DRAKE
and
DRAKE

Saunders Pharmaceutical Word Book

hen various transcription associations invite me to address their group, I usually speak on a topic in natural medicine. Occasionally I’m asked which supplements I recommend and which ones I personally take. As for myself, I have complete blood work done, including hormone levels, twice a year. I use the results as a guide in selecting supplements to correct any deficiencies or bring certain values within the normal range. So unless the questioner is male, over 50, with my lab results, simply listing the supplements that I take would not be a particularly useful answer.

I can, however, recommend supplements that everyone should be taking to maintain optimal health. Below I’ve listed the top half dozen most important supplements, based upon a preponderance of scientific data (references available upon request). I’m not in the business of evaluating supplement manufacturers, but a link to the nonprofit organization where I purchase most of my supplements can be found at the bottom of our home page.

#1: Multivitamins. The most important supplement to take is a good multivitamin. If you can’t get a good multi, any multi is better than no multi. How can you tell if your multi is a good one? It can be tough, since every manufacturer has a different mix of vitamins and minerals. But there are two things you can look for: First, how many tabs/caps comprise a daily dose? One per day provides only the bare minimum baseline. Two per day—taken 12 hours apart—is much better, since water-soluble vitamins are excreted within a few hours. As the daily pill count goes up, you can count on the manufacturer to include a broader range of supplements in higher dosages. There’s only so much they can get into one or two pills, so compromises must be made. The other thing to look for is the manufacturer’s selection of the form of vitamin E the multi contains. It tells a lot about the quality of both the vitamin and the manufacturer. Most multis contain dl-alpha tocopherol. This is the cheapest form, since it’s synthetic. (I won’t go into the natural vs. synthetic debate, but suffice it to say that in the particular case of vitamin E, it does make a difference.) A better form, found in high-quality multis, is d-alpha tocopherol. And the best form, found in some single-vitamin supplements but rarely in multis, is mixed tocopherols and tocotrienols. If the multi you take contains the more expensive d-alpha tocopherol, you can trust that manufacturer has put their users’ health ahead of corporate profit.

#2: Antioxidants. Next in importance is alpha lipoic acid and/or a good antioxidant mix. Oxidation from free radicals, in their various forms, is the primary cause of cellular damage and aging. Alpha lipoic acid (ALA) is unique in that it quenches free radicals in both the watery and lipid parts of the body. Several studies have shown that 300 mg/day of ALA helps prevent diabetic neuropathy and retinopathy. Nondiabetics can get by with half that daily amount. Alternately, an antioxidant mix should be selected to supply what will not fit into the multi. It should contain extra vitamin C (preferably as both ascorbic acid and ascorbyl palmitate), vitamin E (preferably in the form of mixed tocopherols and tocotrienols), selenium, and zinc. It’s a bonus if the mix contains some of the more recently discovered antioxidants, such as Pycnogenol (pine bark extract), resveratrol, or superoxide dismutase (SOD). If the multi is taken once daily, the antioxidant should be taken 12 hours later.

#3: CoQ10. Of great importance to everyone with a functioning heart and brain is coenzyme Q10. CoQ10 is incorporated into cellular mitochondria, where it regulates the conversion of fats and sugars into energy. Endogenous production of CoQ10 declines with age, making supplementation vital to those over 30. The organs that use the greatest amount of energy are the brain and the heart muscle, where a CoQ10 deficiency will manifest as various age-associated disorders. Dosage recommendation: age 30–45, 50 mg/day; 45–55, 75 mg/day; over 55, 100 mg/day. Double this amount if you have a history of heart disease. Take not less than 200 mg/day if you’re taking statin drugs (statins completely block the endogenous production of CoQ10). Note: Boosting mitochondrial energy production results in the increased production of free radicals, which is the only reason CoQ10 supplementation is listed after antioxidant supplementation.

#4: Fish oils. Rich in omega-3 fatty acids, fish oils have a number of important actions in the body. They suppress inflammation by inhibiting pro-inflammatory cytokines and prostaglandins. Supportive but inconclusive research suggests that they can reduce the risk of coronary heart disease by lowering triglycerides and improving arterial blood flow. Several studies have shown that the EPA fraction of fish oil can improve brain function and reduce the severity of depression and ADHD. (Both EPA and DHA are crucial to developing brains, which is one of the reasons why babies fed with breast milk, rich in omega-3 fatty acids, have been shown to have fewer personality problems than formula-fed infants. European infant formulas have been supplemented with omega-3s for decades; U.S. formula makers started such supplementation just a few years ago.) Dosage recommendation: build up to 6000 mg/day of high-quality fish oil, in 2–3 divided doses. (Starting at that dosage may cause diarrhea.) Make sure the brand you choose has a few IU of vitamin E added to prevent rancidity. When you get home, cut one gelcap open. If it smells like rotten fish, it’s rancid; return the bottle for a refund and buy your fish oil capsules somewhere else.

#5 (for women): Cal/Mag/Zinc. Researchers reported in the journal Clinical Therapeutics that 135 million hip fractures and $2.6 billion in medical costs could have been avoided in one study year if people aged 50 and older had taken 1200 mg of supplemental calcium each day for the preceding 36 months. In order for calcium to be effective in preventing bone loss, adequate amounts of vitamin D3, magnesium, and zinc must be present, as well as certain trace minerals. (Phosphorous is also required to make bone, but most people have an excess of phosphorus in the body. Any cola-flavored drink provides a week’s worth of phosphorus from phosphoric acid.) Calcium, magnesium, and zinc can be purchased as a single supplement (Cal/Mag/Zinc), or they can be purchased separately. Most calcium is not well absorbed by the body, so the form of calcium is important. Calcium carbonate (from oyster shells and coral) is the cheapest form and the most poorly absorbed. It requires sufficient stomach acid for absorption, so it should be taken with a meal. People produce less stomach acid as they age, so absorption of this form of calcium likewise declines with age. If you take antacids, you will absorb almost no calcium from calcium carbonate. Calcium citrate (e.g., Citracal) is better absorbed and does not rely on stomach acid. Other forms such as dicalcium malate and calcium bis-glycinate have been specially formulated to enhance absorption. Dosage recommendation: 1000–1200 mg/day of elemental calcium; half that amount of elemental magnesium. Elemental calcium should be listed on the label. It takes 3000 mg of calcium carbonate or 5700 mg of calcium citrate to provide 1200 mg of elemental calcium, which is the reason you won’t find much calcium in a multivitamin. You need only a small amount (5–15 mg) of zinc for building bones, which may already be included in your multi and/or antioxidant mix.

#5 (for men): Saw palmetto/nettle root. Saw palmetto extract with nettle root is used to maintain a healthy prostate. Numerous studies have proven the effectiveness of saw palmetto in preventing and reversing benign prostatic hyperplasia (BPH). Nettle root competitively binds with sex-hormone binding globulin (SHBG), thus allowing more testosterone in circulation. An increase in free testosterone counteracts the effects of estrogen, which feeds prostate cancer. Recent European studies have shown that the addition of pygeum extract is synergistic with the saw palmetto/ nettle root combination, and some forward-thinking supplement manufacturers have started offering this triple combination product. Dosage recommendation: saw palmetto extract, 320 mg/day; nettle root extract, 240 mg/day.

#6: DHEA. Most people over 40 can feel the effects of the declining endogenous production of sex hormones. To restore a youthful balance of these crucial hormones, you should supplement the hormones’ precursor, dehydroepiandrosterone (DHEA). DHEA is the body’s master hormone, and the most abundant circulating hormone in a youthful body. The body uses DHEA as the raw material to make all of the various sex hormones— predominantly estrogens, progesterone, and testosterone— in the quantity and proportion required by the individual. Supplementing the hormone precursor and allowing the body to make whatever hormones it needs is a more rational strategy than randomly supplementing the end-product hormones themselves. Regular testing of hormone levels is required to individualize dosage, which generally falls in the range of 25–100 mg/day. Bringing serum DHEA levels up to those of a typical 25-year-old is the first step. Your endocrinologist can then use those same blood tests to determine which bioidentical sex hormone(s) may then be needed in addition. Caution #1: Do not take DHEA if you have or suspect you may have a hormone-dependent cancer, such as breast, ovarian, or prostate cancer. Caution #2: I strongly recommend against allowing a doctor to indiscriminately prescribe sex hormones for anything other than birth control before age 35. Simply throwing synthetic hormones and horse estrogens at menopausal/ andropausal symptoms without first obtaining a complete hormone workup is a sure route to hormonal hell. If your doctor is not knowledgeable about bioidentical hormones and/or does not use hormone test results to individualize the dosage, find another doctor!

The “miracle supplement” for a longer life! I feel compelled to mention just one more supplement that everyone should be taking. A study published in the September 21, 2001, Journal of the American Medical Association reported that taking this one supplement every day can reduce mortality from all causes by 33%. Shocking? It’s even more shocking that this supplement costs less than 1¢ per day, and its daily use has been recommended since 1983 to reduce or avoid cardiovascular events. This “miracle supplement” is aspirin! Low-dose aspirin therapy has been proven to save lives, but it’s amazing how many people still ignore this advice. We can only wonder how many lives could have been saved and how many trillions of dollars in healthcare costs could have been avoided over the last 23 years by spending a penny a day on an 81 mg aspirin tablet.

Disclaimers: I am not a doctor, nor do I play one on TV. The FDA has not evaluated these statements for accuracy, but in view of the Vioxx debacle, that’s probably a good thing. FDA-approved drugs kill more people each year than the supplements mentioned above. In fact, peanuts kill more people each year than the supplements mentioned above. Your mileage may vary. Objects in mirror are closer than they appear. Do not remove tag under penalty of law.