Do We Need Supplements, And Do They Work?
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Does our diet need a little help?
We asked you for your take on supplements, and got the above-illustrated, below-described set of results.
- The largest minority of respondents (a little over a third) voted for “I just take something very specific”
- The next most respondents voted for “I take so many supplements; every little helps!”
- Almost as many voted for “I just take a vitamin or two / a multivitamin”
- Fewest, about 8%, voted for “I get everything I need from my diet”
But what does the science say?
Food is less nutritious now than it used to be: True or False?
True or False depending on how you measure it.
An apple today and an apple from a hundred years ago are likely to contain the same amounts of micronutrients per apple, but a lower percentage of micronutrients per 100g of apple.
The reason for this is that apples (and many other food products; apples are just an arbitrary example) have been selectively bred (and in some cases, modified) for size, and because the soil mineral density has remained the same, the micronutrients per apple have not increased commensurate to the increase in carbohydrate weight and/or water weight. Thus, the resultant percentage will be lower, despite the quantity remaining the same.
We’re going to share some science on this, and/but would like to forewarn readers that the language of this paper is a bit biased, as it looks to “debunk” claims of nutritional values dropping while skimming over “yes, they really have dropped percentage-wise” in favor of “but look, the discrete mass values are still the same, so that’s just a mathematical illusion”.
The reality is, it’s no more a mathematical illusion than is the converse standpoint of saying the nutritional value is the same, despite the per-100g values dropping. After all, sometimes we eat an apple as-is; sometimes we buy a bag of frozen chopped fruit. That 500g bag of chopped fruit is going to contain less copper (for example) than one from decades past.
Here’s the paper, and you’ll see what we mean:
Supplements aren’t absorbed properly and thus are a waste of money: True or False?
True or False depending on the supplement (and your body, and the rest of your diet)
Many people are suffering from dietary deficiencies of vitamins and minerals, that could be easily correctable by supplementation:
However, as this study by Dr. Fang Fang Zhang shows, a lot of vitamin and mineral supplementation does not appear to have much of an effect on actual health outcomes, vis-à-vis specific diseases. She looks at:
- Cardiovascular disease
- Cancer
- Type 2 diabetes
- Osteoporosis
Her key take-aways from this study were:
- Randomised trial evidence does not support use of vitamin, mineral, and fish oil supplements to reduce the risk of non-communicable diseases
- People using supplements tend to be older, female, and have higher education, income, and healthier lifestyles than people who do not use them
- Use of supplements appreciably reduces the prevalence of inadequate intake for most nutrients but also increases the prevalence of excess intake for some nutrients
- Further research is needed to assess the long term effects of supplements on the health of the general population and in individuals with specific nutritional needs, including those from low and middle income countries
Read her damning report: Health effects of vitamin and mineral supplements
On the other hand…
This is almost entirely about blanket vitamin-and-mineral supplementation. With regard to fish oil supplementation, many commercial fish oil supplements break down in the stomach rather than the intestines, and don’t get absorbed well. Additionally, many people take them in forms that aren’t pleasant, and thus result in low adherence (i.e., they nominally take them, but in fact they just sit on the kitchen counter for a year).
One thing we can conclude from this is that it’s good to check the science for any given supplement before taking it, and know what it will and won’t help for. Our “Monday Research Review” editions of 10almonds do this a lot, although we tend to focus on herbal supplements rather than vitamins and minerals.
We can get everything we need from our diet: True or False?
Contingently True (but here be caveats)
In principle, if we eat the recommended guideline amounts of various macro- and micro-nutrients, we will indeed get all that we are generally considered to need. Obviously.
However, this may come with:
- Make sure to get enough protein… Without too much meat, and also without too much carbohydrate, such as from most plant sources of protein
- Make sure to get enough carbohydrates… But only the right kinds, and not too much, nor at the wrong time, and without eating things in the wrong order
- Make sure to get enough healthy fats… Without too much of the unhealthy fats that often exist in the same foods
- Make sure to get the right amount of vitamins and minerals… We hope you have your calculators out to get the delicate balance of calcium, magnesium, potassium, phosphorus, and vitamin D right.
That last one’s a real pain, by the way. Too much or too little of one or another and the whole set start causing problems, and several of them interact with several others, and/or compete for resources, and/or are needed for the others to do their job.
And, that’s hard enough to balance when you’re taking supplements with the mg/µg amount written on them, never mind when you’re juggling cabbages and sardines.
On the topic of those sardines, don’t forget to carefully balance your omega-3, -6, and -9, and even within omega-3, balancing ALA, EPA, and DHA, and we hope you’re juggling those HDL and LDL levels too.
So, when it comes to getting everything we need from our diet, for most of us (who aren’t living in food deserts and/or experiencing food poverty, or having a medical condition that restricts our diet), the biggest task is not “getting enough”, it’s “getting enough of the right things without simultaneously overdoing it on the others”.
With supplements, it’s a lot easier to control what we’re putting in our bodies.
And of course, unless our diet includes things that usually can’t be bought in supermarkets, we’re not going to get the benefits of taking, as a supplement, such things as:
Etc.
So, there definitely are supplements with strong science-backed benefits, that probably can’t be found on your plate!
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This salt alternative could help reduce blood pressure. So why are so few people using it?
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One in three Australian adults has high blood pressure (hypertension). Excess salt (sodium) increases the risk of high blood pressure so everyone with hypertension is advised to reduce salt in their diet.
But despite decades of strong recommendations we have failed to get Australians to cut their intake. It’s hard for people to change the way they cook, season their food differently, pick low-salt foods off the supermarket shelves and accept a less salty taste.
Now there is a simple and effective solution: potassium-enriched salt. It can be used just like regular salt and most people don’t notice any important difference in taste.
Switching to potassium-enriched salt is feasible in a way that cutting salt intake is not. Our new research concludes clinical guidelines for hypertension should give patients clear recommendations to switch.
What is potassium-enriched salt?
Potassium-enriched salts replace some of the sodium chloride that makes up regular salt with potassium chloride. They’re also called low-sodium salt, potassium salt, heart salt, mineral salt, or sodium-reduced salt.
Potassium chloride looks the same as sodium chloride and tastes very similar.
Potassium-enriched salt works to lower blood pressure not only because it reduces sodium intake but also because it increases potassium intake. Insufficient potassium, which mostly comes from fruit and vegetables, is another big cause of high blood pressure.
What is the evidence?
We have strong evidence from a randomised trial of 20,995 people that switching to potassium-enriched salt lowers blood pressure and reduces the risks of stroke, heart attacks and early death. The participants had a history of stroke or were 60 years of age or older and had high blood pressure.
An overview of 21 other studies suggests much of the world’s population could benefit from potassium-enriched salt.
The World Health Organisation’s 2023 global report on hypertension highlighted potassium-enriched salt as an “affordable strategy” to reduce blood pressure and prevent cardiovascular events such as strokes.
What should clinical guidelines say?
We teamed up with researchers from the United States, Australia, Japan, South Africa and India to review 32 clinical guidelines for managing high blood pressure across the world. Our findings are published today in the American Heart Association’s journal, Hypertension.
We found current guidelines don’t give clear and consistent advice on using potassium-enriched salt.
While many guidelines recommend increasing dietary potassium intake, and all refer to reducing sodium intake, only two guidelines – the Chinese and European – recommend using potassium-enriched salt.
To help guidelines reflect the latest evidence, we suggested specific wording which could be adopted in Australia and around the world:
Recommended wording for guidance about the use of potassium-enriched salt in clinical management guidelines. Why do so few people use it?
Most people are unaware of how much salt they eat or the health issues it can cause. Few people know a simple switch to potassium-enriched salt can help lower blood pressure and reduce the risk of a stroke and heart disease.
Limited availability is another challenge. Several Australian retailers stock potassium-enriched salt but there is usually only one brand available, and it is often on the bottom shelf or in a special food aisle.
Potassium-enriched salts also cost more than regular salt, though it’s still low cost compared to most other foods, and not as expensive as many fancy salts now available.
It looks and tastes like normal salt.
Jimmy Dean/UnsplashA 2021 review found potassium-enriched salts were marketed in only 47 countries and those were mostly high-income countries. Prices ranged from the same as regular salt to almost 15 times greater.
Even though generally more expensive, potassium-enriched salt has the potential to be highly cost effective for disease prevention.
Preventing harm
A frequently raised concern about using potassium-enriched salt is the risk of high blood potassium levels (hyperkalemia) in the approximately 2% of the population with serious kidney disease.
People with serious kidney disease are already advised to avoid regular salt and to avoid foods high in potassium.
No harm from potassium-enriched salt has been recorded in any trial done to date, but all studies were done in a clinical setting with specific guidance for people with kidney disease.
Our current priority is to get people being managed for hypertension to use potassium-enriched salt because health-care providers can advise against its use in people at risk of hyperkalemia.
In some countries, potassium-enriched salt is recommended to the entire community because the potential benefits are so large. A modelling study showed almost half a million strokes and heart attacks would be averted every year in China if the population switched to potassium-enriched salt.
What will happen next?
In 2022, the health minister launched the National Hypertension Taskforce, which aims to improve blood pressure control rates from 32% to 70% by 2030 in Australia.
Potassium-enriched salt can play a key role in achieving this. We are working with the taskforce to update Australian hypertension management guidelines, and to promote the new guidelines to health professionals.
In parallel, we need potassium-enriched salt to be more accessible. We are engaging stakeholders to increase the availability of these products nationwide.
The world has already changed its salt supply once: from regular salt to iodised salt. Iodisation efforts began in the 1920s and took the best part of 100 years to achieve traction. Salt iodisation is a key public health achievement of the last century preventing goitre (a condition where your thyroid gland grows larger) and enhancing educational outcomes for millions of the poorest children in the world, as iodine is essential for normal growth and brain development.
The next switch to iodised and potassium-enriched salt offers at least the same potential for global health gains. But we need to make it happen in a fraction of the time.
Xiaoyue Xu (Luna), Scientia Lecturer, UNSW Sydney; Alta Schutte, SHARP Professor of Cardiovascular Medicine, UNSW Sydney, and Bruce Neal, Executive Director, George Institute Australia, George Institute for Global Health
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How Much Does A Vegan Diet Affect Biological Aging?
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Slow Your Aging, One Meal At A Time
This one’s a straightforward one today, and the ““life hack” can be summed up:
Enjoy a vegan diet to enjoy younger biological age.
First, what is biological age?
Biological age is not one number, but a collection of numbers, as per different biomarkers of aging, including:
- Visual markers of aging (e.g. wrinkles, graying hair)
- Performative markers of aging (e.g. mobility tests)
- Internal functional markers of aging (e.g. tests for cognitive decline, eyesight, hearing, etc)
- Cellular markers of aging (e.g. telomere length)
We wrote more about this here:
Age & Aging: What Can (And Can’t) We Do About It?
A vegan diet may well impact multiple of those categories of aging, but today we’re highlighting a study (hot off the press; published only a few days ago!) that looks at its effect on that last category: cellular markers of aging.
There’s an interesting paradox here, because this category is:
- the most easily ignorable; because we all feel it if our knees are giving out or our skin is losing elasticity, but who notices if telomeres’ T/S ratio changed by 0.0407? ← the researchers, that’s who, as this difference is very significant
- the most far-reaching in its impact, because cellular aging in turn has an effect on all the other markers of aging
Second, how much difference does it make, and how do we know?
The study was an eight-week interventional identical twin study. This means several things, to start with:
- Eight weeks is a rather short period of time to accumulate cellular aging, let alone for an intervention to accumulate a significant difference in cellular aging—but it did. So, just imagine what difference it might make in a year or ten!
- Doing an interventional study with identical twin pairs already controlled for a lot of factors, that are usually confounding variables in population / cohort / longitudinal / observational studies.
Factors that weren’t controlled for by default by using identical twins, were controlled for in the experiment design. For example, twin pairs were rejected if one or more twin in a given pair already had medical conditions that could affect the outcome:
❝Inclusion criteria involved participants aged ≥18, part of a willing twin pair, with BMI <40, and LDL-C <190 mg/dL. Exclusions included uncontrolled hypertension, metabolic disease, diabetes, cancer, heart/renal/liver disease, pregnancy, lactation, and medication use affecting body weight or energy.
Eligibility was determined via online screening, followed by an orientation meeting and in-person clinic visit. Randomization occurred only after completing baseline visits, dietary recalls, and questionnaires for both twins❞
~ Dr. Varun Dwaraka et al. ← there’s a lot of “et al.” to this one; the paper had 16 collaborating authors!
As to the difference it made over the course of the 8 weeks…
❝Various measures of epigenetic age acceleration (PC GrimAge, PC PhenoAge, DunedinPACE) were assessed, along with system-specific effects (Inflammation, Heart, Hormone, Liver, and Metabolic).
Distinct responses were observed, with the vegan cohort exhibiting significant decreases in overall epigenetic age acceleration, aligning with anti-aging effects of plant-based diets. Diet-specific shifts were noted in the analysis of methylation surrogates, demonstrating the influence of diet on complex trait prediction through DNA methylation markers.❞
~ Ibid.
You can read the whole paper here (it goes into a lot more detail than we have room to here, and also gives infographics, charts, numbers, the works):
Were they just eating more healthily, though?
Well, arguably yes, as the results show, but to be clear:
The omnivorous diet compared to the vegan diet in this study was also controlled; both groups were given a healthy meal plan for their respective diet. So this wasn’t a case of “any omnivorous diet vs healthy vegan diet”, but rather “healthy omnivorous diet vs healthy vegan diet”.
Again, the paper itself has the full details—a short version is that it involved a healthy meal kit delivery service, followed by ongoing dietician involvement in an equal and carefully-controlled fashion.
So, aside from that one group had an omnivorous meal plan and the other vegan, both groups received the same level of “healthy eating” support, guidance, and oversight.
But isn’t [insert your preferred animal product here] healthy?
Quite possibly! For general health, general scientific consensus is that eating at least mostly plants is best, red meat is bad, poultry is neutral in moderation, fish is good in moderation, dairy is good in moderation if fermented, eggs are good in moderation if not fried.
This study looked at the various biomarkers of aging that we listed, and not every possible aspect of health—there’s more science yet to be done, and the researchers themselves are calling for it.
It also bears mentioning that for some (relatively few, but not insignificantly few) people, extant health conditions may make a vegan diet unhealthy or otherwise untenable. Do speak with your own doctor and/or dietician if unsure.
See also: Do We Need Animal Products To Be Healthy?
We would hypothesize, by the way, that the anti-aging benefits of a vegan diet are probably proportional to abstention from animal products—meaning that even if you simply have some “vegan days”, while still consuming animal products other days, you’ll still get benefit for the days you abstained. That’s just our hypothesis though.
Take care!
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What’s So Special About Alpha-Lipoic Acid?
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The Access-All-Areas Antioxidant
Alpha-Lipoic Acid (ALA) is one of the most bioavailable antioxidants in existence. A bold claim, but most antioxidants are only water-soluble or fat-soluble, whereas ALA is both. This has far-reaching implications—and we mean that literally, because its “go everywhere” status means that it can access (and operate in) all living cells of the human body.
We make it inside our body, and we can also get it in our diet, or take it as a supplement.
What foods contain it?
The richest food sources are:
- For the meat-eaters: organ meats
- For everyone: broccoli, tomatoes, & spinach
However, supplements are more efficient at delivering it, by several orders of magnitude:
Read more: Lipoic acid – biological activity and therapeutic potential
What are its benefits?
Most of its benefits are the usual benefits you would expect from any antioxidant, just, more of it. In particular, reduced inflammation and slowed skin aging are common reasons that people take ALA as a supplement.
Does it really reduce inflammation?
Yes, it does. This one’s not at all controversial, as this systematic review of studies shows:
(C-reactive protein is a marker of inflammation)
Does it really reduce skin aging?
Again yes—which again is not surprising for such a potent antioxidant; remember that oxidative stress is one of the main agonists of cellular aging:
As a special feature, ALA shows particular strength against sun-related skin aging, because of how it protects against UV radiation and increases levels of gluthianone, which also helps:
- Photochemical stability of lipoic acid and its impact on skin ageing
- Modern approach to topical treatment of aging skin
Where can I get some?
We don’t sell it, but here for your convenience is an example product on Amazon
Enjoy!
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Which Tea Is Best, By Science?
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What kind of tea is best for the health?
It’s popular knowledge that tea is a healthful drink, and green tea tends to get the popular credit for “healthiest”.
Is that accurate? It depends on what you’re looking for…
Black
Its strong flavor packs in lots of polyphenols, often more than other kinds of tea. This brings some great benefits:
As well as effects beyond the obvious:
…and its cardioprotective benefits aren’t just about lowering blood pressure; it improves triglyceride levels as well as improving the LDL to HDL ratio:
The effect of black tea on risk factors of cardiovascular disease in a normal population
Finally (we could say more, but we only have so much room), black tea usually has the highest caffeine content, compared to other teas.
That’s good or bad depending on your own physiology and preferences, of course.
White
White tea hasn’t been processed as much as other kinds, so this one keeps more of its antioxidants, but that doesn’t mean it comes out on top; in this study of 30 teas, the white tea options ranked in the mid-to-low 20s:
White tea is also unusual in its relatively high fluoride content, which is consider a good thing:
White tea: A contributor to oral health
In case you were wondering about the safety of that…
Water Fluoridation: Is It Safe, And How Much Is Too Much?
Green
Green tea ranks almost as high as black tea, on average, for polyphenols.
Its antioxidant powers have given it a considerable anti-cancer potential, too:
- Green tea consumption and breast cancer risk or recurrence: a meta-analysis
- Green tea consumption and prostate cancer risk: a prospective study
…and many others, but you get the idea. Notably:
Green Tea Catechins: Nature’s Way of Preventing and Treating Cancer
…or to expand on that:
About green tea’s much higher levels of catechins, they also have a neuroprotective effect:
Green tea of course is also a great source of l-theanine, which we could write a whole main feature about, and we did:
Red
Also called “rooibos” or (literally translated from Afrikaans to English) “redbush”, it’s quite special in that despite being a “true tea” botanically and containing many of the same phytochemicals as the other teas, it has no caffeine.
There’s not nearly as much research for this as green tea, but here’s one that stood out:
However, in the search for the perfect cup of tea (in terms of phytochemical content), another set of researchers found:
❝The optimal cup was identified as sample steeped for 10 min or longer. The rooibos consumers did not consume it sufficiently, nor steeped it long enough. ❞
Read in full: Rooibos herbal tea: an optimal cup and its consumers
Bottom line
Black, white, green, and red teas all have their benefits, and ultimately the best one for you will probably be the one you enjoy drinking, and thus drink more of.
If trying to choose though, we offer the following summary:
- 🖤 Black tea: best for total beneficial phytochemicals
- 🤍 White tea:best for your oral health
- 💚 Green tea: best for your brain
- ❤️ Red tea: best if you want naturally caffeine-free
Enjoy!
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See what other 10almonds subscribers are asking!
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It’s Q&A Day at 10almonds!
Q: I would be interested in learning more about collagen and especially collagen supplements/powders and of course if needed, what is the best collagen product to take. What is collagen? Why do we need to supplement the collagen in our body? Thank you PS love the information I am receiving in the news letters. Keep it up
We’re glad you’re enjoying them! Your request prompted us to do our recent Research Review Monday main feature on collagen supplementation—we hope it helped, and if you’ve any more specific (or other) question, go ahead and let us know! We love questions and requests
Q: Great article about the health risks of salt to organs other than the heart! Is pink Himalayan sea salt, the pink kind, healthier?
Thank you! And, no, sorry. Any salt that is sodium chloride has the exact same effect because it’s chemically the same substance, even if impurities (however pretty) make it look different.
If you want a lower-sodium salt, we recommend the kind that says “low sodium” or “reduced sodium” or similar. Check the ingredients, it’ll probably be sodium chloride cut with potassium chloride. Potassium chloride is not only not a source of sodium, but also, it’s a source of potassium, which (unlike sodium) most of us could stand to get a little more of.
For your convenience: here’s an example on Amazon!
Bonus: you can get a reduced sodium version of pink Himalayan salt too!
Q: Can you let us know about more studies that have been done on statins? Are they really worth taking?
That is a great question! We imagine it might have been our recent book recommendation that prompted it? It’s quite a broad question though, so we’ll do that as a main feature in the near future!
Q: Is MSG healthier than salt in terms of sodium content or is it the same or worse?
Great question, and for that matter, MSG itself is a great topic for another day. But your actual question, we can readily answer here and now:
- Firstly, by “salt” we’re assuming from context that you mean sodium chloride.
- Both salt and MSG do contain sodium. However…
- MSG contains only about a third of the sodium that salt does, gram-for-gram.
- It’s still wise to be mindful of it, though. Same with sodium in other ingredients!
- Baking soda contains about twice as much sodium, gram for gram, as MSG.
Wondering why this happens?
Salt (sodium chloride, NaCl) is equal parts sodium and chlorine, by atom count, but sodium’s atomic mass is lower than chlorine’s, so 100g of salt contains only 39.34g of sodium.
Baking soda (sodium bicarbonate, NaHCO₃) is one part sodium for one part hydrogen, one part carbon, and three parts oxygen. Taking each of their diverse atomic masses into account, we see that 100g of baking soda contains 27.4g sodium.
MSG (monosodium glutamate, C₅H₈NO₄Na) is only one part sodium for 5 parts carbon, 8 parts hydrogen, 1 part nitrogen, and 4 parts oxygen… And all those other atoms put together weigh a lot (comparatively), so 100g of MSG contains only 12.28g sodium.
Q: Thanks for the info about dairy. As a vegan, I look forward to a future comment about milk alternatives
Thanks for bringing it up! What we research and write about is heavily driven by subscriber feedback, so notes like this really help us know there’s an audience for a given topic!
We’ll do a main feature on it, to do it justice. Watch out for Research Review Monday!
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The Dopamine Myth
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The Dopamine Myth
There’s a popular misconception that, since dopamine is heavily involved in addictions, it’s the cause.
We see this most often in the context of non-chemical addictions, such as:
- gambling
- videogames
- social media
And yes, those things will promote dopamine production, and yes, that will feel good. But dopamine isn’t the problem.
Myth: The Dopamine Detox
There’s a trend we’ve mentioned before (it got a video segment a few Fridays back) about the idea of a “dopamine detox“, and how unscientific the idea is.
For a start…
- You cannot detox from dopamine, because dopamine is not a toxin
- You cannot abstain from dopamine, because your brain regulates your dopamine levels to keep them correct*
- If you could abstain from dopamine (and did), you would die, horribly.
*unless you have a serious mental illness, for example:
- forms of schizophrenia and/or psychosis that involve too much dopamine, or
- forms of depression and/or neurodegenerative diseases such as Parkinson’s (and several kinds of dementia) in which you have too little dopamine
- bipolar disorder in which dopamine levels can swing too far each way
See also: Dopamine fasting: misunderstanding science spawns a maladaptive fad
Myth: Dopamine is all about pleasure
Dopamine is a pleasure-giving neurotransmitter, but it serves more purposes than that! It also plays a central role in many neurological processes, including:
- Motivation
- Learning and memory
- Motor functions
- Language faculties
- Linear task processing
Note for example how someone taking dopaminergic drugs (prescription or otherwise; could be anything from modafinil to cocaine) is not blissed out… They’re probably in a good mood, sure, but they’re focused, organized, quick-thinking, and so forth! This is not an ad for cocaine; cocaine is very bad for the health. But you see the features? So, what if we could have a little more dopamine… healthily?
Dopamine—à la carte
Let’s look at the examples we gave earlier of non-chemical addictions that are dopaminergic in nature:
- gambling
- videogames
- social media
They’re not actually that rewarding, are they?
- Gamblers lose more than they win
- Gamers cease to care about a game once they have won
- Social media more often results in “doomscrolling”
This is because what prompts the most dopamine is actually the anticipation of reward… not the thing itself, whose reward-pleasure is very fleeting. Nobody looks back at an hour of doomscrolling and thinks “well, that was fun; I’m glad I did that”.
See the science: Liking, Wanting and the Incentive-Sensitization Theory of Addiction
But what if we anticipated a reward from things that are not deleterious to health and productivity? Things that are neutral, or even good for us?
Examples of this include:
- Sex! (remember though, it’s not a race to the finish-line)
- Good, nourishing food (bonus: some foods boost dopamine production nutritionally)
- Exercise/sport (also prompts release of endorphins, win/win!)
- Gamified learning apps (e.g. Duolingo)
- Gamified health/productivity apps (anything with bells and whistles and things that go “ding” and measure streaks etc)
Want to know more?
That’s all we have time for today, but you might want to check out:
10 Best Ways to Increase Dopamine Levels Naturally ← Science-based and well-sourced article!
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