Eight supplements that actually improve our health, starting with creatine: The International Society of Sports Nutrition concluded that creatine monohydrate is the most effective nutritional supplement currently available to athletes in terms of increasing high-intensity exercise capacity and lean body mass during training. It’s important to note that it primarily helps with short bursts of high-intensity exercise. A meta-analysis concluded that creatine supplementation is effective in lower limb strength performance for exercise with a duration of less than three minutes. In contrast, creatine doesn’t seem to improve endurance performance. However, it does improve muscle recovery from training.
But it’s not just muscle performance and recovery that creatine seems to be useful for. A 2022 meta-analysis looked at cognitive performance and concluded that creatine supplementation enhanced measures of memory performance in healthy individuals, especially older adults. That study did have its problems, however, as the individual studies that their meta-analysis combined showed varying results, and six of the 10 included studies had a high risk of bias. So, we can’t fully rely on that study, but the initial results are promising.
When it comes to creatine’s safety over a five-year period, the results have consistently shown that creatine supplementation poses no adverse health risks. In particular, the literature does not support any link between creatine supplements and kidney dysfunction. There’s also no evidence that creatine affects a hormone called DHT, and there’s no evidence that creatine causes baldness. It does not cause gout attacks; it decreases uric acid. The current clinical research does not validate the notion that creatine supplements cause dehydration or muscle cramping. The only consistent side effect that’s been noted is weight gain, but this is a positive aspect as it indicates an increase in lean muscle mass. Personally, I take 5 grams of creatine every day, including on the days that I don’t exercise.
Sticking with the theme of exercise performance, let’s look at TMG or trimethylglycine. TMG is thought to improve muscle performance by delaying fatigue in high-intensity activities. It may also enhance muscle building. We’ve got great evidence from a 2017 meta-analysis showing that when you combine exercise with TMG, we see further benefits compared to just exercise alone. That’s the key point: when people are given TMG and they don’t exercise, no benefit is seen. But when you pair TMG with exercise, you see further benefits compared to just exercise alone. For example, a 2021 double-blind randomized controlled trial showed that 14 weeks of TMG supplements improved one-rep max, VO2 max, and repeated sprint ability performance compared to placebo.
But it’s not just muscle performance for why I take TMG. A 2020 meta-analysis looking at the potential risk factors for Alzheimer’s disease or dementia concluded that high blood levels of homocysteine are a factor, and TMG lowers homocysteine. So, it’s possible—though not proven—that TMG supplements may reduce the chance of developing these conditions.
To reduce the risk of developing dementia, I take at least 500 milligrams of TMG every day. Additionally, we may see further protective effects against dementia by adding omega-3 supplements. A massive study called the VITAL trial, which was a placebo-controlled study, showed that the group who took omega-3 supplements had an unexpectedly high 28% reduction in the risk of heart attacks. Moreover, a Mayo Clinic meta-analysis that combined all of the relevant clinical studies together on omega-3 concluded that omega-3 supplements are associated with a statistically significant reduction in the risk of heart attacks with high-grade certainty. I take one to two capsules of omega-3 every day for heart health and possible protective effects for the brain.
The next supplement that actually makes a difference is psyllium husk. More and more research is coming out about how crucial our microbiome, or the bacteria that grow in our gut, is for our health. We can feed our microbiome with fiber. From a 2016 Cochrane review, we can see that higher fiber intakes reduce cholesterol and LDL cholesterol. I mix 5 to 10 grams of psyllium husk into my morning smoothie every day.
Next is collagen peptides or hydrolyzed collagen. From a 2020 meta-analysis that combined 10 separate randomized controlled trials, it was concluded that all of the included studies reported benefits of hydrolyzed collagen on skin health parameters, including moisture, elasticity, wrinkle number, and dryness. Crucially, there were no inconsistencies seen between the different collagen studies. Since then, we’ve had further studies, such as one in 2022, again showing that hydrolyzed collagen reduced wrinkles compared to placebo, with about an 8% reduction. Collagen peptides are short chains of amino acids, and amino acids make up proteins. One interesting question is whether collagen supplements offer any further benefit compared to just supplementing with protein. To explore this idea, we’ve got a 2020 randomized controlled trial looking at burn patients. Half of these patients were given 36 grams of collagen peptides, and the other half were given 35 grams of protein. At the end of the study, the wound healing rate was significantly higher following supplementation with hydrolyzed collagen compared to protein. Based on that study, it does appear that there are further benefits from supplementing with collagen peptides compared to just protein alone. So, for that reason, I supplement with 10 to 15 grams of collagen peptides every day.
Keeping with the theme of improving skin health, let’s have a look at hyaluronic acid. Hyaluronic acid is present in every connective tissue and organ; it’s the backbone that holds everything together. But as we age, our levels of hyaluronic acid decrease to the point where a 75-year-old person only has one quarter of the amount of hyaluronic acid in their skin compared to a 19-year-old person. Multiple randomized controlled trials have been done looking at giving patients hyaluronic acid compared to placebo, and overall, we can see significant benefits from supplementing with hyaluronic acid.
For example, let’s examine a 2021 randomized controlled trial that studied the effects of hyaluronic acid supplementation. After only 28 days, compared to a placebo, there were significant improvements in skin health: the skin was more hydrated by about 10 percent, and wrinkles decreased by almost 20 percent. Importantly, this study had no conflicts of interest to declare, as it was not sponsored by a supplement company.
One safety concern about hyaluronic acid that is often discussed online is whether it accelerates cancer growth. To address this concern, researchers administered hyaluronic acid to mice with cancer and used various imaging techniques to observe the effects. The results showed that hyaluronic acid had no effect on cancer growth. Another important consideration is the molecular weight of hyaluronic acid and its impact on the body. It appears that hyaluronic acid is broken down into low molecular weight by intestinal bacteria, so at this stage, we don’t know which molecular weight is best for supplements. Personally, I take 200 milligrams of hyaluronic acid every day.
The sixth item on my list is multivitamins. Approximately 31% of the U.S. population is at risk of at least one vitamin deficiency. Many people struggle to reach the optimal daily intake for various micronutrients, particularly vitamin B3, vitamin D, vitamin K2, zinc, and magnesium. I’m not advocating for mega-dosing; rather, I suggest a low-dose multivitamin to help individuals achieve their optimal daily micronutrient intakes. Unable to find a multivitamin and mineral that met my requirements, I designed one myself. It’s called Micro Vitamin, and it’s specifically formulated to help people reach their recommended daily intakes of micronutrients without mega-dosing. It also includes TMG and hyaluronic acid and is manufactured in an FDA-approved facility in the USA. Demand for this product has been much higher than anticipated, so I apologize if it sells out and you have to wait. The link is in the pinned comment.
The final supplement I would consider taking, starting at the age of 45, is NAC (N-acetylcysteine). As we age, our levels of oxidants tend to increase in an attempt to maintain survival, until they eventually may become detrimental. Our understanding has evolved; we now know that not all oxidants are bad. What we need is a balance between oxidants and antioxidants. One of the most powerful antioxidants is glutathione, but our levels of glutathione tend to decrease after the age of 45. Glycine and NAC are the building blocks of glutathione, and by supplementing with these, we can help restore our glutathione levels and maintain the balance between oxidants and antioxidants. For instance, a recent randomized controlled trial explored the effects of these supplements on glutathione levels.
A study examining the effect of supplementing older adults with glycine and NAC (N-acetylcysteine) versus a placebo found significant improvements in mitochondrial function. However, we are still very early in the research journey with this strategy. Of everything that we’ve discussed so far, NAC has the least evidence to support its use. Since collagen supplements already contain a lot of glycine, I personally don’t see much added benefit from supplementing with additional glycine alone. Just to reiterate, I would only recommend starting to take NAC from the age of 45.