The Supplement Industry Doesn't Want You to Know This | Dr. Mahtab Jafari

Key Takeaway

Before taking any supplement, get comprehensive blood work done during your annual checkup. Most insurance covers testing for vitamins (B12, D), minerals (iron, magnesium), liver function, kidney function, and electrolytes. Use these results to identify actual deficiencies rather than guessing. The cost of annual testing is cheaper than buying unnecessary supplements year-round. Always take your supplement bottles to doctor appointments so your physician can correlate blood levels with what you're actually consuming.

Episode Overview

Dr. Matab Jafari, a professor of pharmaceutical sciences at UC Irvine, discusses the largely unregulated dietary supplement industry and provides evidence-based guidance on safe supplementation. She emphasizes that the $150-275 billion global supplement market operates with minimal FDA oversight, placing the burden of safety verification on consumers. The conversation covers proper testing protocols, common supplements like vitamins B12 and D, and the importance of addressing nutritional needs through diet first.

Full Transcript

Transcript of The Supplement Industry Doesn't Want You to Know This | Dr. Mahtab Jafari from 10% Happier. Auto-generated from episode audio; may contain minor errors.

Welcome to the 10% Happier Podcast. I'm your host, Dan Harris. Today we're talking about one of the most confusing and controversial areas of wellness and fitness, supplements. Should you be taking them? Which ones should you be taking? How do you know? How do you separate fact from fiction in a multi-billion dollar almost entirely unregulated uh uh uh business where people are making all sorts of wild health claims? what to do. We brought in a ringer, an expert, Dr. Matab Jafari. She's a professor of pharmaceutical sciences and ecology and evolutionary uh biology at the University of California, Irvine.

And she's also written a book called The Truth About Dietary Supplements, an evidence-based guide to a safer medicine cabinet. We'll be right back with Dr. Matab Jafari. Keep it here. Dr. Matab Jafari, welcome to the show. show. show. Thank you and thank you for having me. It's a pleasure. I'm I'm so eager to talk about this because I have so many questions and I've been so confused about this stuff for a long time. Um let me let me start though by getting some background information on you.

H how did you get interested in this? My my understanding is uh it has its roots in in your childhood and perhaps even with your grandmother. your grandmother. your grandmother. Yes, it does. So um so I've been doing biomedical research for the past uh 30 years in various uh capacities but mainly in academia. But uh growing up in Iran, every time I had a minor illness, a stomach pain or anything, my grandmother would give me uh some herbs from her own garden, not from a bottle.

and um you know I I I usually felt better after um getting those remedies from her. So that's how it all started because she also had a garden and she grew her own herbs and fruits and vegetables. But then when I became a professor and I started my own lab and my research, I um I delved a little bit obviously deeper into it because I was a skeptic with some of the remedies that my grandmother used to give me. And the more I studied uh plants and uh botanicals, the more I realized how powerful they are.

Um but as far as the research and my work on dietary supplement goes uh it really started with questions that I get from uh people and um the questions usually start by you know my neighbor or my friend recommended this supplement. What do you think? So this is um this has been going on for two or three decades now and I finally decided to write that book to really create awareness um and um talk to people about the safe use of dietary supplements. So my work predominantly my research at University of California in Irvine now focuses on uh safe use of dietary supplements, testing botanical extracts and dietary supplements in my lab and really creating this uh awareness again on the safe use of dietary supplements.

Okay. So I'm going to ask you a bunch of the questions that your friends and family members and neighbors have been asking you for decades. But before I get into that, uh, because I have a million questions about peptides and vitamins and all these other things, um, let's just talk about the overall landscape. Um, Um, Um, Elanor Vasil, who's producing this episode, gave me some research, uh, coming into this that kind of blew my mind. Um, according to PubMed, the global dietary supplement market is um estimated to be valued between 150 billion and 275 billion um a year I believe and that's that's uh those estimates are a couple years old.

So it may be bigger than that now. Um, so what's your sense about the the size of of this market and uh it's why is it getting bigger and more popular all the time? time? time? I think that these numbers are accurate. When I give public talks on dietary supplement, I usually have a slide that um presents data on the market on the number of dietary supplements. And the estimate for 2025 2026 used to be like 50 or 60 billion, but it's way more than that.

It's very close to the number that you just said. Um and the question is that the question is why? because as you mentioned this is an unregulated uh market. So the question is why people reach for dietary supplements and of course the answer is multiffactorial. I like I like to say that the social media and the marketing practices play a huge role. Um people like to have agency when it comes to their health care and they feel like by reaching out to dietary supplement they are taking proactive steps to help themselves.

Um and so that's like the psychological aspect of uh taking supplements and um everybody wants to be healthy. Everybody wants to improve their wellness, their health and it is hard sometimes as if you if you don't have training to really understand the science, it's sometimes hard to um differentiate science and pseudocience when it comes to marketing practices. So, I wish I had a oneline answer to your question, but it's really multiffactorial why this industry is exploding. exploding. exploding. You don't need to have oneline answers for anything here.

You can go, you can be as nuanced as you want. I just want to give you permission. Um, so when you say it's unregulated, uh, does that mean that, uh, if I, you know, decide to have Dan Harris's protein powder tomorrow, I can make any health claims I want? And also, is anybody going to test, you know, my product? So, dietary supplements uh, are considered as food. Now, so if Dan Harris wants to come up with his own, let's say, protein supplement, you you can do that.

And um FDA does FD is not going to regulate when I talk about regulation meaning that FDA uses different guidelines when it comes to dietary supplements compared to pharmaceuticals. So a dietary supplement does not need to be approved by FDA before it reaches the market. Um, so you can create your own supplement and you can put it on the market and FDA requires that you practice good manufacturing practices and um, and also make sure that you don't use ingredients that are dangerous to uh, public and really the burden of proof when it comes to the quality of dietary supplement is on people is on consumers is is on us.

FDA gets involved when um a dietary supplement has um reports of side effects. So you can go on Medatch. It's a it's a program that FDA offers and you can type in a side effect that you're experiencing with a side effect. And when those uh complaints become like let's say when there are I don't know the exact number so I don't want to say anything wrong but when those complaints increase on this website then FDA starts looking into that company in particular to see why this is happening and as far as the claim goes uh FDA requires dietary supplements to have a statement I'm sure you've seen that it says this statement has not been um approved by FDA.

So, you can make any health claim that you want as long as you have that statement. Uh I don't want to say always because you can make outrageous claims. But let's say that you want to say this supplement is going to help you um sleep better. It's going to improve the quality of your sleep. Then you just have to put that statement that this statement has not been approved or reviewed by FDA. And that's pretty much it. That's all the regulations we have right now. right now.

right now. Okay, Dr. Jafari, um, please excuse my French, but this system that you're describing sounds [ __ ] insane. Given the size of this market, given the the sheer number of people who are relying on these products, the fact that um um um the level of regulation is so low and in some cases non-existent, Yeah. It just seems howlingly irresponsible. irresponsible. irresponsible. It is. Um I agree with with you. It is really an insane situation. And um as as an educator and researcher, what makes it even harder is the public perception.

A survey was conducted not too long ago asking Americans, "How do you feel about your supplements? Do you think they're safe? Do you think they were FDA approved?" And almost half of the people uh thought that yes there is some sort of regulation for these supplements before they hit the market. And uh more than half said that if this supplement is harmful it should not be on the shelves of stores. Um so yes we definitely have a long way to go when it comes to regulation and um this is what I constantly talk about in my in my lectures and in my public presentations that we need to have better regulation for dietary supplements.

Are there you said that the there's some burden on the supplier not to put harmful ingredients harmful ingredients harmful ingredients into these into these into these powders and potions that they're pedalling. But I understand that actually adulteration and contamination are real problems. Yes. Yes. Yes. So the burden of proof when it comes to the safety and the quality of supplements is on us. So you and I as consumers, we have to do our own homework and we need to make sure that the supplement that we are taking has good quality.

On the manufacturer side, they they have to follow good manufacturing practices. I mean this is something that FD requires. But as I said, there are no um FDA is not going to for instance verify the dietary supplement before it hits the market. And you're absolutely right. There has been cases of adulterations, contaminations contaminations contaminations and and these issues persist and in my mind it is going to continue to persist until we have better regulation. Having said that, the good news is that there are some responsible dietary supplement companies out there who practice transparency when it comes to where they get their ingredients and there are third party um third party organizations such as NSF, USB who come in and test those dietary supplements and give the company a stamp, a USB stamp or an NSF stamp to to say that yes, we have tested their products and it is safe.

But not every dietary supplement company goes through that process because it's extremely expensive, time consuming. Uh but the minimum is to study the company uh as a consumer and see if they are transparent from where they get the raw material material material um and how they are manufacturing that supplement. So, I think what you're saying is if I'm tempted to buy a supplement, I'm in a store, I'm looking at a rack of supplements, or an influencer I follow is recommending a a supplement, I should check the label to see if it's USP or NSF um certified.

And if it's not, yes, I should think twice. Well, you should think twice, but there are other ways to check for quality. For instance, consumer lab. I highly recommend people using Consumer Lab. It's um it's a it's another third-party um organization that look at the quality of supplements. So, let's say the supplement that you're taking um doesn't have that stamp because many supplements don't. Smaller companies usually cannot afford going through that process. So the minimum is to make sure that when you go on consumerlab.com and put in the name of the supplement and company, you you're you're not under what I call trouble, problem or red list, meaning that the supplement has had issues with quality.

And another way to check the company is to go on FDA.gov gov and see if FDA has issued any warning letters, any injunction letters or any uh type of warning to that company when it comes to the quality of their supplements. So again, you and I as consumers have to do our homework to make sure that the supplement is safe and has good quality. O O O uh that doesn't seem like the smart system, but we we can stipulate that. Um, all right. So, let's talk about some uh let's get a little bit deeper on the types of supplements that are out there.

Um, I'm going to list what I think are the various types, but please um um revise and extend my list if I've screwed up. But I think we're talking about things like vitamins, minerals, herbs and botanicals, proteins, probiotics, and enzymes. And now everybody's talking about peptides. Is that a reasonably exhaustive list? That's a very good list. It's very very comprehensive. comprehensive. comprehensive. So let's go through these. Um uh what are and this is this is going to be an embarrassingly basic question. So I apologize upfront but what are vitamins?

vitamins? vitamins? So vitamins are um nutrients that uh ingredients that we find in various uh foods and um fruits and vegetables and you know dairy products and you know meat products that we consume that are essential for our health and um homeostasis. homeostasis. homeostasis. meaning that uh we need to have them to survive and to have um to have a good health. Uh and some of them serve as co-actors meaning that they are very very important when it comes to physiological pathways and what makes us uh be healthy and some of them contribute to the health of various organs in our body such as the our bones, our muscle, our brain.

Uh so it's a very it's a this is a very broad definition of what a vitamin is and if we talk about specific examples I'll be happy to uh to tell you what that vitamin does exactly. Uh yeah I do want to get into specific examples so thank you for the invitation. Um okay uh let's start with uh vitamin B. Uh, I've been taking it for years. Um, uh, back starting back when I, uh, became a vegetarian slash sometimes vegan. I'm I'm not that now. Um, uh, but I still take it.

Uh, should I and other people be taking vitamin D? And, uh, if so, how do we know whether we should be taking it? Just just like with other vitamins, the first question that you have to ask yourself is, do I need them? And how do I need B supplements? And when you say vitamin B, there are uh different types of vitamin E, but the ones that people usually reach for, I mean the most commonly used one is B12. So the first thing you have to do is to see if you are B12 deficient.

As you mentioned, unless you are a vegan or a vegetarian, most uh most of us are not B12 deficient because we get enough vitamin B from meat and from uh other food products that we consume. But let's say you do a blood test and you're vitamin B12 deficient, then the chances are that you need to take that supplement. And there are also of course it's not just the deficiency in in your blood with a blood test but there are some other diseases that require B12 or B supplementations and that that is different types of anemas and and other diseases.

So again the first question is do I need to take it? And in your case, since you said that you when when you were a vegetarian vegan, the chances of needing to take B12 was pretty high. Right. So what you're saying now is that next time I go to the doctor, I should uh closely examine my blood test results and if there is no B deficiency, I may want to talk to my do doctor about no longer taking this supplement. Yes, absolutely. It's a very simple test.

it's not that expensive because sometimes um uh people tell me that well I can't afford it and then my immediate answer is that well it's I promise you that the cost of the blood test is cheaper than what you're paying for the supplement on an annual basis. So it is a very simple blood test and you can find out if you're B12 deficient or not and then supplement. If you're deficient then yes you should definitely supplement. This episode is sponsored by BetterHelp. May is mental health awareness month and a reminder that whatever you're dealing with, you do not have to deal with it alone.

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Um because I I a key question for listeners is like how do I know if I if I need any kind of supplement? So when we go to our doctor um what kind of test should we be asking for generally? So we should definitely ask for a for a comprehensive and um a general assessment of uh of vitamins and it's very easy to test for vitamin D, B12, um iron, uh magnesium and things like that. Um so that is like the basic and I think this is something that should happen every year.

So once a year we should we should we should check for these vitamins. Um but sometimes we may need to go one step further because for instance you may be um supplementing with vitamin D and you're on a high dose of vitamin D and you're still deficient. So this is when you should also consider doing a genetic test to see to make sure that you don't have a gen a gene variation that can cause vitamin D deficiency even if you're taking um high doses of vitamin D.

And that genetic test look at your predisposition or your genetic variance for vitamin D receptor gene. And that would tell you if you may need um uh higher doses of vitamin D and what the underlying problem is. And I use vitamin D as an example. And there are other genetic tests that can be done for um other vitamins. But the mo the basic and to begin with when it comes to deficiencies and recognizing them is to do a blood test. And should the blood test be looking at just our whether we have vitamin deficiencies or should it be testing things like um our overall nutritional status, liver function, um uh uh uh electrolytes, things like that.

I'm I'm so glad you brought it up. So, I was referring to just testing for vitamins, but anybody who wants to start taking um dietary supplements, they have to have a baseline liver function test, a baseline uh kidney function test and also electrolytes as you as you mentioned. Uh many of these supplements use liver for metabolism. So, if we have um liver dysfunction, they they can be very harmful. Um and kidney function is another one that is very very important that we have a baseline kidney function because again these supplements use kidneys to either be reabsorbed, excreted or you know ending up in our urine.

So having a liver and baseline kidney function tests are are very very important and especially in older adults. Um we recently published a paper looking at the looking at case reports and the incidence of dietary supplements side effects and interactions with dietary supplements in older adults and definitely in older adults. As we age our kidney function and liver function kind of deteriorates. I don't I I I don't want to sound very negative here but it is part of the aging process. So, we definitely need to have a baseline uh those baseline tests.

So, just to put a very fine point on this, next time we go to our doctors, if we're interested in supplementation, what exactly should we be asking for in terms of our blood test and how much is this likely to cost us? Um, so the good news is that insurance, most insurance companies cover this test. So, it is part of the annual checkup and we don't have to pay uh for them. And the the most basic is to make sure that we have a complete metabolic panel that includes the liver function and kidney function.

We want to make sure that we have a complete blood panel, the CBC they they call it and um a and then part of the annual checkup is always checking for electrolytes, the kidney function, the liver function. Uh so there it is a very comprehensive blood test that is is included when we do the annual check and most and as I said insurance companies pay for it. Are there things we should avoid in terms of testing? I I believe you've expressed some skepticism about tests that analyze hair um and DNA and things like that.

So again just like dietary supplements um the these diagnostic test or tests to assess for you know nutritional status um are also very popular. Uh when you go on social media and look at marketing practices these these tests are also very popular and um I don't want to say all of them but last time I checked they were not FDA approved. So um you mentioned um hair analysis. So we just published a paper looking at the level of looking at the level of minerals in hair and compare it to blood sample because a lot of people think that it's in non-invasive.

I can just do a hair test and I can find out what minerals uh mineral deficiencies I have. Um, so we cannot uh say that a hair test analysis when it comes to mineral is the same thing as a blood test because a blood test shows what I'm experiencing right now or over the past week or two weeks or acutely. A hair test is going to show you what your deficiencies and excess are over a long term. Does it have a clinical value? Yes, because sometimes you know with with some professions you're exposed to um heavy metals and you know other environmental um toxins.

So they accumulate in our hair and the hair test becomes valuable in those situations. But a hair mineral analysis cannot replace a comprehensive blood test. blood test. blood test. Okay, one last question about testing. Mhm. If we see that we've got some sort of deficiency based on the tests that you recommend, is the move to go to supplementation first or see if we can make up for the deficiency via our diet? So my um the first recommendation is diet because if we have a good diet and if our um nutrition is balanced the the chances of needing supplements is is very very low.

So really the first uh place to start is to have a very honest evaluation of our nutritional intake to see how our diet is. Um but sometimes even with good nutrition you may need supplementation and that's when you go to sub to take a dietary supplement but these conversations should happen with your with your healthcare providers. So my recommendation to people is that when you go for the annual checkup, when you go to see your physician, take your supplements with you. Um because for instance, if I am checking your, you know, your nutritional status and I see that you are high in vitamin B12, I need to know what supplements you're taking and at what doses.

So that is that is a recommendation that I always have is to take your supplements to your doctor's appointments to make sure that you have a conversation with them and then if you are deficient in something the first place to start his diet. Okay, this is very helpful. Thank you for bearing with me on the on that digression into testing. Let's go back to um marching through the list of various types of supplements to get your uh take on them. Um we we talked about B uh vitamin B um specifically B12 which as I mentioned is something that I take.

Something else that I take that I think is very common although I'm now questioning whether I need it is vitamin D. Uh many years ago uh I was I saw um my doctor pointed out that my vitamin D levels were in his words in the toilet. So I just started taking a little vitamin D every day. Um, I've also though started to get a little bit more disciplined about getting outside. So perhaps I don't need vitamin D and I don't even sure if the supplementation would help in the first place.

So I said a lot there. What's your take on D? So vitamin D is a is an interesting um vitamin and a very interesting and sometimes controversial topic. Um based on reports 40% of u adult Americans are vitamin D deficient. So maybe when you were deficient you you you were in in in that group. So now the question is how do we define deficiency? And if you go and um use POPMED or Google vitamin D deficiency, it looks like almost every um health association has their own definition of deficiency.

The number that I use is 20. So anything less than 20 is considered deficient. And it really requires supplementation. But then the question is where you are and at what stage of your life you are at what age you have and what are some other medical conditions that you have. Um, so if you have somebody who has osteoporosis and you've had, you know, spontaneous bone fractures, the chances are that you probably need to pay attention to your bone health and you may need more vitamin D because we just don't get out as much as we should.

You know, we are not exposed to sun. the use of sunscreens and everything else really reduces the vitamin D organic production of vitamin D that are that that that we can have naturally. So that's when supplementation is is important. And how to supplement um really depends on your blood level. If you are less than 20, you may have to start with 2,000 units a day. If you are in the, let's say, 40 to 60, you may not need supplement, but you still have to check your, you know, vitamin D levels to to make sure that they don't fall short.

But the recommendation is 1,000 units a day if you're not getting enough um sun exposure. So, I don't know if I answered your question. Well, I think it comes back to back to back to test your levels, talk to your doctor. Um, and if it's indicated, take it. Absolutely. Yes. Absolutely. Yes. Absolutely. Yes. And we'll probably end up repeating that uh as I march through this this list a lot, but that people need to hear it. Um, but let me just ask a few more questions on vitamins.

Vitamin C. Um many people including my wife who's a doctor uh will recommend uh taking some vitamin C if you are starting to feel a little sick or you you're worried that you've been exposed. Um uh what say you? So um vitamin C is a very interesting um vitamin because we have been studying vitamin C believe it or not for almost 80 years and we have different types of studies. Some suggesting that vitamin C is not going to do anything to your cold virus decreasing the duration or the symptoms and some studies suggest that it does.

Um, if you look at these studies collectively, I like to say that when you feel like you are about to get sick, taking vitamin C, not at very high doses, because I've seen people taking three or four grams, which I do not recommend, but taking maybe 500 to 1,000 milligram of vitamin C, is going to probably be probably be probably be helpful to decrease the duration of your cold, maybe by 1.5 five days. That's that's that's what the summary of these studies are. But it is really not going to help much.

Um and we have wonderful sources of vitamin C in our diet. You know, oranges, strawberries actually have more vitamin C than oranges and kiwis. But um if you feel like you're getting cold and sometimes, I mean, I don't want to be disrespectful to people who believe in vitamin C, but sometimes the placebo effect also works. So um so if you take vitamin C at lower levels as I mentioned as lower doses 500 to 1,000 milligram a day it it wouldn't help but daily intake of vitamin C is not really recommended.

Uh they have done studies in travelers who have taken vitamin C compared them to travelers who didn't take vitamin C to say which ones get more sick and there was no statistically significant differences. I don't know if they still sell this, but I remember uh in the airports they would sell something called Airborne, which was I think a multivitamin, and you drop it in your drink and in your water and it dissolves and it tastes good. And I I I used to take it. Um but um sounds like it may not be that useful.

If you have if you have a good diet, if you have a balanced good diet, uh the chances of being healthful is not that high. But but airborne is still being sold. Uh it is actually one of the um I don't know the ranking but it's a it's it is pretty high on the list of uh most popular and sold dietary supplements especially during the flu season and cold season in winter. And airborne is not just vitamin C. It also has some other vitamins. It has zinc and and a few other.

So, I think what you're saying is it probably won't help as a preventative measure, but what if you're you're starting to feel the first tingles and aches of a cold? Will zinc and vitamin C and maybe echanatia, will any of that um help you? I mean, you you mentioned C might help a little bit, but what about those other uh uh supplements? supplements? supplements? So, there are there have also been studies published on these other supplements and and in my mind, the jury is still out.

Um and there is a very um minor I would say minor significance and minor trend towards these supplements helping to reduce the symptoms and maybe to reduce the viral load. to reduce the viral load. But um but but as I said there are no good you know randomized clinical trials looking at them. And of course the the um issue of clinical studies on dietary supplements is is something that we can probably spend a few hours on. Okay, one last vitamin question. I think a lot of people just just reflexively and habitually take a multivitamin.

Is this uh I I suspect your answer is just going to be run the test, talk to your doctor, but I just want to check if there's anything more to say. So what again multivitamins as you mentioned uh is is commonly used. I think last time I checked the statistics almost 30% of US adults take a dietary supplement and I think the number is probably higher than that. Um so with multivitamins again I want to go back to the basics. The first question is do I need them?

If I have a very good diet, the chances of needing a multivitamin is pretty much zero because the the amount of various vitamins that we get in a multivitamins are are pretty low. So, let's say you're D deficient. Um 40 units or 50 units of or even 100 units of vitamin D in a multi- uh vitamin is really not going to be helpful. You have to supplement. So the the amount of these vitamins in a multivitamin is is important. But going back to studies, study after study shows that multivitamins are not going to improve our health.

And two recent studies actually show that taking multivitamins increases mortality. So patients who have been taking these supplements, they had a higher risk for mortality. But I want to step back because this can become like a headline news that oh taking multivitamins is going to increase your mortality. But if you look at the populations who were enrolled in these studies, you have to ask yourself some very basic questions. So maybe people who are taking multivitamins are sicker in general. Their baseline health is not optimized and this is why they are taking vitamins multivitamins.

And this is a problem that we have with most dietary supplement studies is the study design and looking at the characteristics of the populations that we recruited and were included in these studies. For most dietary supplement studies, for instance, we don't have baseline vitamin levels. This has been a big critique of vitamin D studies, especially the ones that failed because the uh supporters of vitamin D supplementations would say that wait a minute, you didn't check vitamin D levels and you put these people on 400 or 1,000 units of vitamin D and you didn't see any efficacy, let's say in bone fracture, cardiovascular health, immune health.

So you can't really make those um conclusions and and this is really an ongoing debate when it comes to studies on dietary supplements. But going back to your multi so I'm digressing here. So going back to the multivitamin question um if you don't have a sound nutrition, if your diet is not good, you may consider taking a a multivitamin. But then you need to have a conversation with your physician because you have to look at that dietary that multivitamins and see how much of each vitamin you have in um in that supplement and if you need more.

This is just fascinating and sobering. Um all right, so we talked about vitamins. vitamins. vitamins. What are minerals? I honestly don't know like what is the difference between a vitamin and a mineral? So minerals are so I give you some examples to just make it easier. So for instance calcium is a mineral, magnesium is a a mineral um and zinc is a mineral, copper is a mineral. So when you do when you test when you do a blood test you can also check the level of uh levels of minerals in your in your blood.

Um a very controversial topic when it comes to mineral is the use of calcium for instance. So we all need calcium in our diet and I know there are ranges um based on you know based on the fact if you're a woman or if you're a female or a male I usually recommend to people try to have at least 1500 milligrams of calcium intake every day. So a lot of people reach for the supplements right a lot of people take calcium supplements because they think that the more is better when it comes to calcium and that is absolutely not true.

Um going back to the baseline test for that we talked about for instance somebody who has kidney problems taking more calcium is really not going to be helpful is actually going to harm them is going to cause more kidney problems and it is also going to deposit more calcium in our blood vessels and that is going to be a separate issue because we are going to develop you know we are going to increase the risk of developing coronary artery disease. Um, so calcium is great. My recommendation is try to get as much calcium as we can from our diet, but if we still need to supplement, we have to be very careful.

Let me ask about another mineral. You mentioned it, magnesium. Um, it's often recommended uh as a a way to help us sleep. What's the what's the truth about magnesium? Does it actually help us sleep? sleep? sleep? Magnesium is another interesting mineral. Um re data suggests that 50% of adult Americans are magnesium deficient. And you may think that we came up with that statistics because we measured blood magnesium levels just like I mentioned vitamin D levels. We measured um magnesium levels in our blood and we were deficient and that's really not the case.

Um the magnesium that we get in our blood tests only represent 1% of the the total magnesium in our body. 60% of the magnesium in our bodies are in our bones and you're not going to you're not going to get uh the amount that we have in our bones in a blood test. So that 50% is based on intake because they we have done epidemiological studies and we have uh we have observed that most of us do not have enough magnesium intake and based on that the uh intake inadequacy we decided that okay we are magnesium deficient.

So now going back to the uses of magnesium, there are some studies for instance suggesting in certain types of uh migraine people who have migraine headaches taking magnesium help them. Um when it comes to sleep studies have been have not been conclusive. Some studies suggest that it may help and some studies suggest that it may not help. I would say that this mo this recent study that was published actually in 2025 look at is probably the best magnesium study and um and I tell you why although the sample size was quite small I think they only look at 60 adults um and but the the good thing about this study was that the supplement that they used was standardized.

It was a form of magnesium uh formulation magnesium tyonate which is which crosses the bloodb brain barrier and then it can end up in our brain. And in that study they showed that magnesium actually improved sleep quality. And the reason that I like this study is that it wasn't just based on a questionnaire because I can be very subjective and ask you Dan how did you sleep last night? And you said oh it was pretty good. So that's very subjective. But in this study, they also evaluated the sleep quality with an aura rink.

So what they did was that these people um they were collecting data on the subjects in this study in a subjective and objective uh manner. And they showed that magnesium supplementation um helped them improve the quality of their sleep. But this is a small study, very small duration. And I believe the study was done over 21 days. What does that mean uh long-term? We don't know. What I recommend to people when they complain about insomnia and sleep disorders is they again go back to their physicians and have a very open and honest conversations with them because often insomnia and sleep disorders could be because of some other illnesses and some other issues.

So, um just reaching out for a supplement or even a medication um to take care of our sleep is probably not uh recommended. And then it comes to insomnia. Of course, you're talking about dietary supplements, but the science shows that cognitive behavioral therapy is probably the most robust uh intervention to improve our sleep. sleep. sleep. Yes, we've had um and meditation. And meditation and meditation. Yes, we've had um sleep experts on the show before and and uh it's been asserted quite uh powerfully and repeatedly uh that that uh CBTI, cognitive behavioral therapy for insomnia, is the uh the the biggest winner in this category.

I will say, and some of my listeners know this, that I've had I had I'm happy to say I had insomnia for a decade. Um, and it turned out I had something called restless leg syndrome that actually has been effectively treated with a combination of iron supplementation and a few medications. medications. medications. Yes, I'm I'm so glad you uh shared that example because if you probably you saw a physician to get the diagnosis of rest leg restless leg syndrome. If you had not done that, you would be over medicating and oversupplementing uh for your insomnia and and it was no good.

It was actually harmful. harmful. harmful. So now you have a diagnosis and you are um treating the issue. When it comes to sleep, uh melatonin uh is there evidence that that it can help? Um yes, melatonin is melatonin is a hormone that we all produce naturally. So we all have uh we all produce melatonin. Some of us um secrete less melatonin. So we may need to supplement even just to improve our circadian rhythm on a day-to-day basis. But but for the most part we have a good production.

Most people have a good amount of melatonin. So melatonin could be useful for occasional insomnia. For instance, your jet lag or you're traveling and um three 3 milligrams one to three milligrams of melatonin is not going to be uh dangerous. Um as a recent study um really raised the alarm on the use of melatonin. It was actually published four or five months ago and they look at 130,000 people who were taking melatonin at least for one year and they reported that melatonin increased the risk for heart failure in those people and um and I don't want to go through the details unless you want me to but really the premise was that it was changing their uh blood pressure and heart rate and this is how these people ended up having higher risk of heart failure.

So, so this is a this study was not published. It was an abstract that was presented at American Heart Association conference in November of 2025 and it hasn't been peer-reviewed. So, when people ask me questions about this study, I said that the study was presented at a conference at a scientific conference, but to my knowledge because I checked this last week, it it hasn't been published yet. and when it's published I'm sure that in the discussion or the critique section uh we are going to find out what are some of the controversial issues that we have to consider about this study.

Having said that my general recommendation is not to take melatonin on a daily basis. If you feel like you have to take it to fall asleep, then on a daily basis, then again, you need to have a conversation with your physician. Um, one problem with melatonin is also the quality of the supplements. Melatonin can be sedative. Um, Dr. Cohen at Harvard published this study looking at melatonin gummies and he reported that some of these gummies had 300% more melatonin than what they reported. That means that you can be really sedated in the morning, meaning that you shouldn't be driving and you shouldn't be you you you should you should really worry.

Um, so melatonin can help to, you know, people to fall asleep, but it's really not a sleep medication. It doesn't help you to stay sleep. One of the things that happens in spring is uh you end up in pictures more frequently. If you're going to weddings, which my wife and I, we've got two coming up, or if you're taking trips, or if you're hanging out with your friends on rooftops, a lot more pictures are being taken and you have to be in them. And if you wear glasses, you want to look good in your frames.

You want to love your frames. Which brings me to uh one of our sponsors today, Warby Parker. My wife Bianca is a huge Warby Parker fan. She's got several pairs of Orby Parker glasses, including one she has on her person pretty much all the time. As she would attest, nothing comes close. When it comes to quality, price selection, and customer service. Once you buy from Warby Parker, you realize how much easier they've made the entire process. They even have this thing called virtual tryon. You can literally try on glasses from your phone before you buy them.

It's wild how well it actually works. Now is the perfect time to upgrade your glasses for spring. Buy one prescription pair and get 20% off any additional prescription pairs at warbyarker.com/happhappier. warbyarker.com/happhappier. warbyarker.com/happhappier. That's 20% off additional prescription pairs when you go to wbarker.com/happier. What is what category do omega3 fatty acids fall into? So omega-3 fatty acids are a form of dietary supplements. So they are not vitamins, they are not minerals as you said they are fatty acids and we have to get them from our diet.

Uh omega trees and omega6 is not something that we can just walk around and produce. So we need to get them um from our diet. And the good news is that there are different sources of omega-3s in our diet. This is another um dietary supplement that there is a there is an objective test um to evaluate whether we are deficient or we have um sufficient amount in our bodies and that is the um the omega index. So that's again another actually you don't even need a blood test.

It is a finger stick test that you can uh measure your omega3 levels or and the ratio of omega3 to omega 6 in your blood. And if your omega3 index is less than 8% um most likely you need to supplement. My My My psychiatrist psychiatrist psychiatrist recommended a large dose of omega-3s as a way to elevate my mood. Um because I've been dealing with a bit of a recurrence of depression over the last couple of months. Any evidence for that recommendation? So the so when we look at all the scientific studies that have been published on omega trees and this is another I want to go back to um the quality of clinical studies because once again we don't sometimes don't know what the baseline of the participants are.

They they could be deficient in omega trees or replete and and we we wouldn't know because we never check for that index. But if you look at the scientific studies on omega trees collectively, there are some small studies that suggest that omega tree is use omega trees are useful for brain health. Um especially if you don't have enough in your diet. But the studies are not conclusive. What we know about omega trees for sure is that if you have high levels of triglycerides and um you take omega trees and sometimes the prescription form not even the dietary supplements unless again you look for a high quality supplement it can decrease triglycerides.

So that's why omega trees are very helpful for heart disease. Omega Omega trees also have anti-inflammatory properties. So some um some data suggests that maybe this is why they are also useful for our you know brain health and cardiovascular function because they decrease inflammation. inflammation. inflammation. I think we're now back at our theme. Um some arguments for omega-3, but get tested, see what your levels are. Talk to your doctor. Um but spec I'm not sure we fully closed the loop on whether they can help with um depression.

Um did did did you answer that part? that part? that part? So so what I what I shared was that there are studies there are small studies suggesting that omega trees can help uh with depression and they can help with brain health in general. Some studies even suggest that they can you know delay dementia. But my conclusion was that these studies are were not done long term because for instance with dementia you you can't test omega trees in four to six weeks or even 3 months and say that okay they had an impact on the symptoms of dementia.

Um the study has to be long term. It has to go over years and maybe sometimes a decade. But but what what I was saying is that the the data and the results are not um conclusive when it comes to the impact of omega trees on um depression for instance. But again my my own little editorial point here is that if you did take the omega trees and you feel improvement then that means that it is working for you. So I am not going to say um Dan stop taking it because it doesn't work.

doesn't work. doesn't work. And sometimes when I share this answer with um like the patients that I see or or my friends they say wait a minute this is a very wishy-washy answer. You are telling me to take it but then the data doesn't show that. I said this is when the per personalization come into effect. Um because if if a study shows that for instance vitamin D is not going to help with your fractures or decrease the risk of having fractures and I didn't check the baseline level but it's working for you then it's working for you.

I don't find that wishy-washy. I find that elasticity to be just wise. Um and and you know then something else that I like to add is that um science is constantly evolving. So we may have had studies that were published 10 20 years ago and the conclusion of those studies are not really consistent with what we are studying now. So we have to remember that when we talk about scientific evidence, scientific evidence evolves and and you're doing a better job with the quality of the studies on dietary supplements.

So so hopefully we will reach a point that I will have this interview, this dialogue with you and say the studies are great, the quality of the studies are great, but we are not there yet. On the subject of depression, another supplement that was actually recommended to me by the same psychiatrist that I haven't I have not taken this is St. John's wart. What's your take on St. John's wart? So St. John's wart um has the it it comes from a plant. So it's a botanical extract and uh one of the ingredients the ingredients the ingredients that um this botanical has one of the hundreds of molecules that this botanical has is very similar the chemical structure of that uh molecule is very similar to SSRI um selective serotonin reoptic inhibitors.

So St. John worse does have um anti-depressant properties but again it used it has to be used under the supervision of a physician because St. John's wart uses this same uh liver metabolic pathways that some other drugs use and it may interact with them. So you you really need to be under the supervision of a physician. I do not recommend people just going to a store and buying St. John wars to improve their mood and improve their depression because with with the with the understanding that oh this is just safe this is a dietary supplement this is a natural product and it's safe there is nothing um safe there because it can interact with your other um drugs and supplements supplements supplements so you mentioned that St.

John St. John's wart is a a botanical. Um, and that actually is one of the categories I wanted to ask you about, herbs and botanicals. And you mentioned early on in this uh conversation that your grandmother used to give you herbs and botanical remedies for various ailments when you were growing up. Um, what is your current view on the efficacy of herbs and botanicals now? Um so humans have used various herbal remedies and botanicals for thousands of years and um in the context of traditional medical practices when they use correctly and appropriately we we know that they work.

Um going back to my grandmother for instance if we had stomach be stomach pain he would give she would give us mint. She would grind up some mint, put them in in hot water, and give us like a mint tea. Of course, she didn't know that by putting the mint in hot water, she's extracting it because you're you're extracting chemicals out of the mint plant when you when you do that. And it it helped us. Um, another example that I use um from my grandmother is in harsh cold winters of Tehran, she used to give us like one teaspoon of um cinnamon to keep us warm and and I really hated that because it was very bitter.

Years later, it it was about 10 years ago that we did a study in my lab with cinnamon and we found out that cinnamon actually activates heat shock proteins. So what I thought it was voodoo by my grandmother is actually I I was able to prove it in my lab which was very interesting. So going back to herbs they do have they can be effective if they are used in the right context. Again, I want to go back to the quality of the dietary supplements, especially herbal products, because unless we know the source, we know the farm that they come from, we know the uh quality of the product, it is really hard to make any assessment about their safety.

And one thing that I always talk about is staying away from these blends, proprietary blends, because you may buy a herbball remedy and they list, I don't know, sometimes 10 or 20 different herbs and there is no information on the dose. There is no information or where these herbs come from. Were they uh where they cultivated from an organic farm uh responsible agriculture practices? We don't know. So I I really want people to think twice when they take an herbal remedy that has many different ingredients.

ingredients. ingredients. Okay. Well, that brings to mind AG1, which is an incredibly popular supplement. It's advertised all over social media. uh they've talked to me and my team about advertising on this show. We had a bunch of um uh requests that I don't think went down well with them and so they're not currently advertisers here. But so what's your take on AG1? My my take on AG1 is the is pretty much what I just shared with you about uh other dietary supplements. I have not had a uh deep dive into this particular supplement.

So I can't really um uh share any scientific data. I don't know if they are out there. But my my take is going back to the quality and making sure that the uh that that that the quality of the product is is verified and it is um it is uh trustworthing. And if you tell me some of the indications that people are recommending AG1, I I can make comments on those two. But I think the basic pitch is that it's just it's just a ton of it's like having a huge salad.

Um and I don't know if that's a a reasonable claim to make, but I think that's the pitch. So this is a very interesting pitch that many um many companies where they sell these green powders. I think the big umbrella for these kinds of supplements is that oh use these green powders because we have poor diets. We don't have enough fruits and vegetables and the green powder or AG1 can replace that. If you're not eating a salad, at least do that. Um my take on that is the same take that I have with everything else.

Number one, these are highly processed. In order to get to the product, you have to go through, you know, uh to go through some chemical, you know, processing. Even if you're freeze drying the the herbs or the uh greens, that is considered processing. So, they're highly processed. And then the other question is the other ingredients in these green powders because they they don't taste good. So unless you add sugar and other additives um there it's not really pleasant to um you know eat them. So I want to go back to the question of quality and finally is it do you think that we are going to get the benefits of the polyphenols that we get from let's say a salad compared to AG1?

There's really no comparison because a fresh salad that you make at home and you eat has polyphenols and antioxidants that are not processed. You know, they they come in your salad bowl and in your salad that uh you can compare you you can compare the efficacy and the health benefits of um whole foods compared to something that is processed. processed. processed. What about protein powders? So protein powders is another interesting topic and I think we are um becoming very obsessed with protein powders because we are realizing that we don't have enough protein um intake.

Um the the average adult in in US does not have enough uh protein intake. So now the question is how am I going to supplement that? Well, for me, the safest and easiest way is with food. So, make sure that you have 30 to 40 g of protein intake with each meal. Um, and I know there are various numbers out there, 1.6 to 2.2 uh grams per kilogram per day. But my recommendation, I try to simplify my recommendation. So, I tell people that you're eating breakfast, look at your breakfast and see if there's any protein there.

Look at your lunch. look at your dinner, your snacks. So try to consume enough protein with each meal and if you can with your with your snacks. Now going back to the protein powders, they um there have been studied and we know that some of them have heavy metals, some of them are contaminated. So then again the question is how can I assure the quality of that protein powder and um a very recent uh study I'm trying to remember the um the funding agency it was it was part of the clean clean um clean label project and they looked at I believe 134 different protein uh powders out there and they reported that 47% of them had heavy heavy metals.

So now the question about these heavy metals is that you know how much of heavy metals because if you look at Prop 65 in California they they almost recommend nothing and that was a big big critique of that work is that it was overexaggerated the amount of heavy metals in these uh protein powder. But to me, if I if I am a consumer and I'm looking at a protein powder and there's a 47% chance that this protein powder may have heavy metal, I will think twice.

So I would again go back to my recommendation with protein powders. It is much safer to to buy something that has the NSF stamp because NSF regulates sports and um nutritional and dietary supplements that are used in sports and protein powder as you know are heavily consumed among athletes. So, I I I know that I'm starting to uh sound like a broken tape recorder, but go back to food. Consume your protein from whole foods and in your diet. And yes, every now and then we may need a protein shake.

So, I don't have anything against that. My sons um you know, consume them, but go for a good quality wine. Speaking of athletes, and I consider myself to be, you know, an amateur athlete and, you know, dedicated, um, worker, outer, um, and I lift weights, etc., etc. Something I hear a lot about in fitness circles, but have never tried myself, and I don't actually even know really what it is, so maybe you can educate me. Um, creatine, what's your take on creatine? creatine? creatine? Um, so creatine is an emerging um, dietary supplement.

Um a lot of people make uh confuse it with a type of protein. They said oh right after workout I have to take my creatine because this is it that this is going to be another protein I'm taking. It is not. Creatine is a dietary um supplement and we have had and again here going back to the science we've had really interesting studies on creatine. So if you are going to the gym and you're lifting and you want to improve the um you know quality and the quantity of your muscle taking creatine can can be helpful.

So the recommendation is um you know after after your workout try to take 3 to five grams of uh creatine and if you have a good kidney function it is pretty safe. Now um we have studies suggesting that creatine could also be good for cognition. it could be good for brain health and um there is a positive trend in these studies but I think we need more um the best benefit with creating when it comes to the impact on brain health was observed in post-menopausal post-menopausal post-menopausal uh women but um if you are an athlete and you're working out um take taking creatine can can be useful because um I don't know how much how deep you want me to go into the mechanism of action of creatine but it really helps the production of ATP in our muscle cells and it also helps with the retention of water.

So you may so you may hear people saying that I started taking creatine and I gain weight. Well, the first one to two kilo extra kilogram or four or five pounds of extra weight is because of the water retention in your muscles and that that's this is not really a weight unless you're also eating a lot of candies and you know sugary uh sugary stuff when when you exercise. And um and the last thing I want to say about uh creatine because I just got this question actually yesterday.

So it's really fresh on my uh mind that the type is important. So creatine monohydrate is probably the one that you should consume because it's better absorbed. Another supplement that people are talking about a lot these days. I think this is a category of supplements. I think um peptides. I'm hearing a ton about peptides. They're all over the internets. Um, what are peptides and what are you what's your take on them? If you have a good diet and you consume enough proteins, you probably don't need any any extra amino acids and any extra peptides.

Um, there are a lot of claims suggesting that when you take peptides, you're going to have better elasticity in your skin, um, your hair, your nails. Um and and I put peptides in the same category as I put collagen that these studies have been very subjective. They I mean not very subjective but semi-subjective because they use surveys and they look at your superficial skin for instance to say that if they work and if they don't work and again going back to the quality if you are convinced that this peptide supplement is going to help you at least go for the right uh quality make sure that the quality of the supplement is good but the data is not very convincing.

Okay, last thing to ask you about, although there are a million other things I could ask you about, but we're we don't have infinite time. Um, probiotics, live microorganisms, microorganisms, microorganisms, um, that allegedly aid uh, digestion. So, pro probiotics and and enzymes. Um, any evidence for these? So probiotics are are also be very popular and um some people just take them on a daily basis. My recommendations on probiotics is that you have to work on your diet. If we want to have a good microbiota in our gut, probiotics are just going to offer a very temporary solution to a gut microbiota that needs to become healthy with our diet.

So my recommendation is if you want to have a healthy gut microbiota uh stay away from sugar um especially processed sugar or uh anything that has high amounts of sugar and consume fruits and vegetables. Uh that is how you have a healthy microbiotic. microbiotic. microbiotic. Taking probiotics for very specific conditions could be helpful. For instance, if you if you are taking antibiotics, I highly recommend that you take a high quality probiotics while you are taking that antibiotics. U and I recommend that you start taking it on day one.

And why do I recommend that? Because probiotics are going to offset the gastrointestinal side effects that for instance the antibiotic is going to uh cause. But taking probiotics on a on a daily basis is really not recommended. Um there are some specific diseases like ulcerative colitis and Crohn's disease that may um require taking probiotics. Again, that's a conversation you need to have with your physician to make sure that you are taking the right one because for people for instance who are imuninompromised for various reasons because they're taking you know drugs um you know to prevent organ rejection and things like that.

uh probiotics can actually be quite harmful because you you you have a you have to again you have to look at the quality and they can um they can cause infections. So um I highly highly recommend again the conversation with the healthcare providers to choose the right type of probiotics and the specific um disease that you are taking probiotics for. you have been very patient with my pesky questions. Uh, I really appreciate it and I want to rei recommend uh that everybody check out uh Dr.

Jafar's book again. It's called The Truth About Dietary Supplements, an evidence-based guide to a safer medicine cabinet. I will put a link in the show notes if you want to go buy it, which again, I think uh would be a wise move if this is a subject you're influested in. Um, but in closing, let me just say Dr. Matab Jafari. Um, thank you so much for taking so much time with me slash us. Oh, thank you. Thank you for having me. Thank you. And thank you for the great questions.