Supplements for General Health | Triage Thoughts Ep. 251

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Why we are starting with the boring supplements

The supplement conversation online has its priorities backwards. The esoteric, poorly-evidenced compounds get the airtime, and the boring, well-researched basics get ignored. This series is going to do the opposite. We are starting with what your grandmother might be taking and what your uncle at the dinner party might ask about: general health supplements. The unglamorous ones that have, in many cases, a decent case behind them, and that ought to be sorted before anyone starts buying obscure powders off the internet.

We will get to the more specific goals later in the series, things like muscle growth, blood pressure, cognition. Today is the baseline.

Where supplements actually sit in the hierarchy

Before any supplement is worth thinking about, the foundations have to be in. There are four of them, and they are deliberately boring.

Sleep. Are you getting enough, and is it any good? You can take every powder in the cupboard and not get close to what proper sleep does for you, because sleep has its tentacles in everything.

Stress management. Even just organising your day counts as a form of it. Taking a supplement to “lower stress” when your life is on fire is going to do roughly nothing.

Training. A programme that is well designed, that you can actually stick to. A muscle-building supplement layered on top of poorly designed, inconsistent training is money on fire.

Nutrition. The big one for the supplement conversation. If your diet is in a genuinely good place, you probably do not need a huge stack of extras. We will repeat that throughout this series.

You do not have to be perfect on all four. But you need the basics: a sleep and wake time, some sort of stress practice, a training plan you actually follow, and a handful of decent food habits. Spending money on supplements before any of that is in place is the wrong order of operations.

How much speculative benefit are you willing to chase?

This is the part most supplement articles skip, and it actually determines half of your decisions.

Some people, hearing “this might give a small benefit to some people, but we have no way of knowing if you are one of them”, will immediately say yes, count me in. Any chance of upside is worth the cost. Others want clearer evidence before they part with the money, and are happier covering the basics from food without buying the insurance policy.

Neither is wrong. It is genuinely a question of your personal philosophy in health and your personal philosophy in life. Not everyone wants to maximise longevity at the expense of money, time and attention. Knowing where you sit on this spectrum matters more than knowing which specific supplements to buy, because a lot of what follows is hedged with “might help” and “potential benefit”, and your tolerance for that hedging is what should drive the call.

There is no zero-cost supplement

A related point that catches people out: there are pros and cons to everything. The default assumption is that a multivitamin, say, can only be neutral or positive. It is not so. Every intervention sits on a cost-benefit ledger.

The cost might be purely financial. It might be a known interaction with a medication. It might be a nutrient you should not be mega-dosing. Or, in the worst case, it might be something nasty in a product you bought from a website you barely vetted because you saw it mentioned on TikTok. The unregulated end of the market is a genuine risk, especially for pre-workouts shipped in from who-knows-where. Most of the time you will be fine. Occasionally, people are not.

This is also why anyone responsible writing about supplements adds the speak-to-your-GP caveat. It is not throat-clearing. If you are on medication, interactions can be consequential, and your GP is the person to flag that with.

Multivitamins

The first one most people reach for. Worth thinking about more carefully than that.

A modern multivitamin is usually a multivitamin-multimineral-multinutrient. The more ingredients squeezed into a single pill, the less likely any one of them is at a dose that actually does anything. Marketing can lean into this misleadingly. “More vitamins and minerals than any product on the market” is meaningless if every ingredient sits at 1% of the RDA.

So before buying, ask what you are actually trying to do. There are roughly two approaches.

The targeted version: there are one or two nutrients you, or your population, plausibly fall short on, and you are using a multivitamin to shore those up. A prenatal multivitamin is a clean example, with the focus on folic acid and a small set of other nutrients.

The insurance version: your diet is mostly fine, but you cannot guarantee the broccoli at the supermarket has the vitamin C the label suggests, and you have no idea whether you are getting any selenium. So you take a lower-dose, broader-spectrum product as a hedge.

Both can be reasonable, and they lead to different choices. The targeted approach wants a higher dose of a smaller set of nutrients. The insurance approach wants modest doses of more nutrients.

Two specific traps. Some nutrients you do not want to mega-dose. Vitamin A at high doses is teratogenic, which matters for any pregnancy multivitamin. Iron is something men generally do not want to load up on, because they are not losing blood regularly and can accumulate it, especially if red meat intake is already high. Read the label.

Then ask whether you would be better off just taking the single nutrient you actually need. If you know your vitamin D is low, take vitamin D. A multivitamin is a clumsy way to fix a specific gap.

We would lean towards third-party-tested products over the cheapest supermarket own-brand. The brand whose whole business is the multivitamin tends to have thought more carefully about doses and forms. You also do not have to take it every day. A few times a week, or on days when the diet is poorer, can be enough if insurance is the goal.

Verdict: yay if you have the disposable income, are mindful of your health, and suspect lapses in your diet. Otherwise, nay.

Omega-3s

Long-chain polyunsaturated fatty acids, with EPA and DHA being the ones we care about. People claim a lot of benefits. The two worth talking about are cardiovascular and cognitive.

The cardiovascular story is reasonable but not uniform. Some trials, particularly with pharmacy-grade, high-potency preparations, show meaningful reductions in cardiovascular risk. Cheaper, lower-dose supermarket products are not the same product, and the outcomes are not always the same. There are some effects on triglycerides, on the vasculature, and on blood pressure. The evidence is mixed enough that you can find studies to confirm whichever bias you already hold. The benefits also appear to be dose-dependent.

What is harder to argue with: these are essential fatty acids. You have to consume them. The body cannot make them. You do not get to opt out, even if you are unmoved by the cardiovascular claims, because a deficiency carries its own costs you may not feel until you are sixty and having a cardiovascular event.

How to get them. Fish is the obvious answer, ideally oily, cold-water fish, two to three times a week. Most people do not eat that much. Average fish intake in Irish adults sits around 25 grams a day, which is well under that target. If you do not like fish, or cannot access it easily, supplementation is the practical route. Algal oils are the option if you are predominantly plant-based.

The numbers. Roughly 100 grams of salmon gives around 1.2 grams of omega-3s. The dose range that seems to be most robustly associated with the bigger benefits is two to five grams of combined EPA and DHA per day, which you are not getting from fish two or three times a week alone. Most supermarket fish-oil capsules sit at around 400 milligrams of EPA plus DHA each, so reaching four grams a day means roughly ten capsules, which most people will not stomach.

A practical landing point: two grams a day of combined EPA and DHA from supplements, alongside oily fish a couple of times a week if you can. If you have a higher cardiovascular risk in the family or a known elevated triglyceride level, you might push higher under medical guidance.

One housekeeping note. Fish oil is an oil, and it goes rancid. If you have bought a big tub on sale, keep it in the fridge. Otherwise, especially in a warm cupboard, the capsules can melt together into a single useless lump.

Verdict: yay.

Vitamin D

Vitamin D is one of the more straightforward yays, with caveats.

Best case, get a blood test, see where you stand, and supplement accordingly with the advice of your GP or dietitian. If your levels are already good, you may not need much, if any. If they are low, supplement and retest. It is a fat-soluble vitamin, so you build up stores; you do not need a dose every day for your levels to remain adequate.

Most people will not get the blood test. The pragmatic recommendation in that case is to lean on the sun in the brighter months, broadly March to September here in Ireland and the UK, with the occasional top-up in a particularly grey week. From late autumn through winter, take a background dose of around 1000 to 2000 IU a day. It does not have to be daily, as long as it is reasonably consistent. There are apps, D Minder being one, that will tell you when the sun where you are is actually high enough to produce vitamin D.

Why bother with the winter dose. Insufficiency is genuinely common, with around 40% of the Irish population sitting in the insufficient-to-deficient range. Vitamin D matters for bone health, which becomes more important with age, and for a number of other systems. The supplement is cheap. You can buy two years of it for a few pounds, and the risk of a modest dose without a deficiency is low. The very high-dose products, the 5000 to 10000 IU options, are not for routine use; they are for correcting a known deficiency under guidance, typically with something like 400 to 800 IU as a longer-term maintenance intake.

One caveat, because vitamin D attracts a particular kind of online certainty. Throughout the COVID period, low vitamin D was repeatedly identified as a risk factor for worse outcomes, which mechanistically is plausible because vitamin D is immunomodulatory. But causation here is messy. When you get sick, your vitamin D levels can drop. So measuring vitamin D in already-sick patients and finding it low can reflect the illness rather than cause it. There is also a healthy user bias: the person out jogging in nature is getting both more sun and a generally healthier lifestyle. The supplement is worth taking. It is not the wonder drug some online voices present it as.

Verdict: yay.

Magnesium

Most of your magnesium should come from green leafy vegetables. Most people are not eating enough vegetables. So most people end up under-supplied. Hard-water areas, like London, give you a bit more from the tap; soft-water areas, less so.

It matters because magnesium is involved in an enormous number of reactions, including effectively everything ATP is involved in, since ATP in the cell is bound to magnesium. If your magnesium is low, a lot of things are quietly running less well. Higher intakes are generally associated with better sleep quality, fewer issues with cramping and restless legs, a small benefit for muscle soreness, decent effects on exercise performance, and a mild reduction in blood pressure.

How to take it. We like a magnesium powder batched with something you already do, so you do not need to remember it as a separate habit. A scoop with an evening drink, or in your training drink, works well. Magnesium bis-glycinate is a sensible form, partly because you also get a little glycine alongside, and it is well tolerated. Magnesium oxide is much more likely to give you loose stools. Capsules are fine if you prefer them; the powder is usually cheaper and largely tasteless.

How much. Most labels give a sensible starting dose, and we would generally trust that. The body has a built-in titration point: take too much and your stools loosen. That is your signal to dial back.

Ideal case, eat more vegetables. The supplement is not the substitute; it is the hedge.

Verdict: yay.

Greens powders

Greens powders sit in the same conceptual space as multivitamins, but lower in the hierarchy. They are a less-trusted insurance policy.

The honest objection is the dose. Five grams of ground-up plant matter, even if dried and dehydrated, is not a meaningful replacement for actual fruits and vegetables. The products that sponsor every podcast on the internet tend to have ingredient lists that read well and doses that do not.

Where they earn their place: travelling, where you cannot reliably get good produce; as a psychological lift on a shake-based meal, where adding greens makes the shake feel like a complete meal rather than a powder in water; or as a small top-up on a particular meal where you genuinely cannot work fruit or vegetables in. Outside those, the answer is to eat more fruits and vegetables.

Verdict: nay for the general case.

Fibre supplements

The story changes if your fibre intake is low. A reasonable target is somewhere around 10 to 15 grams of fibre per 1000 calories consumed. Most people are well under that.

Diet first, as always. Adding bran to porridge, throwing chickpeas or kidney beans into a stir-fry, choosing wholegrain versions of staples. All of that lifts fibre without a supplement.

If, despite that, you are still under, a fibre supplement is reasonable. Psyllium husk is cheap, easy to add to a protein shake or porridge, and has a clear use case where there is actual demonstrated benefit: lowering LDL cholesterol in people whose levels are elevated. There also appears to be a dose-response benefit even at higher baseline intakes, so adding around five grams of psyllium husk on top of an already-decent fibre intake is not necessarily wasted.

One caveat. If you have IBS, particularly the sort where no one can quite tell you what is driving it, adding a random fibre supplement is not guaranteed to be pleasant. It may help, it may make things worse, and you will not know in advance. Talk to your doctor.

Verdict: yay.

Creatine

We will cover creatine in more depth later in the series, because it earns it. For general health, the short version is straightforward.

Around five grams a day is the standard starting point. Recent work has tried to scale to bodyweight, around 0.1 grams per kilogram, which for an 80 kilogram person comes in a little higher. Three to five grams a day is the conventional range. If you eat a lot of red meat or animal products, you are getting some from the diet; if you eat little or none, you are getting much less, and the case for supplementing is stronger.

Beyond the muscle and performance side, creatine looks promising for cognitive health, for staving off cognitive decline with age, and possibly for some protection in concussion contexts. Cost per day is low, especially if you buy the kilo bag. We would happily recommend it to a grandparent.

Verdict: yay.

Probiotics

The most overhyped category in this list, and the one to be most cautious about.

Microbiome science is genuinely interesting, but it is young. We do not yet have a confident map of which strains help which person under which conditions. We can see broad patterns, where certain populations of bacteria associate with certain health outcomes, but we struggle to disentangle whether those populations cause the outcome or simply reflect a lifestyle that produces both. The bacteria living in your gut largely reflect what you have been feeding them. Change the diet and the population shifts in turn.

There are exceptions where the evidence is stronger. Specific probiotic strains for travellers’ diarrhoea. Some evidence in certain forms of IBS for certain strains. These are use cases with a specific question and a specific answer.

The generic, blanket “billions of live units of we-do-not-quite-know-what” probiotic, taken indefinitely by an otherwise healthy person, is harder to make a case for. It is also not free. The higher-quality products are expensive, and you are subtly altering an ecosystem inside you with limited long-term evidence on what that actually means.

The antibiotics question. After a course of antibiotics, should you take a probiotic to repopulate? Mechanistically it sounds reasonable. The evidence is mixed, and the labels are too vague to be useful. “Antibiotic” is a wide category; “probiotic” is a wide category; matching them sensibly requires more specificity than most consumers can get to.

Verdict: nay, with an open mind. The research will improve. For now, the better lever is the diet that feeds the microbiome you want.

What this all adds up to

These are the baseline supplements. They are the first line. If your sleep, stress, training and nutrition are in a reasonable place, and you have these foundational supplements considered, then the more exotic ones we will get to later in the series start to make sense. If the foundations are not there, no clever niche compound is going to rescue the picture. A pre-workout will not make an unhealthy organism perform like a healthy one.

Pick where you sit on the personal-philosophy spectrum. Read the label. Spend the money on the things with the best evidence-to-cost ratio for you. Then go and eat more vegetables.