Who needs to take nutritional supplements?
According to a U.S. Dept. of Agriculture study, over 90% of Americans are deficient in 14 essential nutrients.
Most of us are well aware that we do not eat properly. Poor dietary
habits, busy lifestyles, stress, and other pressures often conspire to
result in less than ideal nutrition. In addition, modern farming
practices and food processing rob the foods we do eat of essential
Most nutritionists therefore agree that most of us should be
supplementing our diet with select nutritional supplements. This is
especially true for those who have chronic medical conditions.
It is important to note, however, that taking vitamins and
nutritional supplements is not a substitute for healthy eating.
Vitamins and supplements in fact are not foods! They are “co-factors,”
substances that help your body utilize food more effectively and allow
your body’s physiology to function better. So if you’re putting garbage
in, you’ll get garbage out, no matter how many supplements you’re
What supplements should I be taking?
While a complete discussion of what supplements you should be taking
is beyond the scope of this site, the following is a list of the
supplements we most commonly recommend for the patients we see in our
practice. Please talk to one of our physicians if you have specific
questions about which supplement(s) might be appropriate for you.
At the very least, most people can benefit from being on a good
multivitamin. Women who are still menstruating may want to choose a
multivitamin that has iron, or take an additional iron supplement.
Women should be taking a calcium supplement, preferably one with
Vitamin D in it. The teenage years are the most important for calcium
intake. In fact, once you reach the age of about 25, your body has laid
down about as much calcium in the bones as it ever will. After that,
calcium supplementation will prevent bone loss, but will not
significantly add any additional bone density. However, most teenage
girls are getting about 40% less calcium than they require for adequate
bone mineralization. Therefore, every teenage girl should be taking
calcium supplements, as well as every adult woman. Generally, calcium
citrate/malate is preferred to calcium carbonate, since it is more
easily absorbed and bioavailable.
Omega-3 Fatty Acids (Fish Oil)
The health benefits of Omega-3 oil cannot be overstated. It can help
prevent heart disease (including atherosclerosis) and stroke, and it is
an anti-inflammatory and anti-oxidant. It has even shown to be helpful
in treating chronic conditions such as osteoarthritis, Multiple
Sclerosis, and other chronic conditions.
A flood of scientific findings on fish oil points to a startling
conclusion: Certain omega-3 fatty acids in the oil, consumed either
from fish or fish-oil capsules, appear to offer as much protection
against dying from coronary heart disease as do cholesterol-lowering
The evidence of fish oil's protective powers is so strong that the
American Heart Association now urges everyone to eat at least two small
3-ounce servings of fish a week (http://www.americanheart.org/presenter.jhtml?identifier=4632). That's particularly important after menopause in women and after age 45 or so in men, when coronary risk starts to rise.
Last fall the heart association advised people who already have
heart disease to consume about 1 gram a day of the active ingredients
in fish oil--omega-3s called EPA (eicosapentaenoic acid) and DHA
(docosahexaenoic acid). To follow that recommendation, the average
person would have to take at least some fish-oil pills or liquid. This
is one of the few times that a major health organization has endorsed
any dietary supplement for treating or preventing disease.
In order to consume the suggested amount of fish oil, most people
need to take fish oil supplements. The danger is that fish, and
therefore fish oil, is potentially contaminated with mercury, and even
with other toxins such as PCB’s, dioxin and lead. If not properly
manufactured and stored, fish oil also can become rancid. Therefore,
it’s critical to obtain your supplements from reputable manufacturers
who have filtered their fish oil to remove these toxins and who can
guarantee their product’s purity and potency. (See “How do I know
what’s a good vitamin product?”)
Flax seed and flax seed oil, by the way, is not the best source of
omega-3. It contains relatively little omega-3 oil. It does contain
alpha-linolenic acid (ALA), which gets weakly metabolized in the body
to omega-3 fatty acid, but it requires a profound amount of ALA in
order to get the suggested amount of EPA/DHA, so flax seed is not
recommended as a primary source of omega-3.
At Valley Sports Physicians, we suggest the average person take
1000-1500 mg a day of fish oil. For patients with arthritis or chronic
diseases, we recommend at least 3000 mg/day, typically in the form of
liquid, rather than capsules.
Glucosamine & Chrondroitin
Glucosamine sulfate and chondroitin sulfate are important
naturally-occurring components of joint cartilage and connective tissue
(such as ligaments and tendons). They are part of the “building block”
molecules that help form and maintain cartilage. As we age, our bodies
produce less of these substances. Numerous studies have shown the
benefits of taking G/C both to help with treating the symptoms of
arthritis and also possibly to slow down the development of arthritis.
Contrary to certain reports, both glucosamine and chondroitin
molecules get absorbed into joint cartilage. In one study published in
a major orthopedics journal, researchers tagged the glucosamine and
chondroitin molecules with harmless radioactive labels so they could
track where the molecules went in the body. They clearly demonstrated
that both molecules became well absorbed into the joint cartilage.
The recommended amount is a starting dose of 1500 mg a day of
glucosamine and 1200 mg a day of chondroitin for the first month. Then
you may try decreasing to 1000 mg and 800 mg of glucosamine and
chondroitin respectively a day.
As with all other nutritional supplements, brand matters. There is
no government oversight over the health food industry, and there are
some glucosamine and chondroitin products on the market that are not
even worth the bottles in which they are packaged. The absolute best
product on the market currently is Cosamin-DS®, made by Nutramax
Laboratories. It is available through our office at a discount, and
through most pharmacies, health food stores, and the internet.
MSM (methyl sulfonyl methane) is another supplement that can help
support connective tissue. It can be useful in treating arthritis,
especially when used in combination with glucosamine and chondroitin.
The connective tissue fibers (ligaments and tendons) are held together
by sulfur bridges or links. MSM is good source of sulfur and therefore
helps bind together the fibers that make up the ligaments and tendons.
MSM is also a weak natural anti-inflammatory and may help with some of
the pain associated with arthritis.
Sulfur is not sulfa. Sulfa is an antibiotic to which some people are
allergic. Since your body contains large amounts of sulfur, it is
impossible to be allergic to it.
The suggested dose of MSM is 3000 mg/day.
Valley Sports Physicians carries a complete line of nutritional
support products from Vital Nutrients and from Nutramax Labs, many of
which are available directly through our office, and others can be
ordered and received usually within about a week. We also have a
patient direct-order program that allows patients to purchase their
supplements directly from the manufacturer. Please talk to our staff
for more information.
Can I take too many vitamins?
When it comes to vitamin and mineral supplementation, more is not
necessarily better. In fact, fat-soluble vitamins, such as vitamin A,
can reach toxic and dangerous levels if doses are too high. In
addition, many people take multiple nutritional products, many of which
may have the same ingredients, leading to doses that are too high. It
is critical that you read labels carefully and that you discuss
everything that you’re taking with your physician. (At Valley Sports
Physicians we ask that patients bring in the bottles of every
supplement they are taking.)
This is why companies that manufacture professional-grade
supplements do not sell their products through health food stores. They
want to insure that patients are using their products correctly and
under physician supervision.
How do I know what’s a good vitamin product?
Most vitamin and nutritional product suppliers assure you they are
giving you the best quality in the marketplace. In our experience they
often don’t deliver the quality that they claim. Most manufacturers do
little or no testing of their products. And many natural product
testing laboratories use unethical practices and poor science to test
the validity of raw materials and finished products. The bottom line is
that you have no guarantee that what’s on the label is what’s in the
While all nutritional product companies claim to have the best
quality, almost none are completing all the steps that are required to
insure comprehensively that quality and purity are consistently
produced time after time. And there is no government mandate that
dictates they should!
Valley Sports Physicians is pleased to offer a line of nutritional supplement products by Vital Nutrients (http://www.vitalnutrients.net/vnflash.asp).
Vital Nutrients is one of only 2 nutrition products manufacturers in
the country voluntarily to follow the same exacting manufacturing
standards that the federal government imposes on the pharmaceutical
At Vital Nutrients, no corners are cut when it comes to quality
assurance. Laboratory quality assurance is not easy to attain. Yet
Vital Nutrients audits and verifies each independent testing laboratory
that they use, to insure that validated analytical methods and ethical
lab practices for raw material and finished product testing are being
followed. They insist that each lab they use follows only highly
purified analytical reference standards, because many laboratories are
not using proper reference standards and scientifically valid testing
methods. Vital Nutrients rejects the use of these laboratories for
testing their products. In fact, Vital Nutrients voluntarily follows
the same manufacturing standards that are required of the
pharmaceutical industry—something no other nutritional products
The Testing Process
Vital Nutrients buys all of its raw materials directly. Before any
material is formulated into a finished product, it is placed in
“quarantine” and subjected to rigorous independent testing.
Every batch of raw materials is routinely tested for:
- Microbiology Contamination – Bacteria, Yeast & Mold
- Authenticity – via Thin Layer Chromatography, HPLC, or Microscopy Identification
- Potency – Assay by HPLC, GC or appropriate scientifically valid test method
- Heavy Metals – Lead, Mercury, Cadmium, Arsenic and Aluminum to the parts per billion level
- Single or Multiple Chemical Solvent Residue tested by Gas Chromatography/Mass Spectroscopy
- Peroxides & Anisidines – Markers of Rancidity (Oil products)
- Herbicide, Pesticide and Fungicide Residue on all botanicals (a panel of 136 chemicals)
- 17 Dioxins & Dioxin-like Compounds, and 14 PCBs to the parts per trillion level (Fish Oil)
Every Finished Product Is Always Independently Laboratory Tested For:
- Label Claim Potency – to insure that what’s on the label is what’s in the bottle!
- Microbiology Contamination – Bacteria, Yeast & Mold
- Stability at 12 months to Assure Potency
- Stability at 24 months to Assure Potency
Here’s the best part—although this testing and quality assurance
comes at great cost to Vital Nutrients, the cost to the patient is the
same or even less than health food store or even internet prices for
What should I know about sports nutrition?
Athletes often ask us what they should be taking to improve
performance. As with many such questions, the answers depend on the
athlete’s age, the sport, co-existing medical conditions, and dietary
At the very least, most supplements marketed to athletes to improve
performance essentially are worthless! The only supplements proven to
enhance performance are caffeine and creatine, but each of these has
its own problems and dangers.
Caffeine is a legal stimulant and can enhance performance in certain
sports involving speed. But it can hinder performance in sports such as
archery and shooting where fine motor control and a steady hand are
Creatine can boost strength and power, but it does so at the expense
of increased weight gain. Creatine may be helpful for sports such as
weight lifting, body building, baseball, and for football linemen. But
because it increases body weight, it can hinder performance in sports
where maintaining lean body weight is critical. Creatine should also be
avoided in teenagers and younger athletes because of the increased
physiologic load placed on the kidneys and the lack of long-term
studies investigating its safety in these age groups.
Make sure you buy your creatine from a reputable supplier. Many
companies either “cut” their creatine with other powders, or they add
other supplements to the creatine, some of which may be banned
substances by the NCAA or U.S. Anti-Doping Agency, or may be downright
harmful. You should only use pure creatine monohydrate.
The correct way to take Creatine is by “cycling.” Mix 5 grams (one
rounded teaspoon) of pure creatine monohydrate in juice, and take it
once daily for one month. Then stop for at least a month to allow a
“washout” period. Higher loading doses used to be recommended, but that
approach has fallen out of favor since it does not appear to be
necessary and puts an unnecessary load on the kidneys.
Proteins are the building blocks of the body, and amino acids are
the building blocks pf proteins. There are 9 “essential” amino
acids—amino acids that are not synthesized in the body and need to be
obtained through the diet. Protein builds muscle, and it rebuilds and
repairs muscle after exercise. During exercise up to 15% of the energy
needs are generated from protein breakdown into glucose.
Protein supplements have long been used by athletes to improve
performance. However, there is no scientific support for protein
supplementation as a performance enhancer. Protein shakes and bars have
gained popularity with the rise of high protein-low carbohydrate diets.
Most athletes need less protein then they think, and they need more
carbohydrates than they believe. A healthy balanced diet provides the
protein needs for most athletes. Athletes in certain sports, such as
weight training, and field events, such as shot put and hammer throw,
may benefit from a small amount of protein supplementation. But too
much protein puts a large burden on the kidneys, which have to filter
the excess protein and amino acids from the blood.
According to the American Society of Exercise Physiologists (ASEP),
the protein requirement for general fitness/nutrition is about 1.0 gram
of protein per kilogram of body weight per day. For moderate-to-high
intensity athletic training, recommended protein requirements are
1.0-1.5 grams per kilogram of body weight per day. For intense athletic
training, approximately 2.1 grams of protein per kilogram of body
weight per day of protein is suggested.
Be careful when choosing “protein bars.” Many bars are nothing more
than glorified candy bars, high in fat and carbohydrate. So read the
Carbohydrates & Fats
The advent of low-carb diets has cast an undeserved bad shadow on
carbs. But carbs are in fact the mainstay of sports nutrition. These
are not the enemy! Carbs provide the necessary quick fuel and energy
for actively contracting muscles. They also provide a sort of “flame”
that helps break down fats more efficiently, providing energy for
endurance events. Stored carbohydrate is referred to as “muscle
glycogen” (MG). During aerobic exercise, it is important to have
sufficient MG stores in order to reduce the amount of protein breakdown
occurring during activity.
The key is carb selection. Avoid simple carbs and instead choose
complex carbs such as fruits and vegetables. Certain pasta
manufacturers (such as Barilla and Hodgson Mills) are now selling
high-protein whole grain pastas that are quite tasty. During endurance
exercise, however, simple carbs may help provide immediate fuel for
sustained activity. Sports drinks such as Gatorade® or Cytomax®, or
easy-to-carry fruits such as bananas or orange slices, can provide
Likewise, fats are necessary and can provide a source of energy for
sustained endurance activities. Fat is also essential for the
utilization of fat-soluble vitamins. Unsaturated fats, such as olive
and canola oil, preferred over saturated fats such as butter.
Approximately 30% of dietary calories should be in the form of fat,
with most of that being mono-unsaturated fats.
Growth Hormone Promoters
Numerous manufacturers have been marketing products claiming to
stimulate release of growth hormone within the body. Such claims are
completely unfounded. These products break down in the stomach and have
no proven effect on growth hormone production. Growth hormone levels
need to be measured by blood tests, and the only way to increase growth
hormone levels is by injection.
Because of the increased risk of oxidative stress and the formation
of free radical molecules, athletes should at least be taking a
multivitamin, and women should add iron. Additional antioxidants, such
as vitamin C, coenzyme Q-10, and omega-3 fish oil should be added.
What should know about Omega-3 fish oil supplementation?
Download our informational brochure.