Paul Coates: Can Supplements Really Help You Lose Weight?

James Hill:
Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:
And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

James Hill:
Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:
Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

James Hill:
Ready for the “And” factor?

Holly Wyatt:
Let's dive in.

James Hill:
Here we go.

Holly Wyatt:
One of the questions I hear all the time from patients and even colleagues is questions about supplements. I think there are so many products on the shelves. There's fat burners, there's appetite suppressants, protein powders, energy boosters, muscle builders, so much stuff. It can feel overwhelming. People want to know, do they work? They ask me, are they safe? Should they be taking them? And if they should be taking them, how do they figure out which ones?

James Hill:
Oh, yeah, Holly. This is a multi-billion dollar industry and it's built on big promises, but the science doesn't always match the marketing.

Holly Wyatt:
And that's why we wanted to dedicate this whole episode to this. I think it's worth it because supplements, they're not going away. That's for sure. And people are trying to lose weight, whether they're trying to maintain it or whatever they're trying to do. A lot of people are wondering what's worth their money, what's not, and they're going to get their information from someone, somewhere. So I think it's worth doing an episode on this.

James Hill:
Yeah, Holly. And to help us sort out fact from fiction, we brought in one of the most trusted experts in this space. Dr. Paul Coates spent nearly two decades as director of the NIH Office of Dietary Supplements, where he guided national research priorities in consumer education. He served as president of the American Society for Nutrition, and he's the lead editor of the Encyclopedia of Dietary Supplements. This guy knows supplements.

Holly Wyatt:
He sounds like the perfect person to have on this podcast. Paul, we're so glad you're here to help us today.

Paul Coates:
Well, it's a big treat to be with you. Thanks for asking me.

James Hill:
Hey, Paul, let's start big. When you look at the supplement market today, with billions of dollars spent and thousands of products out there, what's the very first thought that comes to mind?

Paul Coates:
This is a public health matter. A lot of money is spent on dietary supplements. A lot of people in the United States and around the world use them. And I consider it, therefore, a matter of public health. Sixty-plus percent of American adults use dietary supplements on a regular basis, usually daily. That's according to the Office of Dietary Supplements at the NIH. Others have different numbers depending on what they're tracking. But it's a big deal, and I think we need to pay attention to it.

Holly Wyatt:
So, 60 percent. The majority of Americans are using some type of supplement?

Paul Coates:
Yeah. And not just once. This is regular use. These data come from a major national survey called the National Health and Nutrition Examination Survey, NHANES, which is the linchpin of lots of policy-related issues in the United States. We've spent a lot of time and effort understanding dietary supplement use. And it's from that highly representative population in the U.S. that we get these kinds of data.

James Hill:
Paul, there are a lot of different kinds of supplements, and we're particularly interested in ones that really relate to weight maintenance, weight loss, etc. What are some of the common kinds of supplements that people looking at managing their weight would buy?

Paul Coates:
Gosh, there are so many. And in order to kind of keep track of that, the Office of Dietary Supplements did what's called a fact sheet on dietary supplements for weight loss. And like so many of their other fact sheets, these are written by experts. They're reviewed by other experts. They're updated pretty regularly. And this one in particular, I know because I was there when it was put together. It was a challenge because there are so many different kinds of products, ingredients and combinations of ingredients. This is almost a uniquely American thing that we like things in combination. Among the ones that have been most prevalent over the years, some of which are no longer in the market, are ephedra. There's one that's no longer in the market. Caffeine in the market. Green tea in the market. Conjugated linoleic acid in the market. protein powders, those sorts of things. These are ones that are pretty common and they come and go either because the science defeats them or the science encourages them or more likely people hear from their friends and colleagues and marketers that something, here's a new one for you to try.

Holly Wyatt:
Yeah. The influencers.

Paul Coates:
Yeah.

Holly Wyatt:
[5:39] And they’re the ones that have big reach and suddenly they take a supplement and you can see, I can see. I get questions about it. So it's definitely that marketing through the influencers and people that aren't necessarily doing the research on it, but have had a personal experience with it.

Paul Coates:
Yeah. Or they've got a television show.

James Hill:
So, Paul, what are the reasons why it may be difficult to research all these? In other words, we always say, well, here's a product, there's no research. Why is that? What is the challenge in actually studying scientifically all these things?

Paul Coates:
So just a little trace of background. There are a huge number of dietary supplement ingredients in various combinations in various products. Nobody actually knows exactly what the number is, but it's large. It's in the tens of thousands, perhaps as many as 100,000 products in the U.S. marketplace that have a dietary supplement label on them, and they're marketed as supplements. Doesn't mean that there are all that many ingredients, but there are a lot of options for study. And some of them are pretty arcane combinations of things, things that you might not imagine would ever go together. What happens is that somebody comes up with an idea for a supplement product. They get data from, let's say, ingredient X, ingredient Y, but they haven't necessarily studied the whole thing. So we don't know exactly how all of these products are put together. From the point of view of the research community, it's hard to know which ones to study. Frankly, if you were a company wanting to put a product on the marketplace, it'd be up to you to do the studies, to pay for those studies. But companies don't necessarily spend a lot of money on research and development.

Holly Wyatt:
I think one of the things that our listeners may not realize is that you do have to, you know, when you put things in combination, outcomes could change. And so every time you add things, you can look at individual, but the combination may make a difference. And then you've got to study that. And there's way too many things to study. It would cost a lot of money. So you're saying it makes sense for the company to do it, but it doesn't necessarily make sense for the, you know, the United States to do it because there'd be so many, we wouldn't be able to study them all.

Paul Coates:
You're right. And I certainly came across that during my years directing the Office of Dietary Supplements. The opportunities were legion. There were ever so many. And so we ended up trying to set some priorities for what would be for study. It might be a product, and this doesn't have to do exactly with weight loss, but just in general, a product or an evolving ingredient that showed promise. Maybe it was a vitamin that was already out there, but showed promise for a chronic health condition. That might be a good signal for research study. Another might be a safety concern that has emerged after long periods of time when people might be using large amounts of a single ingredient. So trying to set priorities is always a challenge. And you hit on it that if there are combinations of things that makes, this is high school algebra, you know, permutations and combinations, the numbers can get very big very quickly.

James Hill:
Hey, Paul, I've looked at some of these products, not exhaustively, but some of them will actually cite research. Here's research showing the effectiveness. And I have to tell you, when I went in and looked at some of those studies, they were almost laughable at how bad they were. So what are, you know, just because a product says, here's a study that showed it's effective, what are the red flags for the consumer? What questions should they be thinking about?

Paul Coates:
Yeah, this is such a problem because asking consumers to do their own research is a double-edged sword. It's easy. It comes off the tongue quickly. Consumers have to do their own research, but using what tools? I mean, there are, you can AI generate a summary of something, but it depends on what the input is. It depends which website you look at, which influencer may be prompting these kinds of searches. Frankly, I love it when companies offer up studies in the published literature as examples of what makes their product different. But you're right, Jim. Sometimes those studies, all they are is in the literature. That doesn't mean that they are perfect or that they're even close to being good. A study that was done on a dozen college-age males, let's say, for two months, let's say, on a single dose of an ingredient or a combination, well, it's a signal. It may tell you something about what you should be doing next if you're going to be doing some science on this. But if I saw a study like that, I would be very cautious about wanting to take that product based on that kind of evidence.

James Hill:
The studies that are really needed to comprehensively evaluate products like that probably cost in the hundreds of thousands of dollars, if not in the millions. And my guess is there are very few of these supplement companies that are willing to spend that kind of money for studies. And people like Holly and I, why would we go out and study this if there's not funding to do it and there are so many other questions? So I see there's a real problem here.

Paul Coates:
I agree with you. And it's one that we always face. It's easy to knock companies for not doing the research. If they're just using somebody else's science, or if they are not really doing any science of their own in this space, it's easy to knock them. But they do have a problem. These are products whose regulatory framework does not incentivize them to be doing deep dive kinds of research, as you might expect to find, as you would certainly expect to find, for drugs in the marketplace. The FDA regulates drugs and dietary supplements in a very, very different kind of way. And frankly, there are not a lot of companies that have lots of money. And as I mentioned, they don't necessarily have an incentive since they're perhaps not going to be able to make claims based on the outcomes of any science that they do.

Holly Wyatt:
I think it's so interesting to look at what we require for a drug to make it to market. And I agree, we need that testing at that level, but it's almost opposite. It's so different for a supplement. And yet we believe or we think or the consumer believes the supplements can make a big difference. Oh, but we don't study them that way. And I always say if you think a supplement can make a big difference, can turn on fat burners or can knock your appetite out, it has that power to do that something you want. It also potentially has the power to do something you don't want, a side effect, because powerful drugs usually have an upside and a downside. And yet we don't study supplements like we study medication.

Paul Coates:
Right. Well, you actually hit on something that's really important and that I had to learn that lesson when I was director of the office. If somebody tells me that a dietary supplement has this profound effect on weight loss or risk of something, some chronic disease, then I am going to be looking for the downside because those big effect sizes that you might expect to find with drugs indeed come with side effects are major. So if somebody tells me that there's a big effect of a dietary supplement ingredient on a health condition, then I'm going to be looking to see what evidence there is that anybody's paid attention to safety. Because the bigger the positive effect, the likelihood is also large that there will be high-powered negative effects in some people. Not everybody, but in some people. And so that's the problem with studying supplements. You expect that the effect sizes will be small. If they're small, and you folks have done research in these areas, then it takes what? It takes a lot more participants. It takes a longer period of time. And looking through a great deal of data in order to tease out the pieces that work. I mean, we've done, we've certainly supported studies in supplements for chronic health conditions, some of which have worked, some of which have not. But even among those that have worked, the effect sizes tend to be rather small. And they can only be teased out using big, expensive trial designs.

James Hill:
So, Paul, you've been in this area for a while, and what we've talked about so far are some of the maybe negative aspects of supplements, but there may be some positive aspects too. How do you separate the wheat from the chaff here? What's your sense of the value of supplements for maybe people undergoing weight loss?

Paul Coates:
Yeah. Well, you know this field. You know the field from the weight loss point of view better than I do. I know the sort of the general principles related to supplements. And it does come down to effect sizes being small. Don't expect big outcomes. The one or two cases that I'm aware of where there were pretty profound, it was evidence of pretty profound effect, came with risks. And the signal one in this whole sphere from 20 plus years ago was ephedra. Even when I was new at this job, this was actually my trial by fire, was studies that the atmosphere around ephedra, one of the biggest selling dietary supplements in history at the time. The only one that did better in sales was multivitamins for a while. And the promise was so high for good reason. I mean, it's a fat burner. It really does. It has this adrenergic effect that you could count on. It has an amphetamine-like effect. I was obviously concerned about it from that point of view. But they said it came from a plant. So it wasn't ephedrine hydrochloride in high doses. It was ephedra extracted from a plant that had been used for centuries in traditional Chinese medicine. What I'm getting to here is that there are lots of different kinds of evidence. And what you have to do in circumstances like this is to look at all the evidence and draw conclusions based on that, not just on cherry-picked studies or enthusiastic endorsements from influencers.

Holly Wyatt:
I also think this idea that it came from a plant. I talk about this frequently that natural, people think if it's natural from a plant, it's safe. “I can take anything that's natural.” And I always say, “Oh, my gosh, there's some of the most poisonous things that will kill you right away are natural.” And I think that's a tendency people need to be careful about.

Paul Coates:
Yeah, and I think there were two kind of buzzword things. One was that if it's natural, doesn't mean it's safe. And the other was, if a small amount works, a lot might work better. Those are kind of catchphrases that periodically we have to remind ourselves are not likely to be true. And the natural part, it's so attractive, and it's in fact, important. As you know, there are drugs that have been derived from plant sources and that have been highly regarded and very effective. It's not everything in plants has that kind of effect. But I do like the fact that people are exploring the natural world as a source of ingredients that may have health benefits. That's a great idea. It comes with its challenges, though. And so ODS and its partner at the NIH, the National Center for Complementary and Integrative Health, for many years have run a program that's now called CARBON, Consortium for the Advancement of Research on Botanicals and Other Natural Products. It's a great idea. This actually came to our attention even before I became director of the office. Congress provided language and thankfully some money to the NIH in order to develop a series of botanical research centers around the world, around the country. There was one, in fact, at UAB quite a number of years ago, our friend Steve Barnes. And that program has evolved over the years, but it's with the goal in mind of investigating in appropriate ways the evidence for health effects of ingredients derived from plants. So I love the notion and was very, very supportive of it during my time there. But it doesn't mean that everything that comes from a plant is worth pursuing or that everything from a plant is going to be safe. As you mentioned, Holly, there are examples where that's not the case, digoxin.

James Hill:
Paul, talk about the NIH Office of Dietary Supplements. In brief, what does it do? And are there resources there that can help guide people who may be looking at supplements?

Paul Coates:
The office was first created by Congress, and it was intended to be an opportunity for research to be done and results disseminated to the public about the benefits of dietary supplements. That was in the language of the Dietary Supplement Health and Education Act of 1994. This was the act, by the way, that created the dietary supplement regulatory framework, that they were to be regulated as foods, not as drugs, that they included a series of potential ingredients in them, a list, by the way, that keeps expanding over the years. The last item in the act was to create the Office of Dietary Supplements. And at the time, the budget was fairly small, and relatively speaking, it was a million dollars. And it stayed at a million dollars for a few more years until it really started to jump up. The opportunities for research started to become more evident. And the opportunities to make information available to the public, to practitioners, to the media, to policymakers, to the government. We started to realize those.

Paul Coates:
So I'd say at this stage, the two things, two big categories of things that the office does that have always been part of their brief to identify research opportunities for investigation of dietary supplement ingredients. And then the next, and I always thought that this was the most important part of what the ODS did, was to provide information that would be valuable to practitioners, policymakers, government, industry, and at the end of the day, the most important, the consumer. And so that's what really evolved over the years.

Holly Wyatt:
And so can people, where can they go for the information from this group?

Paul Coates:
Well, let's use dietary supplements for weight loss as the example. So the Office of Dietary Supplements has a website, ods.od.nih.gov. And on that website, there's a lot of information that's available for consumers, including a series of well-thought-out fact sheets on individual ingredients, vitamins, minerals, some herbs, links to fact sheets that have been developed on other ingredients by other parts of the federal government. And then ODS also has a series of fact sheets like dietary supplements for weight loss that really focus on an issue rather than on a particular ingredient. These fact sheets come in two flavors and two languages. The two flavors are there's one for practitioners. So it might be RDs. It might be physicians. It might be for researchers as well as a synthesis of current information. And then there's a version for consumers, which is not dumbed down.

Paul Coates:
It's at an appropriate reading level, but it provides key pieces of information about, in the case of this fact sheet on weight loss, what do they do? What are the ingredients? And then it breaks down some common ingredients in weight loss dietary supplements, gives some information about the name, does it work, and is it safe? So, really simple breakout.

James Hill:
That is really useful information.

Paul Coates:
Yeah. It does provide a little bit of background as well on how they're regulated and can they be harmful, and how do you incorporate them into a sensible approach to weight loss.

James Hill:
Paul, one of the things that I often hear that I think probably is true is when people go into their primary care physician and they're asked about supplements, they aren't always comfortable telling their primary care doc what supplements they're taking. Talk about this, and is there a value in being a little bit more honest about the supplements you're taking when you go in with your primary care provider?

Paul Coates:
Yeah, it really is an important part of the background on you as the patient. I know that people do not always provide that information, and physicians do not always ask for that information. But I do find there is increasing conversation between healthcare practitioners and their patients and clients about supplement use in the context of what are you taking? So prescription drugs, over-the-counter drugs, dietary supplements. I do see the conversation increasing as time goes by.

James Hill:
I think there's a sense that people are embarrassed. It's their fears, their healthcare provider is going to say, what are you crazy taking this thing? There's no data for that. Da, da, da, da, da.

Paul Coates:
Well, I hope that that's not happening as often as it used to. Frankly, it's one of the reasons why people who are in the self-help kind of community, they became disillusioned with their interactions with the traditional American medical system. And so a bit of backlash was going in with information to their doc and hoping that it would start a conversation. And if it didn't, they'd go somewhere else. I believe that's part of the background to the MAHA movement these days, which clearly has had a huge impact in the last several months. But these are the sorts of things that people wanted to take more charge of their own health because they were not certain they were getting what they needed from the traditional medical system.

Holly Wyatt:
Yeah. So that kind of leads us to where I want us to go. I know we may not have data on everything, but are there certain supplements. Because I know our listeners are kind of sitting on the edge of their chair wanting to know, are there certain supplements that do have some research that you do feel have, maybe just even show promise? I know we're not going to maybe be able to say definitively they do this. And let's talk about some of the supplements that have been out there for a while that maybe could be helpful for some individuals. What do you think? Especially kind of thinking about weight, weight loss, weight management, fat burning, that type of thing.

Paul Coates:
All right. Let me set one principle before talking about some individual ones. Remember what I said before. I don't expect to see huge changes in the outcome if the outcome is pounds lost in a certain amount of time.

Holly Wyatt:
We're not going to get 30 pounds of weight loss in 30 days. That's not what we're talking about.

Paul Coates:
Right. Maybe one person did, but nobody else will.

Holly Wyatt:
Okay.

Paul Coates:
So, we have to sort of manage our expectations. And I recall something from a Larry David series, Curb Your Enthusiasm. The title of it actually tells me that. So that's one. Curb Your Enthusiasm is a line from a Larry David series that always reminds me, don't expect too much. What may work very well for one person may have little or no impact on another person. And on a third person, there might be some harm that's unexpected. And the problem is, you don't know in advance which of those buckets you're going to end up falling into. However, there are some for which there is fairly long history of not the best science, but enough science to make me think that there's a potential for benefit and there's little risk of harm. And these include things like caffeine, green tea extract, conjugated linoleic acid, protein powders. These are all ones that have had a long enough history of use from my point of view that if there were some serious harms associated with them, we'd know them. We also, we do know that there are some people who will not benefit and may be harmed but you don't know in advance who they are. We just know that from the results of studies. So those are ones that have provided some help. These are all, along with others, summarized in that fact sheet that I mentioned on dietary supplements and weight loss from the Office of Dietary Supplements.

James Hill:
Paul, there are particular subpopulations that we need to be concerned about that might be harmed from the supplements: adolescents, teenagers, etc.?

Paul Coates:
I'm afraid that sometimes we only learn these things by surprise. And let me use ephedra briefly as an example of that. I mentioned that it had a lot of promise, especially, by the way, when it was in combination with caffeine. That was a big seller for a number of companies in the early 2000s. And there was a lot of anecdotal evidence that people were losing weight by the ton, and it prompted other companies to get into the business. And then this happened.

Paul Coates:
A young pitcher for the Baltimore Orioles whose the evidence said he was only taking ephedra died and he had cardiac death. You don't expect cardiac death in a young athlete. It can happen. Athletes are just as likely to get that as somebody else. It's rare, but it happened and it happened in combination with ephedra. This was starting to be a bit of a signal. And so what we did was to evaluate all of the evidence related to ephedra. We charged a sister agency in the government to conduct a systematic review, an evidence-based review of all of the evidence relating to efficacy and harm associated with exposure to ephedra. And at the end of it all, there was certainly evidence of a modest effect on weight loss. And then there were the signals of harm. And these were very troublesome because they were happening in people in whom you probably would not expect to find outcomes like that, psychiatric issues, heart issues. That's the story that I tell in the context of this question.

James Hill:
Okay.

Holly Wyatt:
It sounds like these fact sheets could be really good and kind of getting snapshots that you've talked about of some of the agents that have been out there, some of the supplements that have been out there. Are there any kind of, I want to say, red flags that you would maybe advise our listeners? If you see this, it's a red flag maybe to think a little bit more before you buy a supplement. Maybe something like no ingredients listed or big claims or anything that's a red flag.

Paul Coates:
Yeah. Big claims. You have to be careful because technically the Food and Drug Administration and the Federal Trade Commission, both of whom have regulatory and enforcement authority over products in this space, are taking a very, very careful look themselves at what claims are being made; advertising, label claims on the bottle, that sort of thing. You know this as well as I do. There have been some weight loss products, supplements and other things that have fallen afoul of those of the laws that are enforced by FDA and FTC so you may not see huge claims but if you do, be cautious because the government probably will eventually come down on them or making claims that are not supported by the science. But that's one. Another is I don't think you mentioned something about no ingredients on the label. It would be a little more sinister than that.

Paul Coates:
By law, ingredients have to be put on the label. However, I know, and other researchers have uncovered this too, there are ingredients in some dietary supplement products that are not reported on the label. And that could either be by error, because how do you know if something's there? You've measured it. But if you haven't measured it, you might not know that it's in there. So there is a laboratory at Harvard and there are other laboratories, commercial laboratories that have identified potential harms with dietary supplement products arising from ingredients that are not on the label. The other thing that sometimes happens is the flip side of that, that something is listed on the label and there's nowhere near the amount of the ingredient in the product. So if something doesn't work, it might be because there's nothing in the product.

James Hill:
Yeah.

Paul Coates:
Now that doesn't happen all that often, but it happens often enough that there are companies that whose MO is to measure things in products and report their results, good or bad. ConsumerLab.com is an example of a company that does that. And it can be a problem if ingredients, If people can't trust what's on the label, then all bets are off.

James Hill:
So, Paul, some of our listeners are probably taking some of these supplements, but we may have some listeners who have heard what you're saying and they're now, should I try some of these supplements? Should I just say, oh, no, no, I don't want anything to do with them? Is it okay to think about trying them? And where would you recommend they start?

Paul Coates:
You mentioned earlier a conversation with your health care provider. That doesn't mean that your health care provider knows everything that they need to know in order to advise you. But if you don't start with a health care provider, I think you're probably setting yourself up for potential problems. The provider may well know something that hasn't come up in previous conversations. So I'd start there. Reliable sources of information. I mentioned the Office of Dietary Supplements, but there are others. Some of the trade associations for the dietary supplement industry have resources aimed at consumers. And over 20 years of interacting with those organizations, they are generally well thought out. They're not in the business of trying to harm people. They want to be in the business of helping people. So their product, their information products are generally quite reliable. That's how I would do research. If I were a consumer, I wouldn't be looking so much at the advertising about a particular product. I might do that and then put that aside and then ask the experts.

Holly Wyatt:
I like that. So, Jim, I think it's time for some listener questions. We've got some good ones, and I even want to know the answer to some of these. So, we'll try to hit these kind of rapid fire, because I want to hit all five that we have, if possible. We got five here. Good ones. I'll start off. This from a listener. If I see a study on a company's website, how do I know if it's real?

Paul Coates:
You don't, unless you have some way of independently checking that. Again, a reliable source is probably where you go for a second opinion.

Holly Wyatt:
Right. And don't just assume because they say there's a study, oh, that means it's legit. I think that's a mistake sometimes people make.

James Hill:
All right. Here's one. My teenager wants to try a fat burning supplement. What should I do?

Paul Coates:
Oh, geez.

Holly Wyatt:
I want you to answer this.

Paul Coates:
Basically, start with what I have been saying throughout. Check with a healthcare provider. Check with a reliable source. Don't just assume that because your kid wants to try one, that it's okay. It might be, but I think I've given you three options, an individual and a dietary supplement. There could be potential benefit, modest. There could be absolutely no benefit and no harm, and there could be harm, modest risk. But all three of those need to be in your mind when you're thinking about making a decision like that.

Holly Wyatt:
All right. I like it. Next question. I've spent hundreds of dollars on supplements and don't have a lot of results to show for it. Is there any way to know what's worth it before I buy? We've talked a little bit about that, but is there any, I guess, you know, they keep buying stuff, it's not working. It sounds like they stop it, but any way to know if it's worth it?

Paul Coates:
No. It's not really easy to know the answer to that question. You might be the one person or the 20 people for whom there would be some benefit. You're much more likely to be one of the 80 people for whom there will be no benefit. The good news is that most of the time, I've talked a little bit about risks, but most of the time there's not evidence of much harm associated with dietary supplements that are usually available in the marketplace. Now, that's a generalization, and it comes with the caveat that I don't know if you or I would be the person who could be harmed. I don't know that in advance.

Holly Wyatt:
Right.

James Hill:
All right. Here's one. If caffeine and green tea really work, can't I just drink coffee and tea?

Paul Coates:
Sure. You could. You might find some benefit. But really, the concentrations are sufficiently high in dietary supplements that contain, let's say, caffeine or green tea extract that you probably couldn't reach those by just ingesting coffee as a drink or tea as a drink. There are exceptions to what I just said. You know that there were some energy drinks that contained mega doses of caffeine. And when somebody asked me this question a long time ago, should I be taking them? And I said, well, if you're drinking those energy drinks that taste like coffee, why don't you just drink coffee? Part of it is a matter of taste. Part of it is a matter of immediacy. “I want to get some results. I want to see something happen. So I'll take the extracts.” One thing to note about both caffeine and green tea is that at high doses, those are really harmful. Caffeine in very high doses, which was available in a powder for a while, it can be a disaster. And green tea extracts have been associated with risk of hepatic disease, liver disease. So I'd just be a little bit cautious.

Holly Wyatt:
Yeah. Once again, some people are super sensitive to it or have a genetic predisposition that it's going to be toxic to the liver. But there's other people who I think they've shown some benefit from green tea, perhaps, not huge benefit, but small benefit in increasing metabolism or fat burning or energy expenditure. So that's, I think, a perfect example of kind of what you're saying. A little bit of an effect for some, maybe no effect for some, and then there's a few people where they can have something that they don't want.

Paul Coates:
Right. Treat them with respect, I think, is my general advice to people. They're biologically active. They're not drugs, but they are biologically active. And that means treat it with respect.

Holly Wyatt:
All right, Jim, is it time for the vulnerability part?

James Hill:
It is.

Holly Wyatt:
I like this. I'm going to go first because I know for sure what I want to ask.

James Hill:
All right.

Holly Wyatt:
So, do you use any supplements?

Paul Coates:
Yep, I do.

Holly Wyatt:
Okay, what do you use? That's what I want to know.

Paul Coates:
So, I'm an old guy, and my ability to absorb vitamin B12 from foods like meat declines with age. That just happens with everybody, maybe at different rates. So I take a vitamin B12 supplement. For a little while, I was taking a vitamin D supplement as well, 2,000 international units a day. Not by choice, but my primary care physician. One of my annual physicals determined that I had a low level of 25-hydroxyvitamin D in my blood, and so he asked me to take vitamin D on a regular basis. And I'll go back next month after a year, and we'll see whether or not it has changed my vitamin D status. It won't have made any difference that I'm aware of to my general health, but I will follow his advice on things like that. I did take a multivitamin for a while because here I was, director of the Office of Dietary Supplements, and I'm talking, but I'm not necessarily doing. Since the most popular dietary supplement combination in the world is a multivitamin, I thought I'd try one. And after a year, I didn't detect anything so I didn't bother anymore. That's me. People may have other reasons for making these decisions. They may have, for example, with weight loss. If one thing doesn't work, maybe there's something else that shows some promise and it would be worth considering.

Holly Wyatt:
Or the deficiencies. There's some people that are deficient in a vitamin because of their diet or because of some aspect of their lifestyle or genetics. They don't absorb it as well. They need a higher dose perhaps. And I think that's one of the confusing pieces. If you're deficient and you take a vitamin, you may feel a difference. If you have plenty of it, it may not make anything any better. A lot of these vitamins that you can take super high doses just come out in the urine and you're just making, I say, really expensive urine. But if you're one of those people that is deficient in one of the B vitamins, it could make a big difference. And you don't know sometimes.

Paul Coates:
Absolutely agreed. Yeah.

Holly Wyatt:
So, I take. I am a big protein powder supplement. I get protein from my diet, but I don't believe that I get enough. So I supplement with a protein powder. I also take a multivitamin because while I would love for my diet to be perfect enough to get everything I need, I know it isn't. And so I want to just make sure I'm not deficient in something. So I tend to take a multivitamin, use protein powder. Those are my two big supplements that I probably take every single day.

Paul Coates:
Yeah. No problem with that at all.

James Hill:
All right, Paul, I have one here for you.

Paul Coates:
Yeah.

James Hill:
You've spent your career trying to bring clarity to this issue of supplements and health. Was there ever a time where you felt overwhelmed by the misinformation and felt like there's no way science is ever going to close the gap to address all the misinformation out there?

Paul Coates:
Yeah. I mean, it was always in the background that the marketing would outstrip the science. And it's because of the framework under which dietary supplements are made available in countries like the United States. There are some requirements. There is definitely regulation. But it makes the assumption. And this is why it's important. The regulatory framework makes the assumption that dietary supplements are safe until proven otherwise, like a food. Food regulations assume that something is safe until it's proven otherwise.

Contrast that to drugs where it's assumed not to be safe until proven otherwise. That's a simple way of putting it. But I think that it'll always be true about the marketing versus the science there are people who get it about how to make these be a little bit more in sync. But honestly, I think this is more of a marathon and not a sprint so I never felt too concerned because I just knew I was never going to be able to close that gap.

James Hill:
All right, Holly. Wow, we covered a lot of ground, Paul. Thank you. Sum it up here. I think you're not telling people to avoid supplements totally, but you're telling them to be careful and try to get as much information as they can. And one source is the Office of Dietary Supplements. So give us that website one more time.

Paul Coates:
Sure. ods.od.nih.gov.

James Hill:
So it's overwhelming out there. I was in Walmart the other day and just went through the supplement section, and oh my God, it just goes on forever, and it's just so many choices. But be careful. Try to get a second opinion. Talk to your health care provider, and check out the tip sheet from the Office of Dietary Supplements. So, thanks for your time, Paul. And let us know your questions. Send us your questions about supplements you're taking or supplements you might take. And Holly, I think we maybe should do another episode on trying to look at some of the most popular supplements and talking a little bit about the evidence out there.

Holly Wyatt:
That's exactly what I was thinking. We could say, we could actually ask our listeners, come up, let's do the top 10 and let's bring Paul back on. And let's really do a little bit deeper dive in the top five or the top 10 and kind of figure out what's out there. I think that would be a fantastic episode. So I'm going to put that on the list.

James Hill:
Okay. Well, thanks, Paul. And see you next time on Weight Loss And.

Holly Wyatt:
Bye, everybody. Thank you.

James Hill:
And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:
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James Hill:
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Holly Wyatt:
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