Be Careful With Supplements

      54 Comments on Be Careful With Supplements

Whew. I believe I finally have my speech for the Weston A. Price annual conference written. I gave a speech on Diet, Health and the Wisdom of Crowds at a college almost five years ago, but I thought it was due for an update. Something like a third to a half of this one will be different.

While I was busy working on the speech, this BBC article about a guy who damaged his liver with a common supplement landed in my inbox. Let’s take a look:

It should have been one of the happiest days of his life. But Jim McCants looks back on his youngest son’s high school graduation with mixed emotions. As he sat down next to his wife Cathleen in the university auditorium, just outside Dallas, Texas, she turned to look at him.

“She said ‘Do you feel OK?'” Jim recalls. “I said, ‘Yeah I feel fine, why?’ ‘Your face is yellow, your eyes are yellow, you look terrible.’ When I looked in the mirror it was shocking.”

It was shocking partly because Jim, then 50, had been working on improving his lifestyle and losing weight, focusing on eating more healthily and taking regular exercise.

But soon after his son’s graduation, Jim was admitted to hospital with a suspected liver injury.

Trying to identify the cause of Jim’s liver injury, those treating him ruled out alcohol.

“For the last 30 years I drank maybe a six-pack of beer a year, no wine. So alcohol was not a big part of my life,” Jim says.

They also ruled out prescription drugs – he wasn’t taking any at the time – and smoking, something he had never done.

“Then my hepatologist drilled in to, ‘What about any over-the-counter supplements?'” says Jim.

As part of his mid-life health kick, Jim had started taking a green tea supplement because he had heard it might have cardiac benefits. These supplements have grown in popularity in recent years, often breathlessly promoted online for their antioxidant benefits, and their supposed ability to aid weight loss and prevent cancer.

The article doesn’t say how many green-tea pills Mr. McCants was swallowing per day. I assume he was taking rather large doses. Other people have apparently done likewise:

While millions of people take green tea supplements safely, at least 80 cases of liver injury linked to green tea supplements have been reported around the world, ranging from lassitude and jaundice to cases requiring liver transplants. Those harmed after taking green tea pills have included teenagers, like 17-year-old Madeline Papineau from Ontario, Canada who developed liver and kidney injury, and an 81-year-old woman diagnosed with toxic acute hepatitis.

A total of 80 reported cases around the world isn’t what I’d call crisis proportions, but the article is a reminder to be cautious with supplements. Just because a supplement is extracted from a plant that won’t hurt you, that doesn’t mean it’s safe to start slamming down pills.

[Addition on October 30: a reader provided a link to this video in comments.  It’s worth adding to the post.]

More than 30 years ago, I was hired as a freelancer to write a brief biography of Dr. Wallace Abbott, who founded what eventually became Abbott Laboratories. Dr. Abbott first developed drugs by learning to take plants with medicinal properties and concentrate them. That’s how most drugs were created back in the day. So when you’re taking that plant-extract pill, keep in mind it’s a drug of sorts.

Or put it this way: if you’re taking a supplement to change your body chemistry in a positive way, too much can change your body chemistry in a negative way.

One of the mistakes people make with both supplements and foods is thinking that if some is good, more is better. Or conversely, if less is good, zero is better.

Paul Jaminet covered that topic quite nicely in the Perfect Health Diet book. He pointed out that for every nutrient – vitamins, minerals, protein, fats, and yes, even glucose – there’s an optimal intake. If you don’t get enough, you aren’t as healthy as you could be. If you ingest too much, it causes damage. Even water will kill you if you drink too much of it.

So what’s the ideal intake? That of course depends on the individual. A body-builder’s ideal intake of protein isn’t the same as a sedentary grandmother’s.  A diabetic’s ideal intake of carbohydrates isn’t the same as a competitive sprinter’s.

Back in a 2015 post, I wrote about Jordan Ellenberg’s book How Not to Be Wrong: The Power of Mathematical Thinking. Although he wasn’t writing about nutrients, Dr. Ellenberg makes the same point as Paul Jaminet: when we only focus on the upside or the downside of something, we see a line. Something like this:

But the answer to many “is it good or is it bad?” questions actually looks like a curve. Something like this:

More is good up to a point.  But then even more causes damage.

That’s why I don’t melt sticks of butter in my morning coffee. Yes, it was a great relief to learn that saturated fats and cholesterol won’t kill me and are, in fact, beneficial as part of a whole-foods diet. But that doesn’t mean the more saturated fat I manage to swallow each day, the healthier I’ll be. Your body needs what it needs. It doesn’t need more than it needs and may not know what to do with the excess.

Getting back to supplements, yes, I take some. I take a multivitamin, vitamin D3, CoQ10, magnesium and Carlson’s cod liver oil. What I’m attempting to do with those supplements is replace some of the nutrients I’d be getting naturally if I lived in the wild, hunted and gathered my own food, and ran around half-naked in warm weather.

But before taking any of them, I did quite a bit of reading on what the proper dose should be for my age, size and health status.

I hope you’re doing the same if you take supplements.


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54 thoughts on “Be Careful With Supplements

  1. Jennibc

    How are you able to determine what the optimal level of anything is? We can’t trust the government recommendations. Trying to google things doesn’t necessarily help because it’s difficult to know which sources to trust. While I don’t melt butter in my coffee, I do use heavy cream and that comment about the too much saturated fat has me a bit alarmed. How would I determine how much saturated fat in my diet is too much? Thanks!

    1. Tom Naughton Post author

      I don’t go by RDAs … those are just enough to prevent disease. I look for articles by people I’ve come to trust, like Dr. Jonny Bowden and Chris Kresser.

      I don’t know how much saturated fat is too much. That would depend on the individual. But I know our paleo ancestors weren’t putting sticks of butter in coffee or otherwise adding loads of extra fat to their foods. I think the key is to avoid thinking the more fat in the diet, the better. Cook with good fats, eat the fat that comes with the food, but no need to pile it on.

        1. Tom Naughton Post author

          Nope. I sometimes add bit of coconut oil to my coffee and froth it up, but I don’t think we need to swallow spoonful after spoonful of the stuff.

      1. Jennibc

        Well dang, my favorite meal of the day is coffee with heavy cream! So for a further question, what should I be looking for to know whether I must give it up? Even based on the current standards, all my lipids values are optimal. Although my HDL is high and that USED to be a good thing, but now I am reading that it might not be. And I have lost a lot of weight and am continuing to lose slowly and really don’t want to rock the boat too much as I am almost to my goal.

        1. Tom Naughton Post author

          To be clear, I’m not telling people to avoid heavy cream in coffee. I’m pointing out that we need to avoid thinking that if some is good, more is better … whether we’re talking about fats, vitamins or supplements.

  2. Tom Welsh

    D3 and magnesium sound good. We also take K2 every day, as it is supposed to work with D3 and magnesium – assuming plentiful calcium intake which most diets provide – to direct minerals out of soft tissues such as arteries and into bones (where they mostly belong). Main source Kate Rheaume-Bleue, although other reliable sources seem to concur.

    There’s a theory that A and D are complementary, so that too much of either can create an artificial deficit of the other. But I have also read that, with adequate intake of both A and D, neither is likely to be harmful. So the cod liver oil looks sensible.

    We don’t take A supplements, preferring to rely on foods such as liver and chocolate.

    1. Tom Naughton Post author

      Good point. Going overboard with supplements can create imbalances we wouldn’t get in a natural diet.

    1. Tom Naughton Post author

      Yikes. That’s what happens when we look for magic solutions in a pill or bottle.

  3. Desmond

    My parents had a machine to measure their blood pressure. I don’t remember the numbers, but over a certain number was RED, below a certain number was GREEN, and in between was YELLOW. I pointed out to my mother that, based on this scale, a blood pressure reading of zero-over-zero was ideal. Which is probably true, because I never met someone who had a heart attack after he was already dead.

  4. Mark B

    I watched your Wisdom of Crowds talk on You Tube a while back and really enjoyed it. Please post a link to this one if it ends up on you Tube as well.

  5. Orvan Taurus

    One thing I do take is D (D3). I work nights, in a northern state – sunlight? What sunlight?
    But D.. is to be respected. Too much is a Bad Idea (I’ve read a few accounts.) And I’d much rather deal with the minor issues from a skipped dose or even several than the serious mess that comes with overdoing it – even if that is supposedly difficult. I knew vitamin A is even more a thing to respect. Something that surprised me was that B6, which is easily flushed away (literally, yes) can lead to problems (nerve issues) if the amount is very high and continual.

    And for green tea? I think I’ll just drink some green tea.

    1. Tom Naughton Post author

      Fortunately, we can have our vitamin D levels tested and know for sure if we’re overdosing.

      1. Firebird7478

        The same cannot be said for Vitamin A. That is one that you really have to be careful of to overdose. It can lead to a variety of conditions like head pressure. The only way to determine A toxicity is to get blood work, then stop consuming A rich foods, wait a few months and see if the levels have dropped. If they haven’t then you know you’re toxic, and it takes a long time for A to leave the system.

      2. chris c

        I had mine done a few years back, it was acceptably high without any supplementation.

        You should have seen the doctor’s face when I said

        “Oh that’ll be all the grass-fed butter and cheese then!”

        She’s gradually coming around to the idea that I’m not killing myself, Which Is Good. I walk in the sun a lot too.

        Long long ago on a diabetes newsgroup someone was recommending chromium. A bunch of people tried it: some had effects, some not. I suspect as with most other things the results depends on whether or not you are deficient, as you say U curves and J curves. Probably even drugs aren’t as linear as they are touted to be.

        My current regime – vitamins C and K2, magnesium (malate), Co-Q10, L-Citrulline and Chondroitin Suplhate, just for belt and braces to try to improve my epithelium/arteries. Oh and lots of salt, and Lo-Salt for the potassium. Doesn’t seem to make much difference though, I suspect it might if I still ate high carb low fat and especially if I avoided meat and fish and filled up with grains and Omega 6 oil, then I’d need to go back on the prescribed drugs too and probably add a few more.

        I’m also rather fond of liver, one of the true superfoods, and lots of seasonal greens.

  6. Lisa

    Vitamin D caused calcification in my muscles, among other things. They’re still pushing it and advocating for high levels.

  7. June

    Overuse of the fat soluble vitamins (A,D,E) is especially dangerous. These are stored in your live and fat tissue and are not easily eliminated from the body.

  8. Elenor

    “otherwise adding loads of extra fat to their foods.”

    On the other hand, the hunters were supposed to have been eating all the fattiest bits of their kills and throwing the sirloins and ribeyes to their dogs! So, it is “adding extra” — or is it the basis of their food?

    1. Tom Naughton Post author

      I believe we valued fat, but the stuff isn’t so abundant in nature that we can add loads of it to our meals.

  9. Keith

    You mentioned taking Carlson’s cod liver oil. Here is a caution related to that, from personal experience. Please tolerate the long background explanation. If you just want the pay-off, jump to the last paragraph.

    I took Carlson’s fish oil for a number of years. At one point I had a chest cold that developed into a lung infection. The doctor treating the infection did a chest X-ray, which showed a pretty large lump of something in my right lung. A short course of antibiotics cleared the lung infection (all the symptoms were gone). The doctor took a follow-up X-ray, and the lump was still there, unchanged. There followed an MRI, an attempt to take a sample via the windpipe for biopsy that was not able to reach the lump, and finally surgery to do the biopsy.

    The lump turned out to be lipoid pneumonia, which usually is a fairly harmless condition, but it looks exactly like cancer on X-ray and MRI images, which is why it warranted such attention.

    One cause of lipoid pneumonia is small amounts of oil getting into the lungs regularly. When you take something like liquid fish oil or cod liver oil daily, every day a small amount of the oil slips into your windpipe, even for people who have no problem with swallowing. The lung has trouble removing oil, so even small amounts added every day build up over time.

    The doctors advised me to switch to fish oil in capsules for my source of fish oil, and the lump disappeared from follow-up X-rays slowly over a period of a couple of years.

    The caution I wanted to give you should be obvious if you read this whole post, but in case you skipped to the end, here it is: There is a fairly high chance that you will develop lipiod pneumonia from daily taking fish oil in liquid form. In the short term, that isn’t directly harmful (though it can be harmful after decades), but it could lead to unnecessary surgery when an X-ray for some unrelated condition leads to suspicion of lung cancer.

    1. Tom Naughton Post author

      I appreciate the warning. I have some krill-oil tablets as well. Maybe I’ll make the Carlson’s a once-per-week thing.

      1. Firebird7478

        Omega-3 stays in your system for three days. It’s not necessary to take a supplement every day.

        1. chris c

          Also I suspect you need less if you aren’t overdosing on Omega 6s, probably a reason for the varied results in trials. I eat the whole fish and occasionally take fish oil or krill oil tabs just to be on the safe side.

      2. Watsong

        I also advise caution with the taking of Cod Liver Oil. Quite some years ago, I began taking “Seven Seas Cod Liver Oil”, (as seen on TV), at the dosage prescribed on the bottle. I did so, in order to get more vitamin D, as night shift work meant that I wasn’t getting any sunlight.

        I went to see the doctor about my awful sleep, (night shift induced), and whether anything could be done about it. He had a blood test taken. It came back with a high A.L.T. The doctor was useless and could only suggest that’s normally due to alcoholism. I don’t drink alcohol, in any form. So it was 100% ruled out. He asked me a string of generic questions related to sleep. Like “Do you drink Coffee?”, “Have you tried exercise?”, that kind of thing. About 3 months and 3 blood tests later, my ALT was gradually rising. I was referred to the senior medical officer – he was equally useless. He just asked me the same string of sleep related questions. The doctor then offered to refer me to the hospital, “if I felt that I wasn’t getting the help I needed”. Well… I wasn’t getting any help!

        I was getting seriously stressed. I couldn’t understand why I had this liver problem. Before my hospital appointment, (which was booked something like a month from the request), I found on the Internet a forum comment about Cod Liver Oil. The poster also had high ALT and said that Cod Liver Oil toxic, due to the way that they process it. So I stopped taking it. When I went to my hospital appointment, a urine sample and blood test were taken. The doctor said that he will get things moving quickly and get, I think a scan, booked. He wanted to check for liver scarring. When I returned for the second hospital appointment, the blood test came back normal. No more high ALT. The only change I made was to stop taking Cod Liver Oil. The doctor just said “It must have been a transient condition”. And that was it. No suggestions, no effective diagnosis.

        So if you are taking a Cod Liver Oil supplement, I recommend getting a blood test done and check the ALT level.

        1. chris c

          Wow! When I was young (1950s, UK) all children were prescribed cod liver oil and concentrated orange juice. Maybe it was better processed. I seem to recall blog articles a few years ago about a certain brand of CLO causing problems but can’t remember which brand.

  10. Lori Miller

    Off-topic, but there’s a new study showing the Spanish are some of the longest-lived people in Europe…despite drinking, smoking and staying up late. The cause? All those fruits, vegetables and family ties, of course. It just can’t be that (according to what I read), they use olive oil a lot more than other oils or margarine. There was a canola oil scandal there many years ago that killed people–so they probably don’t trust the stuff.

    Personally, I’m putting my trust in lard and butter. In condiment amounts, of course.

    1. Tom Naughton Post author

      I already stay up late. I’ll probably skip the smoking.

      I’d like to see how much animal fat the Spanish consume. If I recall, they were considered yet another paradox.

        1. Tom Naughton Post author

          Not surprised at all. I suppose Walter Willett is predicting they’ll start dying prematurely any day now.

    2. KidPsych

      I think Malcolm Kendrick had a post years ago showing he correlation between heart disease and Northern latitudes, surmising that sunshine likely played a role in heart health. I believe Greeks had very low levels of CVD despite smoking like chimneys.

  11. Ulfric

    Beware that the BBC is (among others) a propaganda arm of … let’s call them NPCs.
    Also : nobody takes “green tea tablets” anyway!!

    1. Tom Naughton Post author

      I once ordered a bottle of green-tea extract tablets. I’m glad I kept forgetting to take them and pitched them when they expired.

  12. Patrik

    I’m no fan off supplements but prefer fresh varied food to get my vitamins and plenty of natural fat so my body is able to metabolize them.

    But I would like to point out how grossly disproportionate media reports about complications due to supplements compared to medications. The black/grey zone of patients damaged because of drugs is absolutely enormous and these side effects are both poorly recorded by doctors and almost never brought up in the media.

    On the subject of sketchy drugs and side effects, I recently found an interesting book about vaccination from the 19th(?) century.
    Things that make you go hmm…

    1. Tom Naughton Post author

      True dat about medications. Same caution, though: a substance that changes your body chemistry is something to approach carefully.

      1. Walter

        Every food you eat and the air you breathe affects your bodily chemistry. Your thoughts affect your bodily chemistry, so it’s not only substances.

    1. Tom Naughton Post author

      Well, we don’t know whether giving up meat affects their self-esteem, or if people with lower self-esteem become vegetarians to feel special.

  13. Kathy from Maine

    So, I have a bit of a different question on this one.

    I have had steadily increasing ferritin levels for the past 3 or so years. The first time I was tested, it was 339, a year later it was 326. Just the other day it was 552. This is on a scale of 13 – 150 ng/mL. I’ve been asking about it ever since the first test, and only now are they taking it seriously. Now they want me to have an MRI and ultrasound of my liver to determine whether the ferritin has damaged it.

    Doc says that between now and when the tests are done (late November or early December), I’m to take NO supplements. I really haven’t been taking any on even a semi-regular basis, so no big deal. HOWEVER, now I’m feeling like I really want to start taking milk thistle again since it’s recommended to heal the liver. If I start taking it, I’ll be going against doc’s orders, but why wouldn’t I want to do whatever I can to start improving things right away? I would take no more than 1 – 2 twice a day, as the bottle states.

    Does anyone think that would be a bad thing?

  14. Keith

    I don’t really have a clue, either, but if I were you, I believe I would follow the doctor’s recommendation and not take the milk thistle before the MRI and ultrasound are done. I don’t know anything about milk thistle, but I would not take it just in case it could cause misleading results for either of those two tests. You’ve already been living with the high ferritin for three years, so I imagine another month would not make a big difference.

    You did not mention whether the doctor has determined why your ferritin is high. Checking for whether it damaged the liver seems reasonable, but I think he also needs to find out how to get the ferritin level back to normal. On the other hand, if he was not clear in his explanation, and the purpose of the MRI and ultrasound is to see whether there is some problem with the liver that is causing the high ferritin level, then he already is looking for the cause, but I don’t know how likely it is that is why he ordered those tests.

    So, my uneducated opinion is to not take the milk thistle before the MRI and ultrasound, and if the doctor has not yet determined the cause of the high ferritin and how to lower it, push the doctor to pursue that

  15. Firebird7478

    I have had high ferritin levels for years. The most recent test was last year. My primary care physician nor my osteopathic physician seemed concerned. Some doctor on Twitter wrote a book about the dangers of iron, suckered me into buying his e-book, told me I needed a “therapeutic phlebotomy” to reduce my levels (I had Hep-A 20 years ago and cannot donate blood). Presented that to my doctor and she said it wasn’t necessary and that my levels were elevated because of weightlifting, which is what they told me back in 1986.

  16. Kathy from Maine

    Hey, Keith! Thanks for the reasoned response. We don’t know why the ferritin level is so high. He tested me for genetic hemochromatosis, and that was negative, also negative for hepatitis A, B, C, and I’m not storing an overload of iron. He’s looking to see if the ferritin levels have actually damaged my liver. I’ve research it a lot, and there are no clear answers. Some people just have high levels. One possible treatment is phlebotomy (starting with 1 to 2 draws per week in the doc’s office), and it might take a year or more to get it down to normal levels. Then I’d have to donate blood on a regular basis to keep it there … no problem since I used to donate all the time but stopped because it takes hours out of the day that I don’t have. I did start taking the milk thistle supplement, though haven’t remember to do so every day. I really don’t think it will hurt, and it might help.

    1. Keith

      I am happy to learn that your doctor has been trying to understand the cause of the jump in ferritin level. If he runs out of ideas, I hope he will refer to you some other doctor who might be more successful at discovering the cause. If I were you, I would not be satisfied with an answer that some people just have high ferritin level, since your level is not steady, but is increasing. In my uneducated view, that seems to signal that you have some progressive condition that is raising your ferritin level.

      Good luck to you! I hope you have not yet experienced liver or other damage from this, and that your doctor finds a cause and a treatment that protects your ongoing health.

      1. Kathy from Maine

        Hi! I just wanted to provide an update. Yesterday I had an MRI of my liver, pancreas, and other organs to see if there’s any damage from the high ferritin levels I’ve had for the past several years (at least). I got the results back today. Everything is absolutely normal, no sign of damage, but there’s a bit of fatty deposit on the liver. Not worried about that. I do enjoy a glass or two of wine most nights, so I’ll just cut down on that. I already eat LCHF, so I’m doing everything right.

        Know what the nurse said when she called? She said everything looked “fine,” but to try to cut down on the fatty foods!!!

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