There are thousands of different supplements in the market today, and the efficacy is questionable for at least half of them. Let me start this first by saying that I believe diet and lifestyle are always best, but in cases where this is not enough, taking a supplement can certainly be beneficial.
Here is a list of supplements that I get the most questions about - and which I actually recommend you take on a daily basis. I recommend after reading this post you check out Labdoor which is a company that ranks brands based on efficacy, safety, and label accuracy.
1. Omega-3 DHA/EPA
Just about everyone could benefit from taking an omega-3 DHA/EPA supplement because most are not getting enough from the diet. There are many benefits with taking DHA/EPA, the most notable being that it decreases your overall risk of cardiovascular disease (think decreased risk of stroke, heart attack, etc) because it decreases systemic inflammation, lowers triglyceride cholesterol, and decreases blood pressure . Make sure your supplement contains at least 1,000mg combined DHA/EPA.
Dietary sources: Fatty fish (salmon, sardines, mackerel) are best. Other sources include fortified foods, most notably eggs - just note that this is highly dependent on what the chickens eat. So if chickens are fed flax, this means you are not getting DHA/EPA omega-3, but instead ALA omega-3. More on this below.
Note: The most common and easily absorbable forms of omega 3 are DHA/EPA. Plant based sources of Omega-3 contain ALA and not DHA or EPA. ALA must be converted to DHA/EPA which your body has a hard time doing. So yes, flax and chia are a "good source of omega-3," but this is highly deceiving because your body has a hard time absorbing any of it.
One of the most important minerals, magnesium is essential for bone formation and adequate vitamin D absorption. Magnesium can help with many ailments, but the most common everyday uses include prevention of headaches and migraines, constipation, pre-menstrual syndrome, and muscle aches. If you suffer from any of the above, a 400mg daily magnesium supplement may help, I recommend magnesium citrate.
Dietary sources: Almonds, sesame seeds, black beans, leafy greens, and cashews.
Note: There are many different types of magnesium and most are readily absorbable, but a few that you should avoid include magnesium oxide – this formulation is not easily absorbable by the body and unlikely to give you any benefit. Also avoid magnesium glutamate and aspartate which are linked to the artificial sweetener aspartame.
3. Vitamin D
Vitamin D also promotes calcium absorption and is therefore a necessary factor for keeping bones strong. Very few foods contain much Vitamin D, so the best way to get is from UV light – which most of us will not get especially with the winter and with the use of sunscreen. Low levels of vitamin D are linked to headaches, depression, dizziness, and fatigue. Make sure you take Vitamin D3 and not Vitamin D2 because Vitamin D3 is much more absorbable by your body. Take at least 1,000mg per day and make sure to take with a fatty meal because Vitamin D is a fat soluble vitamin and needs fat to be absorbed.
Dietary sources: Fatty fish contain the highest amount. Other foods that contain minimal amounts include eggs, cheese, and beef liver.
For those of you who want strong, healthy hair and nails (who doesn't?) this is a supplement worth trying. Studies have shown that getting adequate biotin helps brittle nails become stronger and firmer and makes hair stronger thereby preventing hair loss.
Dietary sources: Eggs, fatty fish, meat, almonds, and beans.
If you are a woman of child bearing age and there is a chance you could become pregnant make sure you are taking at least 600mg of folate daily. Folate protects against major birth defects (i.e. neural tube defects) because it is essential for proper brain and spine development of a growing fetus - additionally it helps protect you from developing a folate induced anemia.
Folate (aka L-methlyfolate, L-5-Methyltetrahydrofolate) is the natural form found in foods and is preferred over folic acid. Folic acid is a synthetic version of folate and it must be broken down via several different steps into a compound that can be absorbed (aka its active form). This means when you take folic acid rather than folate there is a higher risk of buildup of folic acid derivatives and less vitamin being absorbed. Read more about this here.
Dietary sources: Eggs, green leafy vegetables, beef liver, and fortified foods.
Note: If you have the MTHFR mutation you should definitely be taking folate rather than folic acid, because this mutation means that you cannot fully break folic acid down to its absorbable form and this can lead to dangerous buildup of folic acid derivatives.
There are many benefits of taking a probiotic, but the most common everyday benefits include decreasing chronic gas, bloating, diarrhea, constipation, as well as improving immune function, absorbing nutrients, and for a healthy weight.
Fun fact: Microbes in your gut will eat up some that food you put into your system meaning this prevents you from absorbing calories – another reason to skip antibiotics if you can.
Your gut has trillions of bacteria so aim to get a probiotic that has at least 5 billion CFU (ideally 30-50 billion), because anything less is not going to do much for you . I recommend Ultimate Flora by Renew Life.
Dietary sources: Kimchi, kombucha, sauerkraut, pickles, and miso.
Note: I always recommend taking a probiotic when taking antibiotics, just keep in mind there is a chance of the antibiotic deactivating the probiotic when taken together. To prevent this from happening, take your probiotic on an empty stomach and make sure it has been a couple hours since you took your antibiotic or are going to take it.
If you are someone who gets cold sores regularly, this may be a good option for you. Studies have shown that taking 500-1000mg of lysine daily can decrease cold sore outbreaks as well as decrease severity and duration of the outbreak. I've heard great success from many patients who take lysine, and I recommend trying if you get cold sores regularly.
Dietary sources: Eggs, beans, meat, cheese, fish, and nuts.
Note: At the first sign of a cold sore, contact your provider immediately to get a prescription of anti-viral medication. Prescription anti-virals, such as Valtrex, work best when taken within the first 24-48 hours of an outbreak.
There are over 200 different types of viruses that can cause the common cold, and you are much more likely to be infected with a virus than bacteria. Unfortunately, antibiotics do not work on viruses and your cold will just have to run its course. That being said, there are certainly many things you can take to make yourself feel better.
Here is a list of the most common cold symptoms I hear in practice and what to look for at the pharmacy to make you feel better.
1. “My nose won’t stop running”
This is one of the most common symptoms associated with a cold, and can be incredibly annoying to be constantly grabbing for a tissue. Start taking a first generation histamine blocker, the most common is diphenhydramine (aka Benadryl) – yes these are marketed as allergy medication, but a side effect of these drugs is that they dry you out and will dry up that snot coming out of your nose and down your throat. Unfortunately, first generation anti-histamines can make you drowsy so best to take only at night time. Note that second generation anti-histamines ( i.e. Claritin, Allegra) do not have as much of a drying effect, but can take these during the day for possible relief.
2.“I am so stuffed up and congested”
Hands-down, most effective medication for this is pseudoephedrine (aka Sudafed) . Pseudoephedrine restricts blood vessels in your nassal passages, in effect reducing the pressure of your sinuses. Unfortunately, this constriction happens to all vessels in your body and can make your blood pressure go up a couple of points and may make you feel jittery because of this - so do not take if you already have high blood pressure and also do not take right before you want to go to bed. Another effective medication for sinus pressure is a nasal steroid such as Flonase. Note that nasal steroids take about a week to see full effect, so you are unlikely to get as much of a response compared to Sudafed.
Important note: Do not buy a product with phenylephrine (aka Sudafed PE), you will see this ingredient listed in any product that markets itself as a decongestant. This is the “Sudafed” that you see on the shelf that you can just walk out with without showing your ID. Phenylephrine has shown to be no more effective then placebo – and yes it will also raise your blood pressure, so not a good alternative for anyone
3. “My ears feel full”
This is an extension of your inflamed sinuses - your ears feel full because your sinuses are blocked, so how do you clear your ears? Clear your sinuses. As stated above, take pseudoephedrine and/or Flonase to help clear this congestion.
4. “I have a cold and the worst part is the cough”
There are a couple of different remedies for this.The American Academy of Chest Physicians recommends a combination of a first generation anti-histamine (i.e. diphenhydramine or Benadryl) PLUS a decongestant (pseudoephedrine or nasal decongestants such as Flonase).
Another popular ingredient for cough is dextromethorphan which you will as the main component in Robitussin DM or Delsym. Dextromethorphan theoretically works to make you stop coughing by blocking the cough reflex in the brain. Studies have shown this to be marginally effective, and I’ve had mixed results in practice as well. Read more about this here.
5. “My cold is gone, but I still have a cough”
AKA “post-infectious cough” can last up to 8 weeks after your cold goes away – 8 weeks! You can try one of the above remedies for cough, but if the cough is very irritating probably best to see your provider for an inhaler or prednisone which should make it go away quicker. Note that if it has been over 8 weeks your cough is likely due to some other cause and you should make an appointment to see your practitioner for evaluation.
6. “I'm coughing up thick phlegm”
For thick gunky mucus, Guaifenesin (aka Mucinex) is the ingredient you should look for to help with this. Note that this medication needs fluids to be able to work, so you must be hydrating yourself properly. Another potential benefit of taking this medication is that is has been shown to work as an anti-cough agent. Studies have shown this medication to be possibly effective for the above, this is another medication I've had mixed results with in practice.
7. “I have body aches”
Take nothing. Try light exercise, stretching, and avoid taking pain relievers. Body aches are a side effect of interferons, which are released in the presence of an infection, and whose job is to fight off the invader making you sick. In other words, body aches are a good sign because this means your body is trying to fight off the infection, let it be. Avoid taking ibuprofen because ibuprofen will block production of these virus killing cells - meaning longer duration and severity of cold symptoms for you.
8. “I had a fever of 102 this morning”
Take nothing. Plenty of fluids. A fever is a normal physiologic defense mechanism by your body to kill the pathogen making you sick - the American Academy of Pediatrics stresses that fever has beneficial effects and no evidence that a fever prolongs illness or causes any neurologic effect in the future. How does a fever work to help you? The increased body temperature stimulates production of your white blood cells (ie your immune system which functions to get rid of the bug making you sick), it lowers viral replication rate, (meaning less virus in your system), and high temperatures are toxic for some of the most virulent bacteria - such as those that cause pneumonia. Bottom line, let your body do its job and avoid taking fever reducers like acetaminophen or ibuprofen.
9. “I need to get better ASAP”
If you want to cut back on the length of your cold, start taking zinc gluconate now. Many studies have shown that zinc can decrease the length of your cold by 4-7 days – that’s like a 50% reduction in the length of your symptoms! If you are going to take anything for your cold, take zinc and take zinc gluconate specifically as it has shown to be the most absorbable formulation - the zinc needs to coat the throat where the virus normally lies. Also make sure to take in lozenge form as pills or drinks with zinc are less effective. Read more about this here.
Honorable mention: Vitamin C has also shown to be able to shorten the length of your cold, but there are limited studies on this, and the studies that do show a positive effect show only a ½ day reduction in the length of your cold when you take Vitamin C.
Obesity, diabetes, and heart disease have skyrocketed and continue to increase since the government’s recommendation for low-fat diet for a healthy heart starting in the 1970s. When we take a closer look at the evidence connecting saturated fat and heart disease, the evidence presented is pretty weak, and more and more evidence is mounting and getting recognition against the long term belief that saturated fat intake leads to cardiovascular disease and death.
The low-fat mantra all started in the 1950s with a scientist named Ancel Keys. He performed a couple of highly flawed studies where he "cherry-picked" data to show that saturuated fat intake caused heart disease. The government and food industry locked onto this idea, despite data and numerous studies that have flooded in to debunk this theory. I highly recommend the books Eat Fat Get Thin by Mark Hyman, MD, and Why We Get Fat by Gary Taubes, for more information and citations of this.
Here are 5 reasons that saturated fats are not going to increase your risk for heart disease or death:
1. Low-fat diets are NOT effective at preventing heart disease
No study has been able to prove that a low fat diet will decrease risk of cardiovascular mortality. Plenty of studies show that saturated fat can increase total cholesterol, and then make the simplified conclusion that saturated fats lead to heart disease. But this is highly misleading because yes, saturated fat will increase total cholesterol because it increases HDL cholesterol (good cholesterol), as well as the good type of LDL cholesterol (more on this below); however, no study can show a direct link between saturated fat intake and cardiovascular related death. Again, there are more studies then I could ever reference, but here are a couple good ones:
In 2010, an analysis of 21 quality studies that looked at roughly 350,000 individuals up to a 21 year period found no risk of saturated fat intake with cardiovascular disease or stroke
And lastly, one of the largest and most expensive and long term clinical trials called the Women’s Health Inititiative (WHI) was meant to show the benefit of a low-fat diet for lowering cholesterol and heart disease. After eight years of this study, the women on low-fat diet had lowered their total and LDL cholesterol, however, there was no beneficial effect on heart disease, stroke, or cancer found from eating a low fat diet.
2. Fat increases your HDL cholesterol (good cholesterol)
Low HDL cholesterol has been found to be a far greater risk factor of having a heart attack than a high LDL cholesterol . When you replace fat in your diet (including saturated fat), with carbohydrate, this lowers your HDL cholesterol. A study by The New England Journal of Medicine explains that a low HDL cholesterol is a “biomarker for dietary carbohydrate.” Saturated fats have been shown to increase your HDL cholesterol (good cholesterol), and to have either no effect on your triglyceride cholesterol or to reduce this (another type of bad cholesterol).
In practice, when I get a patient's labs back and I see a low HDL cholesterol level with high triglycerides, this is an indicator to me that this individual is eating a high carb, low fat diet.
3. Fat increases large LDL particles (good type) and decrease small LDL particles (bad type)
Yes, to make things more confusing there are different types of LDL, large "fluffy" type (think cotton balls), small dense type (think rocks), and many other sizes in between. We want more of the large LDL particles to small dense LDL particles because the small dense LDL particles are much easier to lodge themselves into the walls of your arteries causing your arteries to narrow which leads to decreased blood flow (ie oxygen to your heart). These small dense LDL particles also are known to oxidize which leads to rancidity and inflammation in the blood vessels. Saturated fats will increase large LDL and decrease small LDL which in effect will cut your risk of heart disease.
4. Replacing saturated fats with carbohydrates increases bad cholesterol
This is more of a summary of the above, but I want to reiterate that replacing saturated fats for carbohydrates makes your cholesterol profile much worse. Carbohydrates have been shown to decrease your good HDL cholesterol while increasing small particle LDL bad cholesterol, as well as inceasing your triglyceride cholesterol. As mentioned above, heart disease is most associated with a low HDL cholesterol and high triglyceride cholesterol. LDL is a little harder to predict with heart disease because of the varying sizes and conflicting evidence.
5. Prevents "Diabesity"
Cutting back on fat almost enevitably means you are going to add carbohydrates to your diet, and high carbohydrate intake is what leads to diabetes as well as obesity - this is something that is not disputed. Obesity is a risk factor in itself for heart disease, as is diabetes, put these two major risk factos together and you are talking about a massive increase in your chance of cardiovascular disease (think heart attack).
Just as guidelines have changed in terms of cholesterol containing foods (in case you didn’t know, cholesterol containing foods do not raise bad cholesterol and this has finally been recognized by the American Heart Association (AHA) and the United States Department of Agriculture (USDA)) I have a hunch that there will be new guidelines for saturated fats in the near future.
Be sure to increase your intake of good saturated fats such as organic eggs, organic grass-fed beef, coconut oil, and dark chocolate.
This is a short list of some of the most common foods marketed as healthy, when more often than not they are no better than eating dessert. Always read the nutrition label and the ingredients list before purchasing a food. You have to watch out for sugar because it triggers insulin (fat storage hormone) to be released, whose job is to get sugar out of your blood as quickly as possible and store it somewhere for later use (think your thighs). Unless you are training for something like a marathon or ironman where your muscles will be the first to receive the sugar, try to keep your daily sugar to a minimum - like under 25 grams per day.
1. Skim Milk.
Non-fat or “skim milk” has a surprisingly high amount of sugar. Most brands have about 12 grams per cup – this is almost half the amount of total sugar that is recommended you ingest each day! To put this into perspective, this is the same amount of sugar as eating three Original Chips Ahoy! Cookies or three Milano Original Cookies. I am not a huge fan of cow’s milk (for many other reasons), and I recommend trying unsweetened almond, cashew, or coconut milk as an alternative.
2. Protein/Nutrition Bars.
In general, I recommend staying away from all “high protein,” “high fiber,” “gluten free,” or however else the given bar has been marked as healthy. Strip back all of the fancy advertising and look at the nutrition label and you will find that most of these "health" bars are no better than a candy bar. For example, compare a Snickers Bar to a Clif Bar: a Snickers Bar has 27 grams of sugar and 4 grams of protein. A Clif bar can have up to 25 grams of sugar and 9 grams of protein…is there really that much of a difference between the two?? – Others popular bars to avoid include Balance bars, Luna Bars, Pure Bars, Lara Bars, and even Kind Bars which can be high in sugar. Rule of thumb, stay away from any bar with 10 grams of sugar or more. The only protein bars I recommend are Quest bars because they are high in protein and fiber, low in sugar and in overall ingredients, and Think Thin Bars which are also a healthier alternative.
Yogurt can be very healthy because it is generally high in protein and low in fat. However, you have to be careful with choosing yogurt because most have a ton of added sugar, be especially cognizant of the the non-fat versions because the fat is replaced with sugar to make it taste better. Always check the nutrition label, more than 7g of sugar per serving and you have a dessert not a healthy snack. My favorite is Plain Greek Yogurt Trader Joe's brand which has 22 grams of protein and 6 grams sugar per cup.
Be very picky with granola, the vast majority are heavy in sugar and calories, and low in fiber. Granola is meant to be eaten in a small serving size, usually like a ¼ or ½ cup, meaning you could easily be eating 4 servings in one sitting. And just because the packaging says “made with honey” or “made with all natural ingredients” or some other deceiving marketing claim, this doesn’t make the food any healthier, sugar is sugar. I don’t really recommend granola in general, but if you are going to eat it I recommend eating it plain and would avoid eating it with anything else sugary such as yogurt and/or fruit.
Cereal is generally not a great choice. Almost all cereals are loaded with sugar, low in fiber, and low in protein. And why is everyone eating Raisen Bran??!! It seems like just about every other patient I see is eating this. Raisen Bran has 18 grams of sugar per serving, 18 grams! This is almost the total amount of sugar that you should have in an entire day. Then add some skim milk on there and this puts you over the edge. Forget the raisens and just get plain bran cereal, you can always add your own raisens on top if necessary. The only cereals I recommend are Fiber One Original Cereal (14 grams of fiber per ½ cup!) or Trader Joe’s High Fiber cereal (9 grams of fiber per 2/3 cup) because both are low in sugar and high in fiber.
6. Sports Drinks.
Everyone knows that soda is a diet-don't, but most sports drinks are just as bad. For example, a 12 fl oz bottle of Coca-Cola Coke has around 33 grams of sugar. A bottle of Gatorade has almost 50 grams of sugar (due to having 2.5 servings per bottle). And watch out for those bottled teas because they can have over 20 grams of sugar per serving and can have multiple servings within one bottle. Alternatives to these super sweet drinks are G2 which is a lower calorie version of Gatorade, Vitamin Water Zero, and PowerAid Zero.
I imagine that just about everyone who has drank alcohol before has experienced a hangover at some point in time. Hangovers range in quality and severity with symptoms such as fatigue, nausea, headache, shakiness, dizziness, vomiting, diarrhea, weakness, anxiety, and depression. The only real way to prevent a hangover is to not drink alcohol, but here are some tips that can make it less likely that you will experience a hangover, or at least ways to prevent its severity.
1. Eat a fatty meal before or with drinking.
Fat is the slowest macronutrient to be broken down and absorbed (compared to carbs and proteins), and will slow your digestion of alcohol. Think healthy fats such as avocado, nuts, hard cheeses.
2. Drink a glass of water with each drink.
Hydration is key. The main cause of headache and overall nausea can be much attributed to dehydration.
3. Eat a salty meal before or with drinking.
Not only do you lose water when you drink alcohol, but you also lose essential electrolytes, most notably sodium which helps to keep your body hold onto water.
4. Get plenty of vitamin B.
In addition to losing electrolytes you also lose essential vitamins and minerals when you drink alcohol. The B vitamins are especially vulnerable to depletion and being deficient in one or more of them can contribute to symptoms such as fatigue, depression, and anxiety. Take a vitamin B supplement daily and/or eat foods rich in B vitamins such as eggs, chicken, turkey, and dairy products to help prevent the development of a hangover.
Try and go to sleep at least a couple of hours after your last drink. Alcohol can definitely put you to sleep, but it prevents you from getting into deep sleep or REM sleep, making you groggy the next day.