A Practical Guide To Choosing Supplements

Your supplement shelf can turn into a silent monthly subscription, and the scariest part is not the cost. It’s the uncertainty. We sit down to unpack why supplements so often feel like a black box, how isolated nutrients can behave differently than nutrients in whole foods, and what a sensible, evidence-based supplement routine looks like when you care about real outcomes like strength, metabolic health, energy, and long-term resilience. 

We walk through the decision filters we use as clinicians, starting with the most straightforward case: measured deficiencies you can actually track, like vitamin B12 or vitamin D. From there, we share John’s “Four I’s” checklist (imbalance, insufficiency, infection, isolation) and why the food matrix matters so much when you’re deciding between a capsule and a plate. We also get specific about common scenarios, including vegan and plant-based nutrient gaps (especially zinc and B12), aging and fatty acid needs, and why omega-3 fish oil studies can look mixed compared with the consistent benefits of eating oily fish. 

We dig into risks that don’t get enough airtime, including supplement overload, vitamin toxicosis concerns, and medication-driven nutrient depletion. Metformin and B12, statins and CoQ10, and proton pump inhibitors and mineral absorption all come up, along with a bigger theme: changing a biomarker is not the same as improving an outcome. To keep things grounded, we share what we actually take right now, why creatine has one of the strongest evidence bases in sports nutrition and healthy aging, how creatinine lab values can be misread, and where berberine and targeted probiotics like Akkermansia may fit for metabolic health when paired with lifestyle changes. We close with practical tips on supplement quality and third-party testing, plus how to build a short-term “bridge” plan with clear stop rules. 

Subscribe for more evidence-based self-care, share this with someone whose cabinet is overflowing, and if you found this helpful, leave a review and tell us what supplement you want us to break down next. 

For video recording and open source reference articles: www.thehealthedgepodcast.com

Transcript

Spring Light And Birdsong

SPEAKER_01 0:00

Welcome to the Health Edge, translating the science of self-care. I am Dr. Mark Pettis. Really glad to be with you. And I'm with my friend and colleague, John Bagnulo. John, good morning, my friend.

SPEAKER_00 0:13

Good morning, Mark. It's great to see you. It's great to see you on one of these really beautiful April, end of April mornings.

SPEAKER_01 0:20

Great to see you as well. And end of April, even though in New England it you still are reminded that winter is uh not too far behind the in the rearview mirror. Uh we are getting more of those nice 60, even 70 degree days. And um I just love the uh that six o'clock, seven o'clock, seven thirty hour where it's still light out. Um I was out on my deck last night, John, and it was dusk. And the back of my yard where the where the deck is uh faces east. And so I always get the sunrise in the morning. I'm usually out there getting those early morning rays, all that information that we talk about. Uh and toward the end of the day, the western sun uh casts a glow uh on tops of the trees, uh that yellow, orange glow. You don't see it down low, uh part of partly because the house obscures it and partly because of where the sun is. So it's this beautiful coloring, um, which I just love. And uh listening to the birds out there last night, I've been playing with an app. I don't have a lot of apps on my my phone, but uh one that I have is uh from uh Cornell, uh their bird uh laboratory. Um it's this beautiful um uh educational uh uh place with with all kinds of uh information on birds and habitats. And uh this app, what this app does is you put you you hit the mic on the app and it just listens to the sounds in your environment and identifies all the birds that that's awesome, yeah. So I I had about eight birds last night that came up. Um uh and it's like wow, yeah, it was just this beautiful moment of uh life and and the vibrancy, and it felt really good last night to to be dialed into that.

SPEAKER_00 2:41

Yeah, they start pretty early here. I like the last few nights we've been able to sleep with the screen doors uh open on most of our rooms here in the house because it's been so nice. But yeah, we had a pileated woodpecker start uh pretty early. So it's like a 4 a.m. wake-up call. Uh, and then that just that chorus of you know, like you said, it's it's life to wake up to that and uh and then to be able to go out when I let our chickens out at you know, 6:15, 630 to already have sunlight. It's a very different experience for me than uh you know, than January and February when everything's still really dark and uh and silent. So it's it's awesome. It's awesome to start your day with those sounds of life and that that early light.

The Supplement Question Everyone Asks

SPEAKER_01 3:28

Indeed. Well, we've we've been um offline talking about this uh topic of supplementation, John. Supplements. And um I know in my experience as as yours, um one of the more frequent questions that will come up in a consultation or maybe a public forum presentation will come down to uh you know, what supplements do you take? Um what supplements should I take? Uh and and it really is a kind of a big black box uh where uh I think as our listeners know, the evidence is quite variable from anywhere from non-existent on one end of the spectrum, which does not imply lack of potential efficacy to more solid evidence as we would characterize as maybe a randomized controlled, placebo-controlled trial, um, and and then of course everything in between. Uh and so it I thought it'd be fun, John, to maybe share some of our uh personal supplements um and and then a little bit about you know what what kind of runs through your mind when you're thinking about uh a supplement um uh beyond the evidence. Uh maybe, maybe there are cost issues, maybe there are quality issues, maybe there are um uh true of any intervention. How will I know if what I'm taking is helping me? What can I look for? What can I measure? What can I expect to experience so that I have some way of assessing the upside-downside of that choice? Because many, I've had this personal experience, John, where many um I might look at research on uh let's say uh Eurolyphin A, right? Uh um kind of a hot, right? The the carousel of hot supplements come and go, but interesting research, right? And I think we've talked about this, looking at mitochondrial health. And uh and you and you might see a small study and say, okay, well, that looks really interesting, a little more strength, uh um uh quicker recovery after a workout. And so those are things that you for working out, you can actually assess based on your personal experience, but sometimes there really isn't anything obvious, and and and it leaves that question of what am I going to take this forever? Uh you know, uh you know, can I afford taking this for the next five years? And and so I do think um that process is a helpful one to just kind of share and go through. So I've already said way too much.

SPEAKER_00 6:24

Um, that's great. I think that's great. I mean, that that's the way to look at things, right? Everything has a cost-benefit ratio, everything has a more or less optimal uh perspective. And I think it's always the best starting point, you know, is it you know, how much efficacy is there? Um, is is a supplement really a good fit for the biological systems that we have and the versions of molecules, whether that is a vitamin or a phytonutrient, or you know, are the versions uh are they gonna jive? Are they compatible with with pathways that might need something just slightly different on that molecular basis? Or, you know, something that's really lost, I think, in translation with all of this is what other substances accompany any given compound in a food, you know, that sort of govern it's the way it works in the body. You know, we don't we tend not to consume anything, like foods are gonna be an array, right? That matrix that we you and I talk about frequently. There's always that food matrix, which is there's a synergy there, there's a level of synergy there that is almost never replicated with supplements. And I think that it's a big part of the question, like you know, is it gonna work favorably on its own? Or in some cases, like you and I have discussed, with certain carotenoids, maybe very unfavorably. So there's all these different ways to measure that risk-reward or cost-benefit ratio. But I think even before then, I you know, what you're saying is, you know, I think really a great starting point. Is there any efficacy? Is it worth the money? Is it worth the time? Um, or is there something that's a much simpler solution that would work and be part of your plate or your you know part of a meal?

When A Deficiency Justifies Supplementing

SPEAKER_01 8:16

Yeah, great. And I uh an easier uh place to start, maybe in terms of identifying a particular supplement, um, and this for me uh was many years ago how one how a clinician would think about a supplement. And that was the category of you have something that you're deficient in, that something was identified by a test. Uh, maybe you had some symptoms, and uh, you know, your doctor gets a B12 level, uh, the B12 level's low. And and the decision to supplement that, to bring that level up, um, in the context of food sources, right, um, uh becomes uh uh a reason for the decision, and you can follow those levels. So you start low, you bring it up with a supplement, modified diet, and then you just follow that. To me, that's one of the more um uh measurable, it's it sort of intuitively makes sense. I I've run low on something, it's affecting me, I can measure that it's low. Vitamin D, you know, might like another example, and um what are what are the ways that I can bring those levels up? Uh, and the supplement might be the best adjunct to nutritional forms of that. But but for many supplements, that it's not a simple matter of it was measured, it was low, and I'm replaced. You know, vitamin D comes to mind, B12 comes to mind, magma, you know, some of the usual suspects. Um uh but for a lot of uh supplements that are out there, um there may not be a uh a well-established standard or measure. Um and there you're dealing with sort of the biology, right? As you as you've so nicely put it, John. Uh uh there are a set of conditions that require uh or demand um um some nutrient, nutrients, part of a metabolic pathway that you want to turn the volume up on. Um until much time, maybe those conditions improve, uh, or uh for some people it may be an ongoing thing. And that can be a little bit trickier, right? Because you don't you don't necessarily have something you can measure. Um, and and it's not clear that something that might intuitively make sense uh in the long term is going to serve you well, right? We so there's a there's often we don't know as much um about long-term effects.

The Four I Checklist

SPEAKER_00 11:06

So yeah, how how yeah, no, those really, I mean, that's those are my thoughts. I I a long time ago, um I always and it worked out that I called them the four eyes, the letter I. So these are the four things that I would always, you know, whether I was working with a a client or a patient uh clinically, or I was teaching, I always said, you know, you've you've got four things that might warrant the use of a supplement that you have to consider. One would be an imbalance, right? So are we gonna take a supplement to try to correct an imbalance, maybe just short-term. You know, look at different pathways that you know you might be seeing in a person's blood, or you might be seeing a symptom, some type of condition that would be representative of an imbalance. Is there a nutrient that you could offer that that individual that would restore balance? So that would be the first eye. The second would be, and I kind of liked how you framed it, and I wouldn't call it a deficiency because as soon as you say deficiency, you know, people are gonna automatically go to go to a set of uh, well, they're either going to look at blood, they're gonna try to look at blood levels, or they're gonna look at maybe um like a set of symptoms that would be more classic of a deficiency. But I say insufficiency, so that would be the second eye, right? Because sometimes someone might not have, you use an example, someone might not have scurvy per se, but they could still have an insufficiency of vitamin C for, let's say, optimal wound healing or you know, the synthesis of the tropo collagen helix, which you need to help with a you know, with a fracture to help the healing process of any of any bone, you have to first reform that tropocollagen helix as an example. So you might not have a vitamin C deficiency, but you might not have optimal amounts for that healing process, right? So that would be the second eye. So we've got imbalances, insufficiency, and then infection. A lot of times infections, you know, can warrant the use of a supplement. I always think about iodine. If someone has a, you know, like a long-standing chronic infection, iodine can be really useful at giving, you know, a person's uh white blood cells what they need to, you know, to kind of fight that infection because of, you know, high iodol, for instance, you know, it's been well established over the last 150 or 200 years, can really give a person a little bit of a boost with respect to their ability to overcome an infection. So, and then the fourth one is something to just consider, which is isolation. Is that nutrient going to work in isolation, um, or does it require kind of that synergistic effect that we're talking about? So I always go through those four eyes. That's my checklist that I go through to see if, first of all, is it even warranted? And then, you know, automatically, as you know, you have certain demographics where if someone's a vegan, well, I think insufficiencies, you gotta have you have certain nutrients that are always on your radar, right? Um, so you, and then you, you know, whether it's infections, whether it's a a certain way of eating or a certain lifestyle, it's gonna put certain nutrients on your radar for that individual to think about. So that's kind of how I've always framed it. But, you know, really, Mark, I think what you and I always talk about, which is that ancestral, look at things ancestral, look at the lens of human physiology, how we've evolved. You know, we evolved with with foods and we evolved with, you know, certain groups of foods that were very nutrient dense. And I always try to recommend those first and try to come up with the absolute best sources of those for any individual, because you you tend to have, you know, not only are you going to get an array of nutrients, but you're going to be providing those to the body in the form or the version. And this goes back to like Bruce Ames' triage theory, that's probably going to be more optimal, right? Typically, I mean, not always, but so whether that sunlight is going to be the best possible version of, you know, getting a water-soluble vitamin D in the body, you know, we have to use oral vitamin D because certain times because people just don't have, they don't have the sunlight, they don't have a vitamin D lamp. So we do the next best thing. And it might not be ideal, but it's going to be a lot better than being, you know, deficient. So I think you always have to wrestle with some of these things. You know, what's really available to an individual? Because some individuals aren't going to eat certain groups of foods for whatever reason. And then I think a supplement becomes, you know, it becomes the best option available. But I always go through those four eyes. I try to think about, you know, where someone is at in terms of availability of certain things, uh, their, you know, their preferences for foods or their limitations in terms of what they will eat. But uh at the end of the day, kind of where I'm at now, after 25 years of doing this, is that I probably eat, you know, on terms of supplements, what I consume are very, very minimal. I take creatine. That's the only supplement I take that would be considered considered more like pharmaceutical grade. You know, everything else is going to be one version of a food or another. It's not going to really be a supplement per se. And I try to work at that level now for most of my clients as well. I really recommend very, very few supplements and try to do everything I can to find something that's more food-based. You know, even with iron, I recommend Floridix, which is made with bitters and greens. It's uh, you know, it's what I recommend for people who have, you know, anemia or iron deficiencies. And uh with zinc deficiencies, I try to recommend oysters for anybody, canned oysters. You know, we're gonna get the best ones we can, you know, no additives. Um, so that's kind of the where I'm at now. It's like, what can we find that is food-based that's going to help uh us avoid any of the limitations of the more isolated pharmacological approaches. Um, but again, I, you know, though these aren't always viable solutions for people. And then we go with the the best possible versions of what are going to be in a capsule or uh some type of like tincture form.

Vegan And Aging Nutrient Gaps

SPEAKER_01 17:23

Yeah, I love that analysis, John, and um the the this principle of the matrix, really this incredible um uh synergy between so many uh uh nutrients um uh that um uh it's still not well understood. Uh it's really not the original science community. Uh yet from an ancestral uh perspective, it it just makes so much sense to be getting the complete package. And we frequently talk about research that has yielded surprisingly poor outcomes, um, probably based on that exact issue, uh, giving vitamin A and seeing increases in in lung cancer, um, you know, maybe too much antioxidant, right? Uh um vitamin E and not seeing benefits to cardiovascular risk reduction, um, also an example of wow, you know, I would have never seen that coming. Um, even the omega-3s uh um you know uh yields mixed results in number trials where we know eating fish and um so there are just so many examples of isolated nutrients that in the um don't provide a long-term outcome that one might have predicted, probably because of the impact that not having the full orchestra in place can can create. And then you mentioned, John, I and I think this is really important. Um, certain demographics, like individuals who embrace a vegan lifestyle, what are what are some of the um nutrient deficiencies there, John, that become inevitable over time with that?

SPEAKER_00 19:20

Uh yeah, zinc is uh almost axiomatic. Right? I mean, zinc is so damn difficult to absorb uh from plant sources because it's almost always accompanied by phytates or phytic acid, right? That really, really inhibit absorption. That would be a prime example where if someone is a vegan or has been a vegan even for a year, I think, you know, in there again, and and they have philosophically, you know, there's opposition to eating um something like you know, shellfish, for instance, then I think uh a zinc supplement is, you know, I think it's warranted. And I think it's gonna be a really good choice for that individual, even though maybe the you know the zinc on its own, not being accompanied by other trace minerals isn't quite ideal, it's still gonna be so much better than you know, them developing a zinc insufficiency or deficiency. So, you know, that's one. Obviously, um vitamin B12 can be can be an issue for people who are a vegan. I and I look at those two, and in some cases, iron as well, because it's gonna be almost always non-heme iron in their diet, and that's difficult to absorb depending on their their age and some of their metabolic uh you know tendencies or profile. So, I mean, those I would look at those two trace minerals, B12, as being like the things that I put high on that radar, you know, for an individual that's entirely plant-based. Um, people that are over the age of 65. Um, you know, I also look at certain things that I think are really important. And and those aren't always, again, they're not always going to be um resolved by supplements. I think foods are gonna be a much, much better choice. But you know, you brought up the concept of omega-3s, and it's fascinating, Mark, that if you if, and maybe, you know, again, you can speak to this probably better than I can. When you look at the meta-analyses that have been done with omega-3s, right? And when you and I are talking about omega-3s for our listeners' sake, you know, we're primarily talking about DHA and EPA, right? I mean, that's what these fish oil studies are like. And though a lot of those fish oils are pharmaceutical grade. And and help me, Mark, remember the name of uh what's the what's the the big uh pharmaceutical grade fish oil? What's the name of that?

SPEAKER_01 21:50

Is it left?

SPEAKER_00 21:51

Yeah, yeah, yeah. So when you take that fish oil, and I think this might help explain things to our listeners, you're not getting everything. That you get when you eat an oily fish.

unknown 22:02

Right.

When Supplements Backfire Over Time

SPEAKER_00 22:03

And there are all these other lesser known, lesser understood or appreciated fatty acids that have higher levels of desaturation. They're longer. You also, in a lot of these oily fish, get some of these very unique saturated fats that you and I have talked about in past episodes. You know, these odd chain saturated fats. Those oily fish are really good sources of some of those. And I think that when we get older, I think it's really important for the brain, as well as cardiac tissue, um, and just in general, you know, skeletal muscle, mitochondria, to have a more regular, constant supply of some of these unique fatty acids that you don't get from fish oil, that you get from oily fish, and you get from some other sources of, let's say, saturated fat, um, grass-fed meat, for instance. But like if someone is older and they don't eat oily fish and they don't eat red meat, then you know, I then I start to look at the necessity for a specific blend of fatty acids. And there are some, you know, some supplements out there, some combinations that can be put together. But I would recommend for someone that was older to use like a non-pharmaceutical grade fish oil. And it would be something like cod liver oil, which is um, it's not refined to that level, and then put that with a you know a certain blend of saturated fats together as part of their supplement regimen. So, you know, again, just to your point, the demographic in terms of lifestyle, food, food uh philosophies, then you look at the individual or the population's age, you start putting these things or stacking some of these things on top of each other, and you can end up with, you know, unfortunately, a fairly lengthy list of what you would deem to be necessary supplements, right? I mean, that's it gets once you start stacking different limitations on top of it, um, on top of one another, excuse me, and then I always get left in a place where I, you know, I, because it's not in my personality to settle for less than what I consider to be optimal. So I spend a little bit of time just seeing if there's any, if there's any um latitude or flexibility with respect to their food philosophy, their their approach to what they'll eat. Are there recipes that we could that we could create where they would be okay eating something that maybe just they they avoid because of a taste profile? I try to do everything I can, Mark, to get to make a breakthrough and and allow food to be the primary provider of a nutrient before we settle on supplements. But I I guess, and I again this is I might be getting a little ahead of ourselves here with this, but I'm at a point now where I'm more concerned about like one form of vitamin toxicosis or another. I become more concerned about that than I would have been 20 years ago. Uh, and it's not as though I'm gonna see elevated liver enzymes or, but you are gonna see things like people don't respond to strength training as well, or people actually end up being sick more often because their immune system is now just flooded with antioxidants, right? And they can't generate that response they need to fight an infection initially. So, you know, as I get older and I've worked with people for more years, and I look at all the limitations that supplements have, and I start to see different patterns in patient or in my clients' health, people that take the most supplements, I feel end up with like the most like different levels of suboptimal health or performance. So I've really kind of, you know, I guess you could say I've pendulumed about as far away from supplements as I can get at this point. But I try not to be dogmatic about it and just say, I, you know, I don't say no supplements. I just think they have to really be warranted. Even things that, like we talked about fish oil. I, you know, I've been a I've been a person over the years that have has almost always said there's limitations to a multivitamin. It's, you know, there's certainly you don't want something that's one size fits all because we know that there are all these different nuances to who we are that make some of those nutrients in a multivitamin. Maybe uh, you know, it's not a very good cost-benefit ratio for a person's physiology, but some of them are a good fit. And so you just, if you're gonna take supplements like don't take these uh kind of broad spectrum, like one size fits all mixes, you know, think about what it is your body really needs, and it's gonna give you an optimal response, optimal performance, whatever it is your goal is. Um, so that's kind of where I've yeah, where I've settled.

Medication Driven Nutrient Depletion

SPEAKER_01 26:48

Really helpful, John. I um another category that I think is not well appreciated is this category of drug-nutrient interactions. And um you know, as a physician, I'm I'm mindful that um much of what we prescribe um it doesn't always have attached to it the knowledge or depth of what what some of these interactions over the longer term might look like. Um and these are these might be things uh like metformin, um, which is widely used uh and very effective in managing glycemic control, particularly pre-diabetics. But uh metformin is an example of something that we know can um result in uh insulin resistance, right? Go go figure uh that uh um uh B12 deficiencies with with metal. You know, we know that we know that um statins um will uh can deplete CoQ10. Um uh even though the the research on CoQ10 supplementation and people taking statins with respect to muscle effects, and we we we've looked at this recently, um, are conflicted. You know, it's not a simple matter of if I take CoQ10, I'll negate those those effects. Um that's been my personal experience on statins. Um uh you know, so so a lot of uh what is prescribed can have the uh unintentional effect of depleting. And and that it's important to at least be aware of that uh if you're taking a medication to do a little research on that, um uh because that can be uh you know another edge of that two-edged sword that could be problematic for people.

Biomarkers Versus Real Health Outcomes

SPEAKER_00 28:56

Yeah, those are really good points. That that drug nutrient interaction, inhibition of absorption in some cases, uh, it's very underappreciated. And and even things like I don't know, you you you probably have a really good pulse for the uh percentage of Americans that take one form of proton pump inhibitor or another. I don't know what the number is. I mean, it's got to be 10%, probably, right? I mean, from just from what I see, I don't know that I get the best sample size or representation of an American um in my practice, but let's say it's 10% of those um millions. Uh honestly, Mark, I'd think 50% of them. I see signs of mineral or trace mineral issues, right? Just because of how we when we suppress the acidic environment that we need for mineral absorption, right? There's there's downstream consequences to that, and it becomes really difficult to absorb properly all the you know the minerals and trace minerals that are so dependent on a more acidic environment in the stomach. So, you know, that's another example. But yeah, I mean, it's uh there's there's no shortage, right? There's no shortage of connections between medications that you can certainly deem as necessary or warranted for condition, but there are going to be pathways, whether it's absorption pathways or increased metabolic needs, that really get turned on their head once that medication, you know, is is there on a daily basis. The other thing that you mentioned earlier, how do we assess the effectiveness of a supplement? That's a you know, that's a really, really important question because so many um so many of the of the measurements, right, or the parameters that we use for assessing them, they're not outcomes. And I think it's important to think about is the supplement influencing an outcome or just a biomarker? You and I talk about cholesterol all the time, and I think our listeners have probably had, you know, have got at least some of my you know take on that, which is I don't really like to use cholesterol as a as a as a measure of everything's going in the right direction for an individual's health. Just because someone's cholesterol level comes down doesn't mean that that's a good choice for them, either the dietary changes that they've made or the supplements that they're taking. And I and I look at that with you know some supplements when you know when uh research shows that, well, you know, this supplement generated a 10% reduction in total cholesterol. To me, that's you know, that doesn't necessarily warrant its uh its use. That doesn't mean that it's it's necessarily working in an individual's favor. I mean, it can at times, and certainly if it were to change the the size of the LDL particles and make them, you know, more buoyant, less small, dense, then yeah, but just looking at total cholesterol, um, and again, there's other examples, but I I think that the way we assess the effectiveness of these is a really important point that you brought up at the beginning.

Supplements As A Short Term Bridge

SPEAKER_01 32:06

And it and it's a universal challenge for which there I think there is no easy um solution for for people taking supplements. Uh and just to reiterate your point, John, many supplements might have some really interesting basic research, some laboratory research, um measurable effects on very specific um metabolic mechanisms, biochemical mechanisms. Um, but one can't extrapolate those effects to macro, large-scale health outcomes, mortality, quality of life. We we simply do not know. And unlike a deficiency state, where maybe you have a blood test or a way of measuring uh, you know, the adequacy of what you're taking uh uh for most supplements, uh there isn't an easy test that will necessarily determine that. And you're left with subjective, you know, how do I feel? I started this, I feel better, uh, you know, is it the supplement? Is it a placebo effect? Is it perhaps an ancillary change in lifestyle? Uh and so um it is a bit of a uh kind of a one-way street uh that for some can get, I think, tricky. You start you start stacking supplements, each may have a unique um evidence or um uh you know, some and often basic research attached to it, uh, but really no meaningful long-term data. Um and um you know, these these supplements can insidiously start to dominate your cabinets, your your your countertops. And after a while, you know, you're you're on eight, nine, ten, twelve things and spending a fortune, and it's like, wow, you know, it how much of this is really helping me? And there's no easy way to, I think, assess that for the majority of supplements that are out there. Um like you, John, I I mean I've taken many different supplements through the years, and I think the distinction uh the way I like to think about medications in general, whether it be a you know something pharmaceutical grade, a prescription versus something that falls outside that category, is this um something I need to take forever, or is it a bridge? I think it's better to think about these interventions as a bridge to get you over a set of circumstances that the lifestyle medicine playbook you're developing is one that will ultimately allow you to, on the other side of that bridge, back off that supplement or that medication. And um ultimately I can manage this with just lifestyle. I mean, I I think hyperglycemia is one of the more common uh examples of that, as is hypertension, uh, so that frequently with lifestyle modification, the medication that may have been very appropriate, uh, you know, I mean, I see blood pressures historically, John, of 240 over 120, uh you know, just life-threatening, you know, you can't you can't play around with that. So uh a medication or a blood sugar of 400, um, you know, you've got to break the free fall.

SPEAKER_00 35:47

Yeah.

SPEAKER_01 35:48

Uh but the going in with the intent that this is not a permanent uh genetic issue, uh, there are a set of conditions that we need to identify and ultimately attempt to reconcile, whereby this medication that will break the free fall will not be something that you need to take forever. And I think the same can be said with with supplements. Um it it maybe somebody's taking uh turmeric or uh uh something to help a little bit with uh inflammation, uh until which time, you know, they're with dietary change and some regular movement, that gets gets better. So I too have become very um discerning with supplementation, though I'm really interested in the biochemistry and the biology of a lot of what's out there, particularly peptides and some of these new molecules.

SPEAKER_00 36:44

That's a whole nother Yeah, that's a whole nother podcast.

What We Actually Take

SPEAKER_01 36:47

And we'll we'll talk about that at another time. Um I would never hesitate to take something that I think long term could really serve me well, and particularly with more hard outcomes, as you pointed out, attached to it, John. But that's just not the case for most of us out there. So to some extent, you know, you're hedging your bets. Um uh, you know, the the uh manufacturer of the of the supplement becomes the broker. Uh you're going to invest a little bit in that, and or maybe a lot in that, and um and try to gauge subjectively how those investments serve you uh over time. And uh there are a lot of stocks that I've sold uh after after initially buying through the years. It yeah, I I just couldn't tell if it was helping me or not, and I was just starting to spend way too much money. Um I too take creatine um at you know 5,000 milligrams a day. And uh we we've talked about the research there, and those outcomes are very clinically meaningful and measurable and uh relevant certainly to so many. Um another supplement that I'm taking currently, and this is my uh tendency toward insulin resistance, which I you know very much track closely, is berberin.

SPEAKER_00 38:12

Um very good, yeah.

SPEAKER_01 38:14

Berberin, uh, you know, this is a uh a plant-based compound. I I think it's um golden seal.

SPEAKER_00 38:21

Uh berberine's great, yeah.

SPEAKER_01 38:24

And uh so for for this tendency that I might have to have a fasting sugar of 90, even though my my primary care wouldn't worry at all about that, I I like it a little bit lower. And my A1C is 5'7. Well, okay, it's you know I'm not a diabetic, but it's you know primary care is okay with that. But for me, that it's it's a little bit higher in that in that spectrum. Um and so uh when I uh ramp down the carbs, uh you know, put on a continuous glucose monitor, uh, modify that, maybe add some um uh you know, berberin. Uh I'll see measurable changes in a relatively short time. And almost always when I just clean up my diet and lifestyle, uh, I can just back off that supplement and and have good measures to support that. But that's something I've used from time to time. It it's well tolerated. And that and bitter is another great topic, John, for us to talk about, are such an interesting sort of family of molecules as they interact with metabolic health. And then the last thing that I uh take, John, and and this largely through some of the work that you've done. I mean, I've always uh um tended toward a probiotic, um, at times around antibiotic use, yeah. With some prostate issues on occasion, maybe I've had uh an infection I've needed to deal with, taking a longer course of antibiotics. Um you know, generally I've even though I think the research with probiotics is still some questionable.

SPEAKER_00 40:15

It's very questionable. Yeah.

SPEAKER_01 40:16

But but um I I've been really intrigued with the acromancia. Uh we talked about this recently, pasteurized acromancia, particularly with its effects on metabolic health. And um, as this is one of my personal areas of of focus, um I'm I'm trying that now. Um and very inexpensive. Um and uh and I will again just track my sugars and my A1C and um things that I would be tracking anyway. Um and uh that's that's all I'm taking right now. Um we've got you know it we've got a lot of supplements collecting dust, most are outdated in the cabinet. Yeah, and you know, it has a way of happening after a while. It's like, holy cow. Yeah, and all this stuff.

Creatine Benefits And Creatinine Confusion

SPEAKER_00 41:09

Um I like the berberine a lot. I think that is a good fit for a lot of people. And and I think when you get into that category, herbs or herb-based molecules that might have you know a subset of kind of accompanying molecules with them. I think you're um I think the options for people become much, much more expanded. I think you got some really good fits for people. I take, you know, again, I said I take creatine and then I take lemon balm uh from time to time. It's an adap, it's a it's an adaptogen for the most part. So it can really help. Uh, if you're in sympathetic overdrive, you know, if you got like a really, really long day, you got a lot going on, and you're juggling several things, lemon balm can really take, can really take that ratchet that whole sympathetic overdrive down a little bit. So, yeah, I like that a lot. Um, but again, I think whether it's ashwagandha, lemon balm, I think there sometimes there's really good fits there for people. But again, that's uh it's n equals one, right? You gotta you gotta try these things on their own. And uh what you said earlier really should resonate with our listeners. If you're taking 30 different things, you might not know, you might not know what is what is uh causing what in terms of you know the relationship you get. So I always say like just back everything off, maybe you keep a couple things in place and see how you feel, right? Just kind of listen to yourself. Um, but I I I like berberine. A lot of people I think benefit from that. Um, again, there's different things that are more adaptogen to help people with um whether it's sleep or or their nervous system making a shift towards a more parasympathetic level of activity. Um, but like you, I take creatine because you know, there's days when I might eat a pound of red meat. I might have a half a pound uh in the middle of the day, and I might have a half a pound of red meat at night. I know that'll probably surprise some of our listeners, but I look at red meat as being uh really restorative, really replenishing. Uh I don't look at it as being something that you know I need to limit my consumption of. I'm pretty active, but that being said, even if I had less activity in my life, I I would still eat red meat regularly and in much larger quantities than you're gonna hear most people advise you to because it's such a rich source of so many nutrients that the body needs. It's it's really basic, it becomes basic uh cellular biology when you start looking at what we need physically physically and what our muscles need, what red meat provides. On those days, I might get enough creatine, Mark, right? On the days. That I have that much. But I have a lot of days when, you know, for whatever reason, I don't have red meat or I only have it once a day. And I feel like the five to 15 grams of creatine that I take, I think it's necessary. And like you said, I feel a difference. I I we could look at the meta-analysis on creatine. We could look at the results of stuff, which are phenomenal. I mean, that's a phenomenal resume for any supplement. I know it's it's one of those ones that boy, if you're looking for hard science, it's there. Probably I think you're right.

SPEAKER_01 44:33

Very high, yeah.

SPEAKER_00 44:34

And I don't see any downsides. I mean, you're going to get an elevated creatinine uh test result if you take it regularly. Doesn't mean you have, you know, you can speak to this so much better than I can. Most people that take creatine at the levels that I do will from time to time have an elevated creatinine uh blood marker, and then, you know, it can raise some flags for people. But when you look at that, it's uh it's not causing kidney damage. It's it's just a byproduct of creatine metabolism, right?

Quality Checks And Exit Plans

SPEAKER_01 45:04

It's an artifact, and because creatine is used in in formulas from blood testing to calculate just as people who work out and have larger muscle mass will tend to have a bit higher creatinine because they just have a higher load of creatine and and creatine phosphate in their in their muscles. And uh so uh much in the same way, a 90-year-old woman who weighs uh 85 pounds might have a creatinine that's well within normal limits, but has a very low glomerular filtration rate because um these are the caveats of of creatine. Uh um uh so yeah, there's absolutely no evidence that creatine, even in high doses, and some of the as you talk about red meat. I eat red meat almost every day. Um, and um um I I've also been vegetarian, v, you know, I try all those things. And um, but this is where I'm at and convinced where I need to be right now. And um, I don't ever worry about too much creatine. And the um some of the early um neurocognitive research and Alzheimer's research and and and growing on this robust research base of creatine, as you point out, John, is looking at brain creatine levels um which may require much higher daily intake than what can support muscle health and strength and and muscle protein synthesis. Um and that that's cognitive function, and and those levels are probably those uh amounts in some of the early trials are 10 to 20 uh grams a day, and and there's some interesting potential benefits there, more to come, uh, but the protein story, in my view, is only going to continue to grow. And I think the cognitive piece uh will will be more emergent in in this discussion as that research evolves. So um good stuff, John. So just to kind of summarize, um uh and and uh the first point is you know, do I absolutely need this supplement? Are there alternative ways that I can leverage my diet and and the matrix of nutrients to better serve that need that I that I have? Um uh, you know, the second, of course, is what can I measure? How can I tell if this is working for me? And that that often will not have an obvious answer. And I think then that would beg for the question of, well, if you don't have something you can measure, um, you know, just pay close attention to how you feel and um you know, just keep a little journal. And uh uh in my experience, it you know, if if a couple months in, all other things being equal, everything's about the same for you, uh I would question perhaps whether that's something you'd want to continue using. Um I think the the obviously the evidence base supporting it, and and with AI now, not that AI is perfect, but I do think for the average person, you know, a smartphone is kind of like having a consultant now in your pocket. And so uh just getting a snapshot of where the research is at and in the way that AI will give you bullet points and a few references, um, because often what you'll find is this is a supplement may have very little human data attached to it. Again, which doesn't mean that it's not effective, but just be mindful of that. And then the last thing that comes to mind for me, John, once you've made that decision, and if you want to go with a supplement, generally I would have a plan. I'm gonna try this for uh six months. This is what I'm gonna keep track of. Um uh uh but in terms of quality, I would I would be uh often I use consumerlab.com. It's a um uh like a$20 a year uh subscription, and they do some pretty objective assessments of supplement quality. And um, the most expensive supplements are not always of the best quality. Many of these supplements don't have the exact amount of active ingredient as advertised. A lot of them have other things like heavy metals. Uh, so having a um a reliable objective source you can go to to maybe look at some different brands and and see which can best serve you is uh would be part of that for me as well. But um uh supplements are hardly the the answer, uh the complete answer for the overwhelming majority of people.

SPEAKER_00 50:15

Yeah, I mean what you said earlier, keep it a bridge. And and remember, you're hopefully building a small bridge, not a uh not a golden gate, but but look at it as a small bridge, right? For you know, for a period of time that you, n equals one, can really kind of assess how you feel, how do you respond? Um, and don't look at them like an endless interstate, because that's unfortunately the the uh the path that too many take. And then you know, there are a lot of unintended consequences for long-term supplements that are not a good fit for people. So yeah, great stuff, buddy. As always, man. I I'm so grateful for for you and our conversations here every time.

Closing Resources And Share Request

SPEAKER_01 51:00

Feelings are mutual, John. Well, we we wish everyone well. Um, we'll we'll post this up at the uh the health edge podcast.com, our website. Uh I will put up a few uh systematic reviews for for creatine, some of the things that we've talked about, burbrand for for those that might be interested. Uh and um uh we uh really appreciate people listening to the Health Edge. We uh we love our our community, and uh please share this with friends and family uh because John and I have zero social media presence. So uh uh share this with those you love, and uh, we will see you next week. And John, be well, my friend.

SPEAKER_00 51:44

You too. Love you, buddy.

SPEAKER_01 51:45

Take care, too. Peace.