Vitamin supplements for arthritis

Glucosamine and chondroitin

Before taking glucosamine and chondroitin you should first consider the evidence in relation to your condition. There have been limited, high quality studies for glucosamine and chondroitin and their effectiveness remains unclear, particularly for severe arthritis. However both glucosamine and chondroitin have been found to be as safe as placebo (fake pills), with fewer side effects than some other medicines.

What is glucosamine?

Glucosamine is a sugar naturally produced by the body. It is one of the building blocks of cartilage. Cartilage covers and protects the ends of the bones, allowing bones to move smoothly against each other. Glucosamine comes in two forms – glucosamine sulfate and glucosamine hydrochloride. Glucosamine supplements are usually made from crab, lobster or shrimp shells, although some supplements are made from a plant form of glucosamine. They are available as tablets or liquid and often in combination with chondroitin.

What is chondroitin?

Chondroitin is also a natural substance found in the body. It is believed to help draw water and nutrients into the cartilage, keeping it spongy and healthy. Chondroitin is available as chondroitin sulfate supplements, which are made from bovine (cow) or shark cartilage.

While their effectiveness remains unclear, it appears glucosamine and chondroitin are relatively safe treatment options for people with OA to trial.

How do these supplements help arthritis?

It is believed these supplements may be useful for people with osteoarthritis (OA), where there has been a breakdown of cartilage. It is thought that taking glucosamine and/or chondroitin supplements may relieve the pain and prevent or slow the breakdown of cartilage in OA. Note, most of the studies have looked only at OA of the knee, with very few studies of other joints (for example, hips, hands, back). To date there is no evidence that these supplements are effective for any other forms of arthritis.

What does the research say?

Glucosamine sulphate

  • Pain: opinion is divided about the effectiveness of glucosamine sulfate on pain. In some studies, glucosamine improved pain from OA of the knee more than placebo (fake pills). However in other studies, pain improved about the same whether people took glucosamine or placebo.
  • Cartilage: there is some evidence that glucosamine sulfate can slow cartilage breakdown in the knee.

Glucosamine hydrochloride

  • Studies suggest the hydrochloride form is not effective in relieving pain. The effect of glucosamine hydrochloride on cartilage has not been tested.


  • Pain: there are mixed results from studies of chondroitin. Some studies have found chondroitin reduces pain more than placebo. However other studies have found no improvement in pain with chondroitin.
  • Cartilage: there is some evidence that chondroitin supplements slow cartilage breakdown or repair damaged cartilage from knee OA.
  • Recent studies have shown that the combination of glucosamine sulfate and chondroitin may be effective in slowing the breakdown of cartilage in the early stages of knee OA. Research has also shown that the combination may help in reducing moderate to severe knee pain from OA.


Overall, the results from studies of glucosamine and chondroitin are unclear. There have been some promising results that these supplements may improve pain slightly in the short-term (less than six months). However many studies show little benefit. While their effectiveness remains unclear, it appears glucosamine and chondroitin are relatively safe treatment options for people with OA to trial.

What is the recommended dose?

  • Glucosamine sulfate: 1500mg per day
  • Glucosamine hydrochloride: 1500mg per day (note, glucosamine sulfate is suggested to be more effective)
  • Chondroitin sulfate: 800 – 1000mg per day

Different brands contain different amounts of glucosamine and chondroitin. Read the label carefully to see how many tablets you need to take to get the right dose or ask your pharmacist for advice.

How long will it take to notice an effect?

You may need to take the supplements for four to six weeks before you notice any improvement. If there is no change in your symptoms by then, it’s likely the supplements will not be of benefit for you and it’s advisable you talk to your doctor about other ways of managing your arthritis.

What are the possible risks?

  • Shellfish allergy: most glucosamine supplements are made from shellfish although some made from non-shellfish sources are now available. Talk to your doctor or pharmacist, before taking it, about whether the supplement is safe for you.
  • Bleeding: people taking the blood thinning medicine warfarin should talk to their doctor before starting, stopping or changing their dose of glucosamine as it may interact with warfarin and make the blood less likely to clot.
  • Diabetes: glucosamine is a type of sugar so check with your doctor before taking glucosamine if you have diabetes.
  • Pregnant or breastfeeding women: there have not been enough long term studies to clearly say that glucosamine is safe for a developing baby. Pregnant women should talk to their doctor before taking glucosamine.
  • Other side effects: upset stomach (for example, diarrhoea), headaches, and skin reactions. Talk to your doctor or pharmacist about possible side effects before taking glucosamine.
  • Bleeding: people taking blood thinning medicines, such as warfarin, should talk to their doctor before taking chondroitin as it may increase the risk of bleeding.
  • Other side effects: chondroitin may also occasionally cause stomach upsets.

Websites: Arthritis Research UK , Institute of Registered Myotherapists of Australia , Australian Association of Massage Therapists , Australian Acupuncture and Chinese Medicine Association , National Herbalists Association of Australia , Australian Naturopathic Practitioners Association , Australian Homeopathic Association National Center for Complementary and Integrative Health (US).

4 Essential Supplements Everyone Should Take

July 10th, 2019

• Free eBook: 35 Gut Recovery Recipes

One of the most common questions I’m asked is “Should I be taking daily supplements and if so, which ones?” If you have read my blog or heard me speak you know I always say, “It’s not what you eat, it’s what you can digest and absorb.” In an ideal world, your diet would be pristine and your gut would be in perfect shape to digest and absorb all of the micro- and macronutrients you need to stay healthy. Unfortunately, this is not the case for many people living in the modern world.

Our Western diet is filled with nutrient-poor and calorie-dense processed foods, GMOs, and pesticides. Even our soil has become devoid of nutrients, which means the food that’s grown in it has declined in nutritional value.1 We are constantly exposed to toxins in our food, water, air, and even personal care and cleaning products. Our stress levels have skyrocketed and many people are dealing with gut issues, such as Candida and SIBO, which interfere with proper nutrient absorption.

This combination of a decrease in nutrients in our food and an increase in stress, toxins, and gut issues such as leaky gut is why we can no longer get all of the vitamins and minerals we need from food alone, and why I believe everyone should use a few key supplements to maintain optimal levels of nutrients.

Because we are all unique individuals and biochemically different, the answer to which supplements should you take is not so black and white. In today’s world, I do believe that everyone should be taking supplements of some sort, however the best supplement regimen for you may be different than what’s best for your mother or sister or brother. That being said, there are some essential supplements that I recommend everyone take.

1. High-Quality Multivitamin

Even if you’re following The Myers Way®, it’s likely that you may be deficient in some vitamins and minerals due to the decreased nutrients available in modern foods, increased stress levels and toxin exposure, and the increasing prevalence of gut issues. I do testing day in and day out in my clinic, and most of my patients come back with nutrient deficiencies. And yes, even those eating Paleo or Autoimmune Paleo diets! Since there is no way to know exactly which nutrients you’re deficient in without proper testing, I recommend a high-quality multivitamin to all my patients and their families.

I did TONS of research and simply could not find a multivitamin out there that offers the right quantity and quality of nutrients to help you fill the gaps in your diet and support total body health–that’s why I created my own!

The Myers Way® Multivitamin is high-potency and designed for optimal absorption and bio-availability because, as I said before, it’s what you digest and absorb that counts. I custom-formulated The Myers Way® Multivitamin to provide the widest range possible of vitamins and minerals in their most usable forms, which means methylated B vitamins, chelated minerals, vitamin D as cholecalciferol, and much more. And because of my own struggle Graves’ disease, my multi contains the ideal balance of nutrients to support vibrant thyroid health, including selenium, iodine, zinc, antioxidant vitamins C and E, plus other free radical scavengers.

If you’re brand new to the world of supplements and wondering where to begin, a daily multivitamin is the perfect place to start!

2. Omega 3

The benefits of omega-3 fatty acids are widely publicized. Omega-3s reduce inflammation and may help lower the risk of chronic diseases like heart disease, cancer, and arthritis. And, because they are highly-concentrated in the brain, omega-3 fatty acids are also important for memory, cognition, and behavior.

In addition to maintaining sufficient levels of omega-3, it’s also important to ensure you have a proper omega-3 to omega-6 ratio in your body. You need both of these fatty acids to stay healthy, however problems arise when your intake of omega-6 fatty acids (which are often inflammatory) outweighs your consumption of omega-3 fatty acids (which are anti-inflammatory).

Research suggests that humans evolved on a diet consisting of an omega-6 to omega-3 ratio of 1:1. The modern diet, which is full of processed foods, refined oils, and not enough fruits and vegetables, supplies an omega-6 to omega-3 ratio of 15:1 to 17:1.2 This ratio is highly inflammatory and a recipe for disease. That’s where Omega-3 supplements come in.

You want to be particularly careful about the source of your omega-3 supplements because they are extracted from fish, so many of them contain mercury. The ones I carry in my online store have been tested and certified mercury-free by a third party. Each softgel of our Omega-3 supplement provides 1300 milligrams of EPA and DHA – two omega-3 fatty acids that help balance your fatty acid ratio, reduce inflammation, and improve brain function. Those with rheumatoid arthritis or any other chronic pain condition can take up to 4 grams (3 softgels) a day to reduce inflammation and pain.

3. Probiotics

The future of medicine is turning toward your microbiome–the ecosystem of bacteria and other microbes that live in your gut–to prevent and reverse many diseases. We now know that nearly 80% of your immune system is located in your gut, and up to 95% of your serotonin (the neurotransmitter responsible for regulating mood) is produced in your gut.

This means that if the balance of bacteria in your gut is thrown off, it can lead to a whole host of problems, including autoimmunity, depression, anxiety, and leaky gut, to name a few. Taking a probiotic every day can help keep your microbiome in balance, which promotes a healthy GI tract, relieves digestive discomfort, promotes a normal bowel pattern, and supports overall wellness.

Not all probiotics are created equal, though. Many probiotics contain a mixed bag of bacterial strains, are often grown using dairy, soy, or yeast, and usually need to be refrigerated, making them difficult to travel with. It’s best to take a broad-spectrum probiotic that includes bacterial strains that are naturally found in your gut, and have been researched and proven to boost gut health and immune response.

The probiotics I carry in my store contain four proven strains, are free of dairy, soy, and yeast, and do not need to be refrigerated because of their special packaging. I recommend 100 billion units daily for healing gut damage, infections, and imbalances, and 30 billion units daily for maintenance.

4. Vitamin D

Vitamin D is unique in a couple of important ways. First, your body can make its own vitamin D when your skin is exposed to sunlight. Second, vitamin D is converted into a hormone in your body. Hormones are your body’s chemical messengers. They travel through your blood to your tissues and organs activating chemical reactions that control everything from metabolism, to growth and development, to mood. Over 50,000 of the chemical reactions in your body require the presence of adequate amounts of vitamin D in your blood. Vitamin D contributes to bone strength, heart health, and cancer prevention. It also plays an important role in your immune system, and can be a determining factor in whether or not you develop an autoimmune disease.

Studies estimate that one billion people worldwide have insufficient vitamin D levels and at least 3 million American adults are deficient. However, the rate of true vitamin D deficiency is likely even higher, because research has found that the previous recommended levels of vitamin D were actually too low. I’ve checked the vitamin D levels of thousands of patients in my clinic and virtually all of them had below optimal levels, even those who were taking a vitamin D supplement.

Conventional medicine defines vitamin D3 levels of 30 to 100 ng/mL as normal, yet I always recommend keeping your vitamin D3 levels around 60 to 90 ng/mL for optimal health. If your vitamin D3 levels are low, you can take 5,000 to 10,000 IU per day until you reach your ideal level. The vitamin D supplement that I use and carry in my store combines vitamin D with vitamin K, a fat-soluble vitamin that is necessary for your body to properly absorb vitamin D. This combination D/K supplement is available as drops or capsules.

Never take more than 5,000 IU of vitamin D3 per day without a physician’s supervision and regular blood testing.

Bonus Supplement: Methylation Support™ (Methylated B-Vitamins)

By now, you’ve probably heard of MTHFR mutations (also called MTHFR defects), though you might not know exactly what having one of these mutations means.

Methylation is the biochemical process that helps turn toxins into safer substances that your body can remove. Basically, methylation allows you to detox effectively. Proper methylation depends on the presence of several vitamins and cofactors, including vitamin B6, folate, and vitamin B12.

When you have an MTHFR mutation, your body has difficulty converting these vitamins into forms that your body can readily use. If you have one MTHFR mutation, you absorb one-fifth of the amount of these vitamins as someone with no mutations. If you have two mutations, you absorb one-tenth. The vitamins may be present in your blood, however if you can’t utilize and convert them, they’re useless.

Many conventional medicine doctors miss vitamin B deficiencies in those with MTHFR defects because standard lab testing looks at the amount of B vitamins in your serum, rather than functional lab testing which is a better indications of your methylation needs.

In addition to genetics, poor diet, malabsorption of nutrients, toxic exposure, and certain medications can all interfere with proper methylation, so supporting the methylation process is always a good idea whether you have an MTHFR defect or not.

This is why I recommend a daily methylation support supplement. The one that I take and carry in my store contains pre-methylated vitamin B12, vitamin B6, and folate, along with magnesium. For those with two mutations (like myself), I recommend two capsules a day, and for those with one or no mutations, I recommend one capsule a day. If you suspect a MTHFR defect, the blood test is offered through conventional labs, or you can use the saliva test offered through 23andMe.

Where Should I Purchase Supplements?

Supplements are an unregulated industry, and not all products are created equal. All of the supplements I carry in my store have been personally vetted by me and are pharmaceutical grade, meaning higher quality and often higher dosages than over the counter. They have also been tested by third-party companies to ensure that the ingredients are what they say they are, and that they are free of gluten, dairy, soy, and corn (unless otherwise marked).

You certainly do not have to purchase your supplements from my store, however if you do buy them elsewhere, always make sure to purchase supplements that meet Good Manufacturing Process (GMP) standards. The GMP seal means that the manufacturer has evaluated the purity, quality, strength, and composition of the supplement, that the supplement is safe to take, and that it’s exactly what the manufacturer says it is.

Article Sources


Knowing what are the best supplements to take can seem like a minefield. Not only are the numbers and letters mind-blowing (C or D? B12 or Q-10?), you have to consider which ones are actually worth the money.

But how are you supposed to know? Before you begin to decide what you need, make sure you’re buying supplements from a trusted brand. Food supplement companies don’t have the same manufacturing procedures to adhere to as pharmaceutical companies, however some choose to be approved to the same standard so that they can assure their safety – and this is where you should be shopping. Read descriptions and small-print on anything you buy, and if possible speak to a doctor first.

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Claire Barnes, nutritional therapist for Bio-kult, told Cosmopolitan UK: “Be wary of supplements which have added excipients such as artificial colours, flavours and preservatives.”

If you’re wondering whether it’s even worth the hassle, you’re not alone. But Claire explains: “Whilst many required nutrient levels should be achieved through a healthy diet, certain nutrients are difficult to achieve through diet alone. In the UK magnesium levels in our foods are falling which may be due to acidic soil and unbalanced crop fertilisation.”

The good news is there are ways to help boost this and more. Here’s what the experts say about whether it’s worth splashing the cash:

If you’re starting a high-intensity exercise plan

Verdict: Be sceptical

You might think that pricey protein supplements are necessary after a workout, but that’s not necessarily the case. Azmina Govindji, award-winning dietitian and media spokesperson for the British Dietetic Association tells Cosmopolitan UK: “Protein supplements for sports may be trendy, but they are generally not needed. Eat a range of foods that include natural sources of protein such as lean meat, eggs, fish, tofu, nuts and dairy products, and make sure you’re getting enough calories so you make use of the dietary protein for muscle recovery.

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“If you’re doing very high intensity training, you might find it more convenient to use protein shakes on the go, or from other protein products after an intense session. These are meant as a supplement to your meals and it’s best to get your protein from real food. will give you essential vitamins and minerals you may not get from a commercial product. Eating too much protein may have long term harmful effects.

“Vitamin C contributes to maintaining the normal function of the immune system during and after intense physical exercise, but eat your five a day and you’ll be getting more than enough!”

Holland & Barrett Timed Release Vitamin C With Wild Rose Hips 100 Caplets 1500mg £24.99

If you’ve been feeling tired forever

Verdict: Supplements could help

Azmina says: “Tiredness can be caused by low intakes of certain nutrients. For example, low iron intakes can mean your blood haemoglobin levels are low. You need haemoglobin to help transport oxygen around your body, and not enough can make you feel tired and breathless. B vitamins help you release energy from food, and several nutrients contribute to reduction of tiredness and fatigue, for example, vitamin C, iron, and vitamins B2, B6 and B12.

“But that doesn’t mean if you’re tired you should reach for the supplements. It’s best to talk to your GP – a simple blood test can check if you’re anaemic, in which case you’re likely to need iron supplements. And many foods contain B vitamins – e.g. whole grains, fortified breakfast cereals and eggs.”

Claire also agrees that tiredness could be a sign you need to see your GP: “Many people suffering with chronic fatigue syndrome report gastrointestinal symptoms and irritable bowel symptoms which suggests the gut microbiome could potentially have a role in chronic fatigue,” she explained. “The gut microbiome is also involved in our energy metabolism and our circadian rhythms (sleep/wake cycle).

“Encouraging a diverse and beneficial microbiome through eating fermented foods, such as sauerkraut, kombucha tea and live yogurt as well as supplementing with a multi-strain live bacteria supplement, such as Bio-Kult Advanced 14 strain, could help to improve nutrient levels in the body and increase energy.”

Bio-Kult Advanced multi-strain formula 60 Capsules £15.99

If you suffer from Seasonal Affective Disorder

Verdict: Supplements will help

“SAD has been associated with low serotonin and low vitamin D levels,” Claire says.

“Between October and April in the UK we cannot get adequate amounts of vitamin D from the sun and it is now well known that many of us in the UK are deficient. Vitamin D supplementation during the winter months has been shown to improve mood and is recommended as adequate vitamin D cannot be obtained from food alone.”

OILESEN Vitamin D3 1000, in Extra Virgin Olive Oil soft capsules (Made in Swiss) OILESEN £7.99

If you have super heavy periods

Verdict: Supplements could help

Azmina says: “Lots of blood loss during periods can mean your iron levels are compromised. Women absorb iron more efficiently than men for this reason, but if you’re not eating enough iron-rich foods (for example if you’re on a vegan diet), you may benefit from an iron supplement.

Floradix Iron & Vitamin 84 Tablets iron £10.99

If you can’t stand eating vegetables

Verdict: Be sceptical

Vegans are in luck. Claire explains: “There is no supplemental substitute for eating vegetables. Ideally vegetables should make up half of each meal and should include a spectrum of different colours. Vegetables provide vitamins, minerals, phytonutrients as well as fibre. The average amount of fibre eaten daily by an adult in the UK is approximately 20g for men and 17g for women. Given that the recommended level of fibre intake is advised to be 30g daily, the average adult is still well below reaching this target.

A high-fibre supplement such as Lepicol containing psyllium (a gentle dietary fibre), inulin (a soluble fibre) and live bacteria could help boost daily fibre levels.

Lepicol – Healthy Bowels Formula – 350g Lepicol £14.35

If you keep getting sick

Verdict: Be sceptical

“If you keep getting sick, it’s likely that your immunity could do with a helping hand,” Azmina says. “Best to speak to your GP first, so they can provide a diagnosis.

“Also see a registered dietitian who can assess your eating patterns and advise you on any changes that are needed to supply you with the right mix of nutrients that help you resist infections.

“Vitamin D is the one supplement that you really must have – amongst other things, it helps keep your immune system functioning normally. If you’re unable to eat a varied diet, a supplement of zinc and vitamin C in the winter may be helpful.”

Zinc with Vitamin C zinc £10.49 Related Story

If you’re thinking of trying for a baby some time soon

Verdict: Supplements will help

Azmina says: “Folic acid is absolutely essential for any woman trying for a baby and for the first 12 weeks of pregnancy. Take 400micrograms a day. It helps to reduce risks of spina bifida in the foetus.

“A daily supplement of 10micrograms of vitamin D is also necessary, especially during the winter months.”

And Claire agrees. “Folic acid is well recognised as an important supplement to take in early pregnancy to reduce neural tube defects in infants,” she says. “In actual fact, pre-conception is the ideal time to take folic acid as the neural tube develops during the first few weeks of pregnancy, often before the mother even knows she is pregnant.”

Proceive Women Advanced Fertility Supplement 60 Capsules proceive £24.95

If you’ve got IBS

Verdict: Supplements could help

Claire explains: “Beneficial bacteria in the gut produces acids which help the body absorb minerals. Often in those with an altered gut flora, such as individuals with IBS, minerals such as magnesium, zinc and iron are not so well absorbed which could lead to deficiencies.

“A recent study reported that a large proportion of those with IBS are vitamin D deficient and supplementation may help improve their symptoms and wellbeing.

“Many studies have reported significant improvements in IBS symptoms when taking a live bacteria supplement. They appear to have beneficial effects in reducing bloating, abdominal cramps, improving bowel motility, while also having a beneficial effect on stress, anxiety and mood.

Super ProBio Complex £20.79

If your skin is breaking out

Verdict: Supplements could help

Claire says: “Milk and foods with a high glycaemic burden are often reported as food triggers for acne. Therefore eliminating milk and introducing a low GI diet could be of benefit. Supplementing with soluble fibre could help reduce insulin levels.

“Zinc is a micronutrient that is essential for the development and functioning of the human skin. Studies have shown that many acne sufferers are deficient in zinc.

“If taking supplemental zinc long-term look for a supplement that combines zinc with copper as copper levels can be reduced when taking zinc over a long period or at high levels.”

Cytoplan Zinc & Copper, 60 Tablets zinc £15.85

Visit your GP for personalised advice on which supplements you need to take.

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Related Story Related Story Abigail Malbon Abbi is a freelance journalist for various magazines and websites.

Top 5 Supplements to Take Every Day

It may not be a super sexy topic, but supplements have been an obsession of mine for years! If you’ve been around my community, you know I recommend them in all my programs, and they’re an important part of my own healthy lifestyle.

The good news is that I’m in great company! About 75% of adults take some form of supplements to manage or prevent health issues.1

And let’s be clear, here: yes, I sell supplements in my store. But that’s not why I’m telling you to take them. In fact, it’s the opposite! I offer supplements to my community precisely because I realize how vital they are, and that not all supplements are created equal.

The bottom line is that you do so many other things to make sure you live a vibrant and healthy life. You eat right, work out, drink plenty of water, take care of your skin…

So why skimp on the easiest way to boost weight loss, energy, mental focus, and your immune system?

Just a few smart supplements can help you cover your bases, so you can start each day knowing you’ve given your body the amazing support it needs. (Need more convincing? Check out this article: 5 Important Reasons Why You Need to Take Supplements)

Not sure which supplements to take, and how to choose? I’ve got you covered!

Here are 5 supplements to take every day, so you can lose weight, slow aging, and stay healthy:

1. Multivitamins

Multivitamins are a great form of health “assurance” because you’re giving your body the essential vitamins, minerals, and antioxidants that it needs for optimal health.

Food is the ideal source of those nutrients, but there’s no way to know for sure that you’re consistently fueling your body with everything it needs. In fact, studies show that you can eat a healthy diet and still be on average about 57% short of crucial nutrients!2,3

Another study proved that nutrient deficiency could be a possible reason obesity is on the rise, in addition to other serious health conditions such as insulin resistance and premature aging.4

Turns out Mom was right when she told you to take your vitamins…

How to Choose Multivitamins

When looking for a multivitamin, make sure that it includes a trifecta of vitamins, minerals, and antioxidants.

Vitamins and minerals help strengthen your bones, heal wounds, and boost your immune system. Antioxidants protect your cells from free radical damage, which destroys cells, DNA, and precious collagen.

Remember, these amazing benefits can’t be found in a one-a-day, so make sure you get a multivitamin pack like my Daily Essentials.

2. Omega-3s

This supplement is near and dear to my heart! Omega-3s helped my son survive a traumatic brain injury from a hit-and-run accident, and these healthy fats continue to be a big part of his recovery.

That’s because omega-3s protect your brain, as well as helping heal brain trauma, boosting your mood, and improving overall brain function.5

It’s been said that inflammation is at the root of all disease, and omega-3 fatty acids are a powerful ally in the fight. They’ve been proven to lower inflammation, which can in turn help alleviate chronic pain, arthritis, asthma, autoimmune disease, and even fight cancer!6

Struggling with high cholesterol? It’s omega-3s to the rescue! This daily essential can help lower harmful triglycerides and LDL and increase levels of HDL, the good cholesterol that keeps your arteries clean.7,8

So many reasons to be sure you add omega-3s to your daily supplements!

How to Choose Omega-3s

The most effective way to get omega-3s is from fish oil. Quality is especially important with this supplement!

There’s no way to know how long those fish oil capsules in your local pharmacy or big box store have been sitting on the shelves. Freshness is so important because fish oil can easily go rancid and lose its efficacy.

Make sure the source of your fish oil is 100% certified sustainable, non-GMO, and processed within hours of harvesting, so you know it will give your brain and body the TLC and protection it deserves!

3. Probiotics

The living organisms in your gut (also known as your gut microbiome) are essential – they’re your first line of defense against inflammation and infection.

The key to keeping your gut healthy is to increase the amount of healthy bacteria, while lowering the harmful ones.9 That’s where probiotics can help!

The healthy bacteria from probiotics protect you from stomach upset, food sensitivities, vitamin deficiencies, allergies, and autoimmune disease.10 These helpful flora also eliminate toxins and dispose of potentially harmful waste.

Another important reason to keep the microbiome healthy is that the gut flora affects the chemicals that determine your mood, appetite, sleep quality, and even your sex drive!11

You know your gut is in trouble if you have leaky gut, gas and bloating, joint pain, fatigue, headaches, or trouble losing weight or keeping it off.

If you’re constantly fighting infections, taking antibiotics, or under lots of stress (and who isn’t!), taking a high-quality, daily probiotic will protect your immune system and heal your gut, while keeping you well-rested, frisky, and happy!

How to Choose Probiotics

When choosing a good probiotic, it’s ideal to get one that includes prebiotics as well. Prebiotics are fuel for the healthy bacteria that can help them thrive.

The types and amounts of bacteria in your probiotic are also important because a healthy gut microbiome requires multiple types of bacteria. So get a probiotic with billions of flora that includes a variety of strains.

It’s important to note that not all probiotic labels will be accurate. There’s no regulation regarding the count of bacteria in each capsule, and most companies use the count before shipping. There’s almost zero chance all those bacteria will arrive alive and healthy on your doorstep!

That’s why the prebiotic and probiotic count on my Microbiome Balance label takes into account the cultures that will be lost during shipping, so you know you’re getting AT LEAST as many as the label describes…

4. Vitamin B12

This vitamin is critical for your nervous system and the production of DNA and RNA, which are the building blocks for all of the cells in your body.

That means a B12 deficiency can cause serious health problems, including exhaustion, memory trouble, muscle weakness, shortness of breath, gut issues, and more.12

Studies also show that low B12 causes an increase in risk for cardiovascular disease and even affects your mental wellbeing.13,14 In fact, B12 deficiency has been linked to depression and anxiety disorders, as well as increased symptoms in autism, schizophrenia, and other mental illness.15,16

Because you can only get B12 from eating meat, vegetarians and people who have problems with digestion must supplement with B12.17,18

Anyone suffering from gut issues, taking antacids/reflux medication, or over the age of 50 almost always needs more B12 than their diet alone can provide.

Studies also show that regular consumption of alcohol stops your body from absorbing the B12 in your diet.19 So, regular alcohol drinkers should supplement as well.

How to Choose Vitamin B12

The best way to take a B12 supplement is sublingually or by injection. (“Sublingual” means under your tongue.)

If regular visits to a doctor’s office or giving yourself shots isn’t an option, sublingual drops or lozenges are your best bet.

Taking your vitamin B12 sublingually is helpful because it allows for easy absorption through your gums and mouth tissue. Sublingual use is especially important if you have any digestive problems, as your gut won’t absorb B12 in capsule form.

5. Vitamin D

Vitamin D deficiency is super common, so much so that it’s now considered an epidemic associated with several serious diseases.20

Although called a vitamin, vitamin D is actually a hormone! It has an impressive list of important functions in your body, including keeping your bones and teeth healthy and strong, boosting your immune system to fight infection and autoimmune issues, protecting your heart, and supporting muscle function. 21

Research also shows that vitamin D can even help improve the symptoms of depression and may also boost weight loss by improving your mood and controlling your appetite.22

Although 20 unprotected minutes under natural sunlight encourages your body to make vitamin D, many of us don’t get enough, especially in the winter. And that deficiency during colder months can negatively affect your health all year round!

If you live in a seasonal climate or a desk job keeps you from getting enough time in the sun, supplementing with vitamin D can make a huge difference to your overall health. (Remember, sun exposure while you’re wearing sunscreen won’t help you produce more vitamin D.)

If you’re experiencing symptoms of vitamin D deficiency like fatigue, frequent viral illness and infections, aches and pains, or bone and muscle weakness, it’s time to visit your doctor to get tested and start supplementing!

How to Choose Vitamin D

Vitamin D3 is the most absorbable form of this crucial hormone.

Your vitamin D supplement should also contain vitamins K1 and the MK-7 form of K2, which are essential for the proper absorption of D. Also, because this is a fat-soluble vitamin, be sure to take it with a healthy source of fat.

Bonus: Digestive Enzymes

You’ve heard that saying “You are what you eat,” but the truth is you are what you absorb!

Digestive enzymes in your stomach help your body convert the food you eat into nutrition and energy. These enzymes are the first step in proper digestion.

However, if you’re over 35, experience chronic stress, or have any kind of gut issues, chances are strong that your digestive enzyme production has declined. You’ll know because of telltale gas and bloating after meals, especially anything high-protein like a steak dinner!

A high-quality digestive enzyme will help you avoid uncomfortable digestive upset and better absorb health-giving nutrients from your food and other supplements.23

That’s why I take Metabolic Digestive Balance before every meal that’s not a protein shake. It’s got a powerful blend of digestive enzymes, plus an added carb blocker. (Who doesn’t love a good multitasker?)

With smart daily supplementation, you’ll be taking the easiest step to ensure you look and feel your best. And when you combine smart supplements with a healthy diet, regular exercise, restful sleep, and stress management, you’ll be unstoppable!

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Thanks so much for reading this post! If you’re interested in finding out more about how to dial in your diet and health, please check out my programs. They’re science-based and have already helped thousands of people feel better fast and lose the weight.

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“Joint support” supplements for arthritis

Images: Thinkstock

Published: August, 2014

It may be okay to try alternative remedies, but don’t skip proven treatments.

The first step to treat wear-and-tear osteoarthritis is medication to reduce pain and inflammation. But many men still end up with pain, stiffness, and limits on day-to-day functioning.

“There are a lot of people with osteoarthritis who don’t get cured,” says Dr. Robert Shmerling, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. “There are side effects related to medications and some people don’t get better with physical therapy and weight loss alone. People understandably get interested in other options.”

That often means “joint support” supplements and herbal remedies. Dr. Shmerling says he supports his patients’ decisions to try an alternative therapy “if I have reasonable confidence that something is safe, and the patient understands the other options and isn’t forgoing something important.”

Glucosamine and chondroitin sulfate contain substances naturally present in cartilage. Clinical trials have compared these supplements, separately and together, against placebos but found no difference. “There’s been no convincing evidence that these supplements repair cartilage or change long-term outcomes,” Dr. Shmerling says.


Several other ingredients in the alphabet soup of substances in joint support supplements are dimethyl sulfoxide (DMSO), methylsulfonylmethane (MSM), and S-adenosyl-L-methionine (SAMe). The May 2014 issue of the National Center for Complementary and Alternative Medicine’s NCCAM Clinical Digest summarized the evidence for benefits from these arthritis supplements.

DMSO and MSM. The handful of clinical trials on these substances offer “no evidence of significant reduction in pain compared to placebo,” NCCAM says.

SAMe. A 2009 review found four clinical trials that compared SAMe against a placebo. The difference was small and possibly due to chance.

Herbal remedies

Preliminary research suggests that some supplements made with plants could, hypothetically, reduce the inflammation associated with osteoarthritis. The latest scientific review of two such medicinal plant products was published in May 2014 by the Cochrane Collaboration. It found enough clinical trials to evaluate two herbal remedies sold for arthritis: Boswellia serrata and avocado-soybean unsaponifiables (ASU).

Boswellia serrata. People in the clinical trials who took 100 milligrams (mg) of B. serrata daily for three months said their pain was moderately lower and their functioning slightly better, compared with those who took the placebo.

ASU. Results from six studies of ASU found that taking 300 mg daily for three to 12 months slightly improved pain and functioning. There is no good evidence that it prevents cartilage breakdown.

Unknown risks

In the absence of good evidence that joint-support products deliver what they promise, the potential risks become more important. People who take dietary supplements sometimes report stomach upset, nausea, skin rashes, and allergic reactions. More worrisome are potential drug interactions.

Glucosamine and chondroitin could interfere with the widely used blood thinner warfarin (Coumadin). Are there other drug interactions? “Since supplements haven’t been vetted the same way prescription drugs have, we may not know that,” Dr. Shmerling says.

Nor are the doses and purity of dietary supplements and herbal remedies regulated tightly, as with pharmaceuticals. You can’t be sure what you are getting.

No matter what you try, run through standard options first. “If you buy a $29.99 supplement and stop taking your regular medications, you could really do yourself a disservice,” Dr. Shmerling says. “I do worry about people taking this effort to be natural too far.”

Osteoarthritis: Walk it off

Evidence continues to accumulate that regular exercise, including walking, can help some people with osteoarthritis to reduce their pain and remain more functional. In 2013, a study in the medical journal The BMJ pooled findings from 60 previous clinical trials. Most of the studies (44) involved people with knee osteoarthritis. It found that exercise, compared with not exercising, produced a range of benefits.

A fitness program that combines exercise to build strength, flexibility, and aerobic capacity is most likely to succeed. Walking fits into that picture for those with knee or hip osteoarthritis—especially early in the course of the disease. Those with more severe joint breakdown or pain may have to limit weight-bearing exercise. As an alternative, try swimming, water aerobics, or cycling (stationary or on the road).

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Supplements for Osteoarthritis – Evaluating the Evidence


I’ve reached the age in my life where my joints have started making odd noises – all of a sudden my knees sound like Rice Krispies, which WebMD reassures me is clearly imminent osteoarthritis. At least I’ll have company, as osteoarthritis (OA) affects nearly everyone, once you get old enough. It’s the most common form of arthritis, and treatments are focused on reducing symptoms, as osteoarthritis is incurable. Anti-inflammatory drugs like ibuprofen and naproxen are commonly used to treat the pain associated with OA. They can be effective, but there are also safety concerns with the use of anti-inflammatory drugs. Non-steroidal anti-inflammatory drugs (NSAIDS) have been linked to about 30% of drug-related hospital admissions, and it’s estimated that 12,000-16,000 Americans die annually as a result of gastrointestinal bleeding caused by NSAIDs. They can also cause significant kidney damage in up to 5% of users. Drugs like acetaminophen (Tylenol) are also used commonly but the efficacy of acetaminophen has been questioned, and this drug can be fatal in overdose. With questions about the safety and efficacy of commonly-used drugs to treat OA, there is persistent interest in the use of supplements and other forms of alternative medicine, perhaps based on the perception that these products are safer and potentially as or more effective than “conventional” therapies. A recent paper in the journal Rheumatology summarizes the conclusions of systematic reviews and randomized controlled trials of a variety of herbal products and dietary supplements, and is a helpful guide to inform self-selection and decision-making.

Understanding osteoarthritis

Osteoarthritis is a common debilitating condition of synovial joints. These joints make up most of the movable articulations of the body and are characterised by an articular capsule and synovial lining that surrounds the fluid-filled synovial cavity. This fluid functions somewhat like motor oil, acting as the joint’s lubricant. The opposing ends of the two articulating bones are lined by cartilage which acts like a shock absorber and reduces friction between bones. If you sample a piece of cartilage and observe it under a microscope, you’d see cells called chondrocytes bathing in a matrix composed of collagen fibers, a substance rich in proteoglycans and elastin fibers. Now these proteoglycans are themselves composed of a protein bound to glycoaminoglycans (GAG) – a chain of repeating carbohydrates compound (e.g., hyaluronan). The role of proteoglycans is to act as binding force in articular tissue. GAGs include chondroitin, heparin, and keratan.

Source: Wikipedia

Although its cause is not well understood, osteoarthritis seems to be caused mostly by articulation “wear and tear”, such that nearly everyone by age 70 has some degree of OA. Other factors for OA include genetic inheritance, behavior influences, and obesity. Chronic pain in the knee, hip, fingers and of the lower back are typical symptoms of osteoarthritis. After injury (e.g., trauma or repetitive joint overuse), changes start to occur in the joint itself. First, cartilage cells start to change their metabolism and cause an overall depletion in proteoglycan that leads to damage to the collagen matrix. Then the cartilage swells and loses its ability to absorb joint pressure. As a consequence of cartilage loss, the bone surfaces of the articulation start to wear off which result in deformed bone structures of the joint. Pain from OA is activity-related, with onset during or just after joint use, and then gradual resolution. In the early phase of the condition, pain is episodic and happens after a day or two of overuse of the affected articulation. In severe OA, pain can be continuous. Occasionally, morning stiffness can occur, typically resolving within 30 minutes. While some patients may have physical changes in the joint – particularly joint space narrowing – that can be seen on x-rays, a diagnosis of mild to moderate OA is usually based on a physical examination only. If you’re older than 25, have persistent joint pain in a few joints, and morning stiffness, it’s probably osteoarthritis.

The important and measurable outcomes in OA are global pain as measured by a visual analog scale (VAS), pain function as measured by the WOMAC or the Lequesne Index, and occasionally, joint space narrowing (JSN) as measured using x-ray imaging. As the physical changes seen on x-rays do not accurately predict the severity of symptoms, most trials use pain outcomes as clinically important outcomes to evaluate.

A new review of the evidence

This new paper, published in Rheumatology and entitled “Which supplements can I recommend to my osteoarthritis patients?, is from Xiaoqian Liu and colleagues. The researchers sought out randomized controlled clinical trials and systematic reviews for commonly recommended supplements and “complementary” medicines. Eight systematic reviews and nine RCTs were identified, meaning a total of 16 products were included in the review. The researchers estimated the treatment effect size based on the standardized mean difference where an SMD of up to 0.3 was considered small, 0.3 to 0.8 was moderate, and >0.8 was considered large. The minimum clinically relevant difference was estimated at 0.37 which correlates with a difference of about 9mm on a 100mm pain scale. We use the terms “clinically important” or “clinically relevant” to try to distinguish between changes that are meaningful to patients, and those that are likely not. For example, if you rate your pain a 70 today and a 66 tomorrow, that’s not likely to be clinically meaningful.

The researchers also utilized the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to rate the quality and strength of the evidence, which you’ll see below. A bubble diagram provides a simplified summary of the evidence suggesting which products may be effective and which should be avoided. The bigger the bubble, the higher the rating.

The results

Here’s a summary of what the review found.

Marine omega-3 fatty acids

Fish oils (e.g., cod liver oil), krill oil and products like green-lipped mussel extract have been studied for 6-26 weeks with no evidence of effectiveness, based on low-quality evidence.


Harriet Hall has written about glucosamine regularly. Despite extensive investigation, glucosamine hasn’t been shown to have any convincing meaningful effects, a finding made by this review team as well. This non-effectiveness is consistent across the different forms of glucosamine (sulfate vs. hydrochloride). Glucosamine, however, appears safe.

Chondroitin sulfate

This is another supplement that Harriet Hall recently revisited. This review noted that a Cochrane review found superiority to placebo, but the clinical significance was unclear. Another, subsequent systematic review concluded that chondroitin had no clinically important effects. It was found to be safe, however. The review also noted that combination glucosamine + chondroitin is also ineffective in terms of reducing joint pain or functional impairment in knee pain over six months.

Vitamins D and E

Four studies have evaluated vitamin D supplementation for treating OA. The durations ranged from 1-3 years with doses ranging from 800-2000IU per day to 50-60000IU per month. No clinically meaningful effect on pain or function has been shown.

Vitamin E has also been evaluated at doses of 500IU for 6 months to 2 years, with no effect on symptoms but it was associated with a higher risk of bleeding.


Collagen is a protein, and it’s claimed that consuming it will decrease cartilage degeneration by promoting collage synthesis. When we consume collagen, usually in the form of food, the long chain proteins are broken down during digestion to their original amino acids. There are inconsistent signs of benefit and of unclear clinical importance with collage hydrolysate. Undenatured collagen (derived from chicken sternum cartilage) has been evaluated in two clinical trials for 90-180 days and has been shown to be more effective than glucosamine + chondroitin, or placebo.

Willow bark extract

This is akin to impure, raw aspirin (acetylsalicylic acid) as the raw ingredient of willow bark (salicin) was later used to develop ASA and other anti-inflammatory drugs. A systematic review gave conflicting results in OA, and other trials have shown no effect. (Whether or not this is due to the inconsistent presence of active ingredients is always a question I have with these products.) Adverse effects include gastrointestinal effects, and if this is truly just a raw, unstandardized NSAID, we should expect the same cardiovascular side effects as well.

MSM (Methylsulfonylmethane)

While in-vitro testing suggests that MSM may have inflammatory effects, and MSM is very popular as a supplement, the treatment effects are promising, but not convincing. One systematic review found positive “but not definitive” evidence of a treatment effect compared to placebo. A second systematic review found modest to large treatment effects when used for 12 weeks, though the quality of the evidence was low. Optimal dosing isn’t clear, and the product can cause mild gastrointestinal discomfort.

Avocado and soybean extracts

Avocado/soybean unsaponifiables (ASU) (i.e. extracts) are made of one-third avocado oil and two-thirds soybean oil. Low quality evidence suggests that ASU might have moderate effects in the short-term, but these effects were not observed with more rigorous evaluations. ASU seems to be as well tolerated as a comparable placebo.

Turmeric /curcumin

I’ve written about this product before, which has promising anti-inflammatory effects. The main pharmacological challenge with curcumin seems to be that the product is poorly absorbed. Manufacturers have come up with several different formulations (e.g., nanoparticles, liposomes) but there’s not a lot of high-quality evidence to go on. Like other supplements, what appear to be large treatment effects are complicated by overall poor quality evidence. While curcumin seems to be well tolerated, this is one supplement that may cause interactions with prescription drugs like anticoagulants (“blood thinners”).

Boswellia serrata

Boswellia is a gum resin extract from the frankincense tree. Several potentially active ingredients have been identified with anti-inflammatory effects. Three studies have evaluated two different Boswellia products in knee OA that found clinically meaningful treatment effects on pain and disability improvement. However, the quality of that evidence was evaluated to be low. While it appears to be well tolerated, it has been reported to cause abdominal pain, fever, and weakness.


Pycnogenol is an extract of the maritime pine made up of a concentrate of plant polyphenols, and is claimed to have anti-inflammatory effects. Three studies (of moderate quality) that have evaluated the supplement have found large and clinically meaningful effects for pain and disability. No serious side effects have been reported.

Rose hip

Rose hip is another herbal remedy which has anti-inflammatory properties. It has been studied against placebo in three studies with a duration of 3-4 months. A meta-analysis found small to moderate short-term effects for pain reduction, and a subsequent RCT found no effects. Rose hip was as well tolerated as placebo.

Making sense of the studies

Based on their review, the authors do not recommend omega-3 fatty acids, vitamins D and E, willow bark extract, collagen hydrolysate, glucosamine, chondroitin, combinations of glucosamine and chondroitin, and rose hip. Based on the review, Boswellia serrata extract and pycnogenol appear to demonstrate the most clinically important effects. They also note that while curcumin and MSM demonstrated clinically important effects, the quality of that evidence was low. The authors comment that the overall evidence base remains limited by poor-quality studies, often of short duration, with many sponsored by manufacturers (particularly small studies that showed large effects), noting the following priorities for future research:

They summarize the evidence, and their overall evaluation, in this figure:

The authors conclude that in those with osteoarthritis who are enthusiastic about using supplements, short-term trials of the pycnogenol, curcumin, Boswellia serrata extract, or MSM could be attempted, and should be discontinued after 4-6 weeks if no obvious benefits are noted. Importantly, drug-supplement interactions are not always well understood or well documented, and any supplement should be used with caution (and preferably, consultation with their pharmacist) if being combined with prescription or non-prescription drugs. There are also the very real concerns about supplement quality and batch-to-batch consistency, which complicates evaluations of risk and determining whether or not they work.

Making sense of supplements for osteoarthritis

Given the ubiquity of osteoarthritis and the lack of really good treatment options, it’s worth noting what has been shown to work: Ongoing exercise and weight loss (where appropriate) is backed by moderate-to-high quality evidence and a moderate effect size. This is a benefit that is comparable to anti-inflammatory drugs, but without the cost or the side effects. There are also topical anti-inflammatory drugs, which appear to provide meaningful benefits without the typical NSAID-related side effects.

For those who have exhausted the established options, supplements may look appealing and some may be worth a short-term trial. It’s important to remember that with studies of supplements and drugs alike, as the quality of evidence improves, the treatment effects often diminish or disappear. Still, based on the existing evidence, for your own evaluation it seems reasonable to try products for which there is the best evidence. This is an area where the evidence continues to emerge, so if you’re experiencing OA, cautious skepticism about the “latest and greatest” supplement seems to be reasonable.


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