Supplements and herbs often offer accessible and efficient solutions to health concerns, yet they can also pose significant risks. Welcome to Part 1 of our 'Help You/Hurt You' series, where we delve into the potential risks and interactions of commonly used supplements and herbs. This series is aimed for patients, students, and other health professionals.
Rarely is anything in this world purely beneficial. Life is designed for moderation. I think we can all agree that even too much of a food or too much water over a long period of time can be harmful. Why, then, would we expect that supplementing high amounts of vitamins or minerals for long periods of time be any different?
Tables of Contents:
The Defense: Benefits of Omega 3
The Prosecution: Risks
The Verdict: Our Balanced Take
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A quick lesson on food, vitamins, and minerals
Everyday, our body strives to maintain homeostasis, which is the idea that there are steady internal, physical, and chemical conditions in the body. The body is pretty good at doing this itself, and one of the most common examples of homeostasis includes temperature regulation. If you're too hot, you sweat to cool down via evaporative cooling. If you're cold, you shiver to rapidly activate and relax muscles to warm up.
But to keep our organs and systems working properly, our bodies also need some external substances. That's where food (and sometimes supplements) come in.
While things can certainly get more detailed and complicated, put simply, the body needs:
1) Protein for amino acids and energy, or the building blocks that help us maintain muscle, skin, bone, hair, and cartilage
2) Carbohydrates for fiber, sugar, and energy, or things that help our intestines stay clean via pooping and our blood sugar stay at good levels so our organs can work properly
3) Fats to help us make hormones, absorb fat-soluble vitamins (Vitamins A, D, E, & K), keep our cells and their walls strong, produce energy, and help us grow.
As a general rule, our diets should ideally be a mix of all of those things in order to function best. However, in order to make muscles, hair, hormones, and keep the organs functioning, we need other compounds we call vitamins and minerals.
While our body can make some (like Vitamin D and K), we cannot make others, like the B vitamins and Vitamin C. And minerals are organic compounds like iron, calcium, potassium, and zinc that we also cannot make on our own. Luckily, we do not need large amounts to function everyday, BUT if we are deficient in the vitamins or minerals, it disrupts the chemical processes in our bodies and we can develop diseases or symptoms. Additionally, while our bodies CAN store minerals, it our CANNOT store large amounts of some vitamins. So when we get excessive amounts either via supplements or a large meal we, essentially, pee them out. This is a good thing as it helps us maintain homeostasis, or balance. This is also why some doctors and health professionals believe that, if you are getting a truly balanced diet that supplies all the vitamins and minerals you need, then daily vitamins essentially just make expensive pee.
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Understanding Supplements: A Balancing Act
When it comes to supplements, things can get a bit tricky. Let's imagine them as little helpers that boost our body's normal operations. These vitamins and minerals combine with other nutrients in our body and transform into a bunch of different compounds that help us function.
Imagine a fictional vitamin 'Z' teaming up with an imaginary amino acid 'X' and a make-believe mineral 'V'. Together, they form a super team called 'ZXV', which powers us up when we run fast. So, you might wonder, why not just take a ZXV supplement instead of Z, X, and V separately? It could make us faster, right?
But here's the catch. Sometimes our body can't absorb ZXV directly, so it might just pass through our system unused. Or, if we have too much ZXV, it could be harmful, or it might make us feel down and sleepy. And although ZXV is part of the 'running fast' process, there's little proof that taking ZXV directly makes us faster. So yes, ZXV could make you run faster, but it could also make you feel gloomy and tired. Is the trade-off worth it? That's the big question with many supplements, and what we'll explore in this article.
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Periodically, I'll be sharing how exactly some awesome supplements that can help you, and how they can also potentially hurt you. This is with the intention to show that each supplement should be considered carefully before taking it. Since there are often 100's and 1000's of research articles on supplements, I strongly encourage you work with a physician who can take into account your personal medical conditions, medications, and risk factors so that you're making a safe and healthy decision. Naturopathic doctors (like me!) are educated and trained in how to evaluate the cost/benefit ratio, interactions, and safety of these supplements. But doctors are people too, and since the research is so vast, every doctor can have certain threshold levels for what they consider to be safe and worth it. I encourage you to find a doctor who goes over the pros, cons, risks, and side-effects of each supplement you're taking, and make sure they match your personal risk preference.
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Meeting Today's Plaintiff: Omega-3 Fatty Acids (Fish Oils)
Omega-3s are like the superheroes of fatty acids. We can't make them ourselves, so we have to get them from what we eat. Along with their sidekicks Omega-6s, they help build our cell membranes and control important signals in our body that keep our heart, lungs, and hormones running smoothly.
There are three key types of Omega-3s that we eat: ALA, EPA, and DHA.
ALA, found in things like walnuts and spinach, is the brain booster of the trio. It zips straight to your noggin to keep it firing on all cylinders. Remember, walnuts look like a brain, and they're full of ALA!
EPA and DHA, on the other hand, mostly come from fish like salmon and tuna. They're all-rounders, helping with inflammation control, keeping our hearts, eyes, and nerves in top shape, and even aiding our sleep. Remember, a little inflammation is a good thing – it's part of our immune system – but too much can cause problems. Omega-3s, particularly EPA and DHA, are known for their anti-inflammatory powers, so they're often recommended for people with inflammatory diseases.
ALA can change into EPA, and EPA into DHA, but the body's not great at this – it's a bit like trying to change a bicycle into a car. It only works well if you have enough vitamins and minerals, and even then, the success rate is low.
Specifically, an estimated less than 5% of ALA becomes EPA, and less than 0.5% of ALA becomes DHA. And, again, that is if you have enough of the vitamins and minerals, and also don't have any gene mutations that affect that pathway. This means that if you're not eating fish, your EPA and DHA levels might be low.
The Defense: Benefits of Omega 3
The above risk factors outline why eating fish and/or taking an Omega-3 supplement is essential for many people, especially if you have a limited pallet due to preference, economic conditions, neurodivergencies, or sensory sensitivities. Again, we do not make this nutrient ourselves and we need it to function. If you are not eating it, you are not getting it.
Omega-3 deficiencies are difficult to measure with blood tests, but if you do not have a history of disordered eating and feel comfortable tracking your food for a week, you can probably figure out if you might be deficient. Or you can work with your doctor to figure out.
Some symptoms of omega-3 deficiency include
- dry eyes
- joint pain
- dry, brittle, or thinning hair
- mood changes and depression
- and dry skin or increased sensitivity to sun.
Notice how many of those symptoms are present in many autoimmune diseases or in aging adults, and how many have overlap with other deficiencies, like zinc or iron deficiency. Remember how we needed iron to convert between ALA, EPA, and DHA? If someone is anemic, or has low iron levels or stores, the body might prioritize making the iron go into cells for oxygen delivery as opposed to using it to convert fatty acids. And, given how EPA and DHA modulate inflammatory genes, I think there's something to be said for how limited diets can predispose people to more inflammation, which is unfortunate since this is already a vulnerable population. This might be one small part of the chicken or the egg situation for why people with conditions such as ADHD and Autism have such an increased risk for also having other autoimmune conditions.
Side note: This is another reason I'm really passionate about having a holistic approach to treatment and believe sleep and diet are a huge part of treatment approaches. If something is missing, we can use appropriate supplements and/or lifestyle changes to help fill it in, pending whatever the patient prefers or is emotionally and physically able to do.
While everyone's individual case is different and you should consult with your doctor if you are considering taking this, the general consensus via multiple studies is that an Omega-3 supplementation of 1 grams - 3 grams per day is ideal.
The Prosecution: Risks
But let's flip the coin here. As stated before, I truly believe that if something has a positive effect, it has, by definition, the ability to have a negative effect as well. Something cannot have ability to alter the body and its processes without there also being risk for negatively influencing something. Thus the phrase I've coined, "If it can help you, it can hurt you"
The most important and harmful side effect that fish oil supplements may result in is thinning of the blood and excessive bleeding. While this can be a desirable effect and potentially reduce risk from heart attack, if you are at risk of bleeding or already taking blood thinners, then you need to be careful.
If you take greater than 6 grams a day or mix the fish oil with high amounts of herbs, supplements, or medications that also thin your blood, like Vitamin E, garlic, warfarin (Coumadin), or aspirin, then your risk for excessive bleeding is higher. This is why we ask you to mention all supplements, as these can change how easily you bleed and can be dangerous if you are undergoing surgery or involved in trauma. If you notice more nosebleeds, bruising, or bleeding gums, let your doctor know right away. They might adjust your fish oil dosage.
Fish Oil may also decrease Vitamin E levels in the body due to increase oxidation. Essentially, the way Vitamin C is anti-oxidant, fish oil can be pro-oxidant, or something that has oxidative stress. The decrease in Vitamin E could be your body's way of balancing things out.
And let's not forget some of the less glamorous side effects of fish oil, like diarrhea, increased flatulence (farting/gas), and acid reflux (heartburn).
The Verdict: The Balanced Take
So, what's your take? Do you think the benefits of fish oil or Omega-3 supplements outweigh the risks? Maybe you'd prefer to get your Omega-3s from fish, being mindful of mercury levels, or perhaps you're now considering a supplement. Ultimately, the decision lies with you and your doctor.
My personal verdict? I believe the benefits of fish oil generally outweigh the risks, unless you're on blood thinners. But again, this is just my opinion, not medical advice. Always speak to your doctor before making a decision.
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Below I've listed some of my favorite high quality and good tasting fish oils, aka easier to swallow or without the fish burps. There are definitely some more potent ones I'd recommend for some people, but these are the ones I've had great patient experiences with. I think taste is just as important as quality, especially because if it doesn't taste good you're probably not going to keep with it, doubly so if you're already sensitive or picky with taste.
If you'd like more information and talk about some more points in the article, as always, please feel free to reach out.
Note: Some have affiliated links, and others do not. You can always reach out to me with questions.
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