June 17, 2024 • 33 mins
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Take-Home Messages
· Lifelong use of supplements to prevent an illness is very different from taking a supplement to treat a known deficiency or a specific symptom
· The evidence does not support the use of most all supplements to prevent illness (with multi-vitamins being the exception where there is some evidence)
· Supplements to treat a particular problem can be very helpful, especially if we do our N of 1 study in ourselves
Part One: Understanding Nutritional Supplements
- Various types of supplements: Vitamins, Minerals, Herbals, Probiotics
- Most commonly used Supplements: Multivitamins, Omega-3s, Probiotics, Vitamin D, Calcium, Protein Powder, Psyllium
- We want to live long and well—taking a supplement may help us feel “agency” or that we are proactive in improving our health---even when the evidence does not support it.
Part Two: the Supplement Industry Differs From Pharmaceuticals
- Licensed and prescribed drugs go through extensive testing/FDA oversight to demonstrate that they work and that they are safe
- Nutritional supplements are viewed as “food” and don’t have similar regulatory scrutiny
- Challenges: traditional drugs receive patents and can afford extensive clinical studies. Nutritional supplements generally don’t have patents and can’t afford to conduct extensive research. For this reason, most supplements have very little scientific evidence to support their benefits, even though their claims may suggest otherwise
- Real-Life Example: Critical Evaluation of Broccoli Sprout extract Study
Part Three: Evidence (mostly lacking) for Common Supplements
- Omega-3s: studies don’t show a reduction in heart disease or cardiac death; they may have a role for high blood triglycerides or for patients with rheumatoid arthritis (pain control)
- Vitamins and Minerals: Minimal Impact on Disease Prevention except for a daily multi-vitamin which has supportive evidence that they may reduce cancer and cognitive decline
- Cognitive function: omega 3s and the MIND diet aren’t effective at slowing decline.
- Supplements for specific deficiencies or specific symptoms can be very helpful. You can do your own “N of 1 Study” to see if they help you. Step 1: identify the problem (bowel irregularity, sleep…); Step 2: choose a supplement and begin taking it; Step 3: re-assess after a few weeks. If it helps, great. If not, then likely best to stop.
Dr. Bobby’s regimen: a daily multivitamin, colace (for bowel regularity), and recently started Creatine for muscle strength. I don’t take omega 3s, vitamin D calcium, magnesium, or pro-biotics.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Bobby Dubois (00:03):
Hi, I'm Dr Bobby Dub ois and welcome to
Live Long and Well, a podcastwhere we will talk about what
you can do to live as long aspossible and with as much energy
and vigor that you wish.
Together, we will explore whatpractical and evidence-supported
(00:27):
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
I'm a physician, ironman,triathlete and have published
several hundred scientificstudies.
I'm honored to be your guide.
(00:50):
Today we're going to talk abouta popular but often
controversial topic nutritionalsupplements.
Now, it's popular because awhole lot of Americans take them
.
It's controversial sincethere's often more passion than
(01:11):
real evidence to support theiruse.
As listeners may know, my careerfocused on whether there's
evidence to tell us what doesand doesn't work in healthcare
and, most importantly, for whomit helps or doesn't help.
Now, that could be a surgicalprocedure.
(01:32):
It could be a costly medication.
As a physician, I care aboutpatients and I want to help them
, not hurt them, so it's veryimportant for me to understand
evidence, when it will help themand when it won't.
As a scientist, I studied theseissues and published over 180
(01:52):
peer-reviewed articles on them.
So I approach supplements withthis same mindset or perhaps
some might say bias and I alwaysask myself these types of
questions.
Perhaps some might say bias,and I always ask myself these
types of questions Is thereevidence, good evidence,
(02:14):
rigorous evidence that aparticular supplement works, and
for whom?
Because it may work but it maynot work for everyone, and if
there isn't good evidence inpeople, I don't support their
routine use, I don't use them, Idon't talk to others about them
.
Now, evidence in animals ortest-tubed studies in the lab
are interesting, but bythemselves aren't enough for me.
(02:36):
Theories are great and there'slots of theories, and people
build careers around theories,but I want to see that the
supplement actually helps people, and so that's what I will
focus on with you today andreally on any topic that we will
explore together.
(02:57):
As always, I want to begin withtake-home messages First.
I believe there's a really bigdifference between taking a
supplement for the rest of yourlife to hopefully prevent big,
important diseases like heartdisease, cancer or mental
decline.
Now that's very different thantaking a supplement for a known
(03:21):
problem, like I have a tummytrouble and will Pepto-Bismol
help me.
That's a really differentsituation.
Now, unfortunately, when welook at most supplements to
prevent these long-term chronicdiseases, the evidence is not
very convincing that there's alot of benefit.
(03:42):
Now I like supplements to takecare of a known problem, because
you can quickly figure out ifthey're working, even if the
evidence isn't absolutelyconvincing, and they are usually
pretty safe.
And so these are the take-homemessages, and I will then flesh
(04:02):
each and every one of them out.
Well, let's start with anotherpoint, which is a disclaimer.
I am not a nutritionist, I'mnot trained on food science, but
I'm pretty good at looking atthe evidence of what does and
does not work.
So the plan for this episodeFirst, I'll review what
(04:26):
supplements are and which arethe most important ones that are
commonly used today in theUnited States.
Second, I will briefly describethe supplement industry and how
it's different from thepharmaceutical industry and why
it is that we don't have strongevidence for most products that
(04:46):
they sell.
And third, I'll talk about afew supplements not everyone,
but just a few of the importantones and explore with you what
we do and don't know about theevidence.
As always, I will link thesekey studies in my show notes if
you wish to look at them and, asalways, I welcome your feedback
(05:10):
on that.
So let's get started.
Part one what are nutritionalsupplements?
Can't have a full discussionwithout at least defining terms,
so nutritional supplements fallinto a number of categories.
So nutritional supplements fallinto a number of categories.
They could be a vitamin likevitamin B12 or vitamin D or
something like that.
They could be a mineral that'salso a different type of
(05:33):
supplement, now.
That could be calcium ormagnesium or something like that
.
They could be an herbal likecumin that's a popular one you
hear about.
Or a supplement could be aprobiotic to improve our gut
health.
Now, supplements are usuallytaken on a routine basis,
meaning this is a good thing toimprove my health and I'm going
(05:56):
to take this every year for therest of my life.
But supplements can be takenfor specific needs and we're
certainly going to focus on thata little bit later.
The most commonly usedsupplements in the United States
today is a routine multivitamin.
Omega-3s are very, very popularProbiotics vitamin D, calcium,
(06:23):
protein powder and psyllium,which is like Metamucil or one
of those types of bowel agents.
So those are the most commonlyused ones.
In America today, about half ofus take at least one supplement
and, as you know from eitheryourself or your friends, some
people take a whole lot of them,no-transcript.
(06:53):
Now, one of the reallyattractive appeal of supplements
is that we all want to beproactive with our health and
feel like we're doing somethingand that health and what happens
to us isn't just a roulettegame in Las Vegas.
That, in fact, we want to feelwe have agency and some sense of
(07:17):
control.
So taking a supplement gives usa sense we are doing something
that will help our health,because that's important to
almost all of us to have thatfeeling of agency.
Now there's a trio of challenges, though.
So, on the one hand, we want toactively improve our health,
(07:40):
and there's a lot of companiesout there that want to make
money on just that, and theyrespond to our desire to improve
health, and they have really,really optimistic advertisements
and spokespeople to help sellthese supplements.
And, as I'll get to in a fewminutes, there aren't great
(08:02):
incentives for supplementcompanies to do high-quality,
rigorous research.
Those research studies would bevery expensive and, as we'll
talk about in a moment, becauseyou can't patent these, by and
large, there's not the financialincentive to do wonderful
studies.
So end of part one.
(08:24):
Let's flesh out some of theseand get to understand what we do
and don't know.
So let me explain a little bitabout the supplement industry.
Look, I'm not an expert on thesupplement industry.
I spent a lot of time workingwith the pharmaceutical industry
.
I know that better, but I havea pretty good sense of what
(08:44):
happens in the supplement world.
So pharmaceuticals your classiclicensed drug by the FDA.
They're highly regulated andthe amount of evidence you need
to get a drug through the FDAand approved and on the market
is very high.
And the FDA has very closeoversight before any drug makes
(09:06):
it to the market and they focusthe FDA does on does this drug
actually work and do the thingsthat the drug company says they
do, and is it safe for people totake?
For that reason, on thenutritional side, the FDA has a
very, very, very minor role.
Before a supplement goes on themarket, there's no requirement
(09:30):
that safety studies or efficacystudies meaning does it work are
done.
So they don't approve.
The FDA doesn't approve theclaims for what a company might
say that this will help reduceheart problems or anything else.
Now, the FDA will look atsafety issues after it's on the
(09:52):
market, but they won't requirerigorous studies to get on the
market.
Now why is there such adifference between how the FDA
approaches a typical medicinethat a doctor might prescribe
and a supplement?
Well, the theory is that theseare dietary supplements, not
health aids.
So this is food, and you canpurchase any vegetable or fruit,
(10:18):
basically that you want.
There is no kind of FDAapproval on what fruits and
vegetables a market can sell.
Now this is a little bit odd,because although these are
dietary supplements, or viewedas such, we do take them for
health reasons.
We're hoping they might reduceheart disease or cognitive
decline or cancer or somethingelse.
(10:40):
In the pharmaceutical world,when you develop a drug, you can
get a patent.
That patent goes on for many,many years and because of that
patent you can afford to doreally detailed, rigorous
clinical studies, and to bring adrug to market could cost a
billion dollars or more, and soif you don't have a patent, you
(11:01):
won't really want to do thosekinds of studies.
And that's exactly what happensin the nutritional world,
because I could come out with areally wonderful pill that's for
calcium or magnesium and Imight study it and really
understand who benefits and whodoesn't.
But somebody else from anothercompany could basically come out
(11:23):
with the same thing, becausethere isn't a patent on calcium
or magnesium or vitamin D orsomething like that.
So without that motivation ofhaving a patent and being able
to be exclusive, there justisn't the same incentives and
therefore the studies that aredone aren't as rigorous, aren't
(11:44):
as big and aren't as believable.
Do keep in mind there's a lotof money to be made in
supplements and retailersprobably make 30% to 50% on each
and every bottle that's sold,make 30 to 50% on each and every
bottle that's sold.
Now what I've described here isa bit theoretical.
So let me give you a real, liveexample of what a nutrition
(12:05):
study might look like.
Now they're not all going tolook like this, but this will
give you a sense of why I havesome skepticism about many of
the claims that are made.
So there was an article thatcame out recently and it was
picked up in the press and itbasically said that broccoli
sprouts, the extract of broccolisprouts, improved exercise
(12:29):
performance.
Hey, I would take some broccolisprouts or an extract of
broccoli sprouts if it helped mework out more and do better in
a race.
That sounds like a great thingand the theory is good that
broccoli sprouts haveantioxidants in them and we'll
come to a little bit later whatantioxidants are all about and
(12:53):
that seems like a good thing.
Antioxidants are good.
Broccoli sprouts have them, sothis might in fact help our
exercise performance.
And so they did an actual study.
But when you dig below thesurface, you realize this study
only had nine people in it.
Nine people isn't enough reallyto tell anything.
And they said well, your heartrate didn't go up as high when
(13:17):
you did a standard amount ofexercise.
Well, that was only three-pointdifference.
So for some people it didn'ttake the broccoli sprouts.
Our heart rate went up to 187,and for the other people it was
184.
And they said oh well, itimproved how long you could work
out before you got exhausted.
Well, yes, but it was thedifference between 401 minutes
(13:40):
and 406 minutes.
So tiny, tiny differences withonly nine people.
And then, of course, you readthe description of the authors
and the funding, and what youlearned is that it was funded by
the vegetable growers and thatthe authors have a patent
pending for the broccoli sproutextract.
So does this mean, because itwas funded by vegetable growers
(14:04):
and that the authors have apotential patent, that this
can't be a valid study.
No people can do good studies,but when there's only nine
people the results are reallytiny differences.
But when there's only ninepeople the results are really
tiny differences.
Then I wonder and this is notatypical for studies.
Obviously there's somesupplement studies that are
(14:25):
examined by the federalgovernment or major research
institutions, but for a lot ofthe things you hear about on the
market, this type of broccolistudy isn't all that surprising.
Okay, end of part two.
On to part three.
Is there evidence to supportthe use of these common
supplements?
Now, as I mentioned, and I'llsay again because it's so
(14:48):
important, I view supplements toprevent a disease really
differently than supplements tohandle a known problem.
So, if you have constipation,metamucil or Colace or Psyllium
would be considered anutritional supplement and the
beauty is you can know veryquickly whether it helps you.
(15:10):
It doesn't really matter what alarge study says, it's what
happens in you and you can tellthat very quickly and if it
doesn't work, you don't take itanymore.
Now, more about this later.
But if you're taking anutritional supplement to
prevent a disease, well franklyyou have to take that for
(15:31):
decades and if there isn'treally really strong evidence, I
don't believe taking thatsupplement makes much sense.
In my opinion, often what theyclaim greatly exceeds the
evidence For most of thesesupplements.
If there are any benefits, theamount is likely very small and
(15:57):
that leads to an almostreligious belief in some
supplements that this is theanswer.
We have found it.
By all means, I hope you trustwhat I share with you, but
there's a website that you mightwant to look at.
It's called examinecom and theytend to focus on supplements
(16:17):
and they tend to pull togetherthe evidence.
So you could take a look at itfor melatonin or whatever else
you might have an interest in,and see what they come up with
and see what they have on theirwebsite.
So just another resource, andif something pops up in a
headline, you could look at whatthey have about it and it might
be helpful to you movingforward.
(16:38):
So today I'm going to talkabout a few supplements, but
there's a lot more supplementswe're not going to talk about
today because we just don't havethe time and we may bring those
up in the future or, if youhave an interest in any of them,
reach out to me through mywebsite, through Instagram,
however you want.
(16:59):
So let's start with omega-3sbecause they're very popular.
As I mentioned, it's one of themost commonly used supplements,
and here's that word againantioxidants.
So omega-3s have antioxidants.
So what's an antioxidant?
Without getting lost in thebiochemical minutiae, an
(17:20):
antioxidant helps stop damage toour cells.
There are certain moleculesthat float around.
They're called free radicals.
That happens for a variety ofdifferent reasons and those free
radical molecules can hurt ourcells and an antioxidant
basically stops those freeradicals from doing that damage.
(17:42):
So sounds like a really goodthing.
So taking an antioxidant sureseems like a good idea.
Another piece of this puzzlewhich got everybody excited
about antioxidants andspecifically omega-3s is that if
you look around the world andyou look at sort of
epidemiologic studies, peoplewho eat fish live longer and
(18:05):
they have lower rates of heartdisease.
Fish has omega-3s, likeanchovies or salmon or sardines.
So if eating fish helps you,then taking the essence of fish,
meaning these omega-3s, must bea good idea.
The challenge and this happensover and over in observational
(18:26):
studies when you actually testit out giving omega-3s as a
supplement isn't the same thingas eating a fish, and eating a
fish may not really be what'scausing people to have less
heart disease.
It could be that those culturesthat eat a lot of fish are also
(18:47):
doing a lot of walking aroundand get a lot of exercise, or
they have strong bonds withtheir family, or they're very
good at sleeping every night.
So what you observe doesn'tnecessarily mean that's the
cause or that's the solution.
So there have been lots ofrandomized controlled trials,
(19:11):
and a randomized controlledtrial is basically you take a
group of people and you randomlydivide them into two groups,
group A and group B.
Group A gets supplements, sayomega-3s, group B doesn't.
And then you follow them overtime, you measure certain things
and then you ask the questionwell, did the omega-3s reduce
(19:31):
heart disease?
Did they reduce strokes?
Did they reduce cognitivedecline or cancer?
That's a randomized controlledtrial.
That's really different thanjust I found a bunch of people
who took omega-3s, I found abunch of people who didn't and
then figure out what happened tothem.
Then, another day, we'll talkabout why that type of
(19:51):
observational studies is so muchless powerful than a randomized
control trial.
So there are two very largesummaries of the evidence on
omega-3s.
One is called the Cochranesummary and that looked at 90
clinical trials or so and theyfound no benefit for heart
(20:13):
disease.
Similarly, the Mayo Clinic dida very large summary and again
they found omega-3s did notprevent heart disease.
Now you may run across a studyor you may run across a headline
that says there's benefit forheart disease, but really when
you look at the totality ofevidence because any one study
(20:35):
may not give us the full answerthe totality of evidence does
not show a cardiovascularbenefit.
That's my interpretation of theliterature.
It's also the conclusions ofthese two very large and
well-respected summaries.
So I mentioned earlier thatsupplements are very different
(20:57):
if you're taking it for aspecific problem that you have,
not to prevent something, butfor a problem you have.
So for omega-3s, if you havehigh triglycerides, omega-3s can
lower them.
This isn't just to say, oh, ifyou take it for 30 years you
(21:18):
won't get cancer or cognitivedecline.
You are going to take itbecause you have high
triglycerides and you canmeasure it to see if it's making
a difference.
There's also some evidence thatomega-3s help folks with
rheumatoid arthritis, withdiscomfort Again something you
can test.
If you have rheumatoidarthritis, you try taking the
(21:39):
omega-3s.
If it improves the pain, great.
If it doesn't, you stop Okay.
So that's omega-3s.
What about vitamins and minerals?
Do they reduce cardiovasculardisease and cancer.
Again, another big summary of84 clinical trials.
They looked at vitamin D, theylooked at beta-carotene, they
looked at vitamin E and therewas really no benefit, and
(22:03):
actually in some cases there wassome increased risk.
Where they did find somebenefit was not on these
individual items like vitamin Dor beta carotene, but a simple,
often viewed as boringmultivitamin, a once-a-day
vitamin that actually showed asmall benefit in reducing cancer
(22:25):
, and there's some data that amultivitamin might actually help
you maintain cognitive function.
Many, many studies on vitamin Dhave shown that it doesn't
protect muscle loss.
It doesn't help your gripstrength, it doesn't help you
get up and about.
Vitamin D is a reallyinteresting one.
(22:47):
Now, clearly, if you have amajor vitamin D deficiency and
it's affecting your bones, byall means vitamin D is a great
thing, but if, again, you'reusing it to prevent disease, I
just want to give you a sense ofwhy it isn't.
Just well, I'll take it, and ifit helps, great, and if it
doesn't, it doesn't.
Vitamin D is a double-edgedsword.
(23:07):
If you have bone issues, yes,vitamin D is very important in
helping bones, and not that moreis better.
It's just that if you don'thave enough vitamin D, you can
have problems with bones, butvitamin D because it helps with
calcification, and that's whatbones are calcification it can
(23:28):
also affect your arteries.
So there was a randomized trialnot long ago that looked at
36,000 people and some of thosepeople got vitamin D and calcium
and what they showed is, yeah,there was a small reduction in
cancer mortality in the peoplewho took the vitamin D and
calcium, or mortality in thepeople who took the vitamin D
(23:49):
and calcium, but there was anincrease in cardiovascular
mortality.
Why we don't know for sure, butit could have been that that
extra calcium and vitamin Dcaused some calcification in
your coronary arteries and thatled to cardiac problems.
Now, on the kind of vitamins,minerals and related area, there
(24:10):
is some data and it's actuallyfairly good data that creatine
may help with strength training.
Just taking creatine powder andyou don't exercise isn't going
to make a difference, but thereis data in the fitness
literature that it may helpstrength training and improve
your ability to grow muscle andto be able to lift more and more
(24:30):
weight.
There's also studies on cuminwhich are interesting.
They've shown that it mightlower an inflammatory thing in
your blood called C-reactiveprotein, but we don't really
know what that means.
So just because you take cuminand it might lower this
inflammatory marker, we don'tknow if it's going to make
(24:51):
people feel better, if it'sgoing to reduce the risk of
cancer or heart disease.
And again, as I've mentioned, Idon't focus on blood tests.
I really really really focus onwhat does it do in people?
So where do we go from here?
What about supplements andcognitive decline?
(25:13):
So, for cognitive decline,people have examined whether
omega-3s can prevent that, andso there was a meta-analysis.
This is again a summary ofstudies where they looked at 15
randomized controlled trials andthe omega-3s didn't help
(25:35):
cognitive decline.
So we've talked before aboutthe fact that omega-3s don't
appear to help for heart diseasestandpoint.
Now it appears they also don'thelp for cognitive decline.
Well, in the cognitive declinespace, this isn't what I'm going
to talk about now, isn'texactly about supplements, but
it gives us some understanding.
(25:56):
So this was a really, reallyimportant study and a really
well done and a very largeclinical trial where they
compared a diet.
Now it's called the MIND diet.
It's called the MIND dietbecause they were hoping that
this diet would help people'sbrains and brain health, and the
(26:18):
MIND diet is kind of like theMediterranean diet or the DASH
diet, and that's basically.
They put together foods thatthey thought from various
previous studies might reducethe risk of dementia, like whole
grains, leafy vegetables, nutsand beans and berries all the
things that we think might helpus and that you've also heard in
(26:41):
various supplementadvertisements.
So this was a three-year studyand they tested people for sort
of brain health, cognitivefunction.
But they also looked at theirMRI scans in many of these
people and what did they find?
Made no difference.
So if a diet rich in all ofthese what are supposed to be
(27:05):
mind-oriented foods didn't help,it's likely the supplement
based upon those same thingsisn't going to improve cognitive
decline.
Now, exercise can help, bloodpressure control can help, other
things can help, butsupplements appear not to be
helpful.
And if you hear from someadvertisement that it's really
(27:28):
helpful and been shown toprevent cognitive decline, I
think you really want to askwhat's the evidence?
Was it done rigorously, and canI really believe it?
Well, I mentioned earlier thatI really do like supplements,
but I like them not to preventdisease but if you actually have
a known problem.
So if you go to the doctor andthe doctor tests your blood and
(27:51):
he says, oh, your vitamin B12levels are low and in fact it's
causing some anemia, which mightcause some fatigue for you.
Well, of course, increasingyour vitamin B12 level would be
very important and a supplementcould be very, very helpful, and
people can get vitamin B12deficient if they have something
(28:12):
going on in their stomach thatmight cause them not to absorb
it.
Now where it gets a littletricky is if you do a blood test
that shows a low level butyou're not having any symptoms.
Then it's a little tricky toknow should you actually take
the supplement.
But if your level is low andyou're having symptoms, I think
(28:32):
it's absolutely appropriate,wonderful and extremely helpful
to consider a supplement that'sspecific to that, and
supplements are great if youhave a particular problem you
want to address.
So, if your bowels don't moveregularly, of course Metamucil
or psyllium is a supplement thatcan help you.
(28:52):
We've talked in a previous oneabout caffeine.
Well, if it helps you for doingyour exercise regimen better,
wonderful.
If it keeps you alert,wonderful.
And caffeine can also be viewedas a supplement.
Many people take protein powderor protein supplements because
(29:13):
they don't get enough in theirdiet, and that can be really
helpful too, again, also inolder adults, where we often may
not get as much protein or wedon't absorb it fully.
And, as I alluded to earlier,creatine has been shown to
improve strength training.
So the beauty of supplements foridentified problems is that you
(29:39):
can test it in yourself.
Is that you can test it inyourself Our N of 1 study?
How exciting we can do that.
Again, remember what this N of1 study, applied to a supplement
, might look like, is thefollowing.
Step one assess your baselineissue.
Is it that your vitamin B12 islow?
(29:59):
Is it that your bowels aren'tregular?
Is it you're having difficultybuilding strength while you
exercise?
Is it a sleep issue, an anxietyissue?
Is it a low energy issue?
Okay, so identify what theproblem is.
Step one, and if you canquantify it number of hours of
sleep or how often you move yourbowels in a week great, the
more you can quantify it, thebetter.
There are questionnaires on theweb for awful lot of things.
(30:22):
You might find that.
Step two try a supplement.
Step three see if it works foryou.
The beauty is this is onlygoing to take a week, two weeks,
maybe a month for you to figurethis out.
You're not taking a supplementfor the rest of your life in the
hope it will prevent a disease.
(30:42):
A supplement for the rest ofyour life in the hope it will
prevent a disease.
You'll take it for a coupleweeks and see if it helps you A
wonderful use for a supplementand in a wonderful way for you
to look at it.
All right, we're coming to theend, so I want to provide the
take-home messages.
First, supplements are reallypopular and a lot of money is
spent on them.
Second, taking a supplementgives us a feeling of agency,
(31:07):
that we're actually doingsomething with our health.
Third, there are many reasonswhy companies and supporters of
them make very optimistic claimsthat exceed the evidence.
Fourth, most supplements arepretty safe.
So you got to think about doyou want to take this for the
rest of your life If it's toprevent disease?
(31:29):
What are their costs and arethere potentially some risks?
So let me explain where I'venetted out.
Having followed this area for along time.
There seems to be pretty gooddata that a daily multivitamin
can potentially reduce the riskof cancer and cognitive decline.
(31:51):
I don't believe that many ofthe other popular or advertised
supplements have good evidencethat they prevent major
illnesses, but if you have aspecific current problem.
Absolutely try them and see Forwhatever it's worth.
I take a multivitamin every day, I take colace to keep my
(32:11):
bowels regular and I recentlystarted creatine and it appears
to be helping my exercise and mystrength building program.
So for the moment, I'llcontinue to take that.
I don't take vitamin D, I don'ttake omega-3s, I don't take
magnesium or any othernutritional supplement.
So for whatever it's worth,that's what I do.
(32:33):
I hope that our discussion'sbeen helpful.
I've, as always, linked the keystudies in the show notes.
If you have any thoughts aboutthis podcast or how I can
improve them, or topics that youmight have an interest in, let
me know.
I also will be sending outnewsletters and if that's of
interest, just go to my websiteand sign up
drbobbylivelongandwellcom andyou can also leave me messages
(32:57):
there.
So until next time, live longand well.
Until next time, live long andwell.
Thanks so much for listening toLive Long and Well with Dr
Bobby.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
(33:17):
health and longevity, pleasevisit me at
drbobbilivelongandwellcom.
Hi, I'm Dr Bobby Dub ois and welcome to
Live Long and Well, a podcastwhere we will talk about what
you can do to live as long aspossible and with as much energy
and vigor that you wish.
Together, we will explore whatpractical and evidence-supported
(00:27):
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
I'm a physician, ironman,triathlete and have published
several hundred scientificstudies.
I'm honored to be your guide.
(00:50):
Today we're going to talk abouta popular but often
controversial topic nutritionalsupplements.
Now, it's popular because awhole lot of Americans take them
.
It's controversial sincethere's often more passion than
(01:11):
real evidence to support theiruse.
As listeners may know, my careerfocused on whether there's
evidence to tell us what doesand doesn't work in healthcare
and, most importantly, for whomit helps or doesn't help.
Now, that could be a surgicalprocedure.
(01:32):
It could be a costly medication.
As a physician, I care aboutpatients and I want to help them
, not hurt them, so it's veryimportant for me to understand
evidence, when it will help themand when it won't.
As a scientist, I studied theseissues and published over 180
(01:52):
peer-reviewed articles on them.
So I approach supplements withthis same mindset or perhaps
some might say bias and I alwaysask myself these types of
questions.
Perhaps some might say bias,and I always ask myself these
types of questions Is thereevidence, good evidence,
(02:14):
rigorous evidence that aparticular supplement works, and
for whom?
Because it may work but it maynot work for everyone, and if
there isn't good evidence inpeople, I don't support their
routine use, I don't use them, Idon't talk to others about them
.
Now, evidence in animals ortest-tubed studies in the lab
are interesting, but bythemselves aren't enough for me.
(02:36):
Theories are great and there'slots of theories, and people
build careers around theories,but I want to see that the
supplement actually helps people, and so that's what I will
focus on with you today andreally on any topic that we will
explore together.
(02:57):
As always, I want to begin withtake-home messages First.
I believe there's a really bigdifference between taking a
supplement for the rest of yourlife to hopefully prevent big,
important diseases like heartdisease, cancer or mental
decline.
Now that's very different thantaking a supplement for a known
(03:21):
problem, like I have a tummytrouble and will Pepto-Bismol
help me.
That's a really differentsituation.
Now, unfortunately, when welook at most supplements to
prevent these long-term chronicdiseases, the evidence is not
very convincing that there's alot of benefit.
(03:42):
Now I like supplements to takecare of a known problem, because
you can quickly figure out ifthey're working, even if the
evidence isn't absolutelyconvincing, and they are usually
pretty safe.
And so these are the take-homemessages, and I will then flesh
(04:02):
each and every one of them out.
Well, let's start with anotherpoint, which is a disclaimer.
I am not a nutritionist, I'mnot trained on food science, but
I'm pretty good at looking atthe evidence of what does and
does not work.
So the plan for this episodeFirst, I'll review what
(04:26):
supplements are and which arethe most important ones that are
commonly used today in theUnited States.
Second, I will briefly describethe supplement industry and how
it's different from thepharmaceutical industry and why
it is that we don't have strongevidence for most products that
(04:46):
they sell.
And third, I'll talk about afew supplements not everyone,
but just a few of the importantones and explore with you what
we do and don't know about theevidence.
As always, I will link thesekey studies in my show notes if
you wish to look at them and, asalways, I welcome your feedback
(05:10):
on that.
So let's get started.
Part one what are nutritionalsupplements?
Can't have a full discussionwithout at least defining terms,
so nutritional supplements fallinto a number of categories.
So nutritional supplements fallinto a number of categories.
They could be a vitamin likevitamin B12 or vitamin D or
something like that.
They could be a mineral that'salso a different type of
(05:33):
supplement, now.
That could be calcium ormagnesium or something like that
.
They could be an herbal likecumin that's a popular one you
hear about.
Or a supplement could be aprobiotic to improve our gut
health.
Now, supplements are usuallytaken on a routine basis,
meaning this is a good thing toimprove my health and I'm going
(05:56):
to take this every year for therest of my life.
But supplements can be takenfor specific needs and we're
certainly going to focus on thata little bit later.
The most commonly usedsupplements in the United States
today is a routine multivitamin.
Omega-3s are very, very popularProbiotics vitamin D, calcium,
(06:23):
protein powder and psyllium,which is like Metamucil or one
of those types of bowel agents.
So those are the most commonlyused ones.
In America today, about half ofus take at least one supplement
and, as you know from eitheryourself or your friends, some
people take a whole lot of them,no-transcript.
(06:53):
Now, one of the reallyattractive appeal of supplements
is that we all want to beproactive with our health and
feel like we're doing somethingand that health and what happens
to us isn't just a roulettegame in Las Vegas.
That, in fact, we want to feelwe have agency and some sense of
(07:17):
control.
So taking a supplement gives usa sense we are doing something
that will help our health,because that's important to
almost all of us to have thatfeeling of agency.
Now there's a trio of challenges, though.
So, on the one hand, we want toactively improve our health,
(07:40):
and there's a lot of companiesout there that want to make
money on just that, and theyrespond to our desire to improve
health, and they have really,really optimistic advertisements
and spokespeople to help sellthese supplements.
And, as I'll get to in a fewminutes, there aren't great
(08:02):
incentives for supplementcompanies to do high-quality,
rigorous research.
Those research studies would bevery expensive and, as we'll
talk about in a moment, becauseyou can't patent these, by and
large, there's not the financialincentive to do wonderful
studies.
So end of part one.
(08:24):
Let's flesh out some of theseand get to understand what we do
and don't know.
So let me explain a little bitabout the supplement industry.
Look, I'm not an expert on thesupplement industry.
I spent a lot of time workingwith the pharmaceutical industry
.
I know that better, but I havea pretty good sense of what
(08:44):
happens in the supplement world.
So pharmaceuticals your classiclicensed drug by the FDA.
They're highly regulated andthe amount of evidence you need
to get a drug through the FDAand approved and on the market
is very high.
And the FDA has very closeoversight before any drug makes
(09:06):
it to the market and they focusthe FDA does on does this drug
actually work and do the thingsthat the drug company says they
do, and is it safe for people totake?
For that reason, on thenutritional side, the FDA has a
very, very, very minor role.
Before a supplement goes on themarket, there's no requirement
(09:30):
that safety studies or efficacystudies meaning does it work are
done.
So they don't approve.
The FDA doesn't approve theclaims for what a company might
say that this will help reduceheart problems or anything else.
Now, the FDA will look atsafety issues after it's on the
(09:52):
market, but they won't requirerigorous studies to get on the
market.
Now why is there such adifference between how the FDA
approaches a typical medicinethat a doctor might prescribe
and a supplement?
Well, the theory is that theseare dietary supplements, not
health aids.
So this is food, and you canpurchase any vegetable or fruit,
(10:18):
basically that you want.
There is no kind of FDAapproval on what fruits and
vegetables a market can sell.
Now this is a little bit odd,because although these are
dietary supplements, or viewedas such, we do take them for
health reasons.
We're hoping they might reduceheart disease or cognitive
decline or cancer or somethingelse.
(10:40):
In the pharmaceutical world,when you develop a drug, you can
get a patent.
That patent goes on for many,many years and because of that
patent you can afford to doreally detailed, rigorous
clinical studies, and to bring adrug to market could cost a
billion dollars or more, and soif you don't have a patent, you
(11:01):
won't really want to do thosekinds of studies.
And that's exactly what happensin the nutritional world,
because I could come out with areally wonderful pill that's for
calcium or magnesium and Imight study it and really
understand who benefits and whodoesn't.
But somebody else from anothercompany could basically come out
(11:23):
with the same thing, becausethere isn't a patent on calcium
or magnesium or vitamin D orsomething like that.
So without that motivation ofhaving a patent and being able
to be exclusive, there justisn't the same incentives and
therefore the studies that aredone aren't as rigorous, aren't
(11:44):
as big and aren't as believable.
Do keep in mind there's a lotof money to be made in
supplements and retailersprobably make 30% to 50% on each
and every bottle that's sold,make 30 to 50% on each and every
bottle that's sold.
Now what I've described here isa bit theoretical.
So let me give you a real, liveexample of what a nutrition
(12:05):
study might look like.
Now they're not all going tolook like this, but this will
give you a sense of why I havesome skepticism about many of
the claims that are made.
So there was an article thatcame out recently and it was
picked up in the press and itbasically said that broccoli
sprouts, the extract of broccolisprouts, improved exercise
(12:29):
performance.
Hey, I would take some broccolisprouts or an extract of
broccoli sprouts if it helped mework out more and do better in
a race.
That sounds like a great thingand the theory is good that
broccoli sprouts haveantioxidants in them and we'll
come to a little bit later whatantioxidants are all about and
(12:53):
that seems like a good thing.
Antioxidants are good.
Broccoli sprouts have them, sothis might in fact help our
exercise performance.
And so they did an actual study.
But when you dig below thesurface, you realize this study
only had nine people in it.
Nine people isn't enough reallyto tell anything.
And they said well, your heartrate didn't go up as high when
(13:17):
you did a standard amount ofexercise.
Well, that was only three-pointdifference.
So for some people it didn'ttake the broccoli sprouts.
Our heart rate went up to 187,and for the other people it was
184.
And they said oh well, itimproved how long you could work
out before you got exhausted.
Well, yes, but it was thedifference between 401 minutes
(13:40):
and 406 minutes.
So tiny, tiny differences withonly nine people.
And then, of course, you readthe description of the authors
and the funding, and what youlearned is that it was funded by
the vegetable growers and thatthe authors have a patent
pending for the broccoli sproutextract.
So does this mean, because itwas funded by vegetable growers
(14:04):
and that the authors have apotential patent, that this
can't be a valid study.
No people can do good studies,but when there's only nine
people the results are reallytiny differences.
But when there's only ninepeople the results are really
tiny differences.
Then I wonder and this is notatypical for studies.
Obviously there's somesupplement studies that are
(14:25):
examined by the federalgovernment or major research
institutions, but for a lot ofthe things you hear about on the
market, this type of broccolistudy isn't all that surprising.
Okay, end of part two.
On to part three.
Is there evidence to supportthe use of these common
supplements?
Now, as I mentioned, and I'llsay again because it's so
(14:48):
important, I view supplements toprevent a disease really
differently than supplements tohandle a known problem.
So, if you have constipation,metamucil or Colace or Psyllium
would be considered anutritional supplement and the
beauty is you can know veryquickly whether it helps you.
(15:10):
It doesn't really matter what alarge study says, it's what
happens in you and you can tellthat very quickly and if it
doesn't work, you don't take itanymore.
Now, more about this later.
But if you're taking anutritional supplement to
prevent a disease, well franklyyou have to take that for
(15:31):
decades and if there isn'treally really strong evidence, I
don't believe taking thatsupplement makes much sense.
In my opinion, often what theyclaim greatly exceeds the
evidence For most of thesesupplements.
If there are any benefits, theamount is likely very small and
(15:57):
that leads to an almostreligious belief in some
supplements that this is theanswer.
We have found it.
By all means, I hope you trustwhat I share with you, but
there's a website that you mightwant to look at.
It's called examinecom and theytend to focus on supplements
(16:17):
and they tend to pull togetherthe evidence.
So you could take a look at itfor melatonin or whatever else
you might have an interest in,and see what they come up with
and see what they have on theirwebsite.
So just another resource, andif something pops up in a
headline, you could look at whatthey have about it and it might
be helpful to you movingforward.
(16:38):
So today I'm going to talkabout a few supplements, but
there's a lot more supplementswe're not going to talk about
today because we just don't havethe time and we may bring those
up in the future or, if youhave an interest in any of them,
reach out to me through mywebsite, through Instagram,
however you want.
(16:59):
So let's start with omega-3sbecause they're very popular.
As I mentioned, it's one of themost commonly used supplements,
and here's that word againantioxidants.
So omega-3s have antioxidants.
So what's an antioxidant?
Without getting lost in thebiochemical minutiae, an
(17:20):
antioxidant helps stop damage toour cells.
There are certain moleculesthat float around.
They're called free radicals.
That happens for a variety ofdifferent reasons and those free
radical molecules can hurt ourcells and an antioxidant
basically stops those freeradicals from doing that damage.
(17:42):
So sounds like a really goodthing.
So taking an antioxidant sureseems like a good idea.
Another piece of this puzzlewhich got everybody excited
about antioxidants andspecifically omega-3s is that if
you look around the world andyou look at sort of
epidemiologic studies, peoplewho eat fish live longer and
(18:05):
they have lower rates of heartdisease.
Fish has omega-3s, likeanchovies or salmon or sardines.
So if eating fish helps you,then taking the essence of fish,
meaning these omega-3s, must bea good idea.
The challenge and this happensover and over in observational
(18:26):
studies when you actually testit out giving omega-3s as a
supplement isn't the same thingas eating a fish, and eating a
fish may not really be what'scausing people to have less
heart disease.
It could be that those culturesthat eat a lot of fish are also
(18:47):
doing a lot of walking aroundand get a lot of exercise, or
they have strong bonds withtheir family, or they're very
good at sleeping every night.
So what you observe doesn'tnecessarily mean that's the
cause or that's the solution.
So there have been lots ofrandomized controlled trials,
(19:11):
and a randomized controlledtrial is basically you take a
group of people and you randomlydivide them into two groups,
group A and group B.
Group A gets supplements, sayomega-3s, group B doesn't.
And then you follow them overtime, you measure certain things
and then you ask the questionwell, did the omega-3s reduce
(19:31):
heart disease?
Did they reduce strokes?
Did they reduce cognitivedecline or cancer?
That's a randomized controlledtrial.
That's really different thanjust I found a bunch of people
who took omega-3s, I found abunch of people who didn't and
then figure out what happened tothem.
Then, another day, we'll talkabout why that type of
(19:51):
observational studies is so muchless powerful than a randomized
control trial.
So there are two very largesummaries of the evidence on
omega-3s.
One is called the Cochranesummary and that looked at 90
clinical trials or so and theyfound no benefit for heart
(20:13):
disease.
Similarly, the Mayo Clinic dida very large summary and again
they found omega-3s did notprevent heart disease.
Now you may run across a studyor you may run across a headline
that says there's benefit forheart disease, but really when
you look at the totality ofevidence because any one study
(20:35):
may not give us the full answerthe totality of evidence does
not show a cardiovascularbenefit.
That's my interpretation of theliterature.
It's also the conclusions ofthese two very large and
well-respected summaries.
So I mentioned earlier thatsupplements are very different
(20:57):
if you're taking it for aspecific problem that you have,
not to prevent something, butfor a problem you have.
So for omega-3s, if you havehigh triglycerides, omega-3s can
lower them.
This isn't just to say, oh, ifyou take it for 30 years you
(21:18):
won't get cancer or cognitivedecline.
You are going to take itbecause you have high
triglycerides and you canmeasure it to see if it's making
a difference.
There's also some evidence thatomega-3s help folks with
rheumatoid arthritis, withdiscomfort Again something you
can test.
If you have rheumatoidarthritis, you try taking the
(21:39):
omega-3s.
If it improves the pain, great.
If it doesn't, you stop Okay.
So that's omega-3s.
What about vitamins and minerals?
Do they reduce cardiovasculardisease and cancer.
Again, another big summary of84 clinical trials.
They looked at vitamin D, theylooked at beta-carotene, they
looked at vitamin E and therewas really no benefit, and
(22:03):
actually in some cases there wassome increased risk.
Where they did find somebenefit was not on these
individual items like vitamin Dor beta carotene, but a simple,
often viewed as boringmultivitamin, a once-a-day
vitamin that actually showed asmall benefit in reducing cancer
(22:25):
, and there's some data that amultivitamin might actually help
you maintain cognitive function.
Many, many studies on vitamin Dhave shown that it doesn't
protect muscle loss.
It doesn't help your gripstrength, it doesn't help you
get up and about.
Vitamin D is a reallyinteresting one.
(22:47):
Now, clearly, if you have amajor vitamin D deficiency and
it's affecting your bones, byall means vitamin D is a great
thing, but if, again, you'reusing it to prevent disease, I
just want to give you a sense ofwhy it isn't.
Just well, I'll take it, and ifit helps, great, and if it
doesn't, it doesn't.
Vitamin D is a double-edgedsword.
(23:07):
If you have bone issues, yes,vitamin D is very important in
helping bones, and not that moreis better.
It's just that if you don'thave enough vitamin D, you can
have problems with bones, butvitamin D because it helps with
calcification, and that's whatbones are calcification it can
(23:28):
also affect your arteries.
So there was a randomized trialnot long ago that looked at
36,000 people and some of thosepeople got vitamin D and calcium
and what they showed is, yeah,there was a small reduction in
cancer mortality in the peoplewho took the vitamin D and
calcium, or mortality in thepeople who took the vitamin D
(23:49):
and calcium, but there was anincrease in cardiovascular
mortality.
Why we don't know for sure, butit could have been that that
extra calcium and vitamin Dcaused some calcification in
your coronary arteries and thatled to cardiac problems.
Now, on the kind of vitamins,minerals and related area, there
(24:10):
is some data and it's actuallyfairly good data that creatine
may help with strength training.
Just taking creatine powder andyou don't exercise isn't going
to make a difference, but thereis data in the fitness
literature that it may helpstrength training and improve
your ability to grow muscle andto be able to lift more and more
(24:30):
weight.
There's also studies on cuminwhich are interesting.
They've shown that it mightlower an inflammatory thing in
your blood called C-reactiveprotein, but we don't really
know what that means.
So just because you take cuminand it might lower this
inflammatory marker, we don'tknow if it's going to make
(24:51):
people feel better, if it'sgoing to reduce the risk of
cancer or heart disease.
And again, as I've mentioned, Idon't focus on blood tests.
I really really really focus onwhat does it do in people?
So where do we go from here?
What about supplements andcognitive decline?
(25:13):
So, for cognitive decline,people have examined whether
omega-3s can prevent that, andso there was a meta-analysis.
This is again a summary ofstudies where they looked at 15
randomized controlled trials andthe omega-3s didn't help
(25:35):
cognitive decline.
So we've talked before aboutthe fact that omega-3s don't
appear to help for heart diseasestandpoint.
Now it appears they also don'thelp for cognitive decline.
Well, in the cognitive declinespace, this isn't what I'm going
to talk about now, isn'texactly about supplements, but
it gives us some understanding.
(25:56):
So this was a really, reallyimportant study and a really
well done and a very largeclinical trial where they
compared a diet.
Now it's called the MIND diet.
It's called the MIND dietbecause they were hoping that
this diet would help people'sbrains and brain health, and the
(26:18):
MIND diet is kind of like theMediterranean diet or the DASH
diet, and that's basically.
They put together foods thatthey thought from various
previous studies might reducethe risk of dementia, like whole
grains, leafy vegetables, nutsand beans and berries all the
things that we think might helpus and that you've also heard in
(26:41):
various supplementadvertisements.
So this was a three-year studyand they tested people for sort
of brain health, cognitivefunction.
But they also looked at theirMRI scans in many of these
people and what did they find?
Made no difference.
So if a diet rich in all ofthese what are supposed to be
(27:05):
mind-oriented foods didn't help,it's likely the supplement
based upon those same thingsisn't going to improve cognitive
decline.
Now, exercise can help, bloodpressure control can help, other
things can help, butsupplements appear not to be
helpful.
And if you hear from someadvertisement that it's really
(27:28):
helpful and been shown toprevent cognitive decline, I
think you really want to askwhat's the evidence?
Was it done rigorously, and canI really believe it?
Well, I mentioned earlier thatI really do like supplements,
but I like them not to preventdisease but if you actually have
a known problem.
So if you go to the doctor andthe doctor tests your blood and
(27:51):
he says, oh, your vitamin B12levels are low and in fact it's
causing some anemia, which mightcause some fatigue for you.
Well, of course, increasingyour vitamin B12 level would be
very important and a supplementcould be very, very helpful, and
people can get vitamin B12deficient if they have something
(28:12):
going on in their stomach thatmight cause them not to absorb
it.
Now where it gets a littletricky is if you do a blood test
that shows a low level butyou're not having any symptoms.
Then it's a little tricky toknow should you actually take
the supplement.
But if your level is low andyou're having symptoms, I think
(28:32):
it's absolutely appropriate,wonderful and extremely helpful
to consider a supplement that'sspecific to that, and
supplements are great if youhave a particular problem you
want to address.
So, if your bowels don't moveregularly, of course Metamucil
or psyllium is a supplement thatcan help you.
(28:52):
We've talked in a previous oneabout caffeine.
Well, if it helps you for doingyour exercise regimen better,
wonderful.
If it keeps you alert,wonderful.
And caffeine can also be viewedas a supplement.
Many people take protein powderor protein supplements because
(29:13):
they don't get enough in theirdiet, and that can be really
helpful too, again, also inolder adults, where we often may
not get as much protein or wedon't absorb it fully.
And, as I alluded to earlier,creatine has been shown to
improve strength training.
So the beauty of supplements foridentified problems is that you
(29:39):
can test it in yourself.
Is that you can test it inyourself Our N of 1 study?
How exciting we can do that.
Again, remember what this N of1 study, applied to a supplement
, might look like, is thefollowing.
Step one assess your baselineissue.
Is it that your vitamin B12 islow?
(29:59):
Is it that your bowels aren'tregular?
Is it you're having difficultybuilding strength while you
exercise?
Is it a sleep issue, an anxietyissue?
Is it a low energy issue?
Okay, so identify what theproblem is.
Step one, and if you canquantify it number of hours of
sleep or how often you move yourbowels in a week great, the
more you can quantify it, thebetter.
There are questionnaires on theweb for awful lot of things.
(30:22):
You might find that.
Step two try a supplement.
Step three see if it works foryou.
The beauty is this is onlygoing to take a week, two weeks,
maybe a month for you to figurethis out.
You're not taking a supplementfor the rest of your life in the
hope it will prevent a disease.
(30:42):
A supplement for the rest ofyour life in the hope it will
prevent a disease.
You'll take it for a coupleweeks and see if it helps you A
wonderful use for a supplementand in a wonderful way for you
to look at it.
All right, we're coming to theend, so I want to provide the
take-home messages.
First, supplements are reallypopular and a lot of money is
spent on them.
Second, taking a supplementgives us a feeling of agency,
(31:07):
that we're actually doingsomething with our health.
Third, there are many reasonswhy companies and supporters of
them make very optimistic claimsthat exceed the evidence.
Fourth, most supplements arepretty safe.
So you got to think about doyou want to take this for the
rest of your life If it's toprevent disease?
(31:29):
What are their costs and arethere potentially some risks?
So let me explain where I'venetted out.
Having followed this area for along time.
There seems to be pretty gooddata that a daily multivitamin
can potentially reduce the riskof cancer and cognitive decline.
(31:51):
I don't believe that many ofthe other popular or advertised
supplements have good evidencethat they prevent major
illnesses, but if you have aspecific current problem.
Absolutely try them and see Forwhatever it's worth.
I take a multivitamin every day, I take colace to keep my
(32:11):
bowels regular and I recentlystarted creatine and it appears
to be helping my exercise and mystrength building program.
So for the moment, I'llcontinue to take that.
I don't take vitamin D, I don'ttake omega-3s, I don't take
magnesium or any othernutritional supplement.
So for whatever it's worth,that's what I do.
(32:33):
I hope that our discussion'sbeen helpful.
I've, as always, linked the keystudies in the show notes.
If you have any thoughts aboutthis podcast or how I can
improve them, or topics that youmight have an interest in, let
me know.
I also will be sending outnewsletters and if that's of
interest, just go to my websiteand sign up
drbobbylivelongandwellcom andyou can also leave me messages
(32:57):
there.
So until next time, live longand well.
Until next time, live long andwell.
Thanks so much for listening toLive Long and Well with Dr
Bobby.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
(33:17):
health and longevity, pleasevisit me at
drbobbilivelongandwellcom.
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