PF Episode 22: What's the Deal With Supplements?

What's the Deal With Supplements?

Jen: So, Alex, I have completely reframed my fitness goals for the year.

Alex: Oh, what prompted that?

Jen: Well, a couple of things. Mainly, I dropped out of the half marathon I was going to do in Hawaii, for a lot of reasons. Mostly, I haven't really had the time to train properly. But also, I just feel like I need a break from endurance running. I need to do something different. So I'm going to focus on boxing, and I'm going to try trail running.

Alex: Yeah. All right, getting on the trail running tip. I ran 7.2 miles yesterday on the road, because all the trails have been closed for weeks, and my joints feel miserable.

Jen: Oh no. That's not encouraging. That's not motivating me.

Alex: Well, that's because I wasn't running on the trail — I ran on the road.

Jen: Okay.

Alex: I don't know how you do that. I didn't even sleep well last night.

Jen: So try something different.

Alex: I love it. I love the reframing. I love the trail running, the boxing. I'm excited to see where this goes.

Jen: Me too. Welcome to Practically Fit, Real Fitness Over 40. I'm Jen Chamberlain.

Alex: And I'm Alex Johnson.

Jen: And today we're going to talk about supplements. Are they worth it, or are you just flushing money down the toilet, quite literally? We'll talk about what's worked for us, and then we'll offer some practical tips for figuring out what might work best for you.

Alex: Okay, I hadn't thought about it as literally flushing money down the toilet. That's pretty funny.

Jen: Yeah.

Alex: If you didn't get that on the first go, that's a funny joke.

A Massive Industry

Alex: I think this is a topic worth discussing. I became really aware of supplements in the early 2000s, with fitness magazines and things like that, where every other page was a special advertisement for some kind of crazy supplement.

Jen: Oh, yeah.

Alex: The supplement industry is massive in the United States. I was talking with my wife about this earlier — the difference between here and the UK. Yes, they have supplements there, but people don't take so many of them compared to Americans. So it's really interesting to think about this industry in general. Before we talk about our own takes on supplements, we wanted to look at the science. For this topic, we thought it was important to look at more recent studies, since the supplement industry has changed a lot over time.

Jen: Yeah, that's absolutely right, Alex. My parents were actually big into supplements and health foods back in the 1970s, and I can still remember the distinctive smell of health food stores.

Alex: What did they smell like?

Jen: I don't know, like brewer's yeast and vanilla.

Alex: Oh, I was just asking because I don't remember the 1970s — I wasn't alive.

Jen: Yes, I know, Alex, you weren't quite around back then, but I was. It was a big thing in the 1970s, and I would say things have changed a lot. In general, there seems to have been a shift from health food to supplements in pill form. I'm not sure that's necessarily a positive, and we'll probably talk a little more about that. But what did you find out, Alex?

The Science: What the Research Says

Alex: Yeah, I'm not sure that's a positive either, and we'll talk more about that, like you said. But let's talk about a 2021 article from the International Journal of Environmental Research and Public Health titled "Dietary Supplements — For Whom? The Current State of Knowledge about the Health Effects of Selected Supplement Use." This article takes a broad view of supplements and, honestly, doesn't have a lot of good things to say about their benefits. I'll hit a few of the highlights. It makes the interesting point that the widespread use of supplements may stem from the conviction that a preparation that looks like a drug must have therapeutic properties. So it's this idea for consumers that, "Oh, this looks like it would be beneficial to me, so I need to take it."

Jen: Exactly — it's a pill. And I think, particularly here in America, we have this idea that there's a pill for everything, right? That's the panacea.

Alex: Right. The literature also shows that taking vitamin and mineral supplements, for healthy people, neither lowers their risk of cardiovascular disease nor prevents the development of malignancies — so, cancer. Again, that's not a positive point in favor of supplements. Many scientific societies recognize that omega-3 fatty acids lower blood triglycerides, but whether taking them prevents heart disease is less clear-cut. That's a common form of supplement, the omega-3s. Taking weight-loss supplements is not an effective method of fighting obesity, this paper finds. And sometimes supplements are sold illegally, which is also associated with a higher risk that they may be adulterated with banned substances, making them even more dangerous and potentially life-threatening. So please don't buy your supplements illegally. The one thing the paper says that I think is sort of positive is that supplements are necessary in cases of nutrient deficiency. I remember my dad took iron supplements for a while. But even though a prescription is not required, their use should be recommended and monitored by a physician.

Jen: Oh, okay. Well, that's some heavy reading. It's really interesting. I've actually been reading a lot about how some supplements can be contaminated with all kinds of substances, because they're not as highly regulated as foods and drugs here in the United States. So I think that's definitely something to consider. But on the more positive side, I found an article about supplements as they relate to endurance athletes in particular, since I do some distance running and was curious. It was published in the journal Nutrients and titled "Nutrition and Supplement Update for the Endurance Athlete: Review and Recommendations." It's a long article, but fortunately it was free.

Alex: You didn't have to pay $300 for this article.

Jen: Exactly — just the time spent combing through it. A few of the key conclusions: they take a pretty broad lens on supplements, looking at both food and diet and then supplements specifically. They found that high-carbohydrate diets have long been tested and proved beneficial for endurance athletes — so, hello, carb-loading. But interestingly, they say athletes should maybe pay a little more attention to protein, particularly after workouts, to help with recovery. That makes a lot of sense. In the running community we're all about the carb-load, but we don't think as much about recovery afterward.

Alex: Right.

Jen: They also talk about hydration — you and I have talked about water consumption and written about it. The thinking now is more about drinking to thirst and to your sweat rate, versus a prescribed amount of liquid intake. They did find some supplements could potentially be beneficial, particularly for the endurance of elite athletes. Nitrates, they found, could maybe reduce oxygen costs and perhaps even increase VO2 max, but the studies were mixed when it came to non-elite recreational athletes like you and me, Alex, so I don't know if I'm going to go down that road. They also found that antioxidants might help an athlete who's already in peak training and needing more help on the recovery side. And best of all, they found that caffeine has a very large body of research behind its ergogenic effects — which was the first time I saw that term, but it basically means fatigue-fighting, making you feel more energetic. Who didn't know that? But side effects are the limiting factor. It can cause some GI issues, and it can also make you feel a little too hyped up, I guess.

Alex: And I accept the GI issues of coffee. I just readily accept it.

Jen: Yeah, me too, I'd say it's worth it. And we've talked about probiotics — they said there's just not a lot of quality research on probiotics yet for athletes, but it's possible that some of these supplements might help folks with GI issues. So that's on the positive side.

Lightly Regulated: What the FDA Does and Doesn't Do

Alex: Yeah, and we'll talk about supplements for GI issues here in a bit — spoiler. But I want to make one more point, and go back to something you mentioned, which is that these are lightly regulated substances. Regardless of your thoughts on the prescription drug industry, which is a hot-button topic for Americans, we know that prescription medications are highly regulated by the Food and Drug Administration. Drugs go through rounds of clinical trials before they ever get onto the market. Putting aside your feelings about prescription medication, there's a pretty high level of regulation around those drugs. Supplements, essentially none. Technically, the FDA is responsible for supplements, but it classifies them as food products, not medicines, so there's no safety review of these products before they hit the market. So even if you aren't buying your supplements illegally, there could be some danger there. Could there not, Jen?

Jen: Yeah, absolutely. I've been reading a lot about this recently. I guess it's always been an issue, but it's come to attention a little more. This is one of my practical tips: I think it's very important to look at the source of your supplements and make sure it's a well-recognized brand that's been around a long time. That's still no guarantee, but at least you're playing it a little safer. But yes, it's a big issue, and there really is no regulation. You'll find on supplement labels that they say quite clearly that they're not regulated by the FDA as drugs.

Alex: Yeah, and as we were researching this, I did see someone saying that there are a couple of bodies that will certify supplements, similar to organic foods. If you look for these on the label, you know it's a higher-quality product. Off the top of my head I don't remember what those were, but you can look that up online. So there are some regulating bodies, outside of the government, that will put their labels on certain supplements.

Jen: Absolutely. So that covers a little bit of the science, but let's talk about our own experiences with supplements. Alex, do you take supplements, and do you think they improve your overall health and fitness?

Alex's Supplement Story: From Liquid Creatine to Probiotics

Alex: Yeah, I do take supplements, and I do think certain supplements have some benefits for me. But I think you have to look at this from an aging perspective. My supplementation regimen has changed a lot over time. When I was younger, it was really focused on strength training. I might even write a newsletter post about this soon, for those who don't listen to the podcast, because I think these are some funny stories. I'll never forget my first experience with creatine. This was with one of my best friends, Justin Landry. We were freshmen in college, and we heard about a new type of creatine, because normally creatine was a powder. By the way, creatine is something that's found naturally in your muscles — it's in beef as well, so you can get it by eating steak — and it helps with muscle recovery. The theory around creatine supplementation is that it helps your muscles recover more quickly, to the point where you think, oh, I could get an extra rep or two on these heavy weightlifting workouts. At least that's the idea marketed to you by these companies. Going back to that time, we were reading all these fitness magazines, like Men's Health and Muscle & Fitness, and they were laden with these advertisements and reviews. So we heard about this new type of creatine that wasn't a powder, it was a liquid, and supposedly it worked better because it was instantly absorbed into the bloodstream.

Jen: Okay, immediate.

Alex: And I've got to tell you, the price reflected that effectiveness. This was around 2000, and it was $50 for this tiny bottle.

Jen: Oh wow.

Alex: We were in college, so Landry and I decided we'd split it, and we'd be the only ones who got to use this nectar. I remember the day vividly: we went to a GNC locally, in Round Rock, Texas, to purchase the product. The stuff was so valuable that it wasn't out on the shelf — it was behind glass in this tiny little cabinet. We knew then, oh, this is super potent, this is amazing, this is a great purchase. Huge gains coming. We were like two little kids, gazing, like the kid in A Christmas Story looking at the Red Ryder BB gun, and the guy unlocks the glass case and pulls it out for us to look at. So we purchased it, and immediately we said, okay, time to go to the gym. We couldn't wait. We took the dose — it was a little dropper, about ten drops each — and it tasted like cherry cough syrup. But of course we were both getting the placebo effect. "Yes, I feel it, let's go." "I'm pretty sure I got an extra rep on the bench." We told our friends about it, and they really wanted to try it, and we were like, get your own, this stuff's expensive. We hid it away; we were the only ones who could take it. And after a few months, it was like, I don't really think this is doing anything.

Jen: Yeah. And you know, there's actually science behind the placebo effect — it's real. Some of it is just mental: you think it's going to help, so you're more amped up about it. So it could have been some of that.

Alex: And I swore that was the last time I'd buy that expensive stuff, but about two years later we got talked into another one. It was a type of creatine — not just creatine, it had amino acids and a whole bunch of other stuff. It was called Cell-Tech. I had no idea what was in it. The worst part was the quote-unquote loading phase. To get maximum effectiveness, you had to drink it once every morning and once after lifting on the days you worked out, so several days a week you were drinking it twice a day. After the loading phase, you'd only take it once a day, either in the morning or after a weight workout. This stuff was by far the worst-tasting thing I have ever drunk. Honestly, not just "oh, it tasted bad" — it tasted noxious, like I would imagine battery acid would taste.

Jen: Like something you shouldn't be putting in your body.

Alex: Yes, like you're drinking toxic chemicals, and we're like, ooh, this must be good. Great flavor. It was horrible, to the point where you wanted to vomit when you drank it. I do remember the first time we took it: we were in this ridiculous kickboxing class — not a weight workout. You had to take physical education classes to get your degree, and we thought it was going to be cool kickboxing, like those movies, but it was actually aerobic kickboxing.

Jen: Oh, that was big back then.

Alex: Yeah, that was not cool for us. We were joking around most of the time, but those workouts were really hard to get through. I remember we weren't making it through the workouts, and then the day we took this stuff, it was like, oh, I've got so much energy, I made it through the workout. But I kept that up for about three weeks, and then I couldn't drink it anymore. It was so bad, it made me feel sick. My point being, these are the types of things you do when you're younger because you think you're going to get big muscle gains, but I don't think there's a lot of benefit there.

Jen: I'm going to posit that one of the key ingredients was either caffeine or some kind of stimulant, because, based on the kickboxing experience, it had to be.

Alex: And too dumb to read the label, obviously. But yeah, that was pretty horrendous. So, fast-forward to age 41. These days my supplementation is not like that. We had our podcast about gut health issues, so that's where the majority of my supplements are focused. I take a probiotic every day. I also take another gut supplement that I've been doing recently, a powder that's meant to calm your gut. It has glutamine and things like slippery elm bark and quercetin, all things that are calming for the gut, and I've found it helps with suppressing gas and things like that. I found it helps counteract the other supplement I'm instructed to take by my doctor, which is Metamucil. So I just take fiber. Those are my gut health supplements, which is where most of my supplementation is focused these days — see what I mean about getting older? I also take a multivitamin. We know the jury's out on whether that's beneficial, but my thought is that I eat a pretty healthy diet, so it can't really hurt me, and if anything is excessive, it's just removed through natural processes. And the one other thing I take is zinc. I take a pretty high dose of zinc. I started that during the pandemic. It could be a placebo thing that makes me feel better about not getting sick, but I have a pretty good immune system — I haven't been really sick in, gosh, two years, since I had COVID. So I'm going to say the zinc is good. I think it could be beneficial. Those are the supplements I take these days, a lot different than when I was younger.

Jen's Routine: B12, Calcium, Maca, and NAC

Jen: Yeah, absolutely. I love the story about your younger experimentation with supplements — I think that's really insightful. And it makes sense that you'd concentrate on probiotics, because that's sort of in your family history too.

Alex: Right. What about you, Jen? What's your supplement routine?

Jen: I take five supplements a day, mostly for very different reasons. I take B12 because I'm mostly vegan, and that was actually recommended by a doctor, because you don't always get enough B12 on a fully plant-based diet. I take calcium and vitamin D, also doctor-recommended. Most women my age are recommended to take calcium and vitamin D to help prevent bone loss, like I've talked about many times on the program. There's also some evidence that it could possibly reduce breast cancer risk, and I'm all for that, since that's also in my family history.

Alex: On those, I just have a question: do you get enough in a multivitamin, or does the doctor recommend taking those separately for a higher dose?

Jen: Separately, for a higher dose, because sometimes multivitamins don't quite have as much as you might need of those two. And because I already take B12 and calcium, I don't take a multivitamin — I figure I'm getting the rest in my food, I hope at least. I also take my most "fringe" one, maca, which is supposed to help with some specific symptoms of menopause and also boost energy. I think the jury's out on whether it's beneficial, but I actually like the taste, so I just put some powder in my smoothie every morning. It's not that big of a deal.

Alex: How long have you been taking that?

Jen: I guess about the past year or so.

Alex: Oh, okay, so you've got a bit of a sample size there, and the jury's still out. That's kind of how I feel about my gut health supplement, like I told you. I think it helps, but I don't see any harm there.

Jen: Right, same. I don't see any harm in it either.

Alex: And it tastes good.

Jen: And it tastes good. And then the last one I take is the most unusual. It's called NAC, which stands for N-acetylcysteine. Interestingly — well, it's not interesting that I have this, but the remedy is — I have a little bit of OCD, or that obsessive rumination we talked about on the mental health podcast, and there's been legit research done showing that this particular supplement helps folks with OCD. So I started taking it at the recommended dose. I talked to my doctor, who said it's not harmful, and I thought, if the research supports it, why not give it a try? And I have really, really seen the benefits. It's also an antioxidant, so even if it didn't help with that, it'd still be helpful as an antioxidant, but it has really made a difference in terms of that ruminative thinking. It's amazing sometimes what certain chemicals can do in terms of brain chemistry, that mind-body connection. So that's my routine right now.

Practical Tips

Alex: Yeah, all very legit stuff. It doesn't seem like you're doing anything that hasn't been sanctioned by a doctor, which I think is a lead-in to the tips. I have two simple tips. Number one, as you mentioned before: consult a doctor. If you're going to try new supplements as you age, I think the main thing is to make sure they don't have any contraindications, especially if you're on prescription medication. If you don't want to talk to your doctor about it, at least look it up on one of those websites that checks prescription medication interactions — you can put supplements into those too, and they work really well. An example: for a while I did try CBD oil, and I found it was quite helpful for anxiety. But then I was diagnosed with high blood pressure, and you can't take CBD oil with the same blood pressure medication I had, because they both go through the same pathway in your body and mess things up. So I stopped taking it because of the medicine. It's the same as how you can't have grapefruit with certain medications. So always either consult a doctor, or at the very least look this stuff up to make sure you're not taking two things that have strong interactions with each other, because that is possible. The other tip is to consider your diet first. If you want better performance in your workout, do you really need Super Workout Exploder, or whatever pre-workout supplement? Why don't you just have a cup of coffee? Like you said, caffeine does improve workout performance, but there's no reason to put a bunch of chemicals in your body when you could have something natural, like a cup of coffee or tea. Even fish or flaxseed oil — we talked about the omega-3s earlier, and we know those can be beneficial for brain functioning, but rather than taking a pill for it, you could just eat more fish, or add flaxseed to your smoothies, or put it on top of your oatmeal or cereal. There are different ways you can work these things into your diet without spending a bunch of money on pills. So I would prioritize diet over supplementation, and then, if that's not working, look at the supplements, like I've done with my gut, for example. Jen, what are some practical tips you have?

Jen: Yeah, Alex, I really like that last one. I think diet should be your first line of defense, and that's what I try to keep in mind. I try to eat a really healthy diet most of the time — maybe not a hundred percent of the time, mixing in some treat days here and there — but I focus on diet first, getting a wide range of nutrients, eating a lot of fruits and vegetables, and then just filling in specific gaps, like the ones I mentioned with calcium. I do take vitamin C sometimes, like you were saying with the zinc — particularly in cold season, I'll take some vitamin C to boost my immune system a little. I forgot that one. But yeah, food is your first line of defense, and supplements are like insurance, or what you take if your doctor recommends them. If you are interested in taking supplements, I'd say don't break the budget. There are good sources of supplements you can find online. I wouldn't go for, like you were saying, the Super Workout Exploder — a lot of those are just marketing gimmicks. Do some research before you spend a lot of money on supplementation.

Alex: Yeah. Even at the grocery store or the drugstore, looking for simple vitamins, there's a range of price points now. Zinc is a great example: why do you need to spend $20 on zinc when you could spend $7? There can't be that big a difference, and some of it, like you said, is just marketing, the way they package the supplements. So, definitely don't break the budget if you don't have to.

Jen: Absolutely. And my last tip would be to give supplements enough time to see if they work, but with a critical eye. With the NAC, for example, I made sure to give it a nice long trial — a month taking it regularly — because I think with some of these things it takes a while to build up the amount in your system that would show a benefit. And then I took some time off and found that the benefits reversed, and then I knew it was really working for me and I wasn't just wasting my money, though it's also a very inexpensive supplement. But I think you need to give it a bit of a trial and then be critical and see: is it really working, or is it the placebo effect, or the other things we talked about? So those are my top tips.

Alex: Yeah, that's great advice. And I can tell you, with the fiber, I've tried it without it, and I'm like, ooh, yeah.

Jen: Yeah, exactly.

The Adult Gummies Debate

Alex: Let me ask you one last question about supplements. This could be a hot-button issue. How do you feel about adult gummies?

Jen: Adult gummies. Are you talking about the kind they sell in California?

Alex: No, I am not. I'm talking about the idiocracy that has occurred in our vitamin aisles. So you can tell how I feel about this.

Jen: Clearly, the difference between California and Texas is —

Alex: Yeah, no, I'm just talking about vitamins. I'm not talking about that.

Jen: Yeah, no, I think it's just a way to charge more for them. And also, why does your vitamin have to taste good? We all know how to swallow pills.

Alex: And I've actually tried some of them, and then I started looking at the label, and I'm like, why do I need vitamins with added sugar?

Jen: Like, we're not five.

Alex: Just give me a pill.

Jen: That's crazy.

Alex: We talk about the amount of sugar in our diets, and here we are eating gummies when we could just take a plain multivitamin.

Jen: It makes no sense whatsoever, and it's all marketing, too.

Alex: It's like, "this one is for sleep, and this one is —" oh no, it's all marketing.

Wrap-Up

Jen: That's funny. I'm glad you brought that up. Well, that wraps it up for our episode on supplements. We dug into a little bit of science and talked about how we use them. We'd love to hear from you how you do or don't use supplements, and any practical tips you have. Feel free to weigh in on the comments, or email Alex at alex@practically.fit. And what's up for us next time, Alex?

Alex: We're going to talk about heart rate. I think this is an exciting subject: what is your heart rate telling you, and why should you monitor it? I remember that for a long time I proactively avoided tracking my heart rate when I was doing half marathon training, which, in hindsight, I probably shouldn't have been doing. So I think this is a really interesting subject. Of course, you can fold in the idea of wearables, which are so prominent now for looking at things like heart rate and other measures, but we're going to talk about heart rate next week.

Jen: I can't wait to get into this.

Alex: All right. Until then, head on over to practically.fit. We really appreciate it. We're releasing great content weekly. As Jen mentioned, you can comment on the podcast if you'd like to share your thoughts, and of course you can email me at alex@practically.fit. But until next week, remember: fitness is for everybody.