The Supplement Smackdown | Where to Start

This article, written by Dr. Bill Wilson, presents a strong critique of academic medicine's stance on dietary supplements. Dr. Wilson argues that academic medicine is biased against supplements due to their lack of patentability, leading to a reliance on pharmaceutical drugs with potential conflicts of interest. He advocates for a more nuanced approach to supplements, citing deficiencies in modern diets and the potential for supplements to address specific health concerns, particularly in the context of what he calls "CARB syndrome". He criticizes a JAMA article on supplements as inaccurate and dismissive of the potential benefits of certain vitamins, minerals, and other compounds. Key Themes & Arguments: Bias of Academic Medicine: Dr. Wilson suggests that academic medicine is inherently biased against supplements because they cannot be patented and therefore do not generate the same profit incentives as pharmaceutical drugs. He writes, “I suspect one big reason for their distain is because of the relationship between many academic so-called experts and Big Pharma.” He implies that this bias leads to an underestimation of the potential benefits of supplements and an overreliance on medications. He also points to financial conflicts of interest: "These profits also provide the funding for the academic studies to support the effectiveness of medications and many individuals in academic medicine benefit financially from participating in these trials, creating a possible conflict of interest." Lack of Research on Supplements: He acknowledges the lack of robust research on supplements, stating, "Because supplements are unable to obtain patent protection, there is little or no financial incentive to run the type of trials that are needed to show efficacy and safety of a given supplement." He admits that many supplement studies are small or poorly conducted, but argues that this doesn't invalidate the potential of supplements. "Many of the studies on supplements are small or of such poor quality that they provide no guidance on how supplements should be used clinically." Modern Diet Deficiencies: Dr. Wilson argues that the modern diet is often deficient in key nutrients due to depleted soil and processed foods, making supplementation a reasonable approach for many people. "The problem is, in our modern world with depleted soil and the overuse of fertilizers, much of the produce we consume is lacking in sufficient quantities of key vitamins, minerals and anti-oxidants. Many people consume large amounts of processed food that are devoid of these key nutrients, so taking a multivitamin every day seems like a reasonable thing to do.” He also notes the difficulty of getting sufficient Vitamin D through sun exposure. Importance of Inflammation and Fatty Acid Ratios: Dr. Wilson emphasizes the role of inflammation in health and the importance of balancing omega-6 and omega-3 fatty acids. He notes that the average American has an imbalanced ratio and argues for higher doses of omega-3 fatty acids than those used in many studies: "We now know that omega 3 fatty acids form the core of the bodies’ anti-inflammatory defenses and the best way to be assured that you are getting the right balance of pro-inflammatory omega 6 fatty acids and anti-inflammatory omega 3 fatty acids is to measure the AA/EPA ratio." He states that, to lower an unhealthy AA/EPA ratio, "you need to take on average 10-12 grams of omega 3 fatty acids daily.”