Scientifically Based Recommendations
for Nutritional Supplements.
The following are some recommendations as to some of the most
beneficial supplements that may be worth consuming to improve
health, prolong life, and increase performance, based on current
scientific research. However, while nutritional supplementation
may be helpful, there is no substitute for a healthy diet. There are also
recommendations for avoiding certain supplements due to safety or efficacy
concerns. This section is continually being worked on and revised.
Please note: You should always check with your physician before consuming any supplements, as some of them may be contraindicated for health conditions you may have or may interact unfavorably with medications you are taking.
Research has also shown that elderly with lower levels of vitamin E are more likely to have memory problems.(15) Vitamin E may help to prevent the oxidative (free radical) damage of brain cells that tends to occur over time and may play a role in preventing Alzheimer's disease.
1. Pizzorno J. Total Wellness. Rocklin, CA: Prima Publishing, 1998, p.62.
2. Burton GW, et al. Human plasma and tissue alpha-tocopherol concentrations in response to supplementation with deuterated natural and synthetic vitamin E. Am J Clin Nutr. 1998; 67:669-684.
3. Murray MT. Encyclopedia of Nutritional Supplements. CA: Prima Publishing, 1996, p.53.
4. Princen HMG, et al. Supplementation with low doses of Vitamin E protects LDL from lipid peroxidation in men and women. Arterioscler, Thromb, and Vasc Biol. 1995; 15: 325-333.
5. Devaraj S, Jialal I. Alpha-tocopherol decreases interleukin-1 beta release from activated human monocytes by inhibition of 5-lipoxygenase. Arterioscler, Thromb, and Vasc Biol. 1999; 19(4):1125-33.
6. Belcher JD, Balla J, Balla G, et al. Vitamin E, LDL, and endothelium. Brief oral vitamin supplementation prevents oxidized LDL-mediated vascular injury in vitro. Arterioscler Thromb. 1993; 13: 1779-1789.
7. Leppälä JM, Virtamo J, Fogelholm R, et al. Vitamin E and beta carotene supplementation in high risk for stroke: A subgroup analysis of the alpha-tocopherol, beta carotene cancer prevention study. Archives of Neurology. 2000; 57:1503-1509.
8. Stampfer MJ, Hennekens CH, Manson JE, et al. Vitamin E consumption and the risk of coronary heart disease in women. New Engl J of Med. 1993; 328:1444-1449.
9. Stephans NG, Parsons A, Schofield PM, et al. Randomized controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study. Lancet. 1996; 347(9004): 1849-54.
10. Davey PJ, et al. Cost-effectiveness of vitamin E therapy is the treatment of patients with angiographically proven narrowing (CHAOS trial). Am J Cardiol. 1998; 82:414-7.
11. Meydani SN, Meydani M, Blumberg JB, et al. Vitamin E supplementation and in vivo immune response in healthy elderly subjects. A randomized controlled trial. JAMA. 1997; 277: 1380-6.
12. Rimm EB, Stampfer MJ, Ascherio A, et al. Vitamin E consumption and the risk of coronary heart disease in men. New Engl J of Med. 1993; 328: 1450-1456.
13. Tutuncu NB, Bayraktar M, Varli K. Reversal of defective nerve conduction with vitamin E supplementation in type 2 diabetes: a preliminary study. Diabetes Care. 1998; 21(11):1915-1918.
14. Diabetes Care. 1999; 22:1245-1251.
15. Perkins AJ, Hendrie HC, Callahan CM, et al. Association of antioxidants with memory in a multiethnic elderly sample using the Third National Health and Nutrition Examination Survey. .American Journal of Epidemiology. 1999; 150: 37-44.
16. American Journal of Epidemiology. 1999; 150:290-300.
17. Lonn E, Bosch J, Yusuf S, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005; 293 (11): 1338-47.
18. Bostick RM, Potter JD, McKenzie DR, et al. Reduced risk of colon cancer with high intakes of vitamin E: The Iowa Women's Health Study. Cancer Res 1993;15: 4230-17.
19. Jacobs EJ, Henion AK, Briggs PJ, et al. Vitamin C and vitamin E supplement use and bladder cancer mortality in a large cohort of US men and women. American Journal of Epidemiology. 2002;156: 1002-10
Omega 3 Fatty Acids.
There are three main omega 3 fatty acids--alpha linoleic acid (ALA),
eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Along
with the main omega 6 fatty acid, linoleic acid (LA), alpha linoleic acid
(ALA) is considered essential to human health. EPA and DHA can be
synthesized from ALA, but humans are not very efficient at this
conversion, so an argument can be made that EPA and DHA should also be
Omega 3 fatty acids are extremely important in promoting health and in preventing disease and the best source of the omega-3 oil is in the form of fish oil. Flax seed, flax seed oil, soybeans, soybean oil, canola oil, and walnuts are also good sources of omega 3 fatty acids, particularly alpha linolenic acid (ALA). However, while humans can convert the 18 carbon ALA into the 20 carbon EPA or the 22 carbon DHA, this is not a very efficient process. Studies show that approximately only 8% of dietary ALA is converted to EPA and only 0-4% is converted to DHA in healthy young men. It is much more efficient to consume a high quality fish oil supplement and/or consume fish on a weekly basis, in addition to consuming some ALA containing foods.
There are many positive health benefits of increasing consumption of omega-3 fats. They are essential for normal growth and development. All cell membranes are made of phospholipids, which incorporate fatty acids, and a higher consumption of omega 3 fatty acids has been shown to positively influence membrane formation.
Omega-3 fats have been shown to be helpful in preventing and treating heart disease(5,6), diabetes(7), kidney disease(8), rheumatoid arthritis(9), chronic obstructive pulmonary disease(10), and various inflammatory disorders. This is done partially through regulation of hormones in the body known as prostaglandins. For example, higher consumption of omega-3 fats leads to decreased concentration of thromboxane A2, which leads to platelet aggregation and vasoconstriction. Therefore, consumption of omega-3 fats reduces the likelihood of heart attacks and strokes. On the other hand, by decreasing platelet aggregation, blood clotting is decreased, so be careful if you are taking coumadin or warfarin to reduce blood clotting.
Fish oil has been shown to reduce hardening of the arteries.
Fish oil supplements appear to reduce the death rate in former heart attack patients. A little oil on the valve train can help keep a car running smoothly and extend its life span. The same holds true, it seems, for humans. The 1999 GISSI-Prevenzione trial found that omega-3 oils appear to reduce the chances that former heart attack patients will suffer a fatal cardiovascular event, and may protect them from other causes of death, as well.(12)
Researchers tracked the efficacy of nutritional supplement programs for 11,324 patients who recently suffered heart attacks from hundreds of hospitals and clinics throughout Italy. They examined the effects of daily supplementation with omega-3 fatty acids (1 g), vitamin E (300 mg), or both, on fatal and non-fatal cardiovascular events over the next three and a half years.
Compared to controls, the group receiving omega-3 fatty acids showed a 30% decrease in cardiovascular-related deaths, and a 20% reduction in mortality from all causes. Overall, the rigorous statistical analysis revealed a combined 20% drop in the overall rates for cardiovascular death, non-fatal heart attack, and non-fatal stroke. While vitamin E supplementation did not significantly affect the combined, overall outcomes in the patients, researchers nevertheless pointed out "an indication of a possible beneficial effect of vitamin E" in several important secondary indices, including a 20% reduction in all types of cardiovascular deaths.
A recent review paper looked at all the published research and compared the benefits of fish oil compared with diet, lipid lowering drugs categorized as statins, fibrates and resins, and niacin.(13) While the fibrate class of drugs failed to influence overall mortality and mildly elevated non-cardiac mortality, and while diet, resins, and niacin appeared to provide insignificant benefits, statins and omega-3 fatty acids significantly lowered both overall and coronary heart disease mortality risk during the trial periods. The risk of overall mortality was reduced by 13 percent by statins and 23 percent by omega-3 fatty acids compared to the risk experienced by those who did not receive treatment. When the risk of mortality from heart disease alone was analyzed, the use of statin drugs and omega-3 fatty acids were found to lower the risk by 22 and 32 percent, respectively. In other word, fish oil was more effective than than prescription statin drugs (like lipitor) and other drugs that lower cholesterol in reducing mortality from heart problems, even though it was not as effective at lowering cholesterol.
Several published trials demonstrate that higher intake levels, blood levels, and brain levels of EPA and DHA may help preserve cognitive function as we age and reduce the risk of senile dementia and Alzheimer's disease.(16) DHA is the most common fatty acid in the brain and the brains of Alzheimer's patients have been shown to contain a lower content of DHA.(17) Two recent studies in the American Journal of Clinical Nutrition indicate that a moderate intake of EPA and DHA is strongly associated with reduce risk of cognitive decline.(18,19)
Another recent study also found that young men who have higher levels of omega 3 fats, esp. DHA, in their blood, have more bone density.(14)
Humans evolved consuming a diet that contained approximately equal amounts of omega-6 and omega-3 fats. As consumption of omega-3 fats has decreased and consumption of omega-6 fats has increased, the modern diet in Western cultures now contains a ratio of omega-6 to omega-3 fats of approximately 20 or 30:1.(1) This is due to several factors:
1. Increased intake of vegetable oils from corn, safflower, sunflower, cottonseed, and soy, which contain primarily omega-6 fats.
2. Decrease in fish consumption compared to primitive cultures.
3. Cultivated animal meats, vegetables, eggs and even fish that are lower in omega-3 fatty acids.(2,3,4) Cattle and chickens, for example, are fed grains that are high in omega-6 fats, thus resulting in cattle and chickens who have higher levels of omega-6 fats in their meat.
In order to positively influence our health status and reduce inflammation in our bodies, we should attempt to increase consumption of omega-3 fatty acids while reducing consumption of omega-9 and omega-6 fatty acids. This can be accomplished by reducing the consumption of meat (which is high in arachidonic acid), hydrogenated oils (such as found in margarine), and vegetable oils that contain omega-6, such as corn oil and safflower oil. We should make an effort to consume sources of omega-3 fatty acids, such as olive oil and cold water fish, such as salmon.
Should I take flax seed oil supplements?
What about supplementing with flax seed oil? I used to be a big believer in flax oil supplements, however, it is now becoming clear from the literature that fish oil is the preferred form of omega-3 oil supplement. For one thing, only a small percentage of the ALA in flax oil is converted by the body into EPA and DHA, the most active forms of omega-3 in the body. Secondly, in recent research, there appears to be an association between elevated levels of ALA in the body and increased risk of prostate cancer.(11) Therefore, we do not recommend supplements of flax seed oil. Likewise, mixed oil supplements that include a combination of omega-3, omega-6, and omega-9 oils should probably be avoided, as we already take in too much omega-6 fats and this would just continue the imbalance. Eat wild salmon or other fish at least two times per week and supplement daily with a high quality fish oil (EPA/DHA) supplying at least 500mg per day of both EPA and DHA. As always, check with your doctor to make sure that these recommendations are appropriate for you.
1. Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr. 1999; 70:560S-569S.
2. Crawford MA. Fats in free-living and domestic animals. Lancet. 1968; 1: 1329-33.
3. Van Vliet T, Katan MB. Lower ratio of omega-3 to omega-6 fats in cultured than in wild fish. Am J Clin Nutr 1990; 51:1-2.
4. Simopoulos AP, Salem N. Omega-3 fats in eggs from range-fed Greek chickens. N Engl J of Med. 1986; 315:833 (letter).
5. De Lorgeril M, Renaud S, Mamelle N. Mediterranean linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994; 343: 1454-9.
6. Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish and fibre intakes on death and myocardial infarction: diet and reinfarction trial (DART). Lancet 1989; 2:757-61.
7. Raheja BS, Sadikot SM, Phatak RB, Rao MB. Significance of the omega-6/omega-3 ratio for insulin action in diabetes. Ann NY. Acad Sci. 1993; 683: 258-71.
8. Donadio JV Jr, Bergsalh EJ, Offord KP et al. A controlled trial of fish oil in IgA nephropathy. Mayo Nephrology Collaborative Group. N Engl J Med. 1994; 331: 1194-9.
9. Kremer JM, Lawrence DA, Petrillo GF, et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Arthritis Rheum 1995. 38(8): 1107-14.
11. Leitzmann MF, Stampfer MJ, Michaud DS, et al. Dietary intake of n-3 and n-6 fatty acids and the risk of prostate cancer. Am J Clin Nutr 2004;80:214-216.
12. GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet. 1999; 354(9177): 447-55. (No individual authors were listed. Nearly 50 scientists were involved, and the trial centers numbered over 200. The Medline UI: 99392837 can be used to locate the abstract and order the article.)
13. Studer M, Briel M, Leimenstoll B, et al. Effect of different antilipidemic agents and diets on mortality: A systematic review. Arch Intern Med. 2005;165:725-730.
14. Högström M, Nordström P, Nordström A. N–3 Fatty acids are positively associated with peak bone mineral density and bone accrual in healthy men: the NO2 Study. Am. J. Clinical Nutrition, Mar 2007; 85: 803 - 807.
16. Conquer JA, Tierney MC, Zecevic J, et al. Fatty acid analysis of blood plasma of patients with Alzheimer's disease, other types of dementia, and cognitive impairment. Lipids. 2000; 35:1305-12.
17. Connor WE, Connor SL. The importance of fish and docasahexanoic acid in Alzheimer's disease. Am J Clin Nutr. 2007; 85:929-30.
18. Beydoun MA, Kaufman JS, Satia JA, et al. Plasma n-3 fatty acids and the risk of cognitive decline in older adults: the Atherosclerosis Risk Communities Study. Am J Clin Nutr. 2007; 85: 1103-11.
19. Van Gelder BM, Tijuis M, Kalmijn S, Kromhout D. Fish consumption, n-3 fatty acids, and subsequent 5-year cognitive decline in elder men: the Zutphen Elderly Study. Am J Clin Nutr. 2007; 85:1142-7.
The active ingredients in ginkgo are believed to be
flavinoids, referred to as ginkgo flavone glycosides, and
terpenoids (ginkgolides and bilobalide). Most of the
research has used a standardized extract containing 24%
ginkgo flavone glycosides and 6% terpenoids, at a dose of
40 to 80 mg three times per day.(7)
Ginkgo has been shown to improve blood flow to the brain through several mechanisms, including improving vasoregulatory activity, decreasing blood viscosity, and antagonizing platelet activating factor.(8)
Ginkgo is an anti-oxidant that acts to scavenge free
radicals and to prevent peroxidation of lipids.
Alzheimer's disease results from free radical damage to
the brain, esp. peroxidation of the lipids that make up
the membranes of the neurons in the brain. Thus, ginkgo
may help to reduce loss of cognitive function in patients
with Alzheimer's and other forms of dementia.(5)
Ginkgo must be considered relatively safe, given the studies that have been conducted over the last 15 years. There have only been a few, relatively minor reported side effects related to taking ginkgo, including headaches and dizziness. Large dosages have occasionally caused mild stomach or intestinal upset. Ginkgo may be contra-indicated for patients taking blood thinners such as coumadin or warfarin.
1. Le Bars PL, Kieser M, Itil KZ. A 26-week analysis of a double-blind, placebo-controlled trial of the ginkgo biloba extract EGb 761 in dementia. Dement Geriatr Cogn Disord. 2000 Jul-Aug;11(4):230-7.
2. Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review. Clin Otolaryngol. 1999 Jun;24(3):164-7.
3. Schubert H, Halama P. Dpressive episode primarily unresponsive to therapy in elderly patients. Efficacy of Gingko Biloba in combination with antidepressants. Geriatr Forsch. 1993; 3: 45-53.
4. Pittler MH, Ernst E. Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trials. Am J Med. 2000 Mar;108(4):276-81.
5. Kleijenen J, Knipschild P. Ginkgo biloba for cerebral insufficiency. Br J Clin Pharmac. 1992; 34:352-8.
6. Le Bars PL, Katz MM, Berman N, et al. A placebo controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. JAMA. 1997; 278:1327-32.
7. Kleijenen J, Knipschild P. Ginkgo biloba. Lancet 1992; 340:1136-9.
8. Krigelstein J, Beck T, Seibert A. Influence of an extract of Gingko biloba on cerebral blood flow and metabolism. Life Sci. 1986; 39:2327-34.
The following are some supplements that we do not recommend as there is either a lack of sufficient research at the present time to back up the claims made about them or there is considerable concern about their safety: