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. Hi Chris,
    My wife has allergies against fish, nuts and raw eggs. This comrprises all seafood, all nuts (not peanuts as they are legumes, not chestnuts or pine nuts). She had this allergies all her life (60 this year) and is now getting increasingly concerned about the need for supplements, in particular as there is a history of dementia in her family. In our view, we are on a healthy diet, with plenty of veg (much from our allotment), dairy products and some meat.

    I would very much appreciate your advice

    Many thanks

  2. Regarding supplements; above poster ires mentions anatabloc. Folks this is the first supplement I have ever taken that has a material effect in the way I feel. I have supplemented for decades with multi’s then more specialized supplementation through the years hoping there would be an eventual payoff like staying out of the doctors office and living longer. But never felt any better or worse or least not readily detectable. Anatabloc has changed all that and one thing that has been measured by my GP is my CRP level which went from 3.86mg/dL to 0.68mg/dL in a span of 6mo.
    See user reviews at GNC for anataloc. Incredible but just the tip of the iceberg.

  3. The only MK-4 capsule supplement I can find has 15 mg per capsule. Is it okay to take that amount? Because I much prefer capsules. The only other option I can find is liquid drops, which (I think) contains ~1 mg / drop. There must be some purpose behind the much greater amount, so if you’re aware of what that might be, I’d be interested in hearing about that, if it’s not too complicated to explain.

  4. I like ground coral, bone meal, Mincol and a wide variety of organic wild seaweeds. Since a Paleo diet does not include dairy, a huge amount of calcium is taken out from the diet. By no means do I imply that dairy is essential However, today’s vegetables, meats, etc. have nowhere near the calcium content the used have and need to have to promote optimal health. This is because of depleted soil, whether you eat organic, grass fed or not. To get a crude idea of how much calcium levels have plummeted over the last 80 years or so see http://www.mineralresourcesint.co.uk/pdf/mineral_deplet.pdf. Coral calcium, a bioavailable form of calcium packed with trace minerals, consists of the dominant calcium compound calcium carbonate. It helps to make up for the lack of calcium in foods that have this dominant calcium compound.

    Someone may say wouldn’t bone meal be enough since it is a very good source of calcium? The answer is no because bone meal has the dominant calcium compound of calcium phosphate. Different foods have different calcium compounds and we need all 5 different compounds for optimal health. Not all calcium is the same – they have different effects on body chemistry. Different people have deficiencies of different calcium compounds.

    Bone meal contains electrochemical compound colloids, something also lacking in today’s foods just like the calcium. A much better source, however, is Mincol. Daily manufacturing makes it and you can make your own at home. The Hunzas had this natural occurring in the glacier water. For more information, see http://highbrixnutrientdensefoods.com/2012/10/09/the-benefits-of-high-brix-nutrient-dense-foods-part-3-electrochemical-compound-colloid/ and http://highbrixnutrientdensefoods.com/2012/11/02/more-on-electrochemical-compound-colloid-post-2/.

    Kelp has the dominant calcium compound calcium oxide and tons of trace minerals, something lacking in our real foods supply even more than calcium.

  5. Trial and error is not the best way to choose supplements, yet that’s what many of us have to do, filling our cabinets with products that were costly and unhelpful. Supplements are probably the last thing on my GP’s mind when he sees me once a year. He’s thorough but poorly trained in nutrition and alternative or natural medicine. If it weren’t for blogs like this and other internet resources, I’d be completely on my own. Honolulu desperately needs a good orthomolecular physician.

    • A friend of mine has been struggling to learn and use orthomolecular, natural, nutritional approaches to her health problems. One thing she did is get a 23 andMe genetic test. There are some doctors out there trying to interpret the results of the test for people. For the layperson it is quite complicated and we could use more physicians who have the background to understand it. But finding these people is a problem also. It seems people do better in groups where there are knowledgeable individuals who converse with a group and teach them. Find others like themselves, same problems. Maybe a co-op style of health care, solving many of the same problem at once, group consultation style.

      Chris, perhaps you could cover nutritional testing of various sorts. I’ve heard hair testing is good. I’ve had a blood panel for nutrient statuses called Spectracell.

  6. Great article.
    `Dogma is the enemy of good medicine. My philosophy on treatment has always been: whatever works and causes the least amount of harm.’
    I totally agree. Regarding therapeutic supplementation; I have been taking Anatabloc since it’s release to the public in 2011 to help with arthritis pains that developed over time. At 55 I am fit 6’2″ 185 but suffered years of debilitating low back pain episodes, chronic hip pain diagnosed as arthritis, and frozen shoulder more than once. After about 3 months on Anatabloc these aches and pains diminished and in most cases disappeared altogether. Today I have none of those symptoms. Anatabloc has removed the chronic low grade inflammation in my body. It works at the cellular signaling level by blocking NFKB activation.
    Have you heard of this nutraceutical? It contains a synthesized version of anatabine citrate which is found naturally occurring in tomatoes, potatoes, eggplant, peppers, and even in tobacco leaf. I would really like to get your take on this supplement and it’s ability to down regulate the inflammation process in our bodies.

      • Matt,
        I agree with you completely and prefer natural compounds over manufactured from the ground up chemical concoctions produced and pushed by big pharma. The ‘natural’ label is bit more complex than at first glance however.
        Nutraceuticals are foods or food-derived products that are meant to provide health benefits. They may function exactly like substances that are FDA-approved pharmaceuticals, but they are not categorized as such.
        For example, you may take or sell the extract of willow bark for use as an anti-inflammatory, anti-clotting agent or pain killer without getting FDA approval. You can’t make medical claims about willow bark extract, or the active ingredient salicylic acid, however. Current government policy in the US and many other countries is to reserve that right for products that have passed extremely lengthy and expensive approval procedures.
        If you synthesize a very similar compound, acetylsalicylic acid or aspirin, you have a drug. With regulatory approval, you can therefore make certain kinds of claims regarding its efficacy in the prevention of heart attacks or strokes. There is very little difference in the actual function of the two products, though.

  7. As with diet, taking supplements will be individual. Yes, you can and should get nutrients from foods, but as Chris said, many of us don’t have the ability to digest and absorb important nutrients in foods because of years of damage to our gut. For instance, someone upthread mentioned Brazil nuts. I love nuts, especially Brazil nuts, but right now I am not eating them because they can be an irritant. I am also not eating a lot of vegetables for the same reason. So for me supplements are the way to go. I am taking HCL, Krill Oil, B12 sublingualy, and I recently added Siberian Ginseng and B5 for cortisol issues. Maybe I won’t always have to take these supplements, but I am not going to suffer poor nutrition because I become too dogmatic about getting everything through my diet alone.

    • I don’t consider Siberian ginseng to be a supplement. Chinese medicine school of tonic herbalism has used it and other adaptogens for thousands of years. I would classify them as superfoods to enhance health and promote longevity. See Adaptogens: Herbs for Strength, Stamina, and Stress Relief and The Ancient Wisdom of the Chinese Tonic Herbs.

      Adding tonic herbs to a Paleo regime, appropriately selected for a person’s individual constitution according to TCM principles, can greatly improve a person’s health.

  8. Hi Chris
    I live in the UK and am very interested in studying functional medicine. I am a qualified nurse and am currently training as a paramedic. Do you have any ideas where I should start looking?
    Regards
    Simon

  9. I was the healthiest when I was seeing a naturopath and taking the supplements she prescribed.
    That’s mainly because my diet is awful so my body thrived when I was swallowing pill nutrients.

  10. Since childhood, I’ve had Keratosis Pilaris – that annoying goosebumpy “chicken skin” on the backs of my arms (and in adulthood, the backs of my thighs as well). Very annoying! So I’ll share a supplement that’s done wonders for me – liquid cod liver oil, specifically, the vitamin A in it. Literally within a week of starting it, my KP was 90% gone. If I go off it, though, it comes back within a week. Eating beef and chicken liver weekly does not give me anywhere near the results that cod liver oil does; I don’t notice any result at all, actually, just eating liver.

    So yes, supplements can be enormously helpful!

  11. Hi Chris,

    Great blog(s). Above you say that our modern environment is profoundly different than that of our ancestors and one example you give is:

    “A decrease in diversity of plant species consumed.”

    With being able to get a wide range of fruits and vegetables from different continents not increase the diversity of the plant species we consume? Just a thought…

    Keep up the great work.

    Mark

    • I was thinking the same thing! I live in Seattle… I have easy access to grass fed meats, eggs, liver, butter, etc. + seafood + endless varieties of organic fruits & vegetables + coconut oil + exotic spices, etc. Many of these come from different parts of the country / world.

      I have to believe in “paleo” times my food options would have been limited… especially in the winter (when you consider what grows naturally here). I’d miss out on a lot of antioxidants (berries, colorful veggies, etc) & healthy fats (example: coconut oil). These are NOW available but would not have been back in the day. It seems that my need for supplementation would be REDUCED versus INCREASED based on the food items currently available. Or am I missing something? Possibly the soil is not as nutrient-rich but I’d think that would be more than countered by the increase in variety & abundance.

    • Hi Chris
      When I read that, I also questioned it; in today’s society we seem to have access to the food of every country!

      Then I realised Chris Kresser was probably referring to the fact that farmers specifically breed only certain types of fruits and vegetables. They choose the ones that are easiest and quickest to grow, the ones most resilient to climate and pests, and the ones that taste better because consumers are more likely to buy apples that taste sweet as opposed to apples that taste ew.

      Because of that, the majority of plant species available to us at grocery stores are actually only a small select few that exist in nature.

      I’m just guessing so I hope I’m not giving anyone misleading information 🙂

  12. Hi Chris,

    You didn’t talk about Omega-3, is it necessary? Most of the people have no access to grass fed meat and pasture eggs. What should they do?

  13. My philosophy about supplementation vs. dietary style is that if your prescribed diet *does not allow you* to obtain a certain nutrient because that nutrient only exists in foods you’re not allowed to have, *that* indicates you’re following a bad dietary style. But Paleo could in no way fall into that category. You are allowed such a huge variety of food, and you are allowed *all* the animal foods except dairy (unless you’re Primal, and then it depends), but you can get the nutrients we most look for in dairy by consuming organs and bone broth, so that’s not as bad as it sounds to some.

    There’s a difference between “I need to supplement with vitamin A or fish liver oil because I hate liver,” and “I need to supplement with vitamin A or fish liver oil because I’m a crappy beta carotene converter and I’m *not allowed* to eat liver.”

    I think that’s where people get a little bit confused.

  14. Chris – I greatly appreciate this post and like your “paleo diet as a means to an end, not an end itself” approach and using whatever means to achieve our optimal health. I take supplements under the guidance of a nutrition consultant who utilizes hair analysis for nutritional status and is a proponent of the paleo framework. My hair analysis results indicated adrenal fatigue evidenced by a very strong Na+/K+ inversion. A paleo diet wasn’t enough to overcome the inversion and the addition of the right concoction of supplements has been producing fascinating results in my recovery process (i.e. no longer caffeine dependent and exercise addicted). Supplements definitely have a place, they can be very powerful, and it is so extremely important to use them wisely. Thanks for the informative post!

  15. Not just any supplements though. You want the best quality of supplements, for the best quality of life. Ideally, pharmaceutical science applied to nutraceuticals with quality process control.

  16. Chris,

    My husband and I have an 18 month old daughter who eats mostly paleo/primal, and I was wondering if you recommend she take cod oil and vit D supplements in addition to her diet? She is not a big fish eater, so I am concerned that she should be taking a cod oil or fish oil supplement to balance out her diet. Do you give your daughter any supplements and if so do you recommend certain brands? Thanks!

    • My 3 year old daughter is also mostly paleo/primal and not a huge fish eater. One evening (about a year ago) my husband and I grilled salmon for ourselves, and she tried some. We were so shocked when she couldn’t shovel it in fast enough! Now we try to make this once a week. I think the strong flavor is what appeals to her.

      We prepared it as: skin-on filet of salmon; dry rub mix of salt, pepper, cumin seed; lightly coated cast-iron two-burner grill pan with coconut oil, preheated to just smoking; lay salmon, skin-side down, on pan, cook for 4-6 minutes; place pan under pre-heated broiler (on high) for another 4-6 minutes. Fabulous fish flies fast off fork!

      Good luck!

      • I second this–my 3 year old adores grilled “pink fish” and easily eats an adult-sized serving every time. We just brush on butter with dill.

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