You're listening to Food is Food, the podcast that will support you to ditch diet culture, break free from food rules, and debunk nutrition misinformation. I'm your host, Talia Chekelli, specialist eating disorder dietitian and founder of the TC Nutrition Clinic. If you would like to learn more about our one-to-one nutrition support and group program, or download your free portioning guide, head to www.taliachely.com. Each week we will cover topics that delve deeper into nutrition, intuitive eating, psychology, diet culture, and the consequences of under-eating. Our relationship with food is so complex and is influenced by our thoughts, emotions, and life experiences. Which is why healing from disordered eating is about more than just food. Welcome back to Food is Food. Today's guest is Josie Porter. Josie is a registered dietitian that specializes in weight management, binge eating, gut health, and women's health. She has worked across leading UK hospitals and in private practice. Alongside her clinical work, she's gained another title of author. And she recently published a book, as in recently last week. And the book is How Not to Take Supplements. I welcome Josie to the podcast. Welcome to Food Is Food, Josie.
SPEAKER_00Thank you for having me. Hi.
SPEAKER_01You're very welcome. I am really excited to do a bit about myth busting with you today about supplements, because there seems to be an increasing number that are fairly new to me that I'm seeing coming through my clinic doors. And I thought no better person to ask to help out with this myth busting because you have written a book which is coming out on June the 4th all about supplements and how to take a food-first approach. So I'll include that in the show notes at the end. But I thought today, Josie, maybe we can start with one of the ones I only came to know about recently, which is NMNs. Mm-hmm.
SPEAKER_00What's that NNN? Yeah, it's actually quite hard to say, isn't it? You can't help but say the chocolate. I actually heard about this a good few years ago, and then I remember seeing the Kardashians, I think it was, and they were having IVNMN injected into them. I think maybe after having a drink or something, I can't remember. Or maybe it was traveling. Um and then I feel like since then it's kind of blown up. Yeah, in essence, it's a type of supplement um that you can have orally or you can have through your veins. So IV is what that basically means. And it's a compound that helps us produce something called NAD or NAD. And this is basically a molecule that's has lots of different roles, but the main one sort of being around energy and cellular repair. And the theory behind it is in essence is that as we get older, our levels of this NAD or NAD reduce. So actually, by replenishing them, we can help to repair that, improve, I guess, that cellular repair and try to reverse some of the effects of aging, which is why you see it a lot in like the longevity space with things like health span, lifespan, more so as well, really. And it is really interesting. The theory alone sounds quite exciting, right? But as it's relatively new, you know, when you think about maybe say like vitamin D, for example, it's certainly newer compared to other supplements out there. Um, and yeah, mechanistically, when we look at animal studies, there is some really interesting results there, but ultimately that's just where things start. We need to really be seeing those results in humans. And the data with NAD in humans is really not quite as interesting. We do see that in the studies that exist so far, that levels of NAD do increase when we have supplementation in the right doses. But actually, this hasn't been shown to have any meaningful outcome in terms of like, okay, are we living longer? Are people getting less heart disease, for example? So I'd say at the moment it's still ultimately a gamble. And it's not something that I would take for longevity or like health span or anything like that. I think ultimately we really just do need more data there. And that's not to say that that won't come about, but yeah, it's it's quite a hard thing to study uh longevity and lifespan in humans, particularly in like a randomized control trial. It's not something that I'm aware of has been done. You know, we tend to look at like observational studies where we follow groups of people, like say in the blue zones that tend to live longer, and then we can sort of maybe look at the patterns of which they're eating and how they're living and things like that, and make associations. And of course, we can try and improve that data by doing a statistics, like analysis and things like that on it to try and reduce any confounders and things. Ultimately, yeah, it's something that I would recommend for people right now for what it's been marketed for. I think ultimately it's um something that's that's probably not going to be worth your money. Maybe that will change with research coming out in the next sort of five, 10 years, who knows? But I think for where we're at right now, I think there's more uh clearer data and like food first strategies for improving things like your lifespan, health span, and that are probably better ways to sort of invest your energy and time and money, really. I think it's really interesting as well.
SPEAKER_01You highlighted like where we started to learn more about NMNs and where they became popular was through a celebrity using them. And I think that says a lot, doesn't it? About access.
SPEAKER_00I think there's definitely quite a lot of supplement trends that seem to stem from the Kardashians. You know, I actually quite like them as people, but you know, in terms of like their science and credibility, it's a bit shaky.
SPEAKER_01The next one, Josie, is CoQ10. Can you tell us what CoQ10 is?
SPEAKER_00Yeah, CoQ10 is something you're actually we already make in our body. And again, it actually helps with things like cellular energy and protects our cells basically from damage, the damage that we can get from lots of different things, you know, all around us, you know, sun damage, things like that. You have lots of things going on that can damage our cells day to day. So the role of it is almost like an antioxidant, you could say, so it helps to protect our cells, and that's why you often see it in marketing kind of associated with energy. So people might take it for energy and things like that. When we look at the research, there is some evidence that it can support with things like blood pressure, for example, for particular people with conditions that affect their heart, heart failure. But actually, when you compare it to other strategies that support us with our heart health, it doesn't seem to really stack up as being superior. For example, the DASH diet, which dietitians and nutritionists be really familiar with for supporting heart health, which has lots of different things in there, sort of like reducing sodium, improving uh your fibre intake, and things like that. That dietary approach is more impactful when it comes to supporting your heart health and things like your blood pressure. So I think that's around double the amount of the blood pressure reduction that you would get from like the DASH diet versus taking a CoQ10. And as far as I'm aware, there's not a lot of evidence combining the two to see if actually you get that additional benefit from taking, say, CoQ10 on top of a healthy diet. It seems like there's almost kind of like a ceiling there. But ultimately, yeah, I don't think it's something, at least for heart health, where it's got the most evidence, that's superior. Maybe it could be a nice add-on strategy to experiment with if it's something you're really passionate about and you're that person with a heart condition. But ultimately, again, I don't think it's one that's got lots of evidence behind it for everyone, where I'd be like, yeah, everyone should go and take it. It's quite interesting in the space of uh fertility, which is not my specialist area, um, but do believe that there is some evidence in terms of fertility though, similarly with other sort of antioxidant supplements or compounds that act like antioxidants. I think there are some supplements out there that tend to be recommended sometimes in the fertility space, but always worth working with your fertility specialist before taking anything like that. As sometimes they can also carry a risk with them as well, taking anything that's like an antioxidant or acts like an antioxidant, like CoQ10, for example. But definitely an interesting space.
SPEAKER_01Definitely. And I think you raise a really important point there about a lot of these supplements might be seen to be appropriate for everyone. But we have to think about a person as an individual, are they on other medications? Are there any interactions between supplement medications? Is it appropriate for their lifestyle, the medical condition that they're trying to support? Like you mentioned, fertility might be heart disease, kidney disease, all of these different things that we need to take into account and think: is this supplement right for me as a person rather than spread to the masses?
SPEAKER_00Yeah, absolutely. I think it's quite easy sometimes if you're not a nutrition professional, like a dietitian or a nutritionist with that training. It can be quite easy to think that okay, we see this benefit with this group of people, so we can apply it to everyone, but it's certainly not the case. So yeah, that's definitely worth thinking about as well. And also comparing it to strategies that we already have out there around food. Often food can be as impactful, or if not more impactful, and studies looking at supplements don't always have like an additional arm where they're comparing it to a food alternative as well. I would love to see more of that kind of research being done.
SPEAKER_01I think it's so hard to control, isn't it, when we think about research and having that control group and ensuring that the diet within that group is the same or similar, or within the context of other key factors, physical activity, stress, etc. But I agree it would be absolutely amazing to have that research available.
SPEAKER_00Yeah, I totally agree. Next one, creatine. Yeah, another super popular one that's actually been around for a long time. I think really the earliest research was looking at creatine in sports nutrition and performance. So sort of with the ergogenic benefits and seeing what could be achieved there. It's in essence a compound that again we can make in our body, but we can eat in food. Um, although to get the amounts you get in a supplement, you'd need to eat quite a lot of food, and it tends to be quite animal heavy food as well. So, for example, people on a on a more plant-based diet, vegetarian, vegans, may get less of that. It's harder to achieve getting that same amount for your diets versus a supplement. And in essence, what it does is it helps to give our muscles an extra boost of energy, and that can be really helpful in activities where there's a burst of energy needed, like you know, racket sports, um, but also strength training, which is more commonly associated with benefits, and people often sort of speak about creatine in the sort of uh strength training space, I guess. There is some evidence there. I think there's definitely statistically significant, and particularly if you're someone who's competing, that can be a big difference in terms of perhaps winning a competition. Um so I think it can be really impactful, and there is good evidence for creatine in that space, for giving your muscles that extra energy, perhaps being able to go a little bit further with those sports where there's that burst of energy. But I guess statistically significant is not always real life significance. I think if you're someone who's going to the gym regularly, but you're also doing lots of other things that might benefit your performance, like maybe you are eating enough carbs, you are eating enough protein, drinking enough fluid and resting well. It might be hard to see if creatine is making a significant difference amongst all those other really great things that you're doing. That's not to say that it's not doing anything, but it might not be as like wow as maybe some of these companies creating creatine and marketing creatine might be making it out to be. But that's not to say it doesn't work, it does, but just maybe keep your expectations in line, unless you're someone who's competing where actually that that can that can make a big difference. And I think you know, you see lots of stories online of people taking creatine and having really good benefits with it. But again, they might also be doing lots of other things at the gym or around their sort of gym routine that might also be supporting their performance as well. So I always say don't let creatine take all of the credit for your hard work because I'm sure lots of people don't just go to the gym and take creatine, they're probably also quite conscious of their protein intake and their rest and lots of other things as well.
SPEAKER_01Yeah. And I think creatine is one that it's really interesting when we think about the gummies. Recently there was a lot of air time because there was a bit of some market research done by someone very popular in social media who tested the amount of creatine in the creatine gummies and the big brand names that were creating gummies. A lot of them had very little creatine, much less than what they were advertising was in the product. So this is one where it just really highlights how hard it is, how misleading it potentially is, whether the companies know that they're doing it or not. But the mismatch between what is said that's going to be in the product versus what actually is in it.
SPEAKER_00Yeah, totally. And that's the thing. I think people maybe somewhat assume that because it's put out on the market, maybe they're making claims similar to medicine, but obviously different because they're regulated like food and it is illegal to make such health claims unless it's backed by evidence. But yeah, you know, people might, without really looking into it, think that maybe these supplements are really well regulated and kind of just take something from the shelf, assuming that the dose is right, and what's in there is what's being said on the packet, but that's not always the case. Actually, you need to be really quite diligent out there and really quite conscious of your purchasing and where you're getting things from. And is it tested? Because there's lots of cases where, yeah, like as you've mentioned here, actually the dose is too low, so actually it might um be much lower than what you need to see any benefit, but then also sometimes too high. There was actually some studies recently where they tested some supplements off the shelf and they uh had much higher than what was said on the bottle, and even with supplements or nutrients and compounds that actually could be toxic as well. It's quite scary to think, particularly if maybe you're not necessarily following the guidance on the label to add to that. You might actually be having quite a lot higher than the recommended dose and tipping into that toxicity level, which, if you're doing that over time, could be really damaging to things like your liver and potentially other factors as well.
SPEAKER_01And I know every country is different, but in the UK, I think it's important for people to be aware that the regulations aren't that strict, are they, in terms of some of the supplements that we do have on our shelves. Are you able to share what the current regulations are?
SPEAKER_00Yeah, so with regulations in the UK, supplements are regulated like food. So in essence, what that means is unlike medicine, supplement companies are not required to basically demonstrate that their product is effective. So they don't necessarily need to say, for example, claim that it reduces an inflammatory marker, for example, or that it made someone feel better when they were asked. And so they don't need to do that. In essence, you know, there's lots of products on the market, but we don't really know if they work or not. So that's one side of it. But then also around what's in it, there is an obligation, as per like the FDA, to basically you're required by law to make sure that what you're selling is safe for the consumer and that it's not going to cause any harm, and that the dose and things are safe for the consumer as well. But ultimately, no, there's not really many people actually regulating that and pulling up lots of supplements and testing them. So it's not like a pre-requirement to have any supplements tested for quality before they go out onto the market. Actually, there's lots of supplements out there that haven't had any testing done for effectiveness, but also quality. And again, even things like dose and what's actually on the packet is in the packet as well. The ingredients of this might be different to what you're actually ingesting. So there's lots of different loopholes, really, in a way. That's not to say that supplement companies are out there purposely um trying to cause harm or mislead people, but ultimately these are things that delay products going to market, add extra cost. There might be people who or supplement companies that, in essence, give some of these important steps for the consumer.
SPEAKER_01Yeah, I think it comes from a good place. Yeah. However, unfortunately, these are the tests that are required to make it as safe as possible.
SPEAKER_00Mm-hmm. Mm-hmm. Yeah, totally. And it's uh not mandatory to have third-party testing either. It's also something to bear in mind. Though, you know, a lot of big supplement companies do have that testing. You can sometimes find it on the label or on their website. You can look for that, which is basically where a third party will come in and confirm that what's on their label is in their label. So you can look for that third-party testing as well.
SPEAKER_01Not that it's a supplement, but in Australia, I think it was last year, there was testing of different sunscreen providers looking at the SPF factor. I saw that up because they were, again, similar to the creatine gummies, a lot of companies whose SPF factor was way below what was being marketed. And that has such a huge impact in terms of skin cancer risks. It's just such a tricky area to navigate, isn't it, without there being such solid regulations in place around testing?
SPEAKER_00Yeah, definitely. And you do have to check for more than just a couple of things, really. You almost did a checklist of things to consider before making that investment into a supplement, really.
SPEAKER_01Um, one of the side effects you mentioned earlier was on liver function. And it's really interesting. I had one of my clients that I'm currently supporting went for a blood test and their liver enzymes were elevated, and we were trying to think like what has caused this? Because they were nutritionally nourished for a number of months. It was something you wouldn't commonly see. And they were taking a very well-known greens powder, and their mum actually did a bit of research, and that's how I I found out about it, and then afterwards I did a bit of research too. So that was really eye-opening to me because I knew that it's a very popular brand in the UK. So it's not just tablet forms, it's powdered forms too, where anecdotally we don't, you know, have the solid evidence for it that it can be toxic for some people.
SPEAKER_00Yeah, interesting. And that's UK, not US. Correct. Okay, yeah. I think I've got an idea then what that might be, but yeah. Yeah. Yeah, it's crazy. Yeah, wild. Yeah, I see a lot of other narrative around supplements, people saying, Oh, it's natural. I think I guess people are comparing it to medicine, but it's not natural. You're not plucking a green, not just like making a grease powder in your kitchen, you're not plucking creatine from a tree. I mean, there's an element of it where it's natural, like I get it, it's like a nutrient or a compound, but ultimately the processing that it goes through and how we're taking it, the form, the dose, and everything, that's far from natural.
SPEAKER_01Yeah, and I think what I've noticed in clinic is a shift from say if I think five to ten years ago, there was a lot of greens powders, turmeric, matcha, lion's mane, matches coming back out. But I do feel like it goes in phases. There was a lot of the food-based supplements, and now I'm seeing more of the NN. And I'm just gonna say MM. And creatine. So yeah, it's it's interesting to sort of sit back and see that shift as to what is trending.
SPEAKER_00Yeah, that's a really good point. I hadn't really thought of it like that, actually. It's very interesting.
SPEAKER_01So one that's very popular at the moment is electrolytes. Let's break down when electrolytes are appropriate and when maybe the wellness industry is overselling them to you.
SPEAKER_00Yeah, I'm seeing electrolytes pop up everywhere, and I feel like there's so many different influencers, celebrities. A number of them are now coming out with electrolyte brands, which is really interesting. And sometimes when you go on their website, you might see like they have different types of electrolytes, like some for sport, some for everyday use. And it's just kind of bonkers to me that how we've got here, to be honest with you. Yeah, I don't care. Yeah, but I mean, electrolytes anyway, they're minerals. So sodium is probably quite an obvious one. I think chlora doesn't get as much airtime, but things like magnesium, potassium, or also some as well, and there's a few others, but these are basically uh these electrolytes. Um we can get them in food, and we can also get them through supplements. For the majority of us, we actually get enough through food. Um, if we're exercising or we have any form of losses, so with exercise that would be sweat. But if you're unwell, let's say, or you have anything going on with your gut uh and you have more diarrhea or vomiting, then you may also lose more as well. I mean, sodium in all those instances, so like GI losses or gut losses, and then when sweating is the one that we tend to lose the most of, and then we might lose other electrolytes in varying amounts depending on where we're losing it from. So if we lose it from our gut, we might lose more potassium. Then if we're sweating, it tends to be more chloride, for example, and then there might be some like potassium as well being lost too. And but for the most part, by far, sodium is the one that we lose the most. And because in the UK and even really in the US and in Western countries, actually we consume quite a lot of sodium. It's in a lot of our food, even food that seemingly looks millennially processed, often there might be a little bit of salt in there as like a maybe a preservative, but also for flavour and things like that. So, actually, our intake of salt is really good. Um, so a lot of us don't need any additional salt unless we are losing a lot through those cases that I mentioned. And actually, to be losing such a significant amount, even through like workouts or sweat, it's really more endurance sport. So you're thinking typically sort of more intense exercise for say 90 minutes, like a run. Maybe you're doing quite a bit of a longer run, or maybe you're in quite a hot environment, maybe you're on holiday, or you just live somewhere that's got a hotter climate and you're sweating more naturally. Then that can also be a case whereby actually having some additional electrolytes can be useful. Often it's just salt that we need because salt contains sodium and chloride, so they're contained together. And as I say, we do tend to get plenty in our food anyway. There are, of course, cases where people might be training quite a lot, maybe they're athletes and they're doing lots of that more sweaty-based sport, or they live in a hot environment. Maybe taking some daily might be useful, particularly if you've got more of like a clean diet where you're really not consuming many processed foods at all. Maybe you're consuming just a lot of sort of ingredient-based foods, like your fruits and veggies, and you're sort of cutting them up and processing them yourself and not adding a lot of salt as you cook and things like that. Then absolutely it might make sense to have some salt, but for the average person, we definitely don't need all of these electrolytes in supplement form every day. There's been a few niche cases where maybe a daily electrolyte supplement even might be beneficial. But yeah, it's really much narrower than these supplement companies specifically selling electrolytes and making out. Yeah, absolutely.
SPEAKER_01So not for everyone, but definitely cases where it would be advised. Hot weather, if you're vomiting or have diarrhea and niche cases, so from a medical nutrition perspective, for example, people with pots. Of course, yeah.
SPEAKER_00You know, electrolytes can be really helpful. Yeah, definitely. It's just worth bearing in mind. Like if you're not those, it's up to people as well, and you are having a diet that's quite high in salt already, and then having electrolytes on top of that might really be knocking your sodium up, it's just not great for your heart health.
SPEAKER_01Yes. Definitely. And one of the electrolytes you mentioned is magnesium. So magnesium on its own is also quite popular, I think, especially from a a sleep perspective. Muscle cramps, magnesium is lost in well, not so much loss, but it can also be misused and lead to definitely in the area that I work and lead to sort of as a laxative. So lead to someone's bowels opening more. What are the are there different types of magnesium supplements and where would we maybe suggest them in a safe way?
SPEAKER_00Yeah, um it's definitely something that feels like it's been blowing up maybe even for like the last year or two, really, um, but it's definitely still very present in on like social media and things like that. Uh, there was almost like a sort of Pinterest style uh infographics going around about the different types of magnesium and sort of claiming how if you have a certain type of magnesium it's beneficial for a specific symptom that you might have or a goal. But in reality, when we look at the research on magnesium supplements, they tend to really just use magnesium oxide, probably because it's the cheapest. There are someone like uh biglycinate, sorry. Actually, I don't know how to pronounce it. Um biglycinate or bis? Has it got an S in there or did I make that up? I would have said it bigly. I don't think it has an S in there, does it? No, I think I added the S for some reason. Yeah. Um yeah, maybe there's a reason for that. But yeah, I mean when we actually look at the research, because I started digging into it and I was like, okay, well now I need to know like, are we really going out there and looking at all these different types of magnesium to see if it has like a different benefit? And when I was looking at all the magnesium supplement research, it was mainly really just magnesium oxide being used. And that is the one that we more commonly see on supermarket shelves. I think with the hype around magnesium, we're seeing different types like citrate by glycinate. Um, and so we're seeing some of those out on the market, like different types being more accessible, I guess. But ultimately, when it comes to magnesium and the research on magnesium, it's an interesting one. Most commonly, people use it for sleep, and I think there is some evidence there. Is it really significant? It depends really on who you are and I guess your expectations. Um, so when we look at studies um testing the impact of magnesium supplements on sleep, we tend to see that the people who get the most benefit are those that tend to have lower magnesium intakes in the first place, which actually is quite common. And you look at surveys in the UK, for example, there's quite a number of people that don't tend to really meet their magnesium intakes through food. And that's really because it's the type of food that maybe not everyone eats, particularly if you're from sort of a lower socioeconomic background, the foods that are maybe a bit more expensive, your foods like your sort of whole grains, for example, your nuts and seeds, and pumpkin seeds are a really good source, for example, spinach, your sort of greens, they tend to be good sources. So if you're not having lots of those foods, then it could definitely be a bit harder to get in your diet. I've seen magnesium supplements for children to help them sleep, for example. I can see how children might not be eating lots of those foods. So I do kind of get it. You know, there is a gap. It makes sense to bridge it with a supplement for sure, but if you really can't get enough of those foods, ultimately, it can help if there's a gap. It doesn't seem that having more is beneficial, apart from if you're wanting to have the side effects of it as actually um a good thing, like a benefit. So you can utilize the side effects like um how it relaxes your muscles and how if you take too much, you can actually get things like loosels or diarrhea. Actually, that could be beneficial for someone who's more constipation predominant. So it's not that that's like a deficiency-related issue, it's kind of like uh just a side effect, but actually that side effect can be beneficial for some people. Obviously, the average person uh doesn't want diarrhea, but if you're someone who's more constipated, actually having that could potentially support you with having more regulated bowel movements, for example.
SPEAKER_01Yeah, and that's actually come out in the recent BDAs of the British Dietetic Association guidelines for management of constipation.
SPEAKER_00Mm-hmm. So, yeah, definitely some uses there. Ultimately, if you can get it free food first, it makes sense because if you're getting things like your pumpkin seeds, which for a portion contains almost like half of your daily magnesium needs, I think it's around 40%. If you're having that and you're also getting other minerals in there, a bit of fibre, a little bit of protein, and some healthy fats and things in there as well. So you're getting a whole party of nutrients versus just having magnesium. But ultimately, if you're really finding it hard, then a magnesium supplement is quite low risk. And supplements, again, if you're taking too much, though, a side effect could be things like changes in your bowel movements. So just take make sure you're taking the right amount for you and checking things like third-party testing and such as well.
SPEAKER_01I think that's the thing, isn't it? Like if we take a step back and look at the the UK diet on a whole, we know that the majority of people aren't getting enough fruit and veg and fibre in their diet. So these are the types of supplements similar to like a multi-bit, for example, that could help to just bridge that gap while, you know, if if someone is able to work on improving the quality of their diet.
SPEAKER_00Yeah, I love that. It's the my book title, How Not to Take Supplements, probably has a lot of people thinking I'm anti-supplements, but it's not the case. I think it's just using them to your advantage rather than being misled on them, really. And I like what you say there, like taking it just while you're trying to bridge the gap, because ultimately it is quite hard to change your diet overnight. I think that's actually quite a good use.
SPEAKER_01And I think, Josie, that as well when we think about food in itself, is there's so much that we actually don't know on a very, like, very cellular chemical level of how food interacts. Like I always say to my clients that there are things in food that scientists still aren't able to give a name for. And that's where I think that if we think about the the wellness industry potentially pushing particular supplements and food-based supplements on people, is that it's not ever going to be as good as that food first approach, as you say. It can be helpful, it can be a junk to improving the quality of diet. But it is in some ways that band-aid solution rather than looking at the underlying how can we get those nutrients in.
SPEAKER_00Yeah, definitely. And even uh outside of like physiology and what's going on inside our body and our biology, actually, it's quite interesting how just taking a supplement can change your behaviour as well. Like if we're taking a supplement, there is some evidence looking at moral licensing, which is basically when you do something that you perceive to be good, then actually you can do something in return that's less good because you've kind of, I guess, balanced it out. It's kind of like as I say in the book, when you go to like a drive-thru, maybe you get a burger and a milkshake and some fries or something, and then maybe you get like a bit of salad on the side, or you get a diet coke instead of that milkshake that I just mentioned. There's an element of that, and of course that's okay to do from time to time, but ultimately it depends on what knock-on impact that's having to those other helpful behaviours. Like there was one study where they had two groups of people and they gave one a supplement and one um didn't have the supplement, so like a control arm. And those in the supplement group were more likely to like eat more food, exercise less. So they had these sort of knock-on behaviors that they kind of associated to having that supplement because it kind of almost gave them the green light to perhaps do less in terms of those real life habits. It's so interesting. Yeah, definitely need more research, really, even on moral licensing, but there's a few studies where actually they've shown that and it's quite interesting.
SPEAKER_01And so let's maybe chat about some of the ones that I personally would be recommending under certain circumstances. So omega-3 supplements.
SPEAKER_00Yeah, I was just thinking about omega-3 because actually I feel like with the moral licensing aspect, I mean, I I actually do take omega-3, it's one of the few supplements I will take, even though I do eat oily fish, but I just know that I'm not always that consistent with it. So for me, it's kind of like an insurance policy to bridge that gap. But I sometimes do think, okay, because I'm taking an omega-3 quite consistently, am I therefore, when I'm doing my food shop, kind of putting like oily fish less in my basket? And obviously, with oily fish, there comes other um beneficial nutrients and things in there too. So yeah, it's quite interesting in terms of like the moral licensing that I just mentioned, but yeah, anyway, um, I digress. Uh, omega-3 supplements. Uh so omega-3s are kind of like magnesium in that a lot of people in the UK, and even in again, like Western countries, uh, are not consuming lots of oily fish. And oily fish is where we get really nice, more easy to absorb essential fatty acids in there. So we get EPA and DHA. And what they basically support us with are lots of different processes in the body, but they're anti-inflammatory, and they support like our cells basically. So they're really important to have, but unfortunately, a lot of us are not eating that oily fish, so it's around sort of one to two portions a week of oily fish that will give you your recommended intake to support those functions I mentioned. But a lot of us are not getting that for lots of different reasons. Um, oily fish might not be something that a lot of people like, you know, some people don't really like fish, or it could be like a cost factor, particularly with the cost of living crisis, which is you know not really getting any better. It can be quite expensive to afford fresh fish, or even like you know, frozen fish like salmon, can be more expensive than maybe some of the white fish options, or even just poultry and things like that. So that can definitely come into it. And of course, people who have a plant-based diet, so you can get omega-free fatty acids, so you can get ALA through plant-based foods like your walnuts and chia seas and things like that. But the conversion to the more active form that we can really use in our bodies, so that EPA and DHA is really quite low. So you need to consume quite a lot of these foods, really quite an unrealistic amount to get the same effect that you would from having oily fish. So for that reason, I do think actually it's worth for a lot of people considering an omega-3 supplement if you're not having oily fish for whatever reason. So, you know, the plant-based sources of ALA can definitely help when you're having walnuts, chiacies, and things like that. You're getting again other nutrients, so they're definitely worth consuming. But ultimately, I think omega-3 is quite a nice one that most people could benefit from taking, just to bridge that gap, really, more than anything. Outside of bridging a gap, there is some evidence with omega-3 with certain people with heart conditions, and actually, it can even be like a sort of prescribed in quite high doses to support with cardiovascular health, so things like triglycerides. But there are other things that you can do as well to support your heart health beyond that, and again, that's quite like a specific group of people. So, yeah, and if you're taking lots of uh omega-3, there can be a potential risk there. So high dose omega-3 supplements can increase the risk of things like bleeding for some people. So, again, one that I wouldn't take without checking with your um doctor or dietitian.
SPEAKER_01Yeah, definitely. I agree, omega-3 is one that I would recommend, depending on the person, obviously. And I think that the most common supplements that I generally recommend is vitamin D, iron, and calcium, if there's evidence that there's not high enough intake, or if it's based off blood test results and those markers coming back low. The two other supplements I wanted to ask you about, Josie, are probiotics, because I think that's like so overwhelming for people because there's so many different types. And what I'm seeing now is that there's more and more probiotics that are coming out and saying they have certain functions, which really looks fantastic on the label. However, I think it'd be really difficult. Number one, for people to understand when to take probiotics and the type. And I think there's a lot of everyday people that haven't studied nutrition, like you and I, is understanding that a lot of the supplements on the shelves don't have the research for that particular strain to back it up. So maybe if you just want to talk a little bit about probiotics.
SPEAKER_00Yeah, I agree with you. I think kind of almost like electrolytes, it feels like so many people have a probiotic brand at the moment. It definitely seems to be blowing up. And it is similar to electrolytes as well, they definitely have a place and a purpose. But as you touched on, a lot of the supplements out there that are claiming to be probiotics are not really technically probiotic. The definition is that they need to be live microbes that have been shown to have a benefit to like the host, so have a benefit basically in say humans. And actually, if you take some of the supplements from the shelf or online, the companies haven't necessarily done their own like randomized control trials on their supplements. So maybe they've got lots of different strains in there, but we don't actually know if their combination of strains does have a benefit. And just because they've plucked a few different strains that have their own individual studies on them doesn't mean when you put them all together, they have the benefit that maybe some of these supplement companies are claiming that they have. That's something that's worth bearing in mind. And these trials are quite expensive to carry out. Again, it can delay maybe getting a product to market, profit. Sometimes people will release like a probiotic, or sometimes they they use different names as well to get past like legislation and things like that. Then actually they might release the product and then do the research after once maybe they've made profit on that product, I guess. But that's really not the right way around to be doing it. They're kind of selling a product based on beliefs rather than science. And actually, when you look at some of the data on probiotics that maybe some people have done on their probiotics, probiotics, their supplements, um, it's not necessarily in like a peer-reviewed journal. Sometimes you can't even download the study to have a look at it. So who's to say how good the quality of the study is, what statistical methods they've used, and all sorts of different things. And a lot of them might use things like questionnaires, so they might ask people if they feel better, and actually just asking someone if they feel better can impact their what they say. So you really want to make sure there's like a placebo arm, for example, where you can compare, okay, did this person having something with without any active ingredient, did they see any benefits as well? And sometimes they don't always have a placebo arm to compare to as well. Because often when you look at studies, any supplement really, and they do have a placebo arm, the placebo arm often does feel better as well. It's just that relative difference compared to like the placebo and those taking the test, which normally in this scenario, what we know we're talking about supplements. So it is quite interesting. It can look really fancy and credible on paper, but I think when you dig deeper, a lot of these companies selling probiotics, yeah, are missing some of that key data there. So there are some out there that uh do have their own research on them, and they do see some benefits there as well, above placebo too, and that's in conditions like IBS, for example, also with oscillative colitis, supporting things like remission and certain pediatric conditions, which is not my specialty area, but there are definitely some out there that can be really useful. And like, say, for example, you're taking antibiotics and actually taking them alongside can also be beneficial as well. But yeah, again, you really want to make sure that you're going for a company that has done their own clinical trials and you can see that published data and look at things like placebo as well and what sort of outcomes they're measuring. Ideally, you'd want to maybe see things beyond just like a questionnaire. So a questionnaire can still be useful, not to dismiss that type of data. But if you can get any sort of biomarkers or like stool tests or anything like that to add an additional layer, then that could be quite useful as well. So that's what I'd be looking for.
SPEAKER_01Yeah. I'm curious, Josie, you said some companies aren't calling probiotics probiotics. What are they calling them?
SPEAKER_00Uh, I think I've seen a couple of different names. They might use things like uh symbiotics. There's something that one of my friends who's a gut health scientist brought up to my attention the other day. And I was like, that's really interesting. And he was telling me about yeah, some of these other loopholes that maybe some companies are using at the moment. So yeah, I'm not overly familiar with it because it's a new area, but I think I have seen a couple of companies and I did wonder why they were doing that. So it's something I admit they need to look into more, but yeah, if any nutrition professionals are listening to this, keep an eye out as well. It's quite interesting to see how some supplement companies are getting around it.
SPEAKER_01Yeah, very interesting. I always think with probiotics, there are like absolutely areas, as you mentioned, that probiotics can be so beneficial.
SPEAKER_00Yeah.
SPEAKER_01I tend to look at the US probiotic guide. I know it's not extensive, but at least it's one website that has a list of some of the probiotics that have research and trials done on those specific strains in relation to different conditions like traveler's diarrhea, ulcerative colitis, and those sorts of things. Yeah. But yeah, it is one of those ones that again, there's so many millions of strains of bacteria. The science isn't there yet for us to know exactly how these strains can be impacted in our body, how they're used. And yes, it's it's an exciting area.
SPEAKER_00For sure, definitely. With any of these supplements that we mentioned, probiotics included, uh, ultimately, if people want to try things out for themselves, I think that's you know, it's your money, it's your time, your health, you know, that's that's your decision, really. But it's just worth going in, being aware of all of the considerations, really, like quality, testing, any contraindications, dose, and yeah, just having realistic expectations because ultimately if we think something's gonna work, it does tend to work in some way or another. And then obviously don't let it distract yourself from the sort of heavy lifters, like your diet, for example, and lifestyle habits like moving enough, you know, taking creatine is great, but if you're not doing the right strength training, then questionable as to whether that's really beneficial. Obviously, we are seeing of creatine more evidence coming out around like cognitive benefits and stuff like that, but they're still emerging. So while interesting, you know, I think watch the space.
SPEAKER_01Yeah, for sure. And the last one I want to end on, Josie, very quickly is collagen. So that sort of had its time two years, one year ago, and I feel like electrolytes and magnesium have taken the spotlight a little bit. And initially, when collagen sort of blew up online, I was really skeptical of it. But I believe now there is more research to support the use of collagen in some areas.
SPEAKER_00Yeah, I think it is um quite an interesting one, and I agree. I feel like it was spoken about more in social media, yeah, maybe a few years ago. It was still still present, but yeah, an interesting one. I guess the reason why most people are attracted to it is because of the benefits to skin. So there are actually quite a lot of studies out there looking at the impact that it has on skin. It is mainly on women and it is mainly on women who are slightly older, not old by any means, maybe have are more likely to see some signs of aging in their skin or like collagen being depleted in their skin and things like that. So I think it tends to be sort of from later 30s onwards, where we might see the studies being carried out on. So, for example, women or men even in their 20s, question mark as to whether that's really applicable here. But what those studies do show is that there does seem to be some modest benefits to things like your skin hydration and elasticity. That is statistically significant. I guess is that significant to what you might see in a mirror? That's really up to you. But there is some good evidence out there. You could try it if you're one of those people that I mentioned where it's more likely to have a benefit for an experiment if it's something that's accessible to you. Of course, I do think there are things out there that you should obviously try first, like SPF, obviously, and look and hydration can help and with your skin health as well. Eating a balanced diet with more whole foods, reducing things like sugar may also help as well, also just good for your overall general health. So there's lots of things you can be doing for your skin health first, but you had to if it's accessible to you, and then it could be an extra edge to experiment with if you try it for long enough and you have the right sort of dose. Um so there is some evidence it can support with that collagen, the structure of your skin. It mainly comes down to, I mean, the mechanisms, I guess, as a result of the amino acids that make up collagen. So things like your proline, for example, and it's sort of that actually by ingesting collagen, the amino acids that it's broken down to um and the peptides are what support your skin. So getting the right type of collagen is beneficial. But but also there is quite early mechanistic research around how it might trigger things like an immune response, which might also be beneficial to your skin health. I think there is some evidence. There has been some, I guess, backlash in terms of the research recently, as a systematic review came out, which basically looked at just the research done by non-industry funded studies, of which there were many, and it found that the results really weren't as impressive as originally thought. But I think it's worth bearing in mind that obviously a lot of supplements research is industry funded because who else is going to do that? So ultimately, I think it's worth bearing in mind. Industry funded doesn't necessarily mean it's useless research and it's always going to be misleading. Of course, we are more likely to have more bias in that sort of research. So it's it is worth bearing in mind that there might be some ways in which they've done the study which might make the results more impressive, I guess. But that doesn't mean to say that there's no evidence there at all. So I think it really comes down to are you doing those more sort of heavy lifters first, like the diet and lifestyle, and then you can consider that if it's accessible to you, but keep your expectations realistic. There is also some evidence with like osteoporosis of things like joints, and even in sport as well, so with athletes, uh, where they might have more injuries with things like their joints and stuff like that. And there is some evidence that collagen supplements there may also be beneficial for joint health too, when taken correctly. So that's quite an interesting area outside of skin as well.
SPEAKER_01Yeah, for sure. I think really the summary of our discussion today is to really look at the, as you call them, the heavy lifters. So your diet and your lifestyle as a first approach where possible. And that some of these supplements do have the research behind them and the evidence as a bridge in the circumstances where someone is working on improving those lifestyle behaviours, or if they're not able to, then they can form a really helpful part of supporting nutritional well-being.
SPEAKER_00Yeah, absolutely.
SPEAKER_01Oh, fantastic. Well, I'm so excited, Josie, for our listeners to be able to read more about the Food First Approach in your new book coming out very soon. And I just want to thank you again so much for coming on to Food Is Food.
SPEAKER_00No, thank you for having me. Um, it's a great conversation.
SPEAKER_01Thank you for tuning in to Food Is Food. If you found the episode nourishing, hit subscribe so you don't miss our weekly episodes. And just before we wrap up, a little reminder that the discussions in each episode are for informational purposes and don't replace individualized advice. Because every recovery journey is so unique. Please consult your healthcare provider for support. That's all for today. Stay nourished and see you next time.