes of direct sunlight will produce 10-20,000 IU of vitamin D. Is this measured with a certain amount of skin exposed like short sleeve shirt, face exposed or shirt off etc.?

Goni March 11, 2011 at 5:45 am

Hi
is 100mcg/d of MK-4 going to help? I’m supplementing with 10000 IU-vitamin A and 2400 IU-Vitamin D
Just because K2 supplements are more expensive.
Thanks

Rachel Melson March 26, 2011 at 12:48 pm

White Flower Oil (http://embrocation.50webs.com) was introduced to me by my mother. During one of my headaches, she gave me this tiny bottle of oil and told me to massage it on my temples and forehead. Amazingly, it worked! Somehow the oil penetrates into the affected area and relieves the pain.

JST Books March 31, 2011 at 10:26 am

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JST Books March 31, 2011 at 10:27 am

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Rafi Kam April 10, 2011 at 6:06 pm

I’ve tried Green Pastures CLO + Butter Oil blend but I notice it lists the 2 pill dose as providing 1800 IU of Vitamin A. Here you say CLO is a good source for Vit A and people should be looking to take in over 10,000 IU a day. That’s a hell of a lot of pills – over ten a day. Especially for an expensive supplement.

How much CLO do you take?

By the way, a favorite snack for my Polish family when I was growing up was tinned cod liver laid out over cream cheese on bread. I know the bread is anathema but just saying cod liver out of the tin is a real treat.

Rafi Kam April 14, 2011 at 5:28 pm

never mind… i just noticed your dosage recs above. i’ll look into conversion for the capsules.

Rafi Kam April 14, 2011 at 5:28 pm

never mind… i just noticed your dosage recs above. i’ll look into conversion for the capsules.

Anju Raja April 11, 2011 at 3:04 pm

Dear Chris,
I am more interested to know about the folic acid supplementation vs folate dietary intake.

The following studies both state that folate absorption from supplements were better than dietary sources:

Geraldine J Cuskelly, Helene McNulty, and John M Scott, Effect of Increasing Dietary Folate on Red-cell Folate: Implications for Prevention of Neural Tube Defects, Lancet 34 7(9002): 65 7-659 (9 Mar 1996) [Correspondence: Helene McNulty, Phd, School of Biomedical Sciences, University of Ulster, Coleraine, BT52 1SA, Northern Ireland, UK]

http://www.ncbi.nlm.nih.gov/pubmed/9853543

What are your thoughts on this?

Anju Raja April 11, 2011 at 3:32 pm

one more study from Japan stating that dietary folate did not affect the serum folate levels..

http://onlinelibrary.wiley.com/doi/10.1111/j.1447-0756.2010.01358.x/full

am i missing something.. how did pregnant women get their folate before artificially made folic acid.. I am unable to find any article that states dietary folate is better than supplements, even though common sense would dictate so..

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