By Chris Kresser
In a perfect world, the answer to this question would be “no”. In the world most of us inhabit, I believe the answer is often “yes”. This might seem inconsistent with the Paleo approach. After all, our ancestors weren’t popping pills to stay healthy, so why should we?
Our modern environment is profoundly different than that of our ancestors. In fact, a fundamental tenet of the ancestral health movement is the recognition that we are “mismatched” with our current environment in numerous ways, and it is that mismatch that is responsible for the modern disease epidemic.
A decline in soil diversity and quality (and consequent decline in nutrient density of foods).
A decrease in diversity of plant species consumed.
An increase in exposure to food and environmental toxins.
Overuse of antibiotics, birth control and other medications (damaging the gut and liver).
An increase in chronic stress.
A decrease in sleep quality and duration.
A reduced connection with nature and less time spent outdoors.
A move away from the tight-knit social groups that were the norm for humans until very recently (and the resulting effect on our nervous system).
An increase in the number of hours we spend sitting.
Maintenance vs. therapeutic supplementation
Since I started writing this blog, I have argued for obtaining as many nutrients from food as possible. Humans are adapted to getting nutrients from food, and foods contain many co-factors and enzymes required to absorb those nutrients. However, I have also stated from the beginning that certain nutrients are difficult to obtain even in the context of a healthy diet (such as vitamin D and magnesium), and supplementing with them indefinitely may be necessary. I call this “maintenance supplementation”. Other nutrients that may fall into this category, depending on your diet and health needs, include vitamin A, vitamin K2, selenium, iodine and vitamin C. Vitamin A is only available in significant amounts in organ meats and fish liver oils. While it’s certainly possible (and desirable) to eat organ meats, many people have a strong aversion to them. That makes cod liver oil — a food-based supplement — the next best choice.
As a clinician that specializes in treating people with complex conditions that haven’t been able to find help anywhere else, and as someone that suffered from such a condition myself, I’m also acutely aware of the value of therapeutic supplementation. Therapeutic supplementation involves taking specific nutrients for a specific purpose for a specific period of time. I use this approach in my practice every day. Of course proper diet is the foundation of my work with patients, but by the time people come to see me they’ve often tried every special diet known to humankind (including Paleo, Paleo Low FODMAP, GAPS, and purposely not following a restricted diet), and yet they’re still struggling. Diet is always the starting place, but it’s often not enough on its own to resolve long-standing, chronic health problems. In these cases, smart, therapeutic supplementation is often the catalyst that takes people from chronic illness to optimal health.
I also know this from direct, personal experience. I used many different supplements for several years — including micronutrients, botanicals, probiotics, prebiotics and more — to first kill the gut pathogens I picked up while traveling in Southeast Asia and then reduce inflammation, restore gut barrier integrity, re-establish healthy gut microbiota and address other lingering issues on my way back to health. I viewed these supplements as a raft that would help me get from one side of the river (illness) to the other (health). And that’s exactly what happened. Today the only supplements I take fall into the maintenance category: fermented cod liver oil/butter oil (for vitamins A and D), magnesium glycinate and, on occasion, a probiotic/prebiotic blend.
If you need to supplement, does that mean your diet isn’t working?
Another argument I’ve seen pop up is something along the lines of “If you need to supplement, that must mean your diet isn’t working.” Or you’ve somehow failed. Again, if we lived in a perfect world where it was possible to get all of the nutrients we need in sufficient amounts from food, where everyone was willing to eat the foods that contain those nutrients, and where modern influences like soil depletion, environmental and food toxins, chronic stress, etc. didn’t exist, then yes, I might agree with that statement.
The Paleo diet is a means to an end, not an end in itself.
But in this world, the one most of us live in, supplementation is not necessarily a sign that your diet isn’t working. It’s a means of making it work better. And it can also be that life raft I mentioned above that helps you adapt to a new diet that you’ll thrive on over the long term. When I first switched to a “real food”, Paleo-type diet several years ago, at first I had trouble digesting the large amounts of meat and fat I was eating. My gut was still damaged from the parasites and other gut pathogens I had and the treatments I had done to get rid of them. Should I have given up and gone back to being a vegetarian? I don’t think so; I had already “been there, done that” and I knew what the results were (not good). I knew that if I could just help my body adapt, I’d be able to benefit from the nutrient-dense meats, fats and other foods I was eating.
In the Paleo Troubleshooting Guide I wrote, I used the analogy of someone hooked on heroin. When that person decides to quit, they’re going to go through serious withdrawal, and they’re going to need a lot of support: physiologically, emotionally, psychologically and otherwise. That’s what rehab programs are for. Does that mean it isn’t a good idea for them to get off heroin? Hardly.
Transitioning to Paleo from a Standard American Diet or a vegetarian/low-fat type of diet is not as extreme as quitting heroin, but the analogy still applies. After years of poor nutrition (either too many food toxins or not enough nutrients, or both) and exposure to other harmful aspects of the modern lifestyle, your body may have some recovery or “rehab” to do before it can take full advantage of the Paleo diet.
-It doesn’t matter how nutrient-dense your diet is if you have low stomach acid or impaired enzyme production, because you won’t be able to absorb those nutrients efficiently.
-If your sugar cravings are out-of-control because you can’t metabolize fat properly, you won’t be able to stick with a healthy diet.
-If your detox mechanisms are compromised from nutrient deficiencies and too many toxins, you won’t feel your best.
None of these issues, if they happen, mean that the Paleo diet isn’t a good choice for you. They just mean you need a little extra help — which will be temporary, in the vast majority of cases. (You may also need to tweak your diet a bit to make it a better fit for your needs, which I cover in the Troubleshooting Guide.)
The formulas of supplements aren’t meant to replace nutrients you can get from a healthy diet, nor are they meant to be taken forever (though some may wish to). They’re specific nutrients (vitamins, minerals, botanicals and foods) for a specific purpose (transitioning to and optimizing Paleo) for specific people (those having trouble transitioning to Paleo, or those who simply want to fast-track their transition) a specific period of time (until you’re adapted to Paleo and your health issues resolve). In the end, the goal of therapeutic supplementation is to get you to the point where you don’t need it anymore.
Dogma is the enemy of good medicine. My philosophy on treatment has always been: whatever works and causes the least amount of harm. Much of the time that will be diet. Sometimes it will be a supplement. And yes, occasionally (gasp!) it will even be a drug. The Paleo diet is a means to an end, not an end in itself. Why not use whatever other means we can to achieve our goal of optimal health? We don’t get extra points for wearing loincloths, not showering or brushing our teeth or refusing to go to the hospital when we get in a bad car accident. Most people would agree that clothes, personal hygiene and emergency medical care are welcome modern innovations. We don’t forsake them because they’re not Paleo; we use them because they make our lives better. Supplements belong in this category too — provided we use them wisely and against the background of a nutrient-dense, whole foods diet.