Nutritional supplements are a recurring topic in discussions between doctors and patients. Many people incorporate supplements into the daily routine when they are looking to enhance their well-being or cure an ailment. But how do you know if you’re using the right nutritional supplements? 

On this episode of Back Talk Doc, Dr. Sanjiv Lakhia and Dr. Tod Cooperman, MD discuss how to choose effective supplements, and what factors you should consider when looking to add supplements to your diet. 

Dr. Cooperman is the president, founder, and editor-in-chief of ConsumerLab.com, which is dedicated to independent reviews of supplements. He pursued the testing and review of supplements after seeing the impact of the DSHEA act in the 1990s, which allowed companies to make claims about products that they previously weren’t able to, leading to an explosion of interest in the health supplement market.   

Understanding what goes into supplements can be a complex science in an industry that lacks FDA regulation. The team at ConsumerLab.com has set up detailed testing procedures at specialized labs to identify which products on the market are delivering on their claims. 

Despite a boom in popularity, Dr. Cooperman explains he’s not a fan of gummies because their dosage can be inaccurate due to the semi-liquid environment of the product. 

“There are not a lot of requirements from the FDA, but a product does have to have 100% of what it claims,” says Dr. Cooperman. “So companies don't want to produce a product that's going to fall below that; otherwise, they're in violation of the regulations. So they put in more.” 

Dr. Cooperman also shares insight into how to make an informed purchase, what to be wary of when shopping online for supplements, and what supplements he takes personally.

💡 Featured Expert 💡

Name: Dr. Tod Cooperman, MD

What he does: Dr. Tod Cooperman is a nationally recognized and respected researcher, writer, and speaker on consumer healthcare issues. Dr. Cooperman is a graduate of the Boston University School of Medicine, receiving his M.D. in 1987. He also received his Bachelor's degree from Boston University with a major in Medical Sciences and a minor in Economics. Recognizing a lack of quality standards and oversight in the U.S. dietary supplement industry, Dr. Cooperman founded ConsumerLab.com in 1999, guiding it to become the leading independent evaluator of dietary supplements and nutritional products.

Company: Consumer Lab

Words of wisdom: “Very rarely is there a situation where there are limits on contaminants. That’s left up to the manufacturer, so you’re at the mercy of the supplement company to do the right thing by you when you're buying a supplement. Some companies will cut corners or use simple methods, and others hold their products to a much higher standard.”

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Welcome. You are listening to Back Talk Doc where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery and Spine Associates, where cutting edge nationally recognized care is delivered through a compassionate approach. This podcast is for informational purposes only and not intended to be used as personalized medical advice. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your back talk doc, Dr. Sanjiv Lakhia.

Welcome back to another episode. One of the most common questions I get in my practice has to deal with nutritional supplements. A lot of people are on supplements these days and they bring in bags of them for me to look at and see which ones may or may not be helping their pain. And it's a good question. There's so many brands out there and it can make your head spin trying to figure out what is reputable, what's good quality and what's not. So today I have the perfect guest and expert on, Dr. Tod Cooperman. He's going to help me break down this topic. Tod, welcome to the show.

Thanks very much Sanjiv. I appreciate you having me on.

All right. Dr. Cooperman is a nationally recognized and respected researcher. He's a president, founder and editor-in-chief at ConsumerLab.com, and I've been using ConsumerLab.com for many years since I first found out about it. Guys, if you're not familiar with it, go to it once you're done with the podcast, we'll link to it in the show notes. It's an amazing website that breaks down independent reviews of supplement quality amongst many other things. But Dr. Cooperman is a graduate of the Boston University of School of Medicine where he received his MD in 1987. He also received his bachelor's degree from Boston University with a major in medical sciences and a minor in economics, recognizing a lack of quality standards and oversight in the US dietary supplement industry. Dr. Cooperman founded ConsumerLab.com in 1999 guiding it to become the leading independent evaluator of dietary supplements and nutritional products.

He has been called as an expert witness by committees of the US Health of Representatives and the US Senate to give testimony regarding the quality and regulation of dietary supplements and has been regularly invited to speak about dietary supplement quality at the National Institutes of Health and now this podcast where he is going to help us figure this topic out. So let's roll up our sleeves and get going with it. Todd, tell me a little bit though before we jump into the topic, kind of how a physician who goes to Boston University Medical School finds his way into this type of work.

That's a good question. So I'll try to make it short. So I came out with my MD and realized that I kind of like the intersection of products coming on the market as well and the healthcare and patient care aspects of medicine and wanted to kind of marry that and decided to go right into the pharmaceutical industry where I worked for three years at Bristol Myers, now Bristol Myers Squibb and then into the biotech area working on new drugs based on neuroreceptors. But then realized during that period of time how difficult it is to actually successfully create a new drug and what a long shot that is.

And I really, I think I have an entrepreneurial spirit and felt that I wanted to start something to provide information, not just a product, but information to help consumers. And I was actually, there were articles coming out, this was around 1999, a little bit before that, just a few years after the passage of the DSHEA, which is the Dietary Supplement Health and Education Act was a real turning point in the supplement arena because it allowed companies to start making claims on the products that a product could actually do something.

It couldn't say it could treat or prevent a disease, but might help maintain this or that function. And there was an explosion in the supplement area, especially around herbals at that time. And then articles started coming out here and there showing that there were problems with the quality of these supplements on the market that people were rushing toward. Back then, there was things like ginkgo and echinacea and saw palmetto, very different from where we are now. And there was no one really tested these things on a regular basis. So I decided that that would be what I wanted to do. And I saved some money and hired a guy right out of the FDA who had been testing supplements only on kind of a firefighting basis. He was testing things like ephedra, which had certain dangers at that point and he became our head scientist and we started going out and buying and testing supplements and showing what the quality of these products were.

And then over time, ConsumerLab has really expanded not just to focus on just what's in these products, but what do they do, what's the right dosage. We have over 90,000, I think 95,000 paying individual subscribers to ConsumerLab, many universities, libraries and have expanded also into healthful foods that are sold nationally. We don't go buy and go to a local farm supermarket and just buy the local meat product or something like that. But we're buying packaged products that are sold nationally. So we're looking, we test things like cranberry juice and psyllium and dark chocolates, things that have a health benefit and that's the long and the short of it. And here we are and over like 24 years later, still doing the same essential thing but covering a broader base.

Give us a sense of the company. How many people do you have in the background that are working on things?

The company is relatively small. People are always surprised. The entire company is about 12 full-time people and then some part-time people and programmers on the side on top of who we have here. So it's relatively small group. And the reason why it is, we decided early on, myself and our head researcher, the vice president of research, there are so many different types of products that we test and so many different types of tests that we do. It didn't make sense to create a laboratory, a full laboratory in-house running all these tests, but to be utilizing outside laboratories that are expert in specific areas. So if we test say a fish oil, we will send that to multiple laboratories, each of which is expert in a different area, might be heavy metal testing, it might be testing for oils or we're testing for rancidity. If we're testing a multivitamin, we may be using different laboratories for the water-based vitamins versus oil-based versus minerals.

We're test olive oil. We even use the services of an expert olive oil tester. So there's so many different things that we're involved in. Our focus on the research side is to pick the right methods, which is not easy, pick the right labs and to be able to interpret that data and then report it. So we have a whole staff on the editorial side, including myself and other PhD with expertise in writing about dietary supplements and communicating that information in as simple a way as we can. Although we are told that our information is a little bit very deep because we have extremely interested and knowledgeable readers like yourself who pose great questions to us and we are constantly digging in and learning more to try to answer those questions.

They're very specific things like what time of day and should you take something and what should you not take it with? And all the drug interactions that might be out there. And you mentioned patients come in with bags of supplements. There's so many questions to be asked there, why do you think you need it? Does this really work for that? Is it the right dose, is it the right formulation? Is it the right chemical form? Might it be interacting with the other drugs? Might it be interacting with other things that you're eating? So it really is complicated area. We're constantly trying to add more useful information and there are always new supplements coming onto the market.

Oh, for sure. So let me make sure I understand correctly. It's not that you have a team of white coat chemists in the back room that's running gas chromatography tests. It's that you have a network of experts that can help you evaluate these products in a manner that you feel is necessary. Is that accurate?

Pretty much, yeah. The laboratory testing is mostly done outside. The only in-house lab testing that we do is, since every tablet and tablet needs to be subjected to disintegration testing, make sure it really will fall apart and release its ingredients. And that's a pretty standard test. That equipment and that test we run in-house because we're running those all the time, but we're using outside laboratories for the analytical chemistry. We do obviously the expertise in-house to figure out what tests to run and where to run them and how to interpret that data.

So for some of the scientists out there listening, what are some common methods that are used to look at a product and evaluate its purity or potency?

So I am not the head of research, I'm the head of the company and trying to put everything together. Our head of research is a PhD and toxicology, a pharmacologist, toxicologist who actually, he's not our original head of research who would come out of more academia and the FDA and was with us for I think 14 years. The current head of research for the last 10 years comes out of industry, which is actually very helpful to us because it helps us really understand how industry does things and how they sometimes do things wrong. So he would be able to really be the one to talk about the methods. But when you're looking at a supplement and trying to determine the right test, there are so many different ways of looking at it. There are simple tests that may just be based on assessment of the color that you're seeing in say, turmeric or things that are kind of red.

They're often, they're color-metric based tests that are very poor tests really and can be easily fooled. Yet the industry has commonly used these types of tests. When you get down to the molecular level, that's where you're really being much more accurate and so are using HPLC type methods. It's interesting, if you were to go on a website like Alibaba, which is a massive site that sells everything and also ingredients for supplements. It's not a site that I use, but I remember being shown this several years ago. You can buy all different grades of supplement ingredients on Alibaba, for example. And the price will depend on the method by which it's been certified.

You can buy a very cheap version of some ingredient that's been tested based on its color versus another one that's been tested based on say, HPLC. And the thing about how things are regulated in the US is that the FDA does not specify the method used to determine the quality of the supplement that's left up to the manufacturer to determine. It also doesn't specify even contamination limits. Very, very rarely is there a situation where there are limits on contaminants, that's left up to the manufacturer. So at the mercy of the supplement company to do the right thing by you when you're buying a supplement, some companies will cut corners or use simple methods and others kind of go to hold their products to a much higher standard.

Earlier you were describing ConsumerLab.com, and you're correct, it has evolved, for me at least as a clinician, it's far more than just, it's not just a consumer reports version for supplements. I mean, you can go on your website as a subscriber, you guys do put out kind of your top picks so to speak, but you look at as well, and you post a lot of the up-to-date literature regarding the research studies behind it. And one of the things that I really like that's very helpful is you also talk about the cost per dose or per capsule and what's the best value when you take into account potency, accuracy of what's on the label, what's in the capsule or pill and the cost. And for me, I find that to be very helpful. And I was wondering through all the years, have you seen a correlation between product cost and its effectiveness?

No, unfortunately you can't base it on cost. In fact, often the opposite is true. Some of the most expensive products in the category are more likely to fail than say the middle of the road range products. And you can get actually even very, very low cost products that are high quality if you're buying typically from a very large company. Some people in the supplement area shutter. But the truth is that for a simple ingredient like vitamin D or vitamin C, you can spend 2 cents a penny, whatever and get a great pill from Walmart, from their house brand or Costco because those companies have a lot to lose if they're selling products that are defective. So no, I wouldn't base it on cost. And we do find that a lot of the brands that are sold, say in physician's offices or direct sales, kind of these multi-level marketing companies, the quality can be very good. In fact, they tend to be pretty good. But the cost is usually two, three times higher than you really need to pay for certain supplements. That's my experience. So you can't really just base it on cost.

I don't normally put plugs in for companies, but I'll put a plug in here. You'll make up the cost of the subscription for ConsumerLab.com for one year in your choice of your first one or two supplements if you're looking to buy, because it can certainly be a big difference in cost. And you don't always get what you pay for in this industry. Now the other thing you look at are for contaminations, and that's again, as a clinician, I'm always looking at safety, do no harm first. And it's really disconcerting to me that it seems that you can't really trust what's on a label to be in the bottle in terms of potency. But also sometimes there's other things. What are some common contaminations that ConsumerLab observes in the supplement industry?

So the most common contaminants that we've come across are heavy metals. You're most likely to come across those when you're dealing with herbal products made from plants because many plants absorb whatever minerals are in the ground and if there happens to be lead or arsenic in the area, it's going to absorb that and they can accumulate in those plants. So for example, our tests of psyllium supplements people take for GI kind of regularity, lead contamination is very common. You can find lead in turmeric getting kind of to your area, pain management, turmeric's used often as to reduce inflammation. The evidence is so so may have a moderate effect. In any event, lead can occur in turmeric, in fact, lead has been added to some turmeric just for color purposes. Fortunately, when you're buying an extract like a turmeric extract sold as like curcumin because the curcuminoids, you're less likely to have that contamination from heavy metals because you lose those contaminants when you extract compounds from the herbs.

Certainly fish oil people have always been concerned about there's mercury in fish, maybe there's a problem with fish oil. Interestingly, you don't get mercury and fish oil because mercury binds to protein and fish oil is fat. So for a few years you were testing for mercury and until it just became quite clear, that's really not a problem with fish oil. There used to be a problem with heavy metals also and other minerals like calcium. But really the industry has definitely cleaned up its act there. But we do test any mineral supplement for other heavy metals. There are other very more specific issues such as red yeast rice, which is a cholesterol lowering supplement, although the government doesn't really consider it a supplement because it naturally contains lovastatin, which lowers cholesterol. It's basically, it's a statin.

Statin, yeah.

Yeah. But it can contain if it's manufactured incorrectly, meaning that it's the yeast growing on the rice is if something goes wrong instead of making lovastatin or also known as monacolin [inaudible 00:16:29] different names for the same thing. It can instead make something called citrinin, which is a kidney toxin. So...

Mold toxin?

Yes. Yeah, it's like a mold toxin and affects the kidneys. So we test red yeast rice for that. That's a whole other interesting story because sometimes with supplements, in this case since the government says if you make this product and you actually list the amount of lovastatin in it, it's now a drug and it's not an approved drug, so therefore you're breaking a law. So companies won't say the amount of lovastatin that are actually in there, which is a disservice to the consumer cause they won't know. But that's why we're here to tell people which products actually, how much they actually contain. And in the case of red yeast rice, some contain no statin really because the companies are just trying to stay out of trouble. But at the same time, they're doing terrible disservice to consumers who are buying this to try to get some kind of effect, but they won't get it. So what we look for really depends very much what the ingredient is and what kind of byproducts might occur or what's commonly contaminating it.

So I pulled up on the website the summary for osteoarthritis. I'm just going to read and share a little bit so listeners can understand the work you're doing. I think it's important under the what CL found, among 15 supplements that were selected and tested, only 10 met quality standards and FDA labeling requirements while four did not and the status of one was uncertain. So that's interesting. And I'm not going to list the names of the products, but example A contained only 43.9% of the collagen it claimed to provide another product that was a boswellic product had only 50.9% of its claimed boswellic acids. And oh, by the way, that product I know it well is very expensive.

One of them showed only 1.8% of the claimed amount of boswellic acids. So it goes on and on. It's very, for someone who being an integrative medicine physician, in addition to my physiatry who does recommend supplements regularly, it does make me pause a little bit because I think there's pros and cons to regulations, obviously. Sometimes you can feel like you're swimming upstream as a professional, trying to get people treatments they need. But the flip side is they can ensure a certain level, a standard level of quality. And I think in the supplement industry, that's a concern of mine that people don't always get what they think they're getting. So really thankful that we have this type of work available. So I thought I would just share that with people.

Sure. Thanks for doing that.

Now, if someone gets on the website, they got their membership and they see a product that's top-rated by ConsumerLab, what does that mean?

So it means several things. First, it means that we tested it and we tested the quality of the product because only a product that's been approved in our testing can really be obviously a top pick. If it doesn't have what it claims, it's not going to be a top pick of ours. If it's contaminated, it won't be a top pick. So among the products that are approved in testing, we then go through those and say, okay, in this category you'll say whatever it is, boswellia, vitamin C, [inaudible 00:19:42], whatever it is. We then look at the recommended serving size, basically the dose, is it giving you the amount that's been shown to be clinically effective with that ingredient? Because it may have, some products may have one 10th of what you want. Some products may have 10 times what you want and put you in trouble.

In fact, with vitamins and minerals, most of them, as you know, there are upper limits to how much you want to take. We're factoring that in as well. And I should mention when we talk about regulation, supplements don't even have to tell you and they don't tell you if they exceed these upper limits. These limits are established based on good science indicating that you start increasing your risk of adverse effects when you exceed these levels. And sometimes it's okay to do that if you're deficient in a vitamin mineral, but for most people we really don't want to be doing that. So we're factoring that in as well. And then as you mentioned, we're factoring in, well also the formulation. Is this the best way to take this product as a tablet or a tablet or a gummy? And I must say I'm not a big fan of gummies for a lot of reasons, but they are huge in the market now and growing.

CBD gummies are very popular.

Yeah, we've tested those as well. We had a whole review on CBD, the issue with gummies, first, it's hard to make a gummy, actually this is something we just learned a couple months ago, but last year, I know you're familiar with the USP, United States Pharmacopeia, which is a group that has for well over like 150 or more years, I think has been establishing methods for testing drugs and supplements. Supplement ingredients last year came up with methods. And these methods are submitted typically by industry, by the way. And then the USP evaluates them, but they approve methods for evaluating gummies, multivitamin gummies that allows these gummies to have up to 250% of the listed amount of say vitamin C for a tablet or a caplet. There is a little, an overage allowed, but it may be more like 25, 35, 40%.

So here they're allowing more than double the listed amount to be in the product. I think the other one is, I'm forgetting offhand, it's either folate or B12 also can be, yeah, I think it's folate actually. Folic acid can be also, I think it's 245% of the listed amount, but I think it's a bad idea from a consumer perspective. Companies basically ask the USP to approve that because it's hard to make a gummy and get the right amount in there and also have that amount remain at a hundred percent or greater throughout its shelf life, which is, there are not a lot of requirements from the FDA, but a product does have to have a hundred percent of what it claims through its shelf life.

So companies don't want to produce a product that's going to fall below that, otherwise they're in violation of the regulations. So they put in more. And so if you're buying a gummy, you just came out and got shipped to your local market and you bought it, it can potentially have two and a half times as much say vitamin C and some B vitamins then it says if you got it later on, it kind of nears its kind of best buy date, it'll have a lot less because gummies are actually a liquid, a semi-liquid environment. I think they're about 10, 12% liquid water. And so things break apart and disintegrate faster in a gummy.

Wow. So much to consider and science behind this. Thanks for sharing that. You mentioned the USP. Can you elaborate on that for people and just in general, for someone who's out there, let's say they're at the store and they want to pick up some fish oil or vitamin D, what are some tips that they can keep in mind to determine if bottle A is maybe better than bottle B if they don't have their phone handy to look at your website?

Right. Well, kind of as mentioned before you walk into the store first you got to just make sure that you need that supplement. And if you do do your homework and know how much do you need, some people just hear, oh, I should take some vitamin D, I'm low in vitamin D. There are products that have 10,000 IU. I mean, most things are now labeled in micrograms rather than IU, but we'll stick with IU because most people know that. And there are other ones that have 400 IU. And you need to know, well, how much do you need? Because too much is a problem. You can get too much of a certain vitamin as I mentioned before. In terms of the, then you want to know the type, should it be D2 or D3 at this point, everyone's, D3 is pretty much the only thing on the market and that's fine.

And then as I mentioned, what should it be? Is a gummy, okay? Should it be a tablet? A liquid? And some of the things to consider there are really, you may need to change the dose or maybe this is something that you and someone else in your family are sharing and you want to be able to modify that dose, in which case liquid's a lot easier than breaking a tablet, for example. In terms of brand, as you said, if you really can't use ConsumerLab, you can look on the label. And there are, USP does also have a certification program like ConsumerLab where they're testing products. It's a little different from ours in that, one, well one, they're using the USP methods, which sometimes are too lenient as I pointed out. And also, they're not always getting the product off the shelf like ConsumerLab does.

We will only test products off the shelf. We will not accept products from a manufacturer. And the reason is not really because manufacturers will give you a better version of it. It's that products can suffer during transit, during storage, during sitting on a shelf and can change. And so if all that you really need to factor in, how's that product going to perform? But when you buy it, we're buying it off a shelf only if there is no seals at all. I'd rather buy a sealed product that had the USP seal that had no seal on it. ConsumerLab also has a seal. It's not on as many products as you'll find on the USP, it's a bigger group. They tend to work with companies, try to get products approved across large product lines. We're very focused on specific types of products.

But USP also does something that we don't do, which is they also go into the manufacturing facilities to make sure the companies are following good manufacturing practices. We're not in the factories, we're just focused very completely on the product that you're buying off the shelf. So you can look for USP, there's another group NSF, they do something similar to USP, but downside is, you know, you still won't, the USP or NSF, you're not going to know if these products are really still giving you what you want. It's just that from a quality perspective, they met those requirements.

And I think a key take on point there is to obtain these certifications, whether it's ConsumerLab, NSF or USP, it's voluntary, right?

Yeah.

This has to be a company that's committed to demonstrating to, as consumers, a level of excellence, of quality and they're making the investment in these processes. It's certainly at least a place to start for now, I think. So finding that on the bottle, saying USP certified or certified through ConsumerLab is a great place to start.

Yeah. And actually you can also go on our site. So the products that come in on a voluntary basis, we do have a page that lists those products that have been approved on a voluntary basis. They represent about one quarter of all the products that we test. Most of the products we test are not due to a company asking us to test. And it's really due to our readers requesting that we test certain brands. We're constantly surveying them. So you'll find a lot of products on our site that actually may be fine, but they haven't gone through this voluntary testing because it is expensive and it's probably about $4,000 per product. And a company that has a large product line, it gets expensive for them and certification has to be redone every two years. So a lot of companies don't participate in that. They'll learn about products that are not necessarily approved by those under USP, you'll learn about that on the ConsumerLab site.

So for free, you can see a quarter of the products that have been approved by us on our site, it's under our quality certification program listing. And I would just quickly throw out another nice free thing that we have on our site. You don't know how much vitamin D you should be, you need at your age and your gender. We have a very good free resource there. It's at consumerlab.com/rdas where you can look up really what the requirements are for every vitamin and mineral and just to give you a ballpark of what you need. Although you certainly can meet most of those through your diet, you don't necessarily need to take a supplement.

Yeah. Okay. So I had you on the hot seat here for about 30 minutes about to let you off, but I have one question here that, a little controversial, but I want get your thoughts on buying products from Amazon versus online dispensaries like Full Script or Emerson.

Okay. I can't comment on the Fullscript, Emerson, I just don't know. Cause I think they sell a variety of brands. We think it's most important when you're buying a supplement, you got to think about what you want and then you start looking at brands. I don't like looking at brands and then saying, I'm only going to stick with XYZ brand because a brand can do a great job in one area, like Jarrow, they do a very good job say with probiotics, but they may not be doing as well a job with another type of supplement. So think about the type of supplement you want first. Amazon is a crapshoot, as you know, you can get anything on Amazon.

And there's been a lot of studies recently, one of the supplement manufacturers themselves went out and bought competing products in a number of categories that they produce and found that the majority of products, in most cases from smaller brands that are only sold on Amazon, really did not live up to their labels. It's been astounding what they've been showing. So if you're going to go on Amazon, you want to stick from, I would recommend sticking to a bigger well-known brand and make sure you're actually buying it from that brand and not through a reseller. And you see that on the walmart.com site, also, that a lot of stuff is being sold on Walmart. We had one company tell us we had tested a product that's failed our test and they said, well, if you bought it on Walmart, it was probably a counterfeit. People actually make a counterfeit supplement under their brand name. You want to make sure you're getting it from the actual company and not from a reseller.

That's a good piece of advice. And yeah, I do have some concerns about Amazon in terms of how long it's been sitting in storage, what's the temperature of the environment. And I think that's for me as a clinician, I like using the kind of online virtual dispensaries, like Fullscript that, they cater more to physicians. They also provide a lot of education and information. And then I pick companies, I do start though with looking at what are the good manufacturing processes that are in place for the different nutritional supplement companies and then dive in deeper. And if I can find individual comparisons, I think that, that really helps. I think this is a great episode. I really wanted to get this out there because I get these questions a lot and times it does feel like the industry is like the wild, wild west, but it's not quite like it used to be.

I think since that 2010 DSHEA Act, there have been a lot of improvements and there will continue to be improvements and then the work that you and your organization are doing are extremely helpful. Last question for you, Tod, before I let you go. I'm notorious for trying to learn about my guests health habits and how they stay energetic and healthy. And I think it's really obvious question for you is are there any supplements that you take yourself that you find it'd be very helpful or ones that maybe just recommend in general, what are some of your favorites?

Since we, and we test foods as well. So probably like yourself, I try to do, I started to stay very healthy, eat very, very well, very, very helpful foods. So my needs in terms of supplements are minimal. I will take some vitamin D toward the end of the winter, spring and not a lot, maybe up to a thousand IU. That's it per day typically from a liquid, just because it's convenient. I've had my family members take melatonin because it does trigger sleep. It really does work and you need a very low dose, I wouldn't take too much. One milligram can be plenty. So melatonin, I don't use it that much. Some people in my family do and on my recommendation, some people are a little low in B12, so that's another important one. Just personally, as a 60 year old male I'm in pretty good shape. I don't really take much more than that.

Yeah, I like those. And one I almost universally recommend to people is magnesium. I don't feel like we're getting enough through our diet and even organic foods. And then a lot of the symptoms I suspect I see are from low magnesium. And I also feel like it's a pretty benign product that at a minimum can help with bowel movements, which most people seem to need these days, but then it's individualized, of course. I like your approach, start with good, healthy diet, healthy living. And then I think the supplement's a little bit like food insurance that can fill in the gaps if you feel like you have big holes in your diet, but you can't depend on them as a primary source for health.

Right. I agree with your approach there.

All right, so again, it's ConsumerLab.com. We'll link to that in the show notes. I encourage people to check them out. They do have a lot of free information. Then of course if you want to get more, you can subscribe to their service and just arm yourself with another tool in the toolbox to make a great decision about your own healthcare. So Tod, thank you for your time and thanks for being on the show.

Yeah, I appreciate it, Sanjiv, and I'd be happy to come back if you have any more specific questions and other topics relating to this.

I appreciate it. Thank you.

All right, thanks. Bye-bye.

Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.