We are here with Leah Sherman, a naturopathic Doctor, discussing everything supplements! Which includes vitamins, minerals, herbs, and even essential oils. Leah Sherman is a naturopathic doctor who specializes and has a huge heart for cancer patients! if you are interested in listening/ watching the podcast scroll to the end!
Q: What is considered a supplement? And what else may fall under here (I.e. vitamins, minerals, herbs, homeopathy, tinctures, etc) when discussing supplements and natural remedies?
A supplement is what one would have in addition to a regular diet. But it also goes beyond that. It’s something that would be derived from food, or that you would get from food, like a vitamin or a mineral. Herbs, homeopathy, and tinctures, whether it’s a capsule or powder, would all be considered supplements. Anything that people take for some sort of health benefit would be considered a supplement. It’s an add-on to a regular diet to accomplish something that you are hoping to achieve and have some sort of effect. Whether that effect is symptom relief, adding in nutrition, optimization of brain concentration, or anything like that.
Q:What are some reasons people may need to take supplements?
The emphasis on need! I once saw it broken down this way and I think it is a really good way to break down why people take supplements or would NEED to take a supplement. So the first one is to prevent or treat nutrient deficiencies. For example, preventing scurvy by taking vitamin C, or taking vitamin D for rickets. The bare minimum recommended daily allowance to prevent some sort of deficiency. The next one would be to prevent, delay, or treat a certain medical condition. For example, l Osteoporosis is something that happens as people age, bones start to get thin and weak. And so taking certain supplements, whether it’s calcium, vitamin D, or vitamin K to prevent that. If they have osteoporosis and they’re getting certain medications to manage that, they need to take a certain amount of calcium and vitamin D. The last reason, and I don’t know if it’s necessarily a need, it’s what we call the green pharmacy. So that’s when someone might take ashwagandha to manage stress. You’re taking something in place of a prescription medication or an over-the-counter medication. Taking something like nettles to manage allergies. Those are the three reasons that people would take a supplement.
Q: Does supplements replace food – why or why not?
A multivitamin is a really good example! When somebody takes multivitamins, they’re like, “I’m getting all my nutrients through this”. My answer to this, It’s Always Food First! And you know, when you have that person who comes to you and says, oh my diet’s horrible, so I take a multivitamin, part of you is like, no, don’t do that, and then the other part of you is like, well do that as your diet is worked on. I don’t want people to think of it as I’m gonna eat junk all the time and so I’m gonna take all of these vitamins to make myself better. Because we know it’s not the same. It’s not what people think of when they think of naturopathic doctors, where we do focus more on supplements. But yes, I 150% believe it’s always food first because it has all of those other things, such as fiber, fats, and proteins. It has all of the things that we need to build healthy cells, which makes us healthy. Because food synergistically has all those components that work together in its most natural state. Whereas vitamins are something that has been isolated and then now is in an inactivated form that the body can’t even utilize or, is not even at a therapeutic dose. So then it becomes a little raindrop in a big thunderstorm; it’s not gonna make a difference, other than possibly make a more expensive pee. So food first and supplement where you need!
Q:What are some common myths about supplements that should be debunked?
I think the big one is that they’re all safe! That’s huge, and that goes on so many different levels. It’s anything from somebody who might have a health condition where they probably shouldn’t be taking a certain supplement, to ordering something online and it might not be what it says it is. So safety is a big part of what I do! Making sure my patients are safe, but just thinking that, oh, it’s natural, it’s a vitamin, it’s not gonna hurt me. Oh, I’m just gonna pee it out, you know? And another myth would be, it’s good for anybody! and that plays into the safety aspect too. When a supplement is advertised as “it’s good for every single thing that ever ailed you” that’s not a good thing. Red flag if you hear, something like that! Especially I remember some of the herbal aspects because a lot of the research studies are not there yet, but they might have interactions by saying something that’s a medication for depression or a PPI. So they might have some drug-nutrient interaction. Not everything natural is good for all, and may even be considered safe.
So many people take medications for blood pressure, diabetes, for all kinds of things. And there are herbs that they may take intentionally to help with their blood sugars or to help with their blood pressure, but if they’re taking them at the same time as their medication, either it may interact and cancel out the medication or it will make that medication work more, and they may have really bad sugar crashes or blood pressure crashes and then you’ve got other problems. And so by just taking things off the counter or over the counter I should say, and adding them onto your regimen, if you’re taking a lot of medications, it’s best to have some sort of guidance. The last myth is because it’s cold and flu season, a lot of people take herbs that are not supposed to be something that you take every single day. For example, some people take acacia every single day, all year round. When using herbs, you are supposed, to take a break from them. So whether someone takes it five days on, two days off, or three weeks on a week off, you know, that’s how I was trained that herbs were meant to be taken, and not every single day. You don’t want something that’s ramping up your immune system all the time. The same thing goes with mushrooms, always remember to have those on a rotation basis, you know, especially if it’s immune support.
Q: Are all supplements made equal?
Some are! for example, vitamin D3, is vitamin D3. I don’t want someone getting it from the dollar store, because you have to think about the other components in the vitamin, which ideally is listed on the label, but it’s not always. Quality is the most important thing. If you’re taking this for your health, you don’t wanna take something that either isn’t what it says it is on the label or doesn’t have the quality that you would if you were trying to, you know, eat a good meal, a good healthy meal. So there are certain labels that people can look for on their vitamins and not everything has this label. I guess the number one thing people should look for would be this, does this company do a third-party assessment to check for quality? Some companies are like, oh well we have our people who check our quality and that is another red flag.
Q: What should people be looking out for when buying a high-quality supplement (I.e. third-party testing)?
Good manufacturing practices! is what you wanna look for. And one of the labels that you might see on a supplement would be NSF. Another one is USP (United States, Pharmacopia). Those are certification labels that people pay for to show that they are following certain practices, making sure that their supplements are standardized, and manufacturing quality control.
Q: Could you expand on the importance of GMP-certified and third-party-tested supplements?
It makes sure that the place where the supplement is being manufactured follows those certain standards. You know, the big thing that I keep coming back to is herbs, because, and this may not be specific to what GMP does, but not ordering from a reputable site or even somebody that has a great reputation, but maybe their standards that they’re following aren’t regulated in the limited way that supplements are regulated. You might be taking something that isn’t what it says it is on the label. Looking for fillers, the fewer fillers possible is a really good thing to look for. It’s like reading a food label. Those fillers would be found in the other ingredients part of a supplement label, it might say cellulose or whatever else they might add in there. Another red flag is when something says a proprietary blend. What does that mean? It has some milligram amount and it’s got 42 different supplements and you’re like, what am I taking? Like do they just kind of wave the vitamin or the herb over the capsule and they’re like, okay, it’s in there too? And then the total amount isn’t even a therapeutic dose of any of the things that are in there. And if it says proprietary blend and there is nothing listed! don’t even go near that! So you’re saying some red flags look out for one, no third-party quality testing or identification on that label. Number two, seeing proprietary blends that have this mysterious number amount that you’re like, what’s that even mean? And three, looking at that other ingredient section for a lot of these fillers.
I am leery of anyone who sells supplements to make money for themselves, for example, multi-level marketing. I’m very leery of that because I don’t know if they do follow third-party certifications or not list what’s on the label. People are very into the products that they sell, but I often question the quality because they tend to be very expensive and tend to make a lot of promises. Even considering in a world that’s so online nowadays, it is easy to see that this influencer suggested this product. Take that as a caution, don’t take them as expertise. Just because some random person has a very large audience online and may seem like a great influence, doesn’t necessarily make them an expert in this field to trust their advice to say. For example, if someone says I’m taking vitamin A and it’s been so great for me. So you should too! Because it’s not even taking into account the receiver or other people watching this, the consumer on the other side needs to take into account what their medical history is like, what they’re on, whether is it appropriate for them, or is it even a good supplement in general, or is it a supplement that is terrible or is it at such a high dose that you shouldn’t probably be taking that anyways. Like lots of considerations. And I think that’s something that, that what you just said about high dose, that’s a trend that comes and goes taking super high doses of it’s usually a vitamin or a mineral to achieve some sort of effect, which is another red flag. When I did my training, we learned that taking high doses of certain vitamins could help as antivirals and you would see the side effects that people would have. They would end up just having a lot of nausea when the whole goal was to make people feel better. Any supplement is gonna have a greater amount than what you can get from food. So keeping the vitamin or mineral to the minimum amount to achieve the effect that you wanna achieve. What’s the bare minimum for max benefit essentially?
Q: Are there any supplements that warrant extra caution?
There are a lot of those! let me pull out my list! One of the big ones that you’ll hear a lot is, you know, anything that affects blood clotting, especially if people are on certain medications, you wanna be careful with that. In terms of herbs, there are certain things that I think used to be hard to get ahold of, but I think now with Amazon and the internet, it’s easier to get ahold of things. There are certain herbs called low-dose botanicals, which are toxic at even low doses. It doesn’t take very much to create toxicity. And so you don’t want to just take herbs randomly because you saw on social media that somebody else did and it helped them. I think I mentioned before, anything that claims to cure everything is something you need to be wary of because nothing works like that. I wish maybe one day we’ll Invent it, it, right! And then there are certain supplements, for example, if people take vitamin A, they may be taking a medication that could be similar or might be affected like they need the, you know, to be processed through your liver, let’s say. And if somebody takes high doses of vitamin A, herbs, or other vitamins, that will affect liver function, you don’t wanna stress out the liver, or damage the liver in any way. You can cause damage by taking things that are super high doses or by altering the way your liver and your kidneys metabolize medications. I always remember you talking especially about the P 44 50 enzymes, and that pathway in the liver. But to explain it, it will either speed up and then be not as effective in terms of what it’s supposed to do, or they slow down, and you get a ton more side effects. Truly you just want where it’s meant to be, that sweet in-between, how it was manufactured and thought to be.
The one supplement that we hear about the most is St. John’s Wort. And so people will take St John’s wort for like mild depression, melancholy is what it was traditionally used for. And if somebody uses birth control pills, the St. John’s wort will interact with how your body metabolizes them. Therefore, the medication won’t do what it’s supposed to do. And that can even be an ingredient on a sleep aid supplement or some other proprietary blend. You really wanna be careful. Even eating grapefruit can affect how medications are metabolized. And so a lot of people will get supplements that are vitamins, minerals, probiotics, fish oils, whatever, and they have essential oils in them and you don’t know how much of the essential oil is in there. Is it in there for flavor or some kind of effect? If there are these citrus essential oils, are those potentially gonna interact with your medication? We don’t know cuz we don’t know how much is in there, but we do know that certain essential oils can affect liver metabolism.
Q: Would you also say then that essential oils are a part of that group of cautionary supplements to ingest?
So I don’t consider essential oils a supplement because in my mind a supplement is something that you’re ingesting. And I don’t think that essential oils should be ingested by the masses. Some people are experts and know the proper dosing, people who specialize in aromatherapy. They know which ones can be ingested, and which ones could be used in cooking. You know, you could use lavender essential oil when making shortbread, but there’s a very specific dosing because of the strength of one drop, you know? We used to say that one drop of essential oil is equivalent to 30 cups of tea and nobody’s gonna drink 30 cups of tea in a sitting. I mean that’s a definite medicinal effect. And so, I mean, my rule has always been to not ingest them unless it’s been recommended by somebody who is trained and that doesn’t mean they are somebody who just sells the product. Because I remember at the beginning of the pandemic, I was speaking with someone who was taking large amounts of oregano oil in their water as their antiviral, trying to keep from getting sick and I can’t remember how many drops it was, but I, I remember like gasping and just thinking like you’re gonna burn a hole in your stomach! Because oregano is so potent; It is such a strong herb. I mean I’ve taken oregano tincture in a few drops in hot water and you’re just burping it for days. And that was just a tincture that’s not extracting the essential oil, which is so much stronger. There are a lot of studies looking at the use of essential oils internally, but as I said, it’s gotta be with a trained professional cause you could do more harm. I’m not saying It’s a no, just seek advice from a trained professional on proper dosing and what is acceptable to ingest safely and what’s not. And so that’s why I don’t, I don’t necessarily consider it a supplement because it’s not in the forefront of my mind as something that you should ingest.
Q: Are there any specific drug-nutrient interactions to look out for with common supplements? How can that someone that precaution?
If somebody is doing Accutane, for Acne, And they are taking a high dose of vitamin A, that would be a contradiction. The big ones are antidepressants and birth control. Lexapro for example also has a lot of potential for interactions. If you take something that is a sedative whether you’re, you taking an anti-anxiety medication or you know, an antidepressant and you take herbs that do the same thing. So if you take an antidepressant and then you take something like five to, which is a precursor for serotonin you may get too much serotonin in your body, and it may build up. There they’re all of these little things that you don’t wanna unless you’re working with a trained professional, to duplicate the effect of the medication. The general rule, If you’re not on any medications, of course, take a cautionary approach when approaching supplements, but especially if you’re on any type of medication like it could be birth control, for example, take extra precautions and make sure you ask your provider beforehand. And I emphasize that again, it’s better to be safe! Some interactions aren’t necessarily with medications.
There is a supplement, it’s for hair and nail growth, biotin. What’s included in things like hair, skin, nail formulas or people just take super high doses, you know, five grams, 10 grams of biotin hope to be that their hair will get thicker and their nails will grow longer. That supplement interacts with a lot of labs, especially thyroid labs, and it doesn’t interact with your thyroid. It interacts with the way that the lab interprets, and the reading of those labs. I normally suggest just stopping taking the biotin three days before you’re gonna have a lab draw. Or to let somebody know you were taking biotin at the time. And you can find biotin in multivitamins as well. And then the other one is vitamin C. If you take high doses, 1000, or 2000 milligrams of vitamin C and then you have your blood sugar checked, it can falsely read your blood sugar levels. So those are the two that I think of the most in terms of interactions that get false positives, false negatives, or like just false readings in general.
Q: What would you say are the top three to five most important vitamins people should be taking?
There is a lot of new controversy around vitamin D showing that there is no benefit. And then the very next day there will be an article saying that there is a benefit in terms of different disease prevention. The benefit comes when deficient people, take it and then it increases their levels and that is when the most benefit is seen. The most recent article I saw was about increasing vitamin D levels has a positive effect on depression. The first thing is getting your vitamin D level checked. If it’s under 20, you are deficient, and therefore, take a supplement. The amount would be determined by your provider, I am not your doctor. 30 is considered sufficient, but you may want that number a little higher, depending on what’s going on. Again, check with your doctor to see what your safe level could be. Vitamin D would be something that there is a lot of vitamin D deficiency. For example, if you are in Arizona, many people are deficient because nobody goes in the sun when it’s 120 degrees outside. Similarly, in a more northern hemisphere, there is not much sun in the winter. So I do think that vitamin D would be a vitamin that would be good for many people, but not for everyone.
Depending on one’s diet, I would say consider an omega-3 fatty acid. Because we don’t tend to get a lot of those in the standard American diet. Ideally, you’re getting it from your food, you’re eating your fatty fish, fatty cold water fish, walnuts, or any other foods that contain these omega threes. However, somebody might need to take a supplement for whatever health reason is going on. Finally, a probiotic might be a possibility, the more variety of these gut microbes that you can have, the better. Because it’s not like there’s just lactobacillus living in our gut. So eating different probiotic foods can provide a variety, whether it’s yogurt or sauerkraut, kimchi, Kiefer, or whatever it may be. Plus its food, so it’s tasty! For some people, probiotics can be beneficial, but there are some people where probiotics can make their bowels worse because they’ve got something else going on. There is not one size fits all when it comes to supplements period. I would recommend seeing your provider if you are considering adding any supplements to your diet.
Q: Do you have any tips when shopping, storing and using vitamins, minerals, and supplements?
Check to see how your supplements need to be stored because things like probiotics are shelf stable, and then some need to be refrigerated, but not everybody realizes that. So instead they will leave them out but eventually, it’s not gonna be working the way that it’s supposed to. So just keeping them in the refrigerator is ideal, but in general, you want them to be in a cool, dry place. Fish oils would be good to store in the freezer if you do notice that you get a lot of that repeat fish burs as they call them. In the scientific world. I think that the most important thing though is if you’re taking a good quality fish oil, it really won’t have a fishy taste. One thing we used to tell our patients back way in, you know, way back in the day is to take a capsule and puncture it and smell and see what it smells like, and if it is very fishy, it may have already gone rancid. Also do not store ground flax seed in the pantry, because it is going to go bad, especially flax oil, please do not please put it in the fridge. I work with cancer patients and so they’re very sensitive to smells and so maybe putting your multivitamin in the freezer might help to kind of keep that smell and taste down. Because the taste and smell of vitamins can be a big trigger, especially if somebody’s undergoing cancer treatment, has smell sensitivities, or just has trouble with supplements altogether. The same would apply to a B vitamin or just a B complex in general. The smell is one and also the repeating aspect, which is when that vitamin’s taste and smell stick around for a while after swallowing. If you are taking a B vitamin then storing it in the freezer might help, but only if it is in a capsule. If it’s a tablet, I don’t believe it’s gonna make much of a difference
What are your common questions and concerns when it comes to supplements? Is there anything you are curious about that is not answered above? Ask away in the comment section below 👇