The Nuances of Dietary Supplements

2/3/2021

Did you know the FDA regulates dietary supplements (often referred to as nutraceuticals) as food and not in the same way they regulate pharmaceuticals? Why is that an important point to make?  Because you must rely on the supplement manufacturer to impose their own quality standards.  Choosing high quality, professional pharmaceutical grade supplements is a good way to ensure that you’re not wasting your money.

There is no substitute for a balanced, healthy diet to provide the foundation for your nutritional requirements.  Understanding your individual needs should be guided by a health care practitioner trained in nutrition.

Needs change based on age, gender, specific underlying nutritional deficiencies, and certain medical conditions.  For example, younger, menstruating females may need more iron.  Men and postmenopausal women rarely need extra iron, and excessive iron accumulation can be harmful.  As another example, if you eat lots of fermented food you probably don’t need a probiotic supplement.

You often hear from mainstream medicine that vitamins are a waste of money.  Often these pundits have no training in nutrition, and it is evident by some of the statements they make.

Have you noticed all the interest in certain supplements like vitamin D, zinc, and melatonin (to name a few) to help prevent or mitigate the symptoms of COVID-19?  There is mounting evidence that is helpful and I would point out that on March 3, 2020, we emailed our patients encouraging them to take vitamin D because there was evidence vitamin D helps respiratory infections.  Granted at the time, when there were only 2 deaths in the United States from COVID-19 so we couldn’t say anything specific to this viral infection.

I would like to hone in on two examples of the differences between various supplements to illustrate the point that not all nutraceuticals are created equal.  To pretend that they are would be as ludicrous as suggesting that “wine is wine” and they are pretty much all the same.

Chelated Minerals Versus Mineral Salts

If you take an acid (oxalic acid for example) and combine it with a mineral such as magnesium you create the mineral salt magnesium oxide.  Magnesium oxide is the most prevalent, least expensive, and poorly absorbed form of magnesium.

As another example, if you combine magnesium with citric acid you create the mineral salt magnesium citrate.

In summary, mineral salts are good for constipation and possibly for putting in your bathwater, but not so much if your goal is to increase the amount of the mineral in your body, whether we are talking about magnesium, calcium, iron, etc.

What is a Chelated Mineral?

A chelated mineral is created when the mineral is combined with an amino acid.  Amino acids are the building blocks of protein.  As an example, if you combine iron with sulfuric acid you have the mineral salt ferrous sulfate.  Ferrous sulfate is the most frequently recommended iron replacement, which is poorly absorbed and often wreaks havoc on the digestive tract.

If you combine iron with an amino acid – let’s say iron with the amino acid glycine you create ferrous glycinate.  This formulation is much better absorbed and much less likely to upset your stomach or cause constipation.

It can get a little more complicated when you consider that there are various amino acids you can combine with a mineral.  So, if you combine magnesium with glycine you have a chelated mineral-magnesium glycinate.  If you combine magnesium with the amino acid threonine, you have magnesium threonate. Magnesium threonate is touted as the “magnesium for the brain”.  If you haven’t heard of this exciting form of magnesium, I would suggest you do a little research into it.

Methyl B Vitamins

Now let’s discuss the issue of methyl B vitamins.  The terms folate and folic acid are often used interchangeably, however, they differ greatly from one another.  Folate is naturally present in certain foods including dark leafy green vegetables, avocados, legumes, and asparagus.  Folic acid is the synthetic (man-made) version of folate that is most often found in fortified foods or supplements.

Your body needs folate to make DNA and modify proteins.  In order to do this, it must be in the “active form”, which is methyl folate or more specifically 5-methyltrahydrofolate.  Many of you have probably heard of or been tested for the MTHFR gene variant of which there are 2 types.  If you have one or both variants it is more difficult for your body to process or methylate your B vitamins, including folate and B-12.  You can circumvent the issue by taking B vitamins which are already in the methyl form.

Cyanocobalamin is the synthetic (man-made) version of vitamin B12. Methylcobalamin, the “active form” is naturally present in some foods including fish, meat, poultry, eggs, and dairy.

The bottom line is when looking at your B vitamins look for methylcobalamin versus cyanocobalamin and 5-methyltetrahydrofolate in place of folic acid.  Additionally, look for chelated minerals.

A word of caution is in order.  Don’t be fooled by the label.  Look at the actual ingredients.  I recently had a patient who brought in her bottle of “Chelated Magnesium”.  When looking at the back of the bottle I noted that it had some chelated magnesium, however, the main ingredient was magnesium oxide.