Nancy
Nancy, thirty-five, works as a high school counselor in the Berkshires. She has two boys under the age of ten. With all that going on, she rarely has time for exercise and she put on about fifty pounds over the past fifteen years. She also has disturbing digestive symptoms, which is why her local physician directed her to me. It didn’t take too long to discover that Nancy’s diet, otherwise fairly healthy, was loaded with gluten. With my guidance, she immediately eliminated that and she discovered a new world of gluten-free foods such as black-bean pasta and coconut wraps. After the first three months, she was beginning to slowly drop weight and her IBS symptoms abated somewhat. But her gut was still seriously off. She would go to work every day wondering if she could make it to a bathroom in time if the urge to go came out of the blue. I recommended Nancy take some sophisticated urine and stool tests to see if we could uncover any nasty microbes that might be responsible for her problem, but nothing showed up. It goes that way sometimes. I put her on a multi-strain probiotic and a broad-spectrum digestive enzyme supplement to ensure that the nutrients she consumed were being properly absorbed. It’s helped even if I can’t say why—neither her physician nor I can pinpoint exactly what’s wrong with her gut. But Nancy has gotten enough relief from her symptoms that she can invest her newfound energy in exercise, and she continues to reap the benefits of the dietary changes she has made. To date, she’s dropped twenty of the fifty pounds she intends to lose. She’s convinced that the probiotic has helped her drop the weight. I told her that the latest research on probiotics and weight loss suggests she may be right.
Living in a clean environment and eating fiber-rich plant foods to support the microbiota and adopting a sustaining lifestyle (we’ll discuss that in the next chapter), there’d hardly be a need to supplement anything! But, as you may have noticed, our world, and often our lifestyles, fall somewhat short of perfection. And so I’ve found, particularly with clients who have health vulnerabilities, a prudent use of supplements can be a strategic way to shore up a weight-loss or digestive healing program that may have sprung a few leaks. Nancy’s story is a great example.
But let me say up front: there is no one miracle digestive or weight-loss supplement that comes close to the power of “food as medicine.” I am a supplement minimalist! But, you may ask, what’s wrong with loading up on everything and anything that might possibly help you reach your goals? Here’s the answer. At least once a week, a client will come into my office and unload a shopping bag of supplements on my desk—all products that they have heard about from a well-intentioned friend, from a health food store employee, or from surfing the Web. These pills and powders are supposedly going to boost their metabolism, lift their brain fog, spark their lagging energy and fix their bloated belly. And yet when we carefully go over their food and supplement diaries, I often find that many of these supplements aren’t doing anything beneficial and may even be making their symptoms worse, not to mention depleting their finances! Willy-nilly, taking a smorgasbord nutrients and expecting the complex machinery of human metabolism to run better is naive.
Supplement Support
Now let’s talk about the right way to use supplements. It’s not about taking a random walk down the aisles at GNC or Vitamin Shoppe. Supplementation often requires the skill of a credentialed nutritionist or physician trained in integrative medicine, especially important if you’ve been diagnosed with a medical condition or are taking any medications. Together, you and your health care provider will come up with a strategy that considers only the supplements backed up by the strongest supporting research and that takes into account your personal medical history, family history, genetics, diet, medications and even lab findings. In this context, supplements can be a powerful tool to help soothe digestion, cool the fires of inflammation and stoke your energy.
Two of the most common questions that my clients ask:
How do I know if I need a supplement?
How can I tell if a supplement is working?
The body will sometimes provide physical clues in the form of various signs and symptoms that reflect unmet nutritional needs. For instance, a deficiency in B vitamins can lead to a wide range of symptoms in the mouth—a sore or inflamed tongue, gingivitis, or cracks in the corner of the mouth. Over time, it can lead to neurological problems or show up in subtler signs having to do with energy or hair or nails. There is no substitute for being mindful here and monitoring any significant changes in how you feel.
Frankly, it is often difficult, sometimes impossible, to know if a supplement is helping you. But by keeping track of when you take a supplement and how you feel, you may be able to find a pattern of benefit. Let’s say you marked down on your calendar that you started taking 250 mg of magnesium on September 20, when you were regularly having problems sleeping. On November 20, you write that insomnia is now only an occasional issue. On the flip side, this kind of log-keeping should be able to uncover if the supplement is causing side effects. Hopefully, they are mild and tolerable. If not, drop the supplement—theoretical benefit is never worth real-world harm. Here, digestive upset is probably the most common side effect. And sometimes herbal supplements can have a paradoxical effect as well. You take something to help you sleep and it keeps you up instead. Every person is biochemically different!
Laboratory tests have their place in the self-care universe. I’m talking about sophisticated tests that your physician may not give you when you come in for a checkup unless you specifically ask for them. In combination with the standard lab tests that measure kidney and liver function, they’ll give you and your health care provider a fuller picture of what’s going on in your body. They may well uncover evidence of a nutritional deficiency that can be addressed with the right supplement or of a health vulnerability that responds to the right combination of diet and supplements.
When it comes to weight and well-being, one test in particular leaps to my mind, the TSH, or thyroid stimulating hormone, test, which measures thyroid function (see the Swift Basic Prevention Tests). The thyroid gland is a kind of thermostat that regulates the metabolic rate of the entire body. When it slows down, from Hashimoto’s, a common autoimmune disease, or perhaps from assault by environmental toxins over time, the consequences can be a laundry list of symptoms, including, most prominently, weight gain and fatigue. Addressing low-thyroid with diet, supplements and, if necessary, medications is a book in itself, but the first place to start is with a TSH test, or better yet, a full thyroid panel. I get one every year.
But diagnostic testing doesn’t begin and end with thyroid. Let’s say you have a high level of C-reactive protein, a marker for systemic inflammation and a risk factor for heart attack. You would be wise to try botanicals like turmeric and ginger, and omega-3 fatty acid supplements, all of which have anti-inflammatory effects. High levels of homocysteine, a protein that is a marker for heart disease, can indicate that the body isn’t properly making use of the B vitamins it takes in. Taking supplemental B vitamins in the right form makes sense. For example, methylated forms of B12 (methylcobalamin) and folic acid (L-5-methyltetrahydrofolate) are more accessible to the body than some of the common forms tossed in multivitamins and B-complex vitamins.
I am often asked by clients, “What tests do you recommend my doctor order for me?” Here’s a list that I developed with my friend Dr. Cynthia Geyer, the medical director of Canyon Ranch in the Berkshires, that lays out the lab tests that we consider important baseline measurements for health and wellness. However, keep in mind that no one test is a tarot card for health or illness. We’re looking to find the patterns that emerge from analyzing all your laboratory data—it is critical for clinical decision making! Besides the tests, I’ve included a few thoughts on supplements to consider, in addition to dietary and lifestyle upgrades.
Swift Basic Prevention Tests
High-sensitivity C-reactive Protein (HsCRP) Test
What it measures:
Optimal Level:*
What it tells you:
Hemoglobin A1c (glycated hemoglobin) Test
What it measures:
Optimal level:*
What it tells you:
Fasting Insulin Test
What it measures:
Optimal level:*
What it tells you:
TSH (thyroid stimulating hormone) Test
What it measures:
Optimal level:*
What it tells you:
Vitamin D (serum 25-OH vitamin D) Test
What it measures:
Optimal level:*
What it tells you:
Serum Homocysteine Test
What it measures:
Optimal level:*
What it tells you:
Comprehensive Lipid Panel
What it measures:
Optimal level:*
What it tells you:
The Swift Supplement Prescription
The Swift supplement prescription is a collection of the nutraceuticals (another name for dietary supplements) that I have found most effective for helping to rebalance the digestive tract and supporting healthy weight management. I’ll include a brief overview with recommended dosages, along with some caveats and considerations. This will give you the lay of the land, but it’s not a substitute for the personal advice you receive from your health care provider. Before we jump in, take a close look at the sidebar on supplement “rules of the road,” below.
I’ve grouped the supplements that I commonly use with clients into three groups: Weight Loss and Digestive Health; Digestive Health; Overall Health.
Weight Loss and Digestive Health
Fiber Supplements
It’s certainly a seductive idea: weight loss in a pill! Both pharmaceutical and nutraceutical companies pursue it like the holy grail, and why not? Consumers desperate to lose weight are spending billions of dollars annually on weight-loss products. However, the academic researchers who have looked at these products have been underwhelmed. For instance, a 2009 study in the World Journal of Gastroenterology reanalyzed seventy-seven studies on weight-loss aids and concluded, “lifestyle modification is still the safest and efficacious method of inducing a persistent weight loss.”
I’ll endorse that in a heartbeat! (And remember, by “lifestyle modification,” they’re including diet.) But the evidence that a select few types of supplements can enhance weight loss has gotten a lot stronger in the past few years. Number one on my list of nutraceutical allies are fiber supplements. A more recent review of dietary supplements and weight management found that these fiber supplements—psyllium, for instance—could potentially play a valuable supporting role, mostly by suppressing appetite.
This dovetails with my clinical experience. The vast majority of my clients don’t need fiber supplements to manage their hunger—the meal plans and the recipes that you’ll find in the Swift Diet take care of that. I’m much more likely to recommend a fiber product for digestive health—they’re a great natural way to address elimination problems (constipation or diarrhea). But for some weight-loss clients, hunger is an issue. They’ll come to me and say, “I’m desperate; I need a supplement!” I suggest that they take a fiber supplement before meals along with a large glass of water. These supplements are not a magic bullet. They can have side effects; for instance, increasing gas and bloating and generally gumming up the works if you’re not careful to drink plenty of fluids. But for the client at her wit’s end, they can provide an extra, and relatively inexpensive, push that sometimes makes a big difference.
Recall that in previous chapters we learned that plant foods contain fermentable fibers, prebiotic fibers that support gut health and weight loss, thanks to their beneficial effect on the gut microbiome. The fiber supplements that we’re talking about here have a preponderance of insoluble fibers that pass through the system more quickly, within a day or so. Because fiber is always a matrix of different subtypes, these supplements likely have a mildly beneficial prebiotic effect as well, if nothing on the order of a serving of asparagus. But the major payoff is the appetite suppression—the stuff takes up a lot of room in the gut—and the enhancement of regularity. These supplements also bind with excess cholesterol and excrete it out of the system, lowering blood cholesterol and, by slowing down digestion, keeping blood sugar levels stable. The type of fiber supplement that you choose depends on the outcome you are hoping to achieve, something you’ll want to discuss with your health care provider. The following list describes some common types of fiber supplements that I use most often in my practice.
Acacia fiber
Derived from the acacia senegal plant, acacia fiber is also known as gum acacia or gum arabic.
Benefit: Soluble fiber is a bulking agent; it can be used for constipation and to help with passage of complete bowel movements.
Favorite Brand: Renew Life Organic Clear Fiber
Psyllium seed husk
Derived from the plant Plantago ovata, also known as psyllium, ispaghula or isabgol.
Benefit: Partially fermentable (70 percent soluble); bulk-forming and helpful to improve and maintain GI motility; also useful in blood sugar and cholesterol management.
Favorite Brands: Frontier Natural Products Organic Psyllium Husk, whole or powdered; Konsyl Original Formula
Konjac root (glucomannan)
A component of the cell walls of the konjac plant, a water-soluble fiber.
Benefit: Useful for lowering cholesterol and blood sugar; may also help with constipation and weight loss.
Favorite Brand: PGX Natural Factors
Modified Citrus Pectin and PectaSol
A form of pectin found in many fruits and vegetables, especially in the peel of citrus fruits, apples and plums.
Benefit: Form of soluble fiber that is more easily absorbed in the digestive tract, which may help with reducing diarrhea, reducing cholesterol levels and increasing excretion of toxic metals (for example, mercury, lead and arsenic) in the body.
Favorite Brands: EcoNugenics PectaSol-C Modified Citrus Pectin; NutriCology Modified Citrus Pectin
“Mixed” Fiber Formulas
A mix of different fiber ingredients; some of these products may also contain herbal ingredients (such as prune, apple, inulin, oat bran, agar, guar gum, etc.)
Benefit: Varies with the type of product selected and can be used to manage weight, blood sugar, cholesterol and GI symptoms.
Favorite Brands: Metagenics MetaFiber; Thorne MediBulk; Garden of Life Raw Fiber
Troubleshooting
Probiotics
Like fiber supplements, probiotics can do double duty, enhancing both digestive health and weight loss. Professor Angelo Tremblay, a world leader in obesity research and the lead author of the Canadian probiotic study I talked about in Chapter 1, thinks that a significant part of the weight-loss effect comes from the probiotic’s effect on the gut bacteria that influence the hormones that regulate appetite. The women on the probiotic supplements in his study lost more weight, he believes, because they were less hungry, so consequently they ate less. Another team of French researchers from the University of Rouen takes this idea further. They speculate that the microbiome may directly influence our food preferences. In effect, bad bacteria stimulate our appetite for the bad food that feed them and make us fat. The good bacteria, the kind helped by the probiotics, push our appetite in the opposite direction, toward nutritious, high-fiber foods. It does make you wonder who’s in charge here.
So we have a glimpse of a fast-approaching future where we’ll be able to confidently leverage the power of the microbiome for weight loss. Clearly, we’re still in the experimental stage now. What are the best weight-loss-promoting bacterial strains? How best to combine them? These questions are being studied with some urgency, since probiotics look to deliver weight-loss enhancement with minimal side effects, compared to popular and potentially dangerous over-the-counter or pharmaceutical products that act as stimulants and rev up the central nervous system or cause malabsorption of important nutrients. But probiotics have been more extensively studied for digestive health, and I’m more likely to recommend them to my clients for that reason. If you’re taking probiotics to rebuild your gut bacteria after a course of antibiotics or to address symptoms of gut upset and you’re able to track a weight-loss effect, consider yourself part of a discovery process at the frontiers of scientific weight management!
Let’s review. The official definition of a probiotic supplement is a “product that contains live microorganisms and when taken in adequate amounts confers a health benefit to the host.” In Chapter 4, you learned about nourishing your digestive tract with traditional fermented foods, the original food-sourced probiotic therapy! On the supplement front there is evidence supporting the benefit of probiotics for a wide range of gut-related symptoms and disorders, such as food allergies, constipation, diarrhea, irritable and inflammatory bowel disease (ulcerative colitis and Crohn’s). In addition, probiotics show promise in the treatment of a much broader constellation of conditions including allergies, asthma, autism, high cholesterol, genitourinary infections and rheumatoid arthritis. Ongoing research is looking at the role of “synbiotics,” a combined formula containing a prebiotic such as inulin and a probiotic or probiotic mix of microorganisms. You may need to experiment with different types of probiotics to find the right match for your digestive tract.
I have included a list on the next page that outlines the main clinical benefits of some common probiotic products. In addition to these products, a number of dietary supplement companies have their own probiotic lines.
CULTURELLE
Microorganism strain(s): Lactobacillus casei subsp. rhamnosus GG
Clinical benefit: Prevents rotavirus-related diarrhea in children; GI disorders in children
FLORASTOR
Microorganism strain(s): Saccharomyces boulardii (a probiotic yeast)
Clinical benefit: For travelers and antibiotic-associated diarrhea; IBS and IBD, Crohn’s; recurrent C. difficile infection
ALIGN
Microorganism strain(s): Bifidobacterium infantis 35624
Clinical benefit: Supports healthy digestive system
BIO-K+
Microorganism strain(s): Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R
Clinical benefit: For general digestive health
VSL#3
Microorganism strain(s): 4 strains of lactobacillus (L. casei, L. plantarum, L. acidophilus, L. delbrueckii subsp. Bulgaricus); 3 strains of bifidobacterium (B. longum, B. breve, B. infantis), 1 strain of Streptococcus salivarius subsp. thermophilus
Clinical benefit: For treatment of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD); pouchitis
Troubleshooting
Swift Notes
Digestive Health
Betaine Hydrochloride (Betaine HCL/Trimethylglycine)
This is a manufactured form of hydrochloric acid that, when taken as a supplement, increases the amount of this digestive acid working in the stomach. Why would we want that? Don’t people take over-the-counter and prescription drugs to reduce the stomach acid that causes gastric reflux? The truth is, while popping a pill to tamp down heartburn after an occasional over-spicy meal isn’t a federal offense, the long-term use of acid-suppression drugs to deal with chronic stomach irritation is a misguided strategy. As we age, the stomach produces less hydrochloric acid, which we need for a host of reasons: it maintains the acid environment in the gut, which keeps harmful bacteria and other pathogens at bay; it triggers the release of pepsin and other enzymes necessary for digestion, especially of protein; it aids with the digestion and absorption of nutrients—so insufficient hydrochloric acid sets the stage for serious nutrient deficiencies in vitamin B12, magnesium, iron, calcium and zinc.
Dosages: Betaine HCL capsules vary in dose. Start with one capsule of 350 mg Betaine HCL at the beginning of each meal. Monitor and gradually increase to effective dosage.
Troubleshooting
Swift Notes: I consider HCL adequacy in all of my patients over fifty and especially those with chronic symptoms of deficiency such as bloating, belching, undigested food in stools and skin disorders. I continue to be amazed how often this simple supplement strategy pays dividends. But it often requires a lot of convincing, since most people think the problems they have are due to excess, not insufficient, stomach acid!
Deglycyrrhizinated Licorice (DGL)
DGL soothes the digestive system by promoting the body’s production of mucus that coats the stomach and intestine, and it can be safely used for treating gastroesophageal reflux (GERD), canker sores and gastritis. Licorice root (Glycyrrhiza glabra) has been used in both Eastern and Western medicine for thousands of years to treat a variety of disorders, ranging from asthma to liver disease. But DGL is a special type that has had the glycyrrhizin removed (hence “deglycyrrhizinated”), a compound that can cause serious side effects, such as elevated blood pressure, lowered blood potassium (hypokalemia) and edema. Sometimes referred to as the “lining tamer,” DGL is available in both capsules and lozenges.
Dosage: DGL lozenge (extract 4:1): Chew 300 to 400 mg, two to three times daily, ten to twenty minutes before meals.
Troubleshooting
Swift Note: I recommend DGL on a short-term basis to help clients troubled by heartburn and reflux, often to taper off medications, in consultation with their physician. I usually recommend a thirty-day trial and then reevaluate based on the response—it doesn’t work for everybody. Some clients will use a DGL lozenge only on occasion, for the occasional gastric flare-up.
Digestive Enzymes
The digestive tract secretes a number of enzymes that help break down food into smaller molecules so that it can be more easily digested and eventually absorbed. That is, except when the body happens not to have enough of a particular necessary enzyme. If you’re lactose intolerant, for example, you don’t have enough of the lactase enzyme to break down the milk sugars in dairy and the result is gas, bloating and abdominal discomfort. As we discussed in Chapter 3, a number of foods can provoke these kinds of reactions, but fortunately we can supplement our body’s natural enzyme supply to lessen, sometimes even get rid of, these adverse food reactions.
The enzyme supplements I usually recommend to my clients come from plant sources—bromelain from pineapple, papain from papaya, ficain from fig and actinidin from kiwi, to name a few. But enzymes derived from animal and microbial sources have their place for certain problems. In general, fat maldigestion can be improved with lipase supplementation—lipases are responsible for the breakdown of lipids. Proteases or proteolytic enzymes help break down protein foods. Specific proteases can be helpful in reducing the symptoms associated with dairy and wheat intolerances. Researchers are looking at supplemental enzymes that contain dipeptidyl peptidase IV (DPP-IV), which may have therapeutic value in breaking down gluten and casein, a milk protein.
Gut-related disorders and adverse food reactions have been stealthily on the rise, and the systemic inflammation caused by leaky gut is a prime suspect. Histamine intolerance is an increasingly recognized sensitivity to a common chemical found in a wide range of foods, including alcohol, fish, aged cheeses and egg whites, and it’s produced by our bodies as well. The enzyme that breaks down histamine is called diamine oxidase (DAO), also made by our bodies. In addition to modifying your diet to lower the histamine load, DAO enzyme supplementation can also be helpful.
Although we have a lot more to learn about digestive enzymes and their effects on health, a broad-spectrum or multienzyme product can be of benefit in a wide range of gut-related disorders.
Dosages: Plant-based enzymes: Start with one capsule or tablet at the beginning of a meal or snack. This can be increased to two caps or tablets per meal.
Troubleshooting
Swift Notes: Some enzyme formulas might also contain botanicals such as quercetin, a bioflavonoid that can tamp down the response to environmental allergens.
Ginger (Zingiber officinale)
Ginger is probably best known for its use as a motion sickness aid, but it’s also shown promise for treating osteoarthritis, vertigo, dysmenorrhea, morning sickness and a wide range of gastrointestinal symptoms. Different chemical compounds are responsible for ginger’s gut-protective effects. Some reduce inflammation in the gastrointestinal tract; some calm down the nervous system and may enhance gut motility, and hence regularity. Ginger may also have cholesterol- and blood-sugar-lowering effects, and it is being looked at as a complementary therapy for weight management.
Dosage: The dose depends on the condition being treated. For gastro-protective effects, I usually recommend starting with 250 mg taken three times daily and increase gradually up to 1 to 2 grams daily.
Troubleshooting: Because ginger has blood-thinning (antiplatelet) effects, it can increase the risk of bleeding in some people, although I have rarely encountered this in practice. A number of other dietary supplements can do something similar—omega-3 fatty acids, garlic, angelica, clove, gingko, Panax ginseng, red clover, turmeric—so review with your health care provider any cumulative effects and any potential ginger–prescription medication interactions.
Swift Note: There are certainly other ways to get ginger besides supplements! Brew some strong ginger tea, add freshly grated or dried ginger to your favorite recipes, including salad dressings, soups, stews and main dishes. But it takes a lot of fresh ginger to have a therapeutic effect, so when I want a greater digestive healing boost for an irritable bowel, I recommend ginger capsules.
Peppermint (Mentha piperita)
Peppermint contains menthol, a volatile oil and a popular ingredient in gum, teas, toothpaste, and cosmetics. It’s a calming agent for the skin and gastrointestinal tract since it relaxes the muscles of the stomach and improves the flow of bile, which helps with fat digestion. Several studies have shown that enteric-coated peppermint capsules can effectively treat IBS symptoms such as bloating, gas, pain and diarrhea. So, peppermint is often my first “go to” supplement for IBS.
Dosage: For IBS, use enteric-coated peppermint capsules, 0.2 to 0.4 ml, three times a day, with food.
Troubleshooting
Swift Note: I have worked with many clients who suffered from IBS for years, unaware that peppermint might be helpful. One of my patients wasn’t open to taking supplements but was willing to try peppermint tea. She started sipping on peppermint tea (three teabags per cup!) between meals, and after a few weeks she reported that she was hooked on it—she felt it helped keep her gas and bloating symptoms under control. Some medical practitioners also treat digestive complaints by rubbing a few drops of peppermint oil on the belly, counterclockwise and down in the direction of the transverse and descending colon to help stool movement and elimination. I know a few who swear by it!
Overall Health
Magnesium
Magnesium is a magnificent mineral that actively participates in hundreds of biochemical reactions that impact our mood, muscles, nerves, bones, blood sugar, digestive health, weight and even our ability to detoxify! Although it is widely distributed in many plant foods, especially dark greens, beans, legumes, nuts and seeds, our soils may not be as rich in this vital mineral as they used to be. Most people just don’t get enough. And too much alcohol, prolonged stress and a number of medications, including oral contraceptive agents, lower magnesium levels. It’s also important to note that many medical conditions upset magnesium balance, especially gut disorders such as irritable bowel syndrome, liver disease (cirrhosis) and ulcerative colitis. Symptoms of magnesium deficiency are diverse and can include irritability, anxiety, depression, fibromyalgia, chronic fatigue, muscle spasms and weakness, migraines, restless leg syndrome (RLS), low blood pressure, abnormal heart rhythms, poor nail growth, nausea, constipation and sleep problems. Take note of that last one. A magnesium supplement can make a great sleep aid. No knockout pill, no hangover, just a relaxing way to encourage and enhance sleep.
Dosage: The type and dosage of magnesium depends on the condition being treated, so I’m focusing on just a few gut-related symptoms here.
Constipation: Magnesium citrate, start with 250 mg/day with food and increase up to 6,000 mg/day until good bowel function resumes.
To improve magnesium status: Magnesium glycinate, 125 to 250 mg per day with food
Sleep: Magnesium glycinate, 125 to 250 mg at bedtime
Troubleshooting
Swift Note: For years, I practiced as a renal dietitian, and the kidney remains near and dear to me. Anyone with reduced kidney function should check with their physician before using magnesium supplements, due to an increased risk of elevating your blood magnesium level (hypermagnesemia).
Omega-3 Fatty Acids
As we discussed in Chapter 4, the omega-3s, one type of polyunsaturated fatty acids (PUFAs), are essential fatty acids. You’ve got to get them from food sources, and because a lot of people don’t eat much fish, the richest source, there’s a case to be made for fish oil supplements. As with any supplement, I tailor my fish oil recommendation to the individual. If you’re eating two or three servings of fish a week, supplements may not be necessary. But let’s say you’re not a fish eater. Or you’re showing signs of inflammation that might show up on the lab test for C-reactive protein or in symptoms that might range from gut disorders to joint and skin problems. Then the omega-3s can be a powerful tool in your supplement toolbox. While the research record isn’t as bulletproof as we once thought, there’s still very good evidence for them as anti-inflammatory agents that support immune, cardiovascular, joint and brain health. In other studies, they show promise helping to treat inflammatory bowel disease, hypertriglyceridemia (high triglyceride levels), high blood pressure and rheumatoid arthritis and supporting healthy infant development in pregnancy.
Supplements can be manufactured from animals (fish) or plants (seed oils, algal sources). Fish oils contain the preferred and “preformed” omega-3s (EPA and DHA), while the body must convert the plant omega-3 (ALA) into EPA and DHA, which it does very inefficiently.
There are two main groups of omega-3 fatty acid supplements:
Fish Oil
Plant Seed Oils
Dosage: A wide range of dosages are used, depending on the condition. I usually recommend between 1,000 and 2,000 mg per day for non-fish eaters, taken at a meal that includes some healthy fat. Higher doses of fish oils in the range of 2 to 10 grams per day may be recommended based on the individual’s health status and dietary intake. For vegans, 400 to 600 mg a day of algae-based DHA supplements in combination with nuts and seeds is a workable strategy.
Troubleshooting
Swift Note
Vitamin D
Vitamin D is the sunshine vitamin—our bodies are able to synthesize it from sunshine in large amounts during the warm-weather months. And we can get it in smaller amounts from food sources and, if that’s not sufficient, in supplement form. All told, it’s a multitasking fat-soluble vitamin involved in immunity, bone health, cardiovascular health, cancer prevention, mood, depression, neurological disorders such as multiple sclerosis (MS) and even obesity—a busy hormone and micronutrient! Research continues to uncover the mechanisms by which this critical nutrient affects so many things beyond bone health and even decreases the overall death rate (“all-cause mortality”). But as a clinician, I can tell you that vitamin D supplements, for people with chronically low D levels, can make a major difference in their health status. Clients will sometimes tell me they feel more energetic; they’ll say they’re amazed how few winter colds they caught.
Vitamins and minerals “cross-talk,” so we have to consider D’s balance within the entire nutrient symphony. The recommended allowance for vitamin D established by the Food and Nutrition Board of the Institute of Medicine is 600 to 800 IUs per day for adults. A “tolerable upper limit” has been established at 4,000 IUs. I think the best advice is to “test, don’t guess.” Most research suggests that achieving a serum 25-OH vitamin D level of greater than 20 ng/mL is adequate. However, many integrative doctors suggest an optimal range of 32 to 80 ng/mL.
There are two dietary forms of vitamin D: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). Vitamin D is found naturally in foods such as fatty fish (salmon, mackerel, tuna, sardines, herring); cod liver oil and eggs. It’s also added to fortified foods such as dairy (milk, yogurt, cheese, etc.), nondairy beverages (almond, soy, etc.), grain products (cereals) and other functional foods such as energy bars and drinks. Recently, white button mushrooms have been used to harvest vitamin D from UV light.
Dosage: The right dose should be based on achieving an optimal serum vitamin D level of at least 20 ng/mL. You should have your vitamin D level checked at least twice each year, in the spring and fall. If your level is low, start with 2,000 IUs vitamin D3 (cholecalciferol) taken with a meal that has some healthy fat in it. Ask your doctor to recheck your level in three months to make sure you are in an optimal range. And be sun smart—“incidental” sunlight exposure for as little as ten to fifteen minutes per day can help improve your vitamin D status.
Troubleshooting
Swift Note: My mom had rickets, the classic vitamin D deficiency disease, when she was a toddler, so this vitamin has always intrigued me. And I’m happy to see an increase in the number of people who are having their D levels checked. A few years ago, when I asked large groups of health professionals if anyone had had their levels checked, only a few hands would go up. In the past couple of years, that’s gone up to a third or more of the audience. That’s progress, but not good enough, considering vitamin D’s far-reaching effect on our health.
Zinc
Zinc can be a paradox. It’s one of the most common mineral deficiencies in the Western diet, and low concentrations of it have been associated with elevated levels of fat in the blood, inflammation, insulin resistance and obesity. On the other hand, probably because it’s been shown to be able to reduce the duration and severity of the common cold, some people overdo it with the supplementation. I had one patient who came to me for severe nausea and significant unintentional weight loss, convinced that she had cancer. When I discovered that between her multivitamin-mineral and her other supplements she was taking more than 150 mg of supplemental zinc daily, I told her to discontinue all supplements for a week. The following week she called me in tears. For the first time in over a year, she had no nausea and felt that she could eat again!
But in the proper amounts, we need zinc for the regulation of blood sugar and for myriad other body processes: vision, thyroid function, brain health, reproductive fitness, wound healing and immunity. Zinc has antioxidant properties and acts as a cellular guardian by scavenging harmful free radicals. Many conditions increase the body’s need for zinc, including gastrointestinal disorders such as celiac disease, ulcerative colitis and Crohn’s disease. When our bodies don’t get enough zinc, the symptoms can be all over the map and include lack of taste and smell, depression, poor wound healing, hair loss, night blindness and skin changes such as acne, dermatitis and psoriasis.
Rich food sources of zinc include animal foods such as shellfish (especially oysters), red meat, poultry and cheese. It’s also found in plant foods, including legumes like the soy foods tofu and miso, whole grains, greens and seeds (pumpkin, sesame and sunflower). However, the anti-nutrient phytate in plants can interfere with absorption of zinc. The Swift Diet offers the best of both worlds—limited amounts of animal protein and some fermented foods that help disarm the phytate and enhance the availability of minerals like zinc.
There are many different types of supplemental zinc available—lozenges, capsules, nasal sprays. Zinc sulfate is often the least expensive form but can cause stomach upset. I use zinc citrate to supplement dietary intake and use a special form of zinc called zinc carnosine as a healing agent for gastrointestinal symptoms including inflammation, dyspepsia and GERD.
Dosages: The dosage depends on the condition you are treating. For the common cold: at the first sign of symptoms, take a zinc lozenge, every two to three hours, up to 40 mg zinc daily. For general wellness, take zinc citrate, 15 mg daily. For digestive healing, zinc carnosine, 75 mg daily (17 to 18 mg elemental zinc/58 mg L-carnosine).
Troubleshooting: Like most vitamins and minerals, zinc interacts with other nutrients—too much zinc can cause a copper imbalance, for instance. Zinc also interacts with a number of medications, such as blood-pressure drugs, thiazide diuretics, antibiotics, chemotherapy agents and immunosuppressant medications. Toxicity is also a potential concern at high doses.
Closing Thoughts
The dietary supplement industry is big business, and marketing claims are plentiful and enticing, especially to the person struggling with health issues. While this chapter isn’t (and shouldn’t be) a precise road map for using supplements to support digestive health and weight loss, I’ve given you some ideas that I hope will be useful on the journey you’ll take with your personal health care provider.