Confused About Supplements – I Got you!

Since I am retiring and my patients are transitioning to new providers, I am getting a lot of questions about my choice of supplements – since there are many options out there, why do I primarily use the Xymogen brand of supplements distributed through their WholeScripts warehouse?

SETTLE IN !! – this will be quite the explanation.  I once was also confused about supplements and my journey to learn more about them has been extensive and involves many details.

Like many things in life (such as insurance and taxes) the world of supplements is cloaked in misleading and confusing information designed to keep the consumer an amateur. Even with a medical degree – trying to explore the world of supplements left me with so much confusion. My understanding of supplements was rudimentary and whenever I would go to buy a supplement the rows and rows of supplements on the shelves in stores were so confusing to me that I would invariably leave the store empty handed. Which supplements did I need, what form should that supplement be in (if I wanted magnesium – which type of magnesium), how did I know the supplement contained what it said on the label and how did I know it was not contaminated or compromised? So in 2005 I set out on a journey to learn about all things supplement.

FIRST LET’S ADDRESS THE ELEPHANT IN THE ROOM – DO YOU EVEN NEED SUPPLEMENTS?

My view on this has certainly evolved over the years. In the 1980’s as a young doctor fresh out of medical school and in my 20’s with no health issues or concerns about aging, I took no supplements and prided myself on not even taking an aspirin or cold medication. My medical education had barely covered supplements. We were taught only to address severe nutrient deficiencies, such as vitamin D deficiency causing rickets. For the average patient, the need for supplements was never discussed. Well I am glad to say that times have changed and I have changed as my medical practice evolved.  Over the years, I was reading more and more research that showed the nutrient deficiencies in our modern diet. Foods are now being grown in soil that is depleted of many nutrients, food is being harvested early before maximum nutrients can be obtained, and then it’s being stored and shipped long distances, losing nutrients all along the way. Despite the surplus of calories in the American diet and the ever increasing obesity epidemic, Americans are experiencing “hidden hunger” due to their food lacking nutrients that their body craves. Most of us can get our macronutrients such as carbohydrates, proteins, and fats but it is harder to get the important micronutrients in food (vitamins, minerals and phytonutrients) that are needed for optimal health. On top of that there is our modern lifestyle which demands we get more nutrients to help us deal with stressors and toxins. Many Americans are also on medications such as the birth control pill, antacids, statins, and blood pressure medications to name just a few that can deplete nutrients. New genetic testing is also now revealing that genetically some of us require more of certain nutrients to maintain optimal health.  Then there is the explosion of anti-aging research showing us that paying attention to our nutrient status is very important for long term health. All of this is very important, but the final thing that motivated me to learn more about supplements was that I began aging!! Nothing like vanity to motivate a woman. I have always had the good fortune of being exposed to thousands of women in my practice. I could pay attention to what worked for my patients and what didn’t. Some women aged very well and some didn’t. What was the difference? I think it goes without saying that I found women who aged well had good lifestyle habits but it seemed in today’s world that was not enough. The women in my practice that looked the best and felt the best were also leveraging anti-aging strategies such as supplements.  This shouldn’t be surprising – it is analogous to the simple fact that we can have a good diet and exercise but our skin looks better as we age if we are proactive and nourish it with a good moisturizer. So years ago I came around to the fact that – yes supplements would be a great addition to my health toolkit and my patients health toolkit.

HOW TO NAVIGATE THE MARKETING JUNGLE TO FIND QUALITY SUPPLEMENTS

Having established that supplements contribute to overall good health – I now was faced with trying to discern what constitutes a quality supplement. I have always had a saying – IF YOU ARE INVITING SOMETHING INTO YOUR BODY YOU NEED TO BE PICKY ABOUT THE QUALITY – which is why in recent emails I have covered things like food, air, water, and bath and beauty products. Since I hadn’t really been taught about supplements in medical school I had to do extensive study on nutrition to learn how micronutrients are important for helping us with metabolism, to make hormones and neurotransmitters, how they are needed for building new tissues, for detoxifying the body, and how they assist in repair and anti-aging. I now understood the need for adequate micronutrients. Then in 2005 to address the question of what constitutes a quality supplement I took a trip to visit manufacturing facilities. I was confused about the quality of the supplements on the market and wanted to understand what goes on at supplement manufacturing facilities. Touring these facilities was a huge eye opener for me. It ended up hands down that the most impressive facility I toured was Xymogen’s cGMP manufacturing facility in Orlando Florida. If you are buying from a manufacturer on the label it should say cGMP – which means they are compliant with the current good manufacturing practices which are standards set by the FDA. Xymogen not only has their intensive internal policies which assure compliance (and I was able to see these first hand) but they are actually down the road from a FDA facility which periodically audits them and makes sure they are top notch. They are also tested by another third party to meet NSF (national sanitation foundation) criteria. When I was touring the Xymogen facility I saw how every raw ingredient brought into the facility was placed into a locked room until it had been tested to verify it’s identity and purity, the whole facility was specially designed (insulated ceilings etc) to keep the temperature and humidity in optimal ranges and the air purified. Rooms were specially designed to handle delicate supplements such as fish oils and probiotics and specially designed packaging was used for some delicate supplements. Great care was taken to avoid cross contamination of products (you do not want an allergen to drift into your allergen free product), products are tested for bacterial or other contaminants at several points along the manufacturing line and specially designed stainless steel rooms allow for aggressive cleaning of the rooms. Xymogen also has a unique electronic e-verification code that is put on each supplement bottle to allow tracking of their supplements and the quality of their supplements wherever they end up on the market. They do testing of all their products to determine how long they are shelf stable and put an expiration date on each product (most manufacturers just put the date it was manufactured but you have no idea since they didn’t test it how long it is shelf stable). Finally, the finished product goes to a temperature and humidity controlled warehouse until it is shipped. A huge AHA MOMENT for me was that whenever possible I wanted to order DIRECTLY from the company manufacturing the supplement (versus obtaining a supplement that had been shipped to yet another warehouse -examples of this are products from Fullscript, Amazon or Whole Foods). Why do I think it is so important that my product stays in a good environment as much as possible? To me it’s analogous to wanting pasture raised vs industrial beef and chicken – environments affect the quality of a product. When a supplement comes directly from the manufacturer’s temperature and humidity controlled environment and is shipped directly to me avoiding “middle men”  warehouses (that are distributors not manufacturers)  the supplement is maintained in better condition. I know the UPS or FedEx truck delivering my supplements directly to me from the manufacturer is not temperature and humidity controlled but shipping directly from the manufacturer reduces exposure to environments that degrade or alter supplements.  Since 2005 I have toured the Xymogen facility repeatedly (the last time this year) and have continued to be impressed with Xymogen and the quality of their products. Over the years, supplements have become very popular but most don’t meet my standards. My experience of using quality supplements for myself and my patients and then monitoring outcomes has convinced me that quality supplements are a worthwhile investment. Many times I have had a patient not respond to a supplement but after asking her to upgrade her brand we achieved the desired outcome. Lastly, Xymogen became my favorite supplement brand because for the population of women that I serve (women at midlife) they had the best solutions.

IT GETS EVEN MORE CONFUSING – In more recent years, Xymogen’s state of the art warehouse has been used to distribute (not manufacture) other brands and they named this arm of their company Wholescripts ( so just know that Wholescripts is Xymogen’s warehouse). That’s why when you order Xymogen products directly from their manufacturing facility you are ordering them from Wholescripts. Xymogen has also become the manufacturer for other brands (in the industry a company can private label a product that someone else has produced). To me the problem with private labeling is that it disguises (think the shell game) the origin of the product. This leaves me with questions about the quality of that product when I look at its label (when you private label, because you are not the actual manufacturer, you cannot use the cGMP certification) and middle men warehouses are involved which means more shipping around of the product occurs. Again  – I prefer to order straight from the company that manufactures a product as the shell game is too confusing for me. You can call me lazy (I prefer to call myself efficient) since I am sure if I spent the time to visit and investigate other manufactures that there are good alternatives (but who has that energy and time – you are talking to someone who has had the same hairstyle and makeup for years).  Luckily for me – I have been so happy with the quality at Xymogen that I have not felt the need to  shop around.

HEALTH YOURSELF ACTION

If a health care provider is recommending you take a supplement, ask questions and make sure they can communicate to you the need for the supplement, the quality of the manufacturer and that the storage/transportation of the supplement is optimal to maintain that quality.

Finally, anything I learn I like to share it with my patients (my first degree was a teaching degree). The most efficient way I found to educate my patients about supplements was to always explain my choice of supplements to them. My patients always were taught why a specific supplement was recommended so that they could decide if it was something they wanted to add to their health routine. My patients were also taught how I “shopped” for that supplement so that they could either buy the brand I recommended or shop for one on their own using the principles I had taught them. A great teaching experience was always to have patients bring in any supplements they were taking. Of course I wanted to know what they were inviting into their body and looking at the label I could determine if it was a quality supplement. With the bottle in front of me, I could also teach them how to read supplement labels.

SOME ADDITIONAL SUPPLEMENT PEARLS

SUPPLEMENTS ARE SUPPLEMENTAL – They should never substitute for a proper diet and lifestyle habits. It’s tempting to think that swallowing a supplement will solve health problems (and clever marketing reinforces this) but supplements are just one piece of your overall health plan. As I said earlier, women who take supplements are some of the healthiest patients I see but without exception these women also understand that basic health habits are the true foundation of health.

CHEAP SUPPLEMENTS ARE CHEAP FOR A REASON – Quality supplements cost more for all the technical reasons I have outlined. I can use an analogy most women understand – have you ever been tempted to try a cheaper makeup – say at CVS? I’m willing to say that the experiment didn’t work out very well. The majority of us are willing to spend more for quality makeup because we can see the difference. In today’s crowded supplement market I find it’s best to spend time doing your initial research to find a quality supplement brand you can trust. Having done the research you will know why that quality supplement is worth the higher price. Having done this research you will also be able to spot overpriced inferior brands. 

DO YOUR HOMEWORK BEFORE TAKING A SUPPLEMENT – look up the supplement that is recommended and make sure you feel comfortable adding it to your health regimen. I love that at WholeScripts when you are ordering Xymogen supplements you can open a tab (downloadable information) that takes you to a Doctors Reference Sheet that includes important information about that supplement with references. I encourage patients to look at this to help them decide if a supplement resonates with them.

SUPPLEMENT COMPANIES ARE SELLING SUPPLEMENTS – the recommendation for dosing on the label is often for the maximum amount which of course makes them more money (they know nothing about you). Personally, I always adjust the supplement dosage to account for my small size and my individual needs. I always advise patients on the dosage and don’t just recommend “take what the label says”. This individualized approach leads to better outcomes and usually saves money since not everyone needs the maximal dose.

CONSIDER ROTATING SUPPLEMENTS – Always discuss with your health provider why you are on a supplement and how you should take it but in general many supplements don’t have to be taken every day. I am a pretty sophisticated supplement taker that wants the benefits of supplements but in the interest of not taking too many supplements (not to mention paying for too many) some of my supplements I only take a few days a week or I put them in a rotation with other like supplements.  Supplements are like food – doing the exact same thing every day is not always optimal or needed. This is where a provider well versed in supplements can help you simplify your plan if it seems overwhelming.

ALWAYS KEEP SUPPLEMENTS IN A COOL DARK SPACE as temperature, oxygen and light can degrade them (which is why I am so picky about avoiding unnecessary transportation of supplements). Some supplements such as fish oils are even best kept in the refrigerator or freezer to avoid the oxidation that damages the Omega 3’s.

HEALTH YOURSELF ACTION

 Use this information to help you buy quality supplements. If you want a quality source for supplements (but don’t want to do your own homework) consider my favorite source – www.wholescripts.com there you will find the Xymogen brand that I use the most but you will also find many other quality brands. If you find Xymogen products on Amazon or other retailers/distributors they are priced 10% higher since the Xymogen brand  prefers you order directly from their warehouse to maintain the quality of that supplement.

WOW – IF YOU STUCK IT OUT AND READ THIS WHOLE EMAIL KUDOS TO YOU!! You are now a more informed supplement consumer who can make the best decisions about what supplements you invite into your body. In a future email I will cover (in general terms) the different classes of supplements that I recommend for most women.

I do not think the current healthcare system is giving women the respect and attention they need. Due to this deficiency I am on a mission to help women understand confusing health topics and learn what they can do themselves to optimize their health. 

Your Women’s Health Expert and Advocate,
Dr. Brenda Smith M.D.