Too Many Supplements?

“I want to know how many of these capsules YOU take!” protested a patient recently, when she brought in a supplement list that I could not reasonably shorten for her. (I like to do a supplement review with patients – we commonly identify supplements that are no longer necessary.) 
I reassured her that she wasn’t taking that many supplements, that she could be thankful she was only taking one prescription (and it was thyroid hormone) and that yes, I, too, took more supplements than I could comfortably swallow in one gulp. If you are someone who struggles with the physical act of swallowing pills of any sort, please scroll down to the last paragraph!
Does everyone need to take supplements? Yes, I confess, I do think that there are supplements that everyone needs to consider taking, even if their health is excellent. Let’s start with the assumption that you are eating a complete and healthy diet. That would be a diet rich in healthy fats of all kinds (pasture-raised animals, coconut, nut and/or avocado), a wide variety of proteins (eggs and meat from pasture-raised animals, wild-caught fish), fruits and vegetables covering the entire color wheel, and some fermented foods (pickles, sauerkraut, or fermented dairy).
At a bare minimum, required extra supplements would be:

1. Some form of fish oil. You are excused from this requirement if you are eating cold water fish (salmon, halibut, mackerel, sardines) at least twice a week AND you have not eaten the standard American diet for at least a decade. Fish oil provides a necessary dose of omega 3 fatty acids, essential to just plain health and to brain health in particular. It's very important to take a fish oil that has not become rancid. In the grocery store that might mean the Nordic Naturals brand. In my online store, the product in which I have great confidence is Metagenics essential fatty acid product, Omega-genics, which combines the two important fats, DHA and EPA. 
2. Magnesium. Our vegetables can only contain magnesium if the soil has not been depleted, and most studies believe that most soil in our country is indeed magnesium-deficient. Magnesium glycinate is the most absorbable form, and the least disruptive to bowel function. I suggest 400 mg daily, even for those without any health complaints. Klaire Labs makes a good and affordable product.
3. Vitamin D3. Keep your vitamin D level between 40-65 ng/mL, with the proper combination of sunlight and supplemental vitamin D.

So, really, that isn’t too many, is it?
If you do have some health concern or complaint, the list obviously gets longer. Personal genetics, medical history (both problems and medical treatment), and acute complaints can all call for intervention. Sometimes the intervention can be with some form of food as medicine, but not everyone wants to eat medicinal foods! If you have indigestion, I will first suggest bone broth and sauerkraut, but if that doesn’t work for you, we’ll go on to the possible supplements. Properly chosen supplements support the return of normal physiological function and can often be temporary. On the other hand, if your genetics suggest that you cannot properly process your B vitamins, some supplementation may be permanent. 
Meanwhile, let’s get practical! Do you have to take your supplements absolutely every day? Usually the answer is  no – although I have been known to carry my supplements with me to dinner at a friend’s house! That said, you should be able to miss dosages every few days without problem on a routine basis. On the other hand, if I’ve just recovered from a stomach bug, I will carry a portable form of probiotics for taking several times throughout the day, wherever I am.
And most important, there is actually a proper way to take your supplements - or your prescription, whatever you must swallow. First, swallow them with water. Secondly, separate your pills: tablets in one pile, capsules in the other. I never try to swallow more than 3 at a time – what’s your number? Put the tablet-type pills in your mouth, take a comfortable mouthful of water and gently tip your chin up. Notice the pills sliding under the water and going to the back of your tongue? Now swallow: the pills go down first and the water chases them down. Next the capsules go in your mouth with another swig of water. Gently tip your chin down: notice that the capsules float on top of the water and are now at the back of your tongue. Swallow and again, the pills (capsules in this case) go down first, swallowed and rinsed through by the water.
Next time I’ll talk a bit more about medicinal foods.