Are Supplements Really Necessary? | Chris Kresser

Are Supplements Really Necessary?

by Chris Kresser

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Note: The Paleologix supplements discussed in this post are no longer available. Please click here to view the products recommended as substitutes.

In a perfect world, the answer to this question would be “no”. In the world most of us inhabit, I believe the answer is often “yes”. This might seem inconsistent with the Paleo approach. After all, our ancestors weren’t popping pills to stay healthy, so why should we?

Our modern environment is profoundly different than that of our ancestors. In fact, a fundamental tenet of the ancestral health movement is the recognition that we are “mismatched” with our current environment in numerous ways, and it is that mismatch that is responsible for the modern disease epidemic.

Examples include:

  • A decline in soil diversity and quality (and consequent decline in nutrient density of foods).
  • A decrease in diversity of plant species consumed.
  • An increase in exposure to food and environmental toxins.
  • Overuse of antibiotics, birth control and other medications (damaging the gut and liver).
  • An increase in chronic stress.
  • A decrease in sleep quality and duration.
  • A reduced connection with nature and less time spent outdoors.
  • A move away from the tight-knit social groups that were the norm for humans until very recently (and the resulting effect on our nervous system).
  • An increase in the number of hours we spend sitting.

Maintenance vs. Therapeutic Supplementation

Since I started writing this blog, I have argued for obtaining as many nutrients from food as possible. Humans are adapted to getting nutrients from food, and foods contain many co-factors and enzymes required to absorb those nutrients. However, I have also stated from the beginning that certain nutrients are difficult to obtain even in the context of a healthy diet (such as vitamin D and magnesium), and supplementing with them indefinitely may be necessary. I call this “maintenance supplementation”. Other nutrients that may fall into this category, depending on your diet and health needs, include vitamin A, vitamin K2, selenium, iodine and vitamin C. Vitamin A is only available in significant amounts in organ meats and fish liver oils. While it’s certainly possible (and desirable) to eat organ meats, many people have a strong aversion to them. That makes cod liver oil — a food-based supplement — the next best choice.

As a clinician that specializes in treating people with complex conditions that haven’t been able to find help anywhere else, and as someone that suffered from such a condition myself, I’m also acutely aware of the value of therapeutic supplementation. Therapeutic supplementation involves taking specific nutrients for a specific purpose for a specific period of time. I use this approach in my practice every day. Of course proper diet is the foundation of my work with patients, but by the time people come to see me they’ve often tried every special diet known to humankind (including Paleo, Paleo Low FODMAP, GAPS, and purposely not following a restricted diet), and yet they’re still struggling. Diet is always the starting place, but it’s often not enough on its own to resolve long-standing, chronic health problems. In these cases, smart, therapeutic supplementation is often the catalyst that takes people from chronic illness to optimal health.

I also know this from direct, personal experience. I used many different supplements for several years — including micronutrients, botanicals, probiotics, prebiotics and more — to first kill the gut pathogens I picked up while traveling in Southeast Asia and then reduce inflammation, restore gut barrier integrity, re-establish healthy gut microbiota and address other lingering issues on my way back to health. I viewed these supplements as a raft that would help me get from one side of the river (illness) to the other (health). And that’s exactly what happened. Today the only supplements I take fall into the maintenance category: fermented cod liver oil/butter oil (for vitamins A and D), magnesium glycinate and, on occasion, a probiotic/prebiotic blend.

If You Need to Supplement, Does That Mean Your Diet Isn’t Working?

Another argument I’ve seen pop up is something along the lines of “If you need to supplement, that must mean your diet isn’t working.” Or you’ve somehow failed. Again, if we lived in a perfect world where it was possible to get all of the nutrients we need in sufficient amounts from food, where everyone was willing to eat the foods that contain those nutrients, and where modern influences like soil depletion, environmental and food toxins, chronic stress, etc. didn’t exist, then yes, I might agree with that statement.

The Paleo diet is a means to an end, not an end in itself.Tweet This

But in this world, the one most of us live in, supplementation is not necessarily a sign that your diet isn’t working. It’s a means of making it work better.

And it can also be that life raft I mentioned above that helps you adapt to a new diet that you’ll thrive on over the long term. When I first switched to a “real food”, Paleo-type diet several years ago, at first I had trouble digesting the large amounts of meat and fat I was eating. My gut was still damaged from the parasites and other gut pathogens I had and the treatments I had done to get rid of them. Should I have given up and gone back to being a vegetarian? I don’t think so; I had already “been there, done that” and I knew what the results were (not good). I knew that if I could just help my body adapt, I’d be able to benefit from the nutrient-dense meats, fats and other foods I was eating.

In the Paleo Troubleshooting Guide I wrote, I used the analogy of someone hooked on heroin. When that person decides to quit, they’re going to go through serious withdrawal, and they’re going to need a lot of support: physiologically, emotionally, psychologically and otherwise. That’s what rehab programs are for. Does that mean it isn’t a good idea for them to get off heroin? Hardly.

Transitioning to Paleo from a Standard American Diet or a vegetarian/low-fat type of diet is not as extreme as quitting heroin, but the analogy still applies. After years of poor nutrition (either too many food toxins or not enough nutrients, or both) and exposure to other harmful aspects of the modern lifestyle, your body may have some recovery or “rehab” to do before it can take full advantage of the Paleo diet. For example:

None of these issues, if they happen, mean that the Paleo diet isn’t a good choice for you. They just mean you need a little extra help — which will be temporary, in the vast majority of cases. (You may also need to tweak your diet a bit to make it a better fit for your needs, which I cover in the Troubleshooting Guide.)

Dogma is the enemy of good medicine. My philosophy on treatment has always been: whatever works and causes the least amount of harm. Much of the time that will be diet. Sometimes it will be a supplement. And yes, occasionally (gasp!) it will even be a drug. The Paleo diet is a means to an end, not an end in itself. Why not use whatever other means we can to achieve our goal of optimal health? We don’t get extra points for wearing loincloths, not showering or brushing our teeth or refusing to go to the hospital when we get in a bad car accident. Most people would agree that clothes, personal hygiene  and emergency medical care are welcome modern innovations. We don’t forsake them because they’re not Paleo; we use them because they make our lives better. Supplements belong in this category too — provided we use them wisely and against the background of a nutrient-dense, whole foods diet.

Now I’d like to hear from you. How do you feel about supplementation? Have supplements been useful for you at any point in your healing journey?

  1. Chris I was just wondering if you recommend an iodine supplement such as iodoral during pregnancy for people without thyroid issues? It’s not referred to in your healthy baby code but I’ve heard of adverse consequences of iodine deficiency during pregnancy. Is it safe to take such a dose as 12.5mg per day or is this excessive?

  2. Chris,
    I have not had good results with taking any supplements. This past November my GP told me to start taking calcium and vit. D and a few weeks later my ankle was swollen. I thought I tore something in yoga class , but an MRI showed nothing. Having Crohns for 20+ yrs., I never had joint issues, but now it’s a constant battle. I have stopped all supplements for now, and hope to regain my health back with whole foods.

    • Natalie, see urban domestic diva ‘s blog about her firsthand account on the ‘significant’ positive impact Anatabloc has had on her Crohns / IBS condition. As I’m sure you’re aware Crohns is inflammation driven and down regulating or removing that inflammation is the treatment method. The problem has been that most drugs do as much harm, if not more, than good. NSAIDs, Corticosteroids, Statins, can be very harmful long term.
      Antabine citrate has the ability to safely (zero side effects, zero drug interaction) down regulate chronic systemic inflammation in the body. Consider man has been ingesting the foods that contain anatabine citrate for thousands of years, just not enough of it often enough to reap the therapeutic benefits. Wiki anatabine citrate. Chronic inflammation is the root of 98% of the disease humans are afflicted with so it’s becoming the #1 subject of discussion regarding health and aging.

      • I’d be interested to hear about anyone taking Anatabloc for Chrohn’s.I bought some for my brother who has it. My doctor is a big believer in Anatabloc, takes it himself, and has recommended it to some of his patients.

  3. Seems like I’ve always used supplements of one kind or another. But since moving away from my orthomolecular physician in 1979, I have no idea how much HCL, digestive enzymes, pro-biotics, raw glandulars, etc. to take. Trial and error is expensive. I have a closetful of supplements that have not helped or have made me feel bad. Does anybody out there know of a doc in Honolulu or anywhere on Oahu who would test me? Or anybody who could do a consult via e-mail and concomitant blood testing? Playing by ear and listening to my body has worked to a certain extent, but I have the nagging feeling I’m taking too much of this or too little of that. Any advice would be appreciated.

  4. In 2004 I started reading and taking care of my food, first vegeterian and vegan, and then Paleo and more to PHD. I have not had a headache since then, not to mention cold or flu. I do not use supplement although I tried some several times like multivit, kelp and magnesium. But somehow the kelp pills and multivit are causing an upset stomach. So I am hesitant about starting again. I plan to use magnesium soon. Of course eggs, liver, other organs, cod liver, sprats are regular in my diet.
    But all this info about the diffirent necessary mineral and vits is confusing – which are the really necessary ones for otherwise generally healthy person.

  5. I was not a supplement user until I found a whole food supplement that is outstanding in quality. My family and I eat a nutrient dense diet 90% of the time and take supplements for maintenance and we all feel great and never get sick. But as others have said here you need to be careful of what’s out there, even in health food stores, if it’s not whole foods then it is isolated laboratory made ingredients!

  6. i loved the article too. I just want to give praise to you for being a little critical to paleo diet. I think it’s a fad, just like atkins. These cavemen died at age 40. Antibiotics can save lives, dairy is not that bad and beneficial for kids. My husband’s grandmother was amazingly healthy and chipper until 104 and she would advice shot of whisky at night sometimes:). Researchers point out that positive attitude is number one for health and we should look around and see that negative people are not healthy.
    I take supplements and they help me tremendously. I had a huge intestinal issues after pregnancy. I know if I would go to doctor, they would give me some horrible drug. Instead I experimented on myself. It took me long time, but finally found excellent product–Kyolic Candida cleanse. I believe anybody with intestinal problems should try it. The problem with grains is that manufacturers are adding gluten to the products. If we grind our own flour, bread can be a good source of nourishment. Mr. Kresser’s suggestions of taking approach to food and supplements holistically is excellent. we are removed from nature. We should be outraged that schools keep children sitting for long periods of time, workplaces reward staring at the screen, then we punish ourselves coming home eating dinner and watching tv! we live in unhealthy society and it take conscious effort to be just somewhat healthy! I’d say let’s advocate for yoga breaks for adults, phys ed, fun games every day in school–let’s start there. SOrry to ramble. excellent article–engaging:)

    • Dee: I was not being critical of the Paleo diet in this article. I think it’s a fantastic dietary approach, especially when personalized to fit the individual. My point was simply that diet alone — regardless of how nutrient-dense it is — is not always enough to solve every health problems.

    • Dee,
      I’m sorry, but I have to comment on the life expectancy of those living in the Paleolithic. It’s an average, not a maximum life span. They didn’t all just drop dead on their 40th birthday (wouldn’t that suck!). While the average person alive at that time may have died sometime around age 40, many lived into their 70s, 80s, and 90s; many never lived past childhood.

      Let’s not forget that infant and child mortality at that time has been estimated to be anywhere between 30-40 percent (http://paleodietlifestyle.com/why-cavemen-didnt-die-young/). It is this large infant mortality that creates these low average life spans. Today’s abnormally low infant mortality (less than 1%) is why we have such a high average lifespan. It’s also why our population exploded in the 20th century (less people dying so young). Most people, if protected from infectious diseases, murder, famine, and a poisonous modern diet will likely live into their 70s, 80s, and 90s before dying of natural causes (as opposed to the degenerative diseases we currently die from).

      And if I was to call any diet a fad, it would be modern ones like the current standard American diet. We all evolved eating a diet filled with fresh whole foods (and no pseudo-foods), so I find it hard to consider all Paleo diets faddish (however, I do believe that low-fat or low-carb Paleo diets are a fad that is currently dying).

  7. Chris:
    Heard you in Santa Clara, and was fascinated. Wish it would appear as an article in Wise Traditions, as some do. I would also recommend Co-Enzyme Q10 for us older folks (I’m 64, and in excellent health), and high quality cod liver oil/high vitamin butter oil for nearly everyone (Green Pastures is the only high quality one I know of). I also take a high quality multi-vitamin/mineral for “insurance.” Magnesium is so crucial and so deficient in most people’s diet (potassium, too). I get it from small amounts of crispy pumpkin seeds (richest food source), daily bone broths, a small amount of Azomite daily, and a spray-on magnesium chloride. I try to eat large amounts of a wide variety of leafy greens daily for potassium and numerous other goodies, and plenty of animal fat. Thank you for what you do!
    Gary

  8. I am a person who takes supplements; fish oil (or cod liver oil), vitamin D3, magnesium and a multivitamin to name a few. I took statin drugs for years and was damaged badly by them so I never forget to take Ubiquinol every day. The statin drugs left me with very bad neuropathy so I also take rAlpha Lipoic Acid and Evening Primrose Oil.

    I’m also diabetic and take metformin but it has terrible digestion side effects, and I have had my gall bladder removed, so I also take probotic enzymes to help with that.

    That sounds like too many supplements, but that’s what’s working for me. The rAlpha Lipoic Acid has helped me extremely with the peripheral neuropathy…I can walk again, and those shooting pains in my feet are gone.

    I would like to see a list of the top 5 or 10 supplements you suggest.

    Thanks for great information all of the time!

  9. Chris, appreciate the post and love your blog.

    However, this post conflicts directly with the book you recommend a lot: The Perfect Health Diet. The Jaminets recommend a list of about a dozen supplements that should be beneficial to everyone.

    http://perfecthealthdiet.com/recommended-supplements/

    Do you not agree on their thoughts on K2, Iodine, C, B vitamins, Biotin, Zinc, Chromium, Vandium, Molybdenum, Boron (and a bunch of other optional recommendations).

    I’d like to know because I’ve been dropping about $150 a month on these for my wife and I since I finished the book

    Thanks,
    Wes

    • Wes,
      When Chris said he recommended The Perfect Health Diet book, he meant that he recommended it in general, he did not mean to say he agreed 100% with every detail. Supplements are an area that Jaminet and Kresser do not agree on.

  10. Since I recognised that I have reaction to the substances in a multivitamin I have not taken a single pill of anything, which before was 2-5 pills per day as a minimum. That was over 18 months ago and by today I did not experience any negative side effects of not supplementing, actually I only have seen improvements in my health. Supplement by real foods.

      • I have terrible stomach pains also, with just about any supplement. I’ve undergone many, many tests and the only thing that came back positive is steatorrhea. Have you found anything that helps you with chronic stomach pain???

  11. Fermented Cod Liver Oil Question: If one takes a quality bioavailable mutlivitamin such as your new line, or those specifically made for SCD (similar to PALEO but tweaked for autoimmune IBD… so micronutrient absorption is a key concern… that’s why the “insurance policy” of a multivitamin) would it not be toxic and ill advised to ALSO take FCLO since vitamins A and D are cummulative fat soluble micronutrients? Help… you did not address this in your article, which I did find informative and wonderful!

  12. Love this post, thank you! I am not taking any supplements right now. I’ve been Paleo almost 2 years, and continue to get more and more into it, and understanding different things. I’m about ready to embark on a strick AIP (I also have type 1 diabetes [for only 6 years], which I think my 16 years of poor digestion and leaky gut eventually led me to), to see if it helps heal my gut! And I’m reading now about supplements that can assist, because I’ve been suffering for so long, I truly feel they’re needed to help get me over that hump. This has been a journey for me, and I am confident that I can heal my gut, as years of modern medicine combined with diagnostic testing-has done nothing (wish I knew then what I know now, obviously, but better late than never). I’m doing the absolute best that I can, to reach optimal health, if (proper) supplements help me get there, then I’m totally willing.

  13. There is good info here, along with selling something. I will tell you that us consumers out here are getting BOMBARDED by these specialized product sales to the point of tossing out the emails before being read. How do we keep info and sales separate?

  14. I think supplements are necessary and helpful. It’s important, though, to pay attention to additives and fillers. Some dietary supplements contain harmful substances or ingredients that you may be sensitive or allergic to.

    “Dogma is the enemy of good medicine”. So true!

    (Btw, the first “tweet this” isn’t working)

  15. Generally speaking, if someone is taking digestive enzymes due to the absence of a gall bladder, can they expect to have to take them indefinitely?

    • I would also like to know what kind of hinderence to paleo fat digestion do those without a gall bladder have and if we have to adjust our diet or take supplements(indefinitely).

      • Jayjay–I would love to see a post about your concerns, too! Is it true that coconut oil is fine in any quantity for people who’ve had their gallbladder removed? And what should people who still have their gallbladder but have problems do?

    • I would be very interested in your answer Chis also, I’ve been taking bile salt for about a year now, due to no functioning gall bladder. How long should I expect to take it before my gall bladder starts kicking in again? I’ve been following a Paleo diet for about 2 years.
      Thanks

  16. In the late 90s I became a vegetarian and started taking a multivitamin at the same time. I couldn’t believe how hard my nails became and how infrequently I got colds. I stopped being a vegetarian after about 3 years but kept taking a daily multivitamin. Whenever I stop taking it for any length of time during the Fall or Winter, I will usually get a cold. It is the sort of thing that one has to experience to believe since the medical establishment is so quick to marginalize supplements.

  17. I tend to think of certain foods as my supplements. Currently at maintenance I do almost daily: cod liver oil, vitamin D3, brazil nuts (selenium), tahini (zinc), sometimes K2, and magnesium and Vitamin C.

    I would like to know which FOODS you take daily as your “supplements.” Or, how one might think that way, like I do with brazil nuts and tahini. This is because I take them regularly and in small quantity, then seem like a supplement to me, rather than a dish of food that I would eat once a week or so. I eat a lot of eggs and don’t really consider them a supplement, but if I were talking to a person without knowledge of nutrient-dense eating styles, I would have to begin to qualify the foundational foods, as well. But, there are some foods that are specific to the nutrients in which we are most depleted, and which are so foundational to health that we need to treat that food like a supplement and remember to eat it often enough to gain the benefits.

    Do you have a list of such foods? Not every “super berry” out there, but the foods that address the big issues like magnesium depletion, or the “biggest” issues? Because there are a lot of busy moms, busy people who need the most bang-for-their-buck in terms of money, time and effort. We need the top 5 or top 10 or something that makes it easier for us. And maybe there’s some food you eat regularly that we haven’t thought of. My family won’t eat liver, and from there we digress.

      • I would love to see a list, too. Currently I am taking acerola cherry powder for a vitamin C boost. I “take” Brazil nuts, too, for selenium and kelp for iodine. I’m adding trace mineral drops that come from the Great Salt Lake to my drinking water for a magnesium boost, but I still take a pill. Just remembered pumpkin seeds are a great source so will try to eat more of those. Oysters could make a good zinc and iron “supplement” (selenium, too). Liver is obviously a good one for a number of things–I take actual liver pills in addition to eating it here and there. One could eat natto as a k-2 supplement, if one actually liked it. Just some ideas.

    • Try adding a small amount of calf liver to meatloaf. Adding seasoning and things like bacon or cheese help cover the taste also. Start with a small amount and work from there.

      • Calves liver is amazing but hard to find. Whole Foods used to have grass fed calves liver from New Zealand, but I haven’t seen it there for ages. Does anybody know of a reliable source?

  18. I agree Chris, food should always come first!

    But the modern environment and its effect on our bodies is the game changing factor that necessitates the use of nutritional supplements.

    However, where I often see people go wrong is by taking low quality supplements in the wrong dosages and at the wrong times, leading to further imbalances and a worsening of health. Just because something is deemed “natural” and OTC does not mean that it’s totally benign.

    But hey, I’ll take food and supplements over drugs whenever possible!

    • I am also a proponent of food first, supplements second. If someone hasn’t even tried to modify their diet to include things they’re lacking then I won’t recommend a supplement until they have given it a shot. There’s also problems with absorption due to low stomach acid (mainly from prescription acid reducers). Especially calcium carbonate absorption.

  19. Great article. I noticed you had parasites.. Is the paleo diet alone enough to kill them off, or did you have to use certain supplements? If so, which ones? With Blastocystis, I’ve been using Ferula, Artemesia/Berberine, VSL#3 DS probiotic prescription, Black Walnut Hulls, etc. and can’t get rid of it.

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