Six Key Questions for Evaluating a Nutritional Supplement

A question about nutritional supplements came up at a recent meeting of the men's group breakfast club: "How do I know which supplements to buy?" 

Good question! And a tough one to answer. Before we explore this issue, we might first ask: Do we older men even need supplements? Can't we get everything we need from our food?

Do Most Senior Men Need Nutritional Supplementation?

There's a substantial body of evidence that we older guys are likely to have one or more nutritional deficiencies. It's our individual choice whether or not we choose to deal with this issue.

According to the medical literature, older males are at significant risk for various nutritional deficiencies due to physiological changes with age, reduced food intake, and dietary imbalances. Common deficiencies include energy, key vitamins (such as D, B12, C, E), minerals (such as zinc, selenium, calcium, iron, iodine, copper), and dietary fiber. These deficiencies can occur even in those who appear well-nourished.

Addressing these gaps through improved diet, targeted supplementation, and regular nutritional assessment is important for healthy aging.

Dr. Peter Attia recently spoke on this topic. In his discussion, he talks about the issues associated with nutritional supplements and proposes six questions you need to ask about supplementation.

Attia's Six Key Questions for Evaluating a Supplement

Q1: Are you correcting a deficiency or trying to achieve supramaximal levels?

• Why are you taking this supplement?
• Are you correcting a deficiency (i.e., replacing something your body lacks)?
• Or are you trying to achieve supraphysiologic levels in hopes of enhancing function?
• Example: Taking vitamin D to correct a deficiency vs. taking creatine to achieve supranormal levels.

Q2: Are you taking it for lifespan or healthspan?

Is the supplement intended to improve your lifespan, healthspan, or both?

• Lifespan focus → Aimed at increasing longevity and reducing risk of disease.
• Healthspan focus → Aimed at improving quality of life (physical performance, cognition, emotional health).
• Some supplements may support both (e.g., fish oil for cardiovascular health).

Q3: If lifespan, is it targeting a specific disease or broadly geroprotective?

If it’s taken for lifespan benefits, is it:

• Targeting a specific disease (e.g., reducing risk of heart disease or neurodegeneration)?
• Broadly geroprotective (i.e., slowing down the aging process in a general way)?
• Examples:
• Targeting a disease: Taking statins for cardiovascular disease prevention.
• Geroprotective approach: Rapamycin, which may broadly delay aging processes.

Q4: Is there a biomarker that you can track to suggest that the supplement is having the desired effect?

• Is there a biomarker to track effectiveness?
• A biomarker allows you to measure whether a supplement is working as intended.
• Example biomarkers:
• Omega-3 index for fish oil effectiveness.
• 25-hydroxy vitamin D for vitamin D levels.
• Creatinine levels for kidney function when taking creatine.
• If no biomarker exists, effectiveness must be judged subjectively or indirectly.

Q5: Do we understand the mechanism of action?

• How does the supplement work?
• Understanding how a supplement functions in the body helps assess its potential benefits and risks.
• Important note: You don’t need to fully understand the mechanism to justify use.
• Example: Some medications are widely used without a complete understanding of their mechanisms.
• However, the stronger the understanding of its action, the more confidence one can have in using it.

Q6: What is the balance of risk to reward, including potential side effects, the magnitude of the effect, and the quality of a supplement?

How do the risks compare to the potential benefits? This includes:

• Side effects
• Magnitude of effect (how much benefit you can reasonably expect)
• Confidence in available data
• Quality of the supplement itself (manufacturing, purity, contamination risks)
• Example considerations:
• Low risk, high reward: Creatine monohydrate (strong evidence, minimal risk).
• Unclear risk-reward ratio: Some herbal supplements with limited human data.

The Importance of Quality in Supplements

Supplement quality varies widely due to lack of regulatory oversight.

• Supplements are far less regulated than pharmaceuticals.
• Even in the pharmaceutical industry, quality control is imperfect, especially with generics.
• The supplement industry likely has many more issues than seen in the pharma space.

Key takeaway: Always verify supplement quality using third-party testing and reputable brands.

A Final Note About Quality Control

A quality supplement manufacturer will have their batches of raw material tested by an independent laboratory for quality assurance, such as for potency and purity. They do not depend on the supplier's claims for potency and purity. They will also have their final product tested to make sure the contents match the label.

Since quality assurance testing is expensive, some manufacturers sacrifice this critical step in order to save money and keep their prices lower than the competition. If you ask a manufacturer or distributor to see a lab report, and they say "no" -- proceed with great caution. Remember, the cheapest is not always the best.

References

1. Orwoll, E., Nielson, C., Marshall, L., Lambert, L., Holton, K., Hoffman, A., Barrett-Connor, E., Shikany, J., Dam, T., & Cauley, J. Vitamin D deficiency in older men.. The Journal of clinical endocrinology and metabolism. 2009; 94 4. 

2. Waern, R., Cumming, R., Blyth, F., Naganathan, V., Allman-Farinelli, M., Couteur, D., Simpson, S., Kendig, H., & Hirani, V. Adequacy of nutritional intake among older men living in Sydney, Australia: findings from the Concord Health and Ageing in Men Project (CHAMP). British Journal of Nutrition. 2015; 114. 

3. Vural, Z., Avery, A., Kalogiros, D., Coneyworth, L., & Welham, S. Trace Mineral Intake and Deficiencies in Older Adults Living in the Community and Institutions: A Systematic Review. Nutrients. 2020; 12. 

4. Xiao, L., Fu, J., Lin, L., & Han, Y. Temporal Trends in Incidence of Nutritional Deficiency among Older Adults in China: A Secondary Analysis of the Global Burden of Disease Study 1990–2019. Nutrients. 2022; 14.

5. Das, A., Cumming, R., Naganathan, V., Blyth, F., Ribeiro, R., Couteur, D., Handelsman, D., Waite, L., Simpson, S., & Hirani, V. Prospective Associations Between Dietary Antioxidant Intake and Frailty in Older Australian Men: The Concord Health and Ageing in Men Project.. The journals of gerontology. Series A, Biological sciences and medical sciences. 2019 

6. Brownie, S. Why are elderly individuals at risk of nutritional deficiency?. International journal of nursing practice. 2006; 12 2. 

7. Baugreet, S., Hamill, R., Kerry, J., & McCarthy, S. Mitigating Nutrition and Health Deficiencies in Older Adults: A Role for Food Innovation?. Journal of food science. 2017; 82 4. 

8. Charlton, K. Elderly men living alone: are they at high nutritional risk?. The journal of nutrition, health & aging. 1999; 3 1.

9. Choi, Y., Ailshire, J., & Crimmins, E. DIETARY INTAKE AND NUTRITIONAL RISK AMONG OLDER AMERICANS. Innovation in Aging. 2019; 3. 

The mission of of seattleseniormen.com and greenwoodmensgroup.com is to provide a supportive environment where men from diverse backgrounds can foster camaraderie, develop friendships, share wisdom, enrich one another's lives -- and contribute to all Seattle communities, including Greenwood, Ballard, Crown Hill, Fremont, Green Lake, Licton Springs, Loyal Heights, Magnolia, Phinney Ridge, Ravenna, Sunset Hill, Wallingford, Wedgwood, Whittier Heights and beyond.

See our Disclaimer