AMA #69: Scrutinizing supplements: creatine, fish oil, vitamin D, and more—a framework for understanding effectiveness, quality, and individual need

**Peter Attia** (0:11)
Hey, everyone, welcome to a sneak peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com/subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.
Welcome to Ask Me Anything AMA episode number 69 In today's episode, we cover supplements. As this is a very complex topic, we wanted to approach it first by proposing a framework that you can use to evaluate supplements that we can't make blanket recommendations on since everyone has their own individual health circumstances. To me, the framework is very important here because if I were to just dive into this podcast and give you my point of view on a random collection of supplements, it would be akin to giving you a bunch of fish, when in reality, what I want to do is make sure you, of course, know how to fish. But not just giving you the framework, we also want to give you a few fish. And so we want to use the framework to cover a handful of studies for some popular supplements. We covered creatine, fish oil, vitamin D, vitamin B, or many of the vitamin Bs, and ashwagandha. We also talk about how to look at supplement quality, and we hope that this episode gives you an ability to take said framework and apply it to any supplement you encounter in the future. If you're a subscriber and you want to watch the full video of this podcast, you can find it on the show notes page. If you're not a subscriber, you can watch the sneak peek on our YouTube page. So without further delay, I hope you'll enjoy AMA 69

**Nick** (2:03)
Peter, welcome to another AMA. How are you doing?

**Peter Attia** (2:06)
Great. Thank you for having me again.

**Nick** (2:07)
Always, always welcome. I know sometimes it's tough to get you to clear your schedule, but we're always happy you show up. Haven't missed one yet, so that's always a good thing. So today we're hitting a topic, which is one we get asked about a lot, which is supplements. And this can vary greatly depending on the person, depending on the supplements. And the hard part with supplements is that, while everyone is interested in it, it's so variable person to person, and not even all your patients are taking the same supplements or the same amount and all of that. And so it's really hard to talk about it in a way that makes it applicable to everyone without being like, take this, don't take this, which is something that you've never really done because of how you look at this topic. What we decided to do today was instead look at a framework for how you think about supplements and then go through case studies of a variety of supplements to talk through it to hopefully allow the person listening or watching to then be able to apply it in their own life so they can just get a better understanding and be smarter when it comes to this topic. So we tried to pick ones that we get asked about a lot for the case studies, which is creatine, fish oil, vitamin D, B vitamins, and ashwagandha. So the hope is after this, not only will people understand those specific supplements better that we're going to do the case studies on, but also how they can apply this framework to their own life. With all that said, when patients come into the practice, what percent of the supplements are they taking that you recommend they continue to take?

**Peter Attia** (3:37)
Obviously, any patient that's coming into the practice, we're trying to gather as much information about them as we can through their medical history. And an important component of that is understanding all medications, supplements, hormones, anything they take. I call this the bucket of exogenous molecules. So, generally, we know this on the way in, and there's a ton of variety. There's people who come in who are taking nothing. They don't take any medicine by prescription. They don't take any supplements. Conversely, there are patients who come in on no medications, but a list of supplements that might be two pages long and everything in between. Our view is generally to approach this the way the kidney approaches the filtration of glucose, sodium and potassium, which is you dump everything out and then ask the question, what should be added back in? And I don't mean we literally stop everything, but I'm saying that's kind of the mental model for how we go about thinking about it. Because a lot of times when we ask patients, why are you taking this or why are you taking that? They don't know. They just say, oh, you know, I started this a couple of years ago because I saw somebody on Instagram talking about it, or I saw this doctor a few years ago who told me to take this, but I have no idea why.