Supplements: How To Cut Through The Nonsense

(Photographed by Stephanie Gonot)

By Bari Lieberman for Refinery29

Walking through the supplement aisle at your local Whole Foods can be an overwhelming and confusing experience. There is so much health potential lurking on the shelves, but there’s also a lot of crap. And, trying to dig through what’s right for you is simply exhausting. That’s why we chatted with the expert nicknamed “the supplement doctor” to help decode the mysteries surrounding supplementation, so you can understand what you really should be taking — and what to skip entirely. 

That expert is Mark Moyad, MD, MPH, Jenkins/Pokempner director of complementary and alternative medicine at the University of Michigan Medical Center. He gives lectures to health professionals and patients about supplements and is the author of the upcoming The Supplement Handbook: A Trusted Expert’s Guide to What Works & What’s Worthless for More Than 200 Ailments. The book has over 500 pages of information and research related to supplements for different diseases and conditions.

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Despite his expertise (and nickname), Dr. Moyad doesn’t recommend supplements to everyone. “Take only the ones you’re sure you need, and integrate other healthy lifestyle changes,” he says. “When done correctly, supplements are very much legitimate options today. I don’t see a difference between a really effective drug and a really effective supplement.”

Read on for more advice about what supplements actually work for migraines, PMS, and insomnia — as well as general supplement-buying tips.

Your General Supplement Checklist:

Meet The Qualification
"A supplement, just like a drug, can make your life better if you need it and worse if you don’t. In other words, don’t take it if you don’t need it," Dr. Moyad explains. "Before you go on a pill, first see if you can solve the problem through lifestyle changes: weight loss; exercise; alcohol, sodium, and stress reduction; following a healthy diet — whatever it takes.” Before recommending any supplement, Dr. Moyad questions and potentially tests the patient while also looking at the research on that supplement. “Was the supplement tested on people with the same or similar conditions (or lack of conditions)? People who were of the same age, gender, race, and so on? If the supplement was tested on people with diabetes and you don’t have this disease, then it may not be right for you,” he explains.

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Understand The Relationship Between Price & Quality 
There isn’t one. “Higher-priced supplements are not absorbed better,” Dr. Moyad says. “Some supplement companies will tell you their product is absorbed better than another product that has fewer bells and whistles. But, I always have to ask, apart from a much higher price, what does this expensive supplement do better clinically (in the real world) than the plain, old cheap stuff? If it has not been proven to do anything better (like reduce pain, bone loss, or cholesterol — or improve mood), then I don’t recommend it.”

Look For These Labels
There is no ideal dietary supplement, but below is a partial list of some of the characteristics many people look for in the ‘perfect’ product (these would be reported either on the packaging or the supplement’s website): 

- Heart healthy 
- Safe for mental health
- Safe during pregnancy and for children
- Respected quality-control testing and monitoring methods employed
- BPA-free container
- Phthalates-free
- No fragrances
- No gluten
- Non-GMO
- No hormones
- No pesticides or herbicides
- No preservatives
- No allergens (including soy, peanuts, tree nuts, etc.)
- Tested for heavy metals (such as arsenic, cadmium, lead, mercury)
- Quality assurance report available online

Bottom line: Learn about supplements and decide what you’re willing to spend, what kind of quality control you want, and what factors are most important to you (you may not care about whether the pill contains gluten or sodium, for instance). 

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Think About Timing
“The best time to take a supplement is when you can remember to do it…and always try to take your supplement with or right after a meal, unless the directions or your doctor tells you to take it on an empty stomach. Taking it with a meal maximizes your stomach acid, which aids absorption and minimizes the chances of getting gastrointestinal upset,” Dr. Moyad explains. 

(Photographed by Stephanie Gonot)

Supplements For Migraines
Before taking more pills for migraines, think about what you’re already using. Dr. Moyad has seen cases where taking a cocktail of different dietary supplements is the migraine trigger itself, since these pills can contain irritants such as caffeine and preservatives.

What Works
Note: Do not use the supplements here in combination, and give whichever one you’re trying at least three months before you can expect to see a difference.

Butterbur (Petasites hybridus): up to 75 milligrams, twice a day
This plant contains chemicals called petasites that may have anti-inflammatory properties. Mild gastrointestinal upset, especially burping, was the most common side effect reported, and butterbur contains dangerous compounds known as pyrrolizidine alkaloids (PA), which are toxic to the liver and lungs and increase the risk of blood clots. But, these are supposed to be removed in commercial supplements. Regardless, make sure you purchase only butterbur supplements that are certified and labeled “PA-free.” Additionally, pregnant women should not use butterbur, and you should never consume this plant in any other form (translation: no foraging).

Vitamin B2 (riboflavin): 25 to 400 milligrams a day
Researchers believe that this vitamin may speed up brain metabolism by improving how cells use oxygen, which enhances normal brain function. Always take vitamin B2 by itself — never in a multivitamin or B-complex supplement — so you don’t ingest a toxic dose of other vitamins in the process.

Magnesium: 300 to 600 milligrams a day
A deficiency of this mineral can trigger migraines. When magnesium is low, the body generates a compound called substance P, which stimulates sensory fibers in the brain and can lead to headaches. The most common side effect of taking this supplement is soft stools or diarrhea — so if you suffer from constipation and migraines, you’ll be set.

What’s Worthless For Migraines
Due to lack of clinical research, inconsistent study results, variation in active ingredients, and/or too many negative side effects, steer clear of feverfew, melatonin, and probiotics.

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Supplements For Premenstrual Syndrome:

What Works 
Calcium Carbonate: 1,200 milligrams a day in two divided doses
This is the most tested supplement for PMS, and it has undergone a large, multi-center trial in the U.S. The study found that participants who took calcium carbonate experienced less PMS symptoms (such as pain, negative mood effects, food cravings, and water retention). The improvements were noted during the last two cycles of the study, which implies that you need to be using the supplement for a few months before you’ll see results.

Vitamin B6 (pyridoxine): 50 to 100 milligrams a day
This vitamin is typically used to reduce nausea, and an analysis of at least nine randomized trials finds that it’s helpful in reducing PMS symptoms.

Chasteberry (Vitex agnus-castus): 20 milligrams a day, on average
This herb contains casticin, an ingredient that decreases levels of the hormone prolactin by occupying dopamine (D2) receptors. It’s one of the most commonly recommended herbal products for PMS, but Dr. Moyad notes some quality-control issues; the research on this product has concentrated on the Ze 440 (one 20-milligram tablet) and BNO 1095 (one 4-milligram tablet) extracts, both of which can be difficult to find in the U.S.

What’s Worthless For PMS
Due to lack of clinical research, inconsistent study results, variation in active ingredients, and/or too many negative side effects, avoid saffron, evening primrose oil, prostaglandin E1, black-currant oil, borage-seed oil, black cohosh, wild yam root, Dong quai, soy, vitamin E, ginkgo biloba, and St. John’s Wort.

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Supplements For Insomnia & Jet Lag
Before trying supplements, here are 16 lifestyle changes that can help you log more quality sleep.

What Works
Note: Do not use any sleep aid if you’re pregnant or breastfeeding, and do not administer to children without close monitoring by a doctor.

Melatonin: up to 0.5 to 3 milligrams, 15 to 30 minutes before bedtime or when waking in the middle of the night (not both); for jet lag, 0.5 to 5 milligrams before bedtime until you adapt to the new time zone.
Melatonin has a great safety record, but it’s still possible to develop a dependence on it; over time, it can lose its effect. As with prescription sleep aids, taking too much melatonin can make you tired the next day and may interfere with your memory, so find the lowest dose of melatonin that works for you and take it for only as long as is needed (the shorter the amount of time, the better). Look only for products that offer melatonin by itself, not mixed with other active ingredients.

Valerian (Valeriana officinalis): 200 to 600 milligrams, 30 to 60 minutes before bedtime
Valerian affects the availability and transport of GABA, or gamma-aminobutyric acid, which has a calming effect on the brain. Always look for valerian as a root extract with at least 0.8% valerenic acids, which are the active ingredient. Never combine this supplement with other sleeping pills or central-nervous-system depressants such as strong pain medications, because it can cause serious breathing or other respiratory problems.

5-HTP (5-hydroxytryptophan): 50 to 100 milligrams, 10 to 15 minutes before bedtime
5-HTP easily crosses the blood-brain barrier and is rapidly converted to serotonin. Higher doses can cause nightmares or vivid dreams, and 5-HTP should not be combined with any other medications that also impact serotonin levels, such as antidepressants.

L-theanine: 100 to 200 milligrams a day, 30 to 60 minutes before bedtime
Researchers believe L-theanine (also known as N-ethyl-L-glutamine) has the potential to reduce stress because it increases multiple compounds in the brain, such as GABA, serotonin, and dopamine, all of which promote relaxation. As a result, it can improve sleep, especially if stress is keeping you awake.

What’s Worthless For Insomnia & Jet Lag
Due to lack of clinical research, inconsistent study results, variation in active ingredients, and/or too many negative side effects, avoid: kava or kava-kava, passionflower, hops, wild lettuce, Jamaican dogwood, California poppy, chamomile, lemon balm, skullcap, and Patrinia root. Chamomile tea is supposed to be relaxing and sedating, but the studies on this are weak, Dr. Moyad notes.

(Photographed by Stephanie Gonot)

FAQs

Can a supplement go bad? 
“For fish oil, limited testing shows that the supplement can break down and begin to oxidize after a year or two. If I exceed the expiration date by three to six months, for most supplements, I don’t lose any sleep over it. There are a few exceptions… If you notice a change in color or smell, it’s time to toss it.” A helpful tip for when you’re purchasing is to check a few bottles on the shelves. There may be options with later expiration dates.

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What’s really in a supplement? 
One problem, Dr. Moyad notes, is that you’re essentially “being sold a laundry list of compounds within the same bottle.” The supplement industry is huge and competitive, and “competition brings some bad folks and some good folks,” he explains. “In order to position yourself in the market, you have to have some sort of unique product or blend. In an effort to make a unique product, some of these supplements…can be very contaminated or contain a lot of products that were never tested together. If you dilute it, you pollute it; if you’re going to look for a product that has the research, look for the actual product by itself. Don’t look for a product that has 10 different herbs in there. For me, all that does is jack up the price and increase the chance of toxicity, because those things were never studied in combination.” 

So, how do I know what supplements to take? 
“Develop a core group of experts,” including your doctor and/or dietician, Dr. Moyad explains. While the clerks at the health food store are knowledgeable, they may not know the intricacies and details about your personal health history. Use The Supplement Handbook for reference and insight into the research. Take all of the information you’ve gathered and make a decision as an informed team.

Part of this article includes information reprinted from The Supplement Handbook by Mark Moyad, MD, MPH. Copyright (c) 2014 by Mark A. Moyad, MD. By permission of Rodale Books. Available wherever books are sold.