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Patient Home  >  Nutritional Foundation Program  >  Supplement Information
Supplement information

Supplements discussed in this section include:

1. Multivitamin/mineral
2. Magnesium
3. Omega-3 fatty acids (fish oil)
4. Vitamin D
5. Probiotics
6. Anti-inflammatory spices
7. Antioxidants: Coenzyme Q10 and lipoic acid
8. Proteolytic enzymes
9. Vegetable/fruit powders
10. Glucosamine/chondroitin.

Supplementation should always be considered in the context of our diets. It is important to embrace the fact that most people cannot supplement or medicate themselves out of the dietary dilemma outlined in Table 1, which leads to the expression of most chronic inflammatory diseases including unhealthy and accelerated aging.

Table 1. Estimated food sources for 87-92% of calories in the average American diet (14,27)

 1-2%  Alcohol
 10-11%  Dairy Products (milk, cheese, butter)
 3.5%  Whole Grains
 20.4%  Refined Grains (various flour products [bread, pasta, etc.]; cereals
 18.6%  Refined Sugars (sucrose, high fructose corn syrup, glucose, etc.)
 17.6%  Refined Omega-6 Oils (salad/cooking oils, shortening, margarine)
 15-20%  Fatty, Obese Animal Products


When researchers, such as Dr. Bruce Ames, look at this dilemma they conclude that we should improve our diets and consider taking certain key nutritional supplements. Dr. Ames suggests that we should consider taking a multivitamin/mineral (2), which should be iron-free unless there is an iron deficiency. Dr. Ames also suggests supplemental magnesium, fish oil, vitamin D, alpha-lipoic acid, acetyl-L-carnitine, and fiber (2).

Important additional supplements that support energy production and modulate free radicals and inflammatory activity include coenzyme Q10 (CoQ10), probiotics, and anti-inflammatory spices such as ginger, turmeric, and garlic. Dr. Ames’ view, which we agree with, is that supplements should most commonly function as part of a metabolic tune-up for disease prevention and health restoration (3-5).

In certain situations, specific supplements are merited, such as glucosamine and chondroitin sulfate for joint health, chromium for glucose regulation, and according to the American College of Physicians and the American Pain Society, white willow bark for low back pain. Otherwise, most of us require the same Polymeal foods [as outlined in the diet page] and basic supplements.

In the remainder of this page, the following supplements are discussed: multivitamin/mineral, magnesium, omega-3 fatty acids, vitamin D, probiotics, anti-inflammatory spices, CoQ10, lipoic acid, proteolytic enzymes, vegetable/fruit powders, and glucosamine/chondroitin. Anabolic Laboratories manufacturers many nutritional products and descriptions are provided for each in the product section of the website.

1. Multivitamin/mineral

Dr. Ames perspective on the need to supplement with a multivitamin comes from the understanding that deficiencies in key micronutrients, including folic acid, vitamin B12, vitamin B6, niacin, vitamin C, iron, or zinc will mimic radiation in damaging out DNA (6). He states that:

“Common micronutrient deficiencies are likely to damage DNA by the same mechanism as radiation and many chemicals, appear to be orders of magnitude more important, and should be compared for perspective. Remedying micronutrient deficiencies should lead to a major improvement in health and an increase in longevity at low cost” (6).

Remedying such deficiencies should come from anti-inflammatory diet that can be supplemented with a multivitamin (2-6). In support this view, a recent study demonstrated that women taking a multivitamin had longer telomeres compared to non-supplement users, which may help delay aging and chronic disease expression (37).

2. Magnesium

Some researchers have referred to magnesium as a forgotten mineral, which is likely due to the emphasis that has been given to calcium. This is surprising as magnesium is involved in over 300 metabolic reactions, including the production of cellular energy (ATP) by mitochondria.

Magnesium also plays a key role in blood sugar regulation, controlling free radical activity, and reducing inflammation (21,30). Appendix A lists the various issues that researchers have identified that can be promoted by a deficiency in magnesium. Click here to see Appendix A in the Vitamin Deficiency Appendices.

We also know that all aspects of joint, tendon, cartilage, and ligament metabolism are dependent on magnesium (32). Researchers emphasized the importance of magnesium when they suggested that consideration should be given to adding magnesium to our water supply (8).

3. Omega-3 fatty acids

Omega-3 fatty acids are most concentrated in cold-water fish. We also derive them from grass-fed animals and wild game. Each of these animals directly, or indirectly, derives their omega-3s from their food. Grass-fed animals and wild game consume vegetation, while the fish we eat consume smaller fish that consumed zooplankton that ate phytoplankton.

In addition to eating fish, grass-fed meat and wild game, we can also eat green vegetables to derive omega-3 fatty acids. Certain seeds are also rich in omega-3s, such as chia, hemp, and flaxseeds. When we consume omega-3s, our body converts them into a variety of anti-inflammatory chemicals. The problem is that most people consume far too few omega-3 foods. Instead, most people consume excessive amounts of omega-6 foods.

In contrast to omega-3s, the omega-6 fatty acids are converted into pro-inflammatory chemicals. We do need a balance between the two fatty acid families to maintain proper immune function and cell communication. Experts indicate that a 1:1 ratio of omega-6 to omega-3 is ideal, while less than 4:1 is acceptable.

To put this ratio concept into practical terms, consider a very basic description of immune function. We need an initial pro-inflammatory [omega-6] response to injury and infection, but then we need an anti-inflammatory [omega-3] response to promote healing. A 1:1 to 3:1 ratio of omega-6 to omega-3 allows for normal immune function and healing occur. Elevated ratios lead to chronic inflammation and chronic disease.

The average American’s omega-6 to omega-3 ratio is estimated to be 10:1 to 25:1, which means that America is chronically inflamed and destined to suffer from issues associated with an excessive omega-6 intake [Click here to see Appendix B, a list of issues related to insufficient omega-3 intake and/or excessive omega-6 intake].

From Table 1 [above], we can see that almost 20% of our calories come from omega-6 oils (corn, sunflower, safflower, cottonseed, peanut, soybean) and another 20% comes from fatty animal products with excessive levels of saturated and omega-6 fatty acids. We need to substantially reduce or eliminate these calories and replace them with Polymeal foods [see Diet section of website and Nutritional Foundation Booklet].

In addition to making favorable dietary changes, taking omega-3 fish oil supplements is a common clinical recommendation that is supported by research. The typical supplemental amount is 1-2 grams (or 1000 mg – 2000 mg) of EPA/DHA per day.

EPA is short for eicosapentaenoic acid, while DHA is the abbreviation for docosahexaenoic acid. These are the omega-3 fatty acids found in fish oil. A fish oil capsule that contains 1200 mg of oil will typically contain 600 mg of EPA/DHA, which means that 2-4 capsules per day would be a common recommendation.

4. Vitamin D

Human beings produce vitamin D as a consequence of sun exposure. The only appreciable sources of vitamin D in the food chain are wild caught fatty fish, Shitake mushrooms, and wild reindeer meat (11); which are foods that very few people consume. As vitamin D is not found in our food supply and because people avoid the sun and/or use sunscreen, we now know that most people are deficient in vitamin D (11,18,19). Researchers have identified multiple conditions that are promoted by vitamin D inadequacy [Click here to see Appendix C in the Vitamin Deficiency Appendices].

Please take note that deficiencies of magnesium, omega-3 fatty acids, and vitamin D lead to the promotion of similar conditions, which suggests that they support body health in similar fashion. And it turns out that each calms down the inflammatory state and leads to a healing or anti-inflammatory state. For this reason, supplementation with these nutrients, in addition an anti-inflammatory Polymeal diet is an important recommendation (2).

5. Probiotics

Within our digestive system we have a large population of bacteria that are needed to maintain normal health. Interestingly, there are more bacteria in our gut than there are cells in our body. The term “microbiota” is used to describe our gut bacterial population.

The term “probiotics” refers to healthy supplemental bacteria. The most commonly supplemented probiotics include the Lactobacillus and Bifidobacterium species.

We now know that healthy gut bacteria help to reduce inflammation throughout the body. This is especially evident as we age (17). Table 2 lists the proposed benefits of supplementing the diet with probiotics.

Table 2. Proposed benefits of supplemental probiotics (20,31)

Create proper pH
 Improve mucosal healing
 Improve gut nourishment
 Reduce binding of pathogenic bacteria
 Prevent peripheral invasion by pathogenic bacteria
 Improve gut bacteria integrity
 Increase anti-inflammatory chemicals
 Reduce pro-inflammatory chemicals
 Calms gut immune system

When we consume excessive amounts of sugar and flour on a consistent basis, which is the case for most Americans as previously described, this leads to a reduction in the number of healthy bacteria. Regular antibiotic use can also reduce the healthy bacteria population. In other words, most Americans would likely benefit from supplementing the diet with probiotics on a cyclic basis, probably two to three times per year.

6. Anti-inflammatory spices

When you stop for a moment and consider why you may like various ethnic foods, the reason that should come to mind is the fashion in which such foods are spiced. We now know that ethnic spices, such as ginger, turmeric, garlic, basil, rosemary, coriander, red chili, etc., offer substantial anti-inflammatory benefits (1), which helps to explain why the Mediterranean and Asian diets are associated with less expression of chronic disease. In this regard, a specific pro-inflammatory signaling molecule called nuclear factor kappa-B (NF-kB) is known to be involved in the expression of numerous conditions (see Table 3).

Table 3. NF-kB-linked diseases (1)

 Arthritis
 Crohn's disease
 Myocardial infarction
 Alzheimer's  Cancer  Psoriasis
 Allergy  Diabetes  Obesity
 Atherosclerosis  Multiple sclerosis
 


Researchers indicate that the previously mentioned spices have an effect on NF-kB expression (1), which may explain one of the mechanisms by which traditionally spiced ethnic diets are known for their health-promoting benefits. If one does not regularly spice their meals, supplementation with spices is a reasonable consideration.

7. Antioxidants – Coenzyme Q10 and lipoic acid

Not generally appreciated is that overeating sugar, flour products, and refined oils (see Table 1) will lead to elevations in blood sugar and fats. The greater the elevation of sugar and fat is associated with greater inflammation and oxidant stress. So the first step toward reducing oxidants/free radicals is to avoid the overconsumption of sugar, flour, and refined oils (24).

We can also supplement with antioxidants and most of the nutritional products discussed previously in this section have antioxidant functions. However, we can take supplements that are known for their more specific function as antioxidants; the most renowned being coenzyme Q10 (CoQ10) and alpha-lipoic acid.

In addition to their antioxidant functions, both CoQ10 and lipoic acid promote ATP production and have anti-inflammatory benefits (15,35). CoQ10 is also thought to regulate healthy gene expression in skeletal muscle (22), while lipoic acid has important blood sugar regulating functions (35). These diverse functions of CoQ10 and lipoic acid make them the most attractive antioxidant supplements.

8. Proteolytic enzymes

Proteolytic enzymes, which help to degrade inflammatory proteins, have long been known to reduce acute inflammation associated with injuries. For example, in one study, patients who sprained their ankles were given either proteolytic enzymes or placebo for 10 days starting one day after injury. The enzyme group exhibited less swelling, less pain, and better ankle mobility. The patients who took enzymes returned to work within 1.7 days compared to 4.4 days for those taking placebo. The supplemented group was also able to resume exercise training much earlier (9.4 days post injury) compared to the placebo group (15.9 days) (10).

9. Vegetable and Fruit supplements

Technology allows for the effective dehydration of vegetables and fruits, so they can be converted into a powder and used as a supplement. These are excellent supplements for those who do not consume adequate vegetables and fruit. Substantial amounts of phytonutrients are available in such supplements. Phytonutrients have both anti-oxidant and anti-inflammatory benefits.

10. Glucosamine/chondroitin

Glucosamine sulfate and chondroitin sulfate are popular supplements and research supports their use in pain relief. Most of the studies evaluated pain improvement in patients with osteoarthritis of the knee. In research trials with glucosamine/ chondroitin, a 20% or better improvement in pain is considered a success (13), which is an important fact to understand as many patients in the clinical setting often improve 20% with glucosamine and yet perceive the intervention to be a failure.

Patients and doctors must also consider the manufacturing of their supplemental glucosamine and chondroitin. We know that unless glucosamine/chondroitin is pharmaceutical made, it is possible that label claims may be inaccurate. The stated amounts on the label often do not align with values determined by independent laboratory analysis. Researchers suggest we are best to use pharmaceutically made glucosamine/chondroitin (28,29).

Researchers have also identified factors that help to predict successful outcomes in patients with OA of the knee who supplement with glucosamine. An important predictor turned out to be body mass index (BMI) (2). The normal range for BMI is 18.5 to 24.9; an over weight individual will have a BMI of 25-29.9; while an individual is considered obese if the BMI is above 30.0. Patients tend to have better outcomes with glucosamine/chondroitin if the BMI is below 28.0, which means that the best responders have a normal BMI or are slightly over weight (9, 13, 25,28).

While many view excess body fat as stored energy and a burden on joints, another view is important to appreciate. Excess body fat serves to activate the immune system and create chronic inflammation (7), which is a likely reason why supplements and medications are less effective in these patients.

We began the supplement section by indicating that supplementation should always be considered in the context of our diet, which is reflected in our overall health status. This fact is precisely demonstrated in the context of supplemental glucosamine/chondroitin. The pursuit of health, in general, and healthy joints should involve an anti-inflammatory diet that is supported by key nutritional supplements.

Summary

It is important to remember that good nutrition begins by maintaining an anti-inflammatory diet, to which key supplements can be added. Patients who stick with this program are consistently pleased with their results.


References

1. Aggarwal BB, Shishodia S. Suppression of the nuclear factor-{kappa}B activation pathway by spice-derived phytochemicals: reasoning for seasoning. Ann N Y Acad Sci. 2004; 1030:434-41.
2. Ames BN. Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage. Proc Nat Acad Sci. 2006;103(47):17589-94.
3. Ames BN. The metabolic tune-up: metabolic harmony and disease prevention. J Nutr. 2003;133:1544S-48S.
4. Ames BN. Supplements and tuning up metabolism. J Nutr. 2004;134(11):3164S-68S.
5. Ames BN. Increasing longevity by tuning up metabolism. To maximize human health, lifespan, scientists must abandon outdated models of micronutrients. EMBO Rep. 2005;6(S1):S20-S24.
6. Ames BN. DNA damage from micronutrient deficiencies is likely to be a major cause of cancer. Mutation Res. 2001;475(1-2):7-20.
7. Axelsson J, Heimburger O, Lindholm B, Stenvinkel P. Adipose tissue and its relation to inflammation: The role of adipokines. J Ren Nutr. 2005; 15(1):131-6.
8. Bar-Dayan Y, Shoenfield Y. Magnesium fortification of water. A possible step forward in preventive medicine? Ann Med Interne (Paris). 1997;148(6):440-4.
9. Bennett AN, Crossley KM, Brukner PD, Hinman RS. Predictors of symptomatic response to glucosamine in knee osteoarthritis: an exploratory study. Br J Sports Med. 2007;41:415–419.
10. Bucci L. Nutrition Applied to Injury Rehabilitation and Sports Medicine. Boca Raton: CRC Press; 1995: p.167-76.
11. Cannell JJ, Hollis BW. Use of vitamin D in clinical practice. Alt Med Rev. 2008;13(1):6-20.
12. Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ. Athletic performance and vitamin D. Med Sci Sports Exer. 2009;41(5):1102-10.
13. Clegg DO, Reda DJ, Harris CL et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. New Eng J Med 2006; 354:795-808.
14. Cordain L, Eaton SB, Sebastian A et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005;81:341-54.
15. Crane FL. Biochemical functions of coenzyme Q10. J Am Coll Nutr. 2001;20(6):591-598
16. Ford ES, Mokdad AH. Dietary magnesim intake in a national sample of US adults. J Nutr 2003; 133:2879-82.
17. Guigoz Y, Dore J, Schiffrin EJ. The inflammatory status of old age can be nurtured from the intestinal microenvironment. Curr Opin Clin Nutr Metab Care. 2008;11(1)13-20.
18. Holick MF. Deficiency of sunlight and vitamin D. BMJ. 2008:336;1318-19
19. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87(suppl):1080S-86S.
20. Isolauri E. Probiotics: effects on immunity. Am J Clin Nutr 2001; 73(suppl):444S-50S.
21. King DE, Mainous AG, Geesey ME, Egan BM, Rehman S. Magnesium supplement intake and C-reactive protein levels in adults. Nutr Res. 2006;26:193-96.
22. Linnane AW, Zhang C, Yarovaya N et al. Human aging and global function of coenzyme Q10. Ann N Y Acad Sci. 2002; 959:396-411.
23. NIH website on essential fatty acids. http://efaeducation.nih.gov/sig/eicosa3.html
24. O’Keefe JH, Gheewala NM, O’Keefe JO. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol. 2008;51:249-55.
25. Pavelka K, Gatterova J, Olejarova M, Machacek S, Giacovelli G, Rovati LC. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2002; 162:2113–23.
26. Plumb MS, Aspden RM. High levels of fat and (n-6) fatty acids in cancellous bone in osteoarthritis. Lipids Health Dis. 2004, 3:12.
27. Putnam J, Allshouse J, Kantor LS. US per capita food supply trends: more calories, refined carbohydrates, and fats. Food Review. 2002;25(3):2-15. [Economic Research Service, USDA]
28. Reginster JY, Deroisy R, Rovati LC. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet. 2001; 357:251-56.
29. Reginster JY, Bruyere O, Faikin G, Henrotin Y. Current concepts in the therapeutic management of osteoarthritis with glucosamine. Bull Hosp Joint Dis. 2005;63(1&2):31-36.
30. Rodriguez-Moran M, Guerrero-Romero F. Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetes subjects. Diabetes Care. 2003;26:1147-52.
31. Sartor RB. Bacteria in Crohn's disease: Mechanisms of inflammation and therapeutic implications. J Clin Gastroenterol. 2007; 41(Suppl 1):S37-S43.
32. Senni K, Foucault-Bertaud A, Godeau G. Magnesium and connective tissue. Mag Res. 2003; 16:70-74.
33. Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.
34. Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med. 2008;233:674-88.
35. Singh U, Jialal I. Alpha-lipoic acid supplementation and diabetes. Nutr Rev. 2008;66(11)646-57.
36. Tiku ML, Shah R, Allison GT. Evidence link chondrocyte lipid peroxidation to cartilage matrix protein degradation: possible role in cartilage aging and the pathogenesis of osteoarthritis. J Biol Chem. 2000; 275: 20069-76.
37. Xu Q, Parks CG DeRoo LA, Cawthon RM, Sandler DP, Chen H. Multivitamin use and telomere length in women.
38. Chou R, Qaeem A, Snow V et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.
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Founded in 1924, Anabolic Laboratories is a pharmaceutical manufacturer of clinically dispensed nutritional products for the licensed health care professional.

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