Supplements

Why a Physician Writes About Supplements

Most supplement information falls into two camps: uncritical marketing (“this will change your life”) or blanket dismissal (“supplements are expensive urine”). Neither serves patients well.

I prescribe supplements daily in a hospital setting, monitor them with laboratory testing, and adjust them based on response. I also see the damage from unguided supplementation: patients spending hundreds a month on products that interact with their medications, contain contaminants, or simply do not work.

This guide sits between those two camps. Every entry carries an evidence grade and its limitations, and it is written by someone who uses these tools clinically.

Evidence Grading System

Every supplement recommendation on this platform uses a five-tier system:

Level	Meaning	Example
Strong	Multiple RCTs, meta-analyses	Vitamin D for immune function, omega-3 for inflammation
Moderate	Limited RCTs, consistent observational data	CoQ10 for statin users, NAC for glutathione support
Emerging	Preclinical evidence strong, human trials early	NMN for NAD+ restoration, fisetin as senolytic
Traditional	Historical clinical use, limited modern trials	Andrographis for infection, milk thistle for liver
Insufficient	Marketed but unproven	Most “detox” supplements, many nootropic stacks

Quality: The First Question

Before asking “what should I take?” ask “what am I actually taking?”

The Quality Problem

The supplement industry operates under far less regulatory scrutiny than pharmaceuticals. The FDA does not pre-approve supplements for safety or efficacy. Third-party testing consistently finds products that contain less active ingredient than labeled, contain contaminants, or contain entirely the wrong compound.

What to Look For

• Third-party testing: USP Verified, NSF Certified for Sport, or ConsumerLab approved
• GMP certification: an actual third-party audit, beyond the compliance that is legally required anyway
• Form matters: Magnesium oxide (poorly absorbed) vs. magnesium glycinate (well absorbed). Ubiquinone vs. ubiquinol. Folic acid vs. methylfolate.
• Practitioner-grade lines: Thorne, Pure Encapsulations, Designs for Health, Klaire Labs maintain higher standards than mass-market brands

The German Advantage

In Germany, products like mistletoe extract (Iscador, Helixor) and systemic enzyme therapy (Wobenzym) are approved pharmaceuticals rather than “alternative supplements,” so they go through drug-level manufacturing oversight and clinical testing.

Core Categories

Vitamins

Vitamin D3 + K2. The most commonly deficient nutrient in chronically ill patients. We target serum 25(OH)D of 40-60 ng/mL. K2 (MK-7) directs calcium to bones, preventing vascular calcification. A 2025 DKFZ meta-analysis found 20% mortality reduction in deficient cancer cohorts. Always test before dosing. Evidence: Strong.

B-Complex (methylated). Methylcobalamin, methylfolate, P-5-P, riboflavin-5-phosphate. Essential for energy metabolism, methylation, and neurotransmitter synthesis. Critical for MTHFR variant carriers. Evidence: Strong for deficiency.

High-Dose IV Vitamin C. At pharmacologic levels (achievable only via IV), vitamin C acts as a pro-oxidant selectively cytotoxic to cancer cells. A Phase 2 RCT showed doubling of overall survival in metastatic pancreatic cancer. Requires G6PD (glucose-6-phosphate dehydrogenase) screening. Oral vitamin C cannot reach these levels. Evidence: Moderate-Strong for oncology.

Minerals

Magnesium. Cofactor in 300+ enzymatic reactions. A 2026 RCT showed magnesium L-threonate supplementation associated with 7.5-year cognitive age reduction. Six forms for six purposes: glycinate (sleep), L-threonate (cognition), malate (energy), taurate (cardiovascular), citrate (bowel motility), oxide (avoid, because of low bioavailability). Evidence: Strong.

Zinc. Essential for T-cell maturation and immune function. 15-30 mg/day. Long-term use requires copper co-supplementation. Evidence: Moderate.

Selenium. Required for glutathione peroxidase and thyroid hormone conversion. 200 mcg/day selenomethionine. Narrow therapeutic window: excess is toxic. Evidence: Moderate.

Antioxidants and Mitochondrial Support

NAC (N-Acetylcysteine). Glutathione precursor (4-fold synthesis increase). Mucolytic. Biofilm disruptor. Used in our Lyme protocols for both detoxification support and biofilm disruption. 600-1,800 mg/day. Evidence: Moderate-Strong.

Glutathione. The master antioxidant. IV delivery bypasses poor oral absorption. Liposomal and S-acetyl forms improve oral bioavailability. Lyme patients frequently exhibit depleted glutathione. Evidence: Moderate.

CoQ10. Mitochondrial electron transport chain cofactor. Ubiquinol form better absorbed. Combined with alpha-lipoic acid, a prospective study showed substantially reduced fatigue in chronic COVID patients. Essential for statin users. Evidence: Moderate.

Fatty Acids

Omega-3 (EPA/DHA). Anti-inflammatory through resolvin and protectin synthesis. Decreased omega-3 levels documented in CFS patients. Triglyceride form outperforms ethyl ester for bioavailability. Test with omega-3 index (target 8-12%). Quality varies enormously, so check TOTOX (total oxidation) values and heavy metal testing. Evidence: Strong.

Herbal and Botanical

Curcumin. NF-kB inhibition, anti-inflammatory, anti-proliferative. Bioavailability is the challenge: it needs a piperine, liposomal, or phytosome formulation. Evidence: Moderate.

Berberine. AMPK activator (same pathway as metformin), antimicrobial, glucose regulation. Emerging evidence as PD-L1 checkpoint inhibitor with immunomodulatory actions. Evidence: Moderate.

Mistletoe Extract. Immunostimulation through lectins activating NK cells and T-cells. Approved as cancer therapy in Germany. 62% of oncology patients in German studies received mistletoe. Phase I trial at Johns Hopkins established safety. Evidence: Moderate (European standard of care for integrative oncology).

Ashwagandha. HPA axis regulation. A 2025 meta-analysis confirmed statistically significant cortisol reduction (15-30%) and anxiety improvement. Evidence: Strong for stress/cortisol.

Enzymes and Fibrinolytics

Nattokinase. Fibrinolytic enzyme. A 2024 study showed 84% microclot reduction in vitro. Directly relevant to Dr. Beate Jaeger’s microclot research in Post-COVID. RCT found enzyme + probiotic combination achieved 91% fatigue-free status in Post-COVID at 14 days. Evidence: Emerging.

Wobenzym. German pharmaceutical. Combination of bromelain, trypsin, papain, and rutin. Meta-analysis confirmed non-inferiority to diclofenac for knee osteoarthritis with better safety profile. Evidence: Moderate.

Longevity Compounds

NMN/NR. NAD+ precursors. January 2026 RCT showed both double circulating NAD+ levels. NMN reduced inflammatory signals post-exercise (February 2026 RCT). FDA confirmed NMN remains available as dietary supplement (September 2025). Important caveat: lifespan extension NOT proven in humans. Evidence: Emerging.

Quercetin. Senolytic (clears senescent “zombie cells”), anti-inflammatory, mast cell stabilizer. Quercetin + dasatinib is the most studied senolytic combination. Evidence: Moderate for anti-inflammatory, Emerging for senolytic.

Drug-Supplement Interactions

Most supplement guides skip this section. The interactions that matter most:

• Omega-3 + anticoagulants: Additive bleeding risk at high doses (>3g/day)
• Curcumin + chemotherapy: May interfere with certain agents; timing matters
• St. John’s Wort + practically everything: Potent CYP450 inducer
• NAC + nitroglycerin: Potentiates hypotension
• Vitamin K2 + warfarin: Alters INR (consistent intake is key, not avoidance)
• Berberine + metformin: Additive glucose lowering (monitor closely)
• Ashwagandha + thyroid medication: May increase thyroid hormone levels
• Quercetin + cyclosporine: Increases drug levels

Always disclose your full supplement list to every prescribing physician.

Supplements to Stop Before Treatment

If you are coming to St. George Hospital for treatment, we will give you specific guidance. General principles:

• 7-14 days before surgery: Stop omega-3, vitamin E, ginkgo, garlic supplements (bleeding risk)
• Before apheresis: Stop nattokinase/serrapeptase (fibrinolytic overlap)
• Before immunotherapy: Discuss antioxidants (theoretical concern about reducing treatment efficacy)
• Before hormone-sensitive procedures: Pause DIM, I3C, maca, DHEA

Building Your Stack

The most common mistake is starting with advanced compounds before establishing foundations. Our approach:

Foundation (everyone): Vitamin D3+K2, magnesium, omega-3, B-complex, probiotics. Test, dose, and verify.

Condition-specific (guided by labs): NAC for glutathione support, CoQ10 for mitochondrial function, zinc for immune support, curcumin for inflammation. Add based on diagnostic findings, not marketing.

Advanced (physician-supervised): NMN/NR for NAD+ restoration, senolytic protocols, peptides, IV formulations. These require monitoring and medical oversight.

Start with fewer, higher-quality supplements rather than more, cheaper ones. Test before and after. If a supplement isn’t moving your biomarkers in the right direction within 90 days, stop it.