Last year, you could barely keep that hot supplement in stock, and now it’s collecting dust in the storeroom. Meanwhile, you’re fielding endless questions about a vitamin no one cared about just a few months back. Thank the ever-evolving world of research and today’s quick-hit media machine for consumers’ fickle supplement-purchasing patterns.
To help you make sound supplement-ordering decisions this year, we asked leading integrative practitioners to examine four of the top consumer health concerns and the best-selling supplements for each between October 2009 and October 2010, based on data from Schaumburg, Ill.-based market-research firm SPINS. We also scoured recent research and asked our experts to weigh in and offer their recommendations for the four conditions. The result? A comprehensive guide to the 15 supplements every retailer should know about now.
Tieraona Low Dog, MD
Low Dog is fellowship director at the Arizona Center for Integrative Medicine and a clinical associate professor of medicine at the University of Arizona. She chaired the U.S. Pharmacopeia Dietary Supplements and Botanicals Expert Committee from 2000 to 2010.
Holly Lucille, ND, RN
Lucille is a nationally recognized licensed naturopathic doctor, author and educator. She owns Healing From Within Healthcare in West Hollywood, Calif., and wrote Creating and Maintaining Balance: A Woman’s Guide to Safe, Natural Hormone Health (Impakt Health, 2004).
Joseph E. Pizzorno Jr., ND
Pizzorno is a naturopathic physician, educator, researcher and coauthor of Textbook of Natural Medicine (Churchill-Livingstone, 1999) and Encyclopedia of Natural Medicine (Three Rivers Press, 1997). He is the founding president of Bastyr University in Kenmore, Wash.
Cardiovascular disease remains the number-one killer of U.S. adults—by a long shot—so it’s no wonder heart health tops consumers’ lists of concerns. According to SPINS, shoppers purchased $227 million worth of supplements targeting hypertension, atherosclerosis and high cholesterol in natural foods stores, excluding Whole Foods Market. “The majority of cardiovascular disease is preventable and treatable with dietary changes, physical activity and targeted nutritional supplementation,” Pizzorno says. “Along with lifestyle interventions, supplements typically have broader benefit than pharmaceuticals because they address the dysfunctions that underlie chronic disease, rather than treating the symptoms.”
Our experts unanimously tout omega-3-fatty-acid-packed fish-oil supplements for their vast cardiovascular benefits, especially since people rarely get enough of fish oil’s active components, EPA and DHA, from food. “Most people would benefit from eating 12 ounces of fish per week,” Low Dog says. “But since many do not, fish oil is high on my list [for heart health].”
How it works: EPA and DHA alter the fatty-acid content of cellular membranes—improving cell function—and combat the inflammation that causes most cardiovascular diseases, Pizzorno says. “They reduce blood pressure in hypertensive individuals, lower triglycerides, improve insulin resistance, prevent and treat metabolic syndrome, and reduce arrhythmias and cardiac death.”
To maintain a healthy heart and circulatory system—and protect the brain and eyes—Low Dog suggests a daily dose of a molecularly distilled fish oil that offers 600 to 800 mg of EPA and 300 to 500 mg of DHA. But those with heart disease or elevated triglycerides may need up to 3,000 to 4,000 mg total per day, Pizzorno says.
Take note: “Make sure fish oil is clean and free of heavy metals and dioxins,” Lucille says. “Manufacturers must be able to prove product purity.”
An anti-inflammatory and antioxidant with myriad therapeutic benefits, turmeric—more specifically, its active constituent curcumin—demonstrates potential heart-protecting qualities, although curcumin research to date has been limited to lab and animal studies.
How it works: Even without conclusive human trials, Pizzorno says “curcumin’s ability to stop inflammation suggests it may help prevent and treat cardiovascular disease.” Lucille agrees: “Curcumin stops platelets from clumping together, which improves circulation and may help protect against atherosclerosis.” Both experts recommend a daily curcumin dose between 1,000 and 2,000 mg.
Take note: Lucille says standard curcumin’s bioavailability is poor, so clinical trials have used large dosages (up to 12 grams daily) to get small amounts into the bloodstream. But high doses may make cost an issue. To combat this, she says, “new research is focusing on approaches to improve curcumin’s bioavailability, such as adding lecithin or piperine,” which is a pepper plant extract that increases absorption. Lucille also points to a product, BCM-95 Bioavailable Curcumin, that uses phospholipids and turmeric essential oils to boost absorption.
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This antioxidant occurs naturally in cell mitochondria and makes the key molecule adenosine triphosphate, or ATP, which controls protein production and muscle contraction. People with high cholesterol and those with congestive heart failure generally have low coenzyme Q10 levels. Although statins—drugs frequently prescribed to combat high cholesterol—deplete the body’s Co-Q10 stores, supplements can restore levels and even relieve the muscle pain that statins commonly cause, according to a 2007 study published in the American Journal of Cardiology.
How it works: Studies show that Co-Q10 supplements may lower blood pressure and help prevent and combat cardiovascular diseases by acting as an antioxidant and curbing blood-clot formation.
Take note: “A dose of 100 to 200 mg per day is used for most cardiovascular concerns, but much higher doses may be appropriate for specific conditions,” Pizzorno says.
Vitamin D’s benefits for bone health, immunity and even preventing cancer are becoming better known, but our experts say that this nutrient is also crucial for a healthy heart. “Vitamin D is one of the most frequently deficient yet physiologically important nutrients for cardiovascular health,” Pizzorno says. He points to analysis published in the American Journal of Cardiology in October 2010 that linked the widespread vitamin D deficiency in the U.S. to heightened prevalence of hypertension, myocardial infarction, stroke, diabetes, peripheral vascular disease and other conditions. In 2009, researchers at Salt Lake City’s Heart Institute at Intermountain Medical Center found that of almost 28,000 adults over age 50 with no history of cardiovascular disease, those with very low vitamin D levels were 77 percent more likely to die, 45 percent more likely to develop coronary artery disease, 78 percent more likely to have a stroke and twice as likely to develop heart failure than patients with normal vitamin D levels.
How it works: Too little vitamin D can increase the risk of calcium buildup in the arteries, which leads to atherosclerosis and potentially a heart attack or stroke. The vitamin can also counter the body’s renin-angiotensin system, which constricts blood vessels when blood volume dips, raising blood pressure. Although the current dietary reference intake is 600 IU per day, many experts now recommend 1,000 to 2,000 IU, especially in winter months when few people get adequate D from the sun.
Take note: Vegetarians, dark-skinned people and those with liver or kidney disease are more likely to be vitamin D deficient.
With 40 million Americans experiencing anxiety disorder and one in 10 adults reporting depression, according to the Centers for Disease Control and Prevention, brain health is at the top of customers’ minds. And although wildly popular, pharmaceutical antidepressants can cause side effects like fatigue and nausea. “People often can’t slow down enough to treat the causes [of depression and anxiety],” Lucille says. “So supplementing to help get through the day has become very popular.”
As with heart health, fish oil stands above all supps for brain health, according to our experts’ recommendations and SPINS’ reports, which show that depressed people spent almost $57 million on fish oil in natural products stores. “A higher intake of the omega-3 fatty acids found in fish oil has been associated with a reduced risk for depression and other mood disorders,” Pizzorno says.
How it works: “EPA and DHA are known to alter membrane fluidity, gene expression, inflammatory proteins and other neurotrophins known to be abnormal in depressed patients,” Pizzorno explains. “While EPA alone may affect depression, I prefer a supplement with both EPA and DHA; clinical trials have used doses of 2 to 7 grams in combination.”
Take note: Results of studies on fish-oil supplements’ effect on mental health vary, suggesting that their performance may depend on the severity of depression, the exact type of mental disorder and whether fish oil is used alone or in conjunction with other treatments affect the success of supplementation.
Also known as tulsi, this Ayurvedic herb has a wide range of therapeutic uses, most notably as relief for generalized anxiety disorder and mild depression.
How it works: Holy basil’s adaptogenic properties bolster the body’s natural defenses against stress, inflammation and illness. In the case of brain health, “holy basil can dramatically and rapidly improve anxiety and depression for many individuals by helping to manage and reduce [the stress hormone] cortisol,” explains Lucille, who recommends taking two of Enzymatic Therapy’s Holy Basil Trinity Blend 675 mg capsules per day.
Take note: The method by which holy basil’s active components are extracted matters, Lucille says. She believes that Enzymatic Therapy’s combination of extraction methods yields the most potent punch.
More brain health supplements
Low serotonin is a major marker of both depression and anxiety—and 5-hydroxytryptophan, serotonin’s chemical precursor, can boost levels of this neurotransmitter.
How it works: “Our bodies use 5-HTP to make serotonin, which plays a significant role in mood, sleep, pain control, inflammation and other functions,” Lucille says. A daily dose of 300 mg has been shown to abate anxiety in a controlled study, she adds.
Take note: 5-HTP should not be taken with antidepressant medications, Lucille says. The combo can cause liver damage and serotonin syndrome, a potentially dangerous condition marked by headaches, diarrhea, chills, rapid heart rate—and even seizures and coma.
Vitamin B complex
“Studies have linked lower intakes of B vitamins—specifically B12, B6 and folic acid—either individually or as a group, to higher risk of depression,” Pizzorno says. Riboflavin (vitamin B2) may also affect depressive disorders, according to recent research.
How it works: Most B complex formulas include the eight water-soluble B vitamins, which are chemically distinct from one another and service different body functions—for instance, vitamin B6 aids in red blood cell formation, while B12 is key to metabolism. But studies show that many of the B vitamins can affect mental well-being. Replenishing depleted B vitamin stores can boost production of serotonin and the neurotransmitter dopamine, according to research published in the Journal of Clinical Psychiatry in 2009.
Take note: Alcohol, caffeine and refined sugars can destroy B vitamins in the body.
Emerging research supports the role of supplemental SAM-e—short for S-Adenosylmethionine, a natural compound found throughout the body—in combating depression. Most notable is a 2010 trial published in the American Journal of Psychiatry that showed its effectiveness as a complementary remedy, relieving symptoms in participants who hadn’t responded to prescription anti-depressants alone.
How it works: Upping the body’s diminished SAM-e concentrations—oftentimes a result of low folate or vitamin B12 levels—promotes synthesis of serotonin and dopamine, which can ease depressive symptoms. Daily doses between 800 and 1,600 mg have been shown effective, according to an editorial published in the August 2010 issue of the American Journal of Psychiatry.
Take note: Although recent studies suggest that SAM-e is safe to use with other antidepressants, further research is needed to evaluate its long-term efficacy and use as a primary depression treatment.
To prevent and relieve indigestion and gastroesophageal reflux disease, more customers are starting to choose supplements over proton-pump inhibitors like Prilosec and Prevacid, which reduce the amount of acid in the stomach. Pizzorno says these pharmaceuticals treat the symptoms but don’t effectively restore gastrointestinal function. What’s more, last May the U.S. Food and Drug Administration warned that PPIs may increase bone-fracture risk.
While people tend to associate probiotics with all things digestive—and SPINS tracks probiotics as popular choices for lower digestive-tract issues like irritable bowel syndrome and diarrhea—for upper digestive-tract woes, specifically indigestion, heartburn and GERD, natural products customers purchased $32 million worth of digestive enzymes.
“Generally, I suggest bitter herbs before meals to stimulate the body’s production of hydrochloricacid and pancreatic enzymes, [which aid digestion],” Low Dog says. “But if gas and bloating persist—and there are no food intolerances or allergies—I’ll recommend a trial of digestive enzymes. I believe that many who take PPIs for heartburn would do better with bitters and/or digestive enzymes.”
How they work: Due to stress, medications, age or diet, some people don’t have enough enzymes to break down food, which results in gas, bloating and acid reflux after meals. Research shows that supplemental enzymes from fungal, plant or animal sources help the body digest protein, carbs, fats and fiber and nix these symptoms when taken with food or within an hour of eating.
Take note: Typical formulations include lipase, amylase and pancreatin, Pizzorno says, but some newer products use specific enzymes that may offer additional therapeutic benefit for those with gluten and casein intolerances.
Although licorice is commonly used to treat digestive woes, Low Dog cautions that taking more than 1,000 mg for several weeks can raise blood pressure and cause potassium loss due to a compound called glycyrrhizin. But licorice products in the deglycyrrhizinated form, known as DGL, are safe for long-term use, says Low Dog, who recommends DGL for heartburn and GERD and for people weaning off PPIs. “Chew 600 to 800 mg of DGL 20 minutes before meals for four to six weeks; then use as needed,” she says.
How it works:According to Pizzorno, DGL increases blood flow to damaged tissue and sparks mucus production in the stomach, which helps to guard against the discomfort-causing digestive acids.
Take note: Pizzorno says the typical dose of 250 mg three times per day may work best in conjunction with other therapies that restore healthy mucus membranes or eliminate causes of stomach-lining damage, such as the bacteria H. pylori.
More digestive health supplements
“One of my top 20 herbs, ginger is great for those who have sluggish digestion or gas, bloating and heartburn after meals,” Low Dog says.
How it works: A 2008 study published in the European Journal of Gastroenterology and Hepatology found that ginger triggers more frequent muscle contractions, thus moving food from the stomach into the intestines more quickly and minimizing indigestion.
Take note: Ginger can also reduce nausea and vomiting brought on by pregnancy or motion sickness, says Low Dog, and its anti-inflammatory properties make it effective for relieving arthritis pain. So, she recommends products that combine ginger with other anti-inflammatories like turmeric, holy basil or boswellia.
“I like aloe vera juice for individuals with gastritis and inflammatory bowel disease,” Low Dog says. With more than $10 million in sales, aloe vera was the second most–purchased remedy for GERD, after digestive enzymes, according to SPINS.
How it works: Aloe vera juice coats the esophagus and keeps stomach acids from flaring. “The mucopolysaccharides [an active ingredient] have an amazing anti-inflammatory effect on the GI tract lining,” explains Low Dog, who recommends drinking 3 to 4 ounces of aloe vera juice per day to settle digestive unrest.
Take note: “Go with [pure aloe vera gel] products that do not contain latex, or aloin, which is the ‘laxative’ part of the plant, and always follow directions on labels,” Low Dog says. Aloe vera can cause diarrhea in some people, however, and some experts caution against using it while pregnant, because it could trigger premature uterine contractions; and while breastfeeding, as it could be too tough on a newborn’s digestive system.
Lucille stresses that perimenopause and menopause are normal hormonal transitions—not ailments requiring treatment, as many people believe. Still, “women can become very symptomatic [during these transitions] due to endocrine disruptors from our environment and taxed adrenals from too many modern-day stressors,” she says.
Sales figures suggest that more women now reach for supplements to alleviate menopausal symptoms like hot flashes and night sweats. “Data from the ongoing Women’s Health Initiative and the Heart and Estrogen/Progestin Replacement Study have illustrated the consequences of conventional hormone-replacement therapy, encouraging women to seek healthier alternatives,” Pizzorno says.
Natural foods store shoppers also spent $40 million on supplements to relieve premenstrual symptoms like cramps and bloating, according to SPINS.
“Women with PMS and menstrual cramping and those who feel down, don’t sleep well and experience joint aches and pains often do well with black cohosh,” Low Dog says, adding that men can use it for the same purposes. The herb has also been shown in several studies to improve menopausal symptoms like night sweats and hot flashes, and to ease depressive symptoms in postmenopausal women when taken with the herb St. John’s wort. Even though some study results have countered black cohosh’s benefits, the American Botanical Council maintains that the herb is safe and effective.
How it works: Exactly how black cohosh relieves menopausal and PMS symptoms remains unclear, but some researchers hypothesize that it sparks the brain’s serotonin receptors, which are linked to the hypothalamus, the body’s temperature-control center. A variety of black cohosh preparations exist, but the quantity of the key active constituent, triterpene glycosides, is standardized in most supplements, Lucille says. “Black cohosh also has a very good safety profile and can be taken by breast cancer survivors. I recommend the standardized extract at about 20 to 40 mg per day.”
Take note: “Black cohosh was once thought of as a phytoestrogen, but recent studies have found no estrogenic activity,” Lucille says. And because the herb is nonestrogenic, “it does not have the hormonal benefit for bone health of HRT,” Pizzorno says. Black cohosh can also take some time to become effective, Lucille cautions. “I have my patients stay on it for at least 12 weeks,” she says.
More women's health supplements
“Magnesium plays a role in controlling menopausal symptoms, as well as many physiological processes affected by aging,” Pizzorno says, adding that the nutrient is often deficient in diets. He points to a recent small study that showed magnesium supplements reduced bone turnover—which can lower bone-mineral density—in postmenopausal women with osteoporosis. “Magnesium is underused—it’s one of my top supplements for menstrual cramping,” says Low Dog, who suggests 300 to 600 mg per day of magnesium glycinate or magnesium citrate.
How it works: Magnesium activates enzymes, helps generate energy, dilates blood vessels, and aids muscle contraction and relaxation to reduce cramping, according to the University of Maryland Medical Center. The mineral also regulates levels of other nutrients, namely calcium.
Take note: “Magnesium can cause diarrhea, so cut back if you get loose stools,” Low Dog says, adding that magnesium supplements—not magnesium-rich foods—can pose problems for people with poor kidney function.
Many women take calcium for bone health, but research shows it may also relieve PMS symptoms, Low Dog says. “You need 1,000 to 1,200 mg of calcium from all sources, so most women don’t need to take more than 500 mg [of supplements] per day. Calcium citrate is inexpensive and appropriate for all ages.”
Vitamin D goes hand in hand with calcium, as it enhances absorption of the mineral. Therefore, “it’s probably most important for women to have their vitamin D levels checked and aim for a serum level of 40 to 60 nanograms per milliliter—optimal calcium absorption occurs around 35 nanograms per milliliter,” Low Dog advises.
How it works: Calcium’s potential PMS-easing effect isn’t fully understood, but some experts suspect the mineral interacts with estrogen during menstruation.
Take note: Taking high levels of calcium over long periods of time can harm the cardiovascular system, Low Dog warns.