💊 Supplements 101: Choosing and dosing vitamins + minerals

Welcome back!

I get many questions about whether it is necessary to take supplements even if you’re eating a whole foods diet, and how to know which supplements to take and at what doses.

Ideally, we could meet all of our vitamin and mineral requirements from food alone, but there are several factors that make this more challenging in today’s world. In this newsletter, I am going to share my thoughts on my personal supplementation strategy, including:

• 3 reasons why I take supplements

• How to utilize testing to guide supplementation

• What I look for in supplement brands

It is extremely, extremely important to work with YOUR doctor on your supplement regimen. You cannot follow anyone else’s regimen and expect it to work for your body. In fact, doing that can be dangerous: many supplements can interact with medications and cause problems, and may not be right for your biology. Do not start or change supplements without consulting your doctor. Resources for finding doctors who will be familiar with root-cause health and supplementation can be found on my website.

3 reasons why I supplement despite eating a whole foods diet

1. Our food is nutrient depleted due to industrial agriculture and ultraprocessed foods

Our modern diet is nutrient depleted due to industrial agriculture, long food transit times (the average piece of food travels 1500 miles from soil to plate, where it loses nutrients to decay), and ultraprocessed foods (which are stripped of nutrients).

As many as half of all Americans are deficient in at least some critical micronutrients. This is partly because of soil depletion (which robs our food of nutrients) and partly because our diets lack diversity, with 80-90% of Americans not eating the recommended amounts of vegetables and fruits, and about 60% of our daily calories coming from ultraprocessed foods 🤦‍♀️ .

Only 1% of US farmland acreage is currently certified organic, and just about 1.5% of farmland is estimated to be implementing regenerative practices that facilitate nutrient-rich crops and meats (deep dive on why regenerative agriculture is critical for health HERE).

When food grown from regenerative soil is compared to conventionally grown non-organic food, the vitamin and mineral differences are stark. In one study, regeneratively grown food had, on average, 34% more vitamin K, 15% more vitamin E, 14% more vitamin B1, 17% more B2, 15% more carotenoids, 20% more total phenolic, 11% more calcium, 16% more phosphorus, 23% more zinc… the list goes on and on!

While I aim to get as much of my food as possible from farms at the farmers market who I know use regenerative practices like cover crops, composting, minimal tilling, and more, I also know that we are facing an uphill battle getting the nutrients from food that our cells NEED to function, and supplementing can be an insurance policy.

2. Improving fertility outcomes

My partner and I want to get pregnant in the next few months, and the research is overwhelming that supplementing with vitamins and minerals improves fertility outcomes and fetal/infant health. According to a 2022 paper called Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients, “insufficient vitamin intake is associated with a wide range of pregnancy complications including anemia, C-section, depression, gestational diabetes, hypertension, infertility, preeclampsia, and premature rupture of membranes, and infant health problems including asthma, autism, low birth weight, congenital heart defects, intellectual development, intrauterine growth restriction, miscarriage, neural tube defects, orofacial defects, and preterm birth.” Women who take supplements before and during pregnancy have better birth outcomes for themselves and their infants.

On top of vitamins and minerals, supporting the body with antioxidants like CoenzymeQ10 (CoQ10) may help preserve egg quality, since a female’s eggs (oocytes) can be damaged by excess oxidative stress. In Good Energy, I mention that CoQ10 is a micronutrient that is required for transferring electrons in the mitochondria’s electron transport chain (ETC), while also embedding in the cell membrane to offer antioxidant protection. After eggs are released from the ovary at ovulation, they undergo rapid “aging” and degradation as they make their way to the uterus, with many changes occurring to mitochondrial activity and mitochondria structure. CoQ10, which serves as a mitochondrial cofactor and improves mitochondrial function, significantly improves egg aging after ovulation. It reduces levels of oxidative stress and DNA damage and inhibits cell death pathways, thereby preserving egg (oocyte) quality. 

A study of pregnant women shows that 90% of pregnant women do not receive adequate nutrients during pregnancy from food alone.

Male-factor infertility accounts for 50% of all infertility cases (!!!), and research shows that much of the reason men are having infertility issues is due to excess oxidative stress and free radicals negatively affecting sperm. Therefore, it’s not too much of a suprise that research has shown that subfertile men who supplement with antioxidants have been shown to have DOUBLE the rates of ability to get their partner pregnant than those who don’t supplement. It is astonishing to me that it is not front page news that all men planning to have children should be eating antioxidant rich foods and supplementing with antioxidants like coenzymeQ10, N-acetylcysteine, and others. (Note: WeNatal has prenatals for MEN that include antioxidants. I have no financial relationship to the company, just a big fan).

The current Recommended Dietary Allowances (RDAs) for vitamins and minerals are far too low to support pregnancy. Many of these RDAs were established in World War 2 to prevent deficiency diseases like rickets and scurvy, but not designed to provide optimal nutrient levels for intense periods of biologic activity and depletion like preconception, pregnancy, and postpartum. We need to be getting more nutrients through our diet, and possibly through added supplements, than we are.

There’s also data to suggest that nutrient deficiencies may be related to postpartum depression risk (for instance, omega-3 and vitamin D status). This is important, because postpartum depression is becoming an epidemic, with rates increasing 7x between 2000 and 2015 according to the CDC, and up 105% according to the American Journal of Obstetrics and Gynecology! This is a TRAVESTY - we are letting mothers and families down. I imagine this stark rise may be due to a mix of nutritional, environmental, toxin-related, and cultural factors that have diminished community for mothers, and that propagates lack of respect and support for mothers in American society.

The CDC, World Health Organization, and American College of Obstetrics and Gynecology (ACOG) ALL recommend taking a prenatal vitamin. If you need more evidence of why we need to prioritize our nutrient status around fertility, take a look at this figure from this paper (below), which shows the significant evidence for maternal vitamin status leading to differential outcomes for the infant. 👇️ 

The suffix -cide means “act of killing.” Astonishingly, it is estimated that up to 20% of suicides worldwide are done by intentionally ingesting pesticides. We share an immense amount of biology with the organisms we intend to kill with these insecticides, fungicides, herbicides, and more.

What’s more, some of the most commonly used pesticides, like atrazine, promote the conversion of testosterone to estrogen, which can several have negative effects in women (like increased breast cancer risk, infertility), men (depletion of testosterone, infertility), and fetuses (birth defects).

How can we help bring a pesticide-free world to fruition? It starts with each of us prioritizing eating organic food as much as possible and standing firmly against buying or serving food sprayed with pesticides.

I find that even among the most health and environmentally conscious people I know, there's still confusion about why buying organic food matters for humans and the planet. I get it - chemical companies have paid a lot of money to produce ghost written academic papers that create confusion! But it’s time to wake up. Below, let’s start with a breakdown of what conventional, organic, and regenerative really means.

Vitamins and minerals also matter outside of the mitochondria for optimal metabolic health. For example, magnesium helps enable glucose transporter proteins (like GLUT4) to bring glucose into cells. It’s also necessary for the protein enzymes that process Vitamin D, which is related to insulin production. And it promotes a biochemical process called autophosphorylation, which ultimately impacts insulin sensitivity.

Determining supplement needs and doses: TESTING HELPS

In determining what doses and types of supplements I’m going to take, I look to specific labwork to help guide me. This is a “test, not guess” strategy.

I get a full biomarker panel of bloodwork from Function Health or Next Health (through their Premier Membership) every few months which test things like iron, magnesium, vitamin D, homocysteine, and hormones, which then can help guide what levels of hormones I need.

Then I also do a nutritional test through Genova Connect called Metabolomix+, which gives me exact recommendations for the doses of supplements to take (see below for my results).

For instance, since my labwork showed that my homocysteine level is high (which is a key marker of cardiovascular risk), it means that I likely need to improve my B-vitamin levels, as B-vitamins are critical in the recycling of homocysteine (see below: vitamin B12, folate [B9] and vitamin B6 are required for homocysteine recycling).

Below is some of my recent labwork from Genova, Next Health, and Function Health and how I use it to guide my supplementation decisions.

In my Genova Metabolomix+ results, I saw that I have an increased need for several vitamins and minerals, including Vitamin A, E, CoQ10, alpha lipoic acid, several B vitamins, omega-3 fatty acids, and digestive enzymes. In reacting to the results, the first step is ALWAYS to emphasize whole foods that contain these elements. Fortunately, Genova gives you detailed educational information in your Metabolomix+ report on how to get these nutrients from natural food sources. For instance, I can get more magnesium by eating more pumpkin seeds, and more omega-3s from eating salmon and sardines.

In addition, I also use these results to accurately dose my supplements in conversation with my Functional Medicine doctor. I can see in my results that I have significant needs for several B-vitamins, and that with my multivitamin alone (I take WeNatal), I am not covering the bases. This is corroborated by my Next Health results that show I am low on vitamin B12. Therefore, I add a B-complex from Thorne on top of my multivitamin to get high enough levels. (Note, I have no financial connection with WeNatal, Next Health, or Thorne).

On my Next Health labs, I also found out that my testosterone is on the low end of normal, and my Functional Medicine doctor shared that some ways to improve that is through resistance training and stress management, and also through getting adequate zinc, magnesium, and vitamin D, as well as starting Ashwagandha.

My Function Health results showed I’m in the low end of normal for vitamin D (and not in the optimal range), and that my magnesium is low. Therefore, this inspires me to up my vitamin D supplementation (and get more time in the sun to produce it naturally! ☀️ ), and prioritize magnesium rich foods and supplements. One thing I love about Function Health’s results is that they show you both optimal ranges and normal ranges, and which foods and supplements can help optimize levels👇️ 

Based on my lab work (which I get repeated every few months to refine my diet, lifestyle choices, and supplements), this is the supplement regimen I’ve developed for myself, below. (Note: this is NOT advice for you. This is based on my labs and my conversations with my Functional Medicine doctor and is not medical advice. You need to test and work with a doctor to determine your supplement needs):

It is important to note that my recommended supplement doses based on labwork and what I am taking is not a perfect match. The key for me is to develop a strategy rooted in testing, tune in with how I feel, and re-check every several months to see how my labs look. This is not an exact science, it’s an iterative process. I work with my doctor to make sure I’m not taking too much of anything. I HIGHLY recommend working with a Functional Medicine doctor to help you fine tune your biomarker interpretation, dietary approach, and supplementation strategy. On my website I have a list of resources to find Functional Medicine doctors.

Why do I stick with a fairly intensive supplement strategy? Because I find that it works for me: I feel incredibly energetic, have no chronic symptoms, my overall health biomarkers are very good, and my biological age is 19.7 (and has been declining!).

What I look for in supplement brands

1. Are all the ingredients clean and verified safe?

At a minimum, I want to know that all ingredients are FDA GRAS (which means “generally recognized as safe,” which is a fairly loose regulation, but better than nothing) and that products are ideally third party tested or certified by NSF Certified for Sport.

2. Non-active ingredients: No artificial colorings, no “natural flavors” or “artificial flavors,” and no added sugars

You’d be shocked how many supplements included added sugars in the forms of sugar, sucrose, sucrose syrup, glucose, glucose syrup, dextrose, maltose, lactose, sorbitol, xylitol, maltodextrin, high fructose corn syrup, agave nectar. Read the non-active ingredients and look for the bare minimum in there. Supplements don’t need sugar!

3. Has the finished product I am ingesting been clinically tested?

Most supplement companies simply combine clinically tested ingredients but have no idea if the combination is safe and effective.

One of the things I like about Mitopure is that there are 300+ studies on Mitopure and Urolithin A, and Timeline has done 15+ years of clinical and pre-clinical research on cellular health and aging. Studies have been published in top journals, including JAMA, Nature, and Cell. This is similar with Pendulum, who have peer reviewed studies on clinical efficacy in top journals. (This is virtually unheard of in the supplement industry.)

4. Does the supplement include the most bioavailable and active forms of vitamins?

There are so many molecular structures of each vitamin, and you want to choose the types that are most easily absorbed and have the best function in the body. For instance, when looking for a magnesium supplement, you may see options for magnesium L-threonate, malate, oxide, carbonate, citrate, glycinate, and sulfate. Magnesium L-threonate is the most effective at crossing the blood-brain barrier (and therefore acting on the brain), while magnesium glycinate, malate, and citrate are highly bioavailable for overall absorption. Therefore, I take a mix of these bioavailable forms.

Similarly, there are several types of B-vitamins to choose from, and you want to choose the types that are most easily absorbed and will have the most potent function in your body. Common forms of vitamin B9 on supplement labels include folic acid, folate, 5-methyltetrahydrofolate (5-MTHF), and folinic acid. 5-MTHF is what I choose because it can be utilized by individuals with methylenetetrahydrofolate reductase (MTHFR) gene mutations, which a fairly significant portion of the population carry. WeNatal and Thorne both included “methylated” B-vitamins, like methyltetrahydrofolate, so I choose these.

5. Is the packaging sustainable?

I favor brands that use glass or metal bottles and ideally send refill packs, as opposed to sending their supplements in disposable single-use plastic bottles (read my screed on the perils of plastics, here). This is one of the reasons I love packaging from Timeline and WeNatal, as they give you a single bottle to re-use and send refills in sustainable packaging.

6. Do I trust the team and founder?

I have been fortunate to get to know the founders, CEOs, and teams of several supplement companies over the years, and so a big factor in whether I trust a supplement company is knowing the integrity of the people behind the supplement. What do they believe? What is their mission? This is one of the reasons I use and respect WeNatal, Momentous, Pendulum, Timeline, and Energy Bits. I don’t personally know the teams at Thorne or Pure Encapsulations, but I do know that they follow rigorous testing and are trusted by functional medicine doctors around the world.

With good energy 💓

Dr. Casey

📆 Coming up! 👇️ 

👩‍🏫 New Course for Healthcare Practitioners

Many of the healthcare professionals in this community have been asking for more information about all of the things I discuss in Good Energy.

I am so excited to share that I’m doing a 6-week bootcamp with Rupa Health starting October 21st where you’ll learn how to master metabolic health, transform your practice and your patients’ lives, and detect metabolic dysfunction early with comprehensive diagnostics.

Join me for for six comprehensive lectures, six live Q&A sessions, an included Access Medical Labs Metabolic Panel and a free copy of my #1 Best-selling book, Good Energy.

Live sessions will be held at 2:00 pm PDT / 5:00 pm EST on October 23rd, 30th, November 6th, 13th, 20th, and December 4th. All sessions are 60 minutes, recorded, and will be made accessible to enrolled practitioners.

Sign up for the bootcamp here.

🎓️ FREE live lecture with Rupa Health - ALL ARE WELCOME!

Join us on October 11th, 2024 9AM PT and learn about the clinical importance of understanding metabolic health in every patient, how to test for it and key dietary and lifestyle changes that can start to improve it.

In this lecture, I’ll discuss:

• The Burden of Metabolic Dysfunction in the US and the Metabolic Spectrum of Disease: Gain an understanding of the spectrum of metabolic diseases and review the criteria for diagnosing metabolic syndrome.

• Understand the Landscape of Metabolic Testing: Identify the essential metabolic tests to order for every patient at least twice a year, and distinguish between optimal and normal ranges for each test.

• Introduction to Benefits of Using Continuous Glucose Monitors (CGMs) in Practice: Understand the process of ordering a CGM for patients and how to interpret the data it provides

Register for the live class here. Hope to see you!

💪 One thing you can do this week to make a difference

Sign up for the coalition against chronic disease and join for a roundtable discussion at the Senate on September 23rd (NEXT WEEK!) 📣 

End Chronic Disease is a coalition co-founded by my brother, Calley, and joined by founders and CEOs of incredible health and wellness companies like Sweetgreen, Thrive Market, Momentous, Pendulum, Plunge, and so many more.

🇺🇸 End Chronic Disease is convening health leaders to join in a nonpartisan roundtable discussion in Washington DC on September 23rd, 2024, with Sen. Ron Johnson about better ways to combat the chronic disease crisis. It will be held in the iconic Kennedy Caucus Room in the Senate. Testimony from: Robert F. Kennedy Jr., Jillian Michaels, Max Lugavere, Vani Hari, Calley Means, Marty Makary MD, MPH, Brigham Buhler, Dr. Chris Palmer, Jason Karp, Courtney Swan, Grace Price and Alex Clark.

RSVP HERE if you’ll be able to join this historic event.

Join the Metabolic Revolution Rally in DC

My friends Dr. Rob Lustig, Dr. Chris Palmer, and Vinnie Tortorich are going to be a part of a metabolic health rally in DC on October 13th. The rally will be held from 3:30-4:45 PM at the National Sylvan Theater on the grounds of the Washington Monument.

This is organized by Metabolic Revolution, a grassroots group of healthcare professionals, nutrition experts, and citizens whose mission is to to spread awareness about the powerful healing that metabolic therapies can provide.

To participate in the upcoming rally, sign up here.

👀 In Case You Missed It

📚️ New book alert: The Hidden Power of the Five Hearts

3-time New York Times bestselling author Kimberly Snyder has a new book out TODAY called The Hidden Power of the Five Hearts. It is about awakening the power of your “heart brain”, through teachings and the science of heart coherence, which is a scientifically validated way to increase your physical health, mental clarity, emotional intelligence, as well as elevate your daily thoughts, success and peace. The world needs this message - we are far too much in our “heads,” and would benefit from unlocking the power of the HEART! Order the book here and share with your family and friends.

📚️ Good Energy is BACK IN STOCK on Amazon!

📑 New media features

Check out these recently published articles:

• “How The Mind Controls Metabolism” on the Rupa Health blog

• “Forget the Fads: True Health Is Built on Simplicity and Connection” on The Next Big Idea Club’s Book of the Day Newsletter

🎙️ New podcast on The Megyn Kelly Show

In this episode, I join Megyn Kelly to discuss the hidden truths in the medical and healthcare establishment, including the influence of Big Pharma, the dangers of ultra-processed foods, and the importance of whole food nutrition.

Watch the full episode on YouTube here or listen on Apple Podcasts and Spotify.

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