Where food meets medicine – Mayo Clinic Press

Have you ever felt energized after a hearty salad, or sluggish after a slice of cake? Or maybe tomatoes upset your stomach, or alcohol triggers your migraines. Integrative nutrition is all about this connection between what we eat, how we feel, and the bigger picture of our health. And that’s before we even get into all the supplements you can take.

On this episode of On Nutrition, we talk with Dr. Brent Bauer, director of the Mayo Clinic Complementary and Integrative Medicine Program, about how we can combine integrative nutrition with conventional medicine to get the best of both worlds.

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Tara Schmidt: We’re at Mayo Clinic and we pay for the subscription to this giant database of all the supplements in the world. This is “On Nutrition,” a podcast from Mayo Clinic where we dig into the latest nutrition trends and research to help you understand what’s health, and what’s hype. I’m Tara Schmidt, a registered dietician with Mayo Clinic in Rochester, Minnesota. This episode – Integrative Nutrition.

Conventional medicine does a lot for us — we can get surgeries to fix major issues, and pharmaceutical drugs to treat complex conditions — but your health isn’t just whether or not there’s something majorly wrong with you. There are tons of little lifestyle habits and choices that add up to create the big picture of our wellness. For example, do you take a supplement every day? Or are there certain foods that help you feel well — or consistently make you feel unwell? That’s where we get into integrative medicine — and specifically, integrative nutrition.

How do we figure out those practices that keep us feeling good, and when should you reach for a supplement instead of a head of broccoli? To guide us through the ever-evolving world of integrative nutrition, Dr. Brent Bauer is joining us this episode. He’s a doctor of internal medicine and the director of the Mayo Clinic Complementary and Integrative Medicine Program. He researches and evaluates integrative medicine therapies so patients can get the best that conventional and complementary medicine there is to offer. Hi, Dr. Bauer. Thank you so much for hanging out with me today.

Dr. Bauer: My pleasure.

Tara Schmidt: Before we get into the nitty gritty of your field as it relates to nutrition, I would like you to share what you believe are the differences between complementary medicine, integrative health, and I think this is a little controversial, but maybe alternative medicine? But for those who are unfamiliar, can we get your take on those three different terms?

Dr. Bauer: Let’s go back 30 years. You would have most likely heard alternative, or unorthodox. Those were the terms the medical community applied to the things patients were increasingly doing. Acupuncture, yoga, maybe some herbs. That was kind of a pejorative term. Then we started figuring out, no, some of the things patients were doing weren’t replacing medicine.

It’s complementary. We had, for a while, complementary and alternative medicine, or CAM. Then finally we as physicians learn that there’s enough research to suggest that many of these things can be actually beneficial if you bring them together.

What we have at Mayo is what’s called an integrative medicine program, and that’s part of a larger group called integrative medicine and health, but really, the integrative part of this is we do a lot of research. We can answer the questions when our patients come to us and say, “Can I do acupuncture before surgery? Should I use this herb to help my arthritis?” We can give them not only a summation of the data that’s out there, but also how it actually works here at Mayo?

Tara Schmidt: A lot of that has to do with bio-individuality, this idea that we’re all biologically unique. Can you talk to us more about what that means and how it can be applied to what you do and within someone’s diet as well?

Dr. Bauer: If we had 100 patients in front of us, and we gave them all, let’s just pick an herb, they’re all going to take ginseng, we would have probably 100 different responses. Even though we know many patients find ginseng helpful for dealing with cancer-related fatigue, that’s a couple trials we’ve done here at Mayo.

We use that for those patients, not in isolation, but in conjunction with their good nutrition, their exercise and so forth. We have to recognize that we’re all kind of weird and we’re all weird in a good way, but it just means we can’t say this is truth and everybody must follow just the Mediterranean diet or everybody must just eat this many carbs, etcetera.

There’s a lot of individuality that we always don’t get a chance to explore fully in conventional medicine.

Tara Schmidt: When you say that, I feel like the biggest barrier we in the medical community have is time. You’ve got a 15 minute consult. I had a 45 minute consult. I thought that that was pretty wonderful, but we’re just unfortunately time restricted and that can sometimes lead to less personalized care.

But we do the best of course, prior to the visit, during, after to learn about our patients and see what we can use our time for.

Dr. Bauer: That’s the biggest complaint when I see patients from all over the country, all over the world. If they’re coming from around America, 99 percent of them will say, “Gee, I don’t get this much time with my doctor back home.” I’m very quick to point out that it doesn’t mean they’re bad doctors, it just means our system has developed in such a way that we reward patients for doing things to patients. Procedures and surgery are generally pretty well compensated.

Sitting down and having that conversation that can teach them a whole new way of eating, a whole new way of thinking or exercising, that can actually have lifelong benefits, those are generally found very hard to bill for in a way that can compete with the procedure.

We have become very procedure-oriented to a large extent in the medical system. That’s to the detriment of our patients.

Tara Schmidt: Sometimes even dieticians seeing someone for a specific disease state isn’t covered and it just makes me cringe because I feel like there could be so much more than medication or a surgery or a procedure that could be done.

Dr. Bauer: There should be because can you imagine if every patient had an invested, knowledgeable dietitian as part of their annual care? What if they also had a coach? What if they also had a physical therapist? Now, what if we really approached people as the complex human beings that they are?

Then we could really individualize that patient in front of us to the best ability, the nutrition, the exercise. It is really kind of what medicine once was striving to be and then we kind of got derailed with third-party payers and Medicare and this and that. But underneath it all, we still all want to do the best for our patients.

Tara Schmidt: What resources do we have outside of coming into the office so that everyone, even though they probably should, should have a psychologist of some sort. If you can’t show up at a psychologist’s office, is there an app? Is there a Facebook group? We have to be a little bit weary of everything that comes with the internet. But generally speaking, there’s other options and those I feel like are expanding. Absolutely.

Dr. Bauer: That’s, again, where integrative medicine has a nice foothold because I can look at different biofeedback devices. We use some in our executive health program that use the brainwaves, your EEG, to help you understand what stress is, what stress isn’t, and how to biofeedback your way into training the brain which I could do with yoga or tai chi or meditation, but I don’t have time, even in the time I have, to teach all of those things.

But I can give people an app that they can work on and at least get started with. The toolkit is much broader today. And again, patients are more savvy in some regards and they have more access generally. That’s ultimately the most important thing out of this is that really the most important person for our health is us.

What does health mean from an integrative medicine perspective? Obviously I’m going to say, with my dietitian hat on, that food is a big part of health. But what else is there? If we’re talking about health, food is part of how we get optimal health. So is exercise. So is sleep. Our social connectedness, our spirituality, and so is our connection to nature. When I think of health, I think those are the seven main areas.

We have to be engaged in actively thinking about and really thinking of those seven pillars. How do I honor my nutrition each day? Where’s my spiritual practice today? How am I going to connect to nature today?

Tara Schmidt: And advocate.

Dr. Bauer: And Advocate is absolutely right. We have to ask for more from our healthcare system as individuals. Because we’re not getting what we should necessarily right now.

Tara Schmidt: I agree. For patients that you see, tell me about access. Is this a popular path for patients? Is it limited access? Is it more of a fringe choice for some people who are interested in that style of medicine?

Dr. Bauer: My patient population is everybody at Mayo Clinic. If you go into our ordering system and you’re going to order an EKG or order a potassium level, you can also order an acupuncture treatment, you can order a massage, you can order an herb consult. It’s integrated. Integrative medicine is integrated at Mayo Clinic.

Now, does that mean every physician, every nurse, every practitioner here thinks that every time they have a patient in front of them? Of course, the answer is no. But patients who say, “You know, I’d really like to explore the role of supplements,” or “I’d really like to explore whether acupuncture could help me.” Most of the time that will lead the clinician, of whatever stripe they might be, to go to the web or to the ordering system and they can put that in and be seen by not just me, but lots of other folks here.

Tara Schmidt: I’ve used that order before, and especially for patients who are on a long, long list of supplements. I assessed their diet as best as I could, especially related to the nutrients and the evidence in those supplements. Those lists are pretty long, so I put in an order to say, you’re going to sit down with someone who’s probably going to red pen a lot of these and say, you might not need this. This would be a better choice. Or you’re getting plenty of this in your diet.

Hopefully they read my note, maybe not. But we feel very fortunate that we have this gigantic team. Of course, not all health systems have that.

Dr. Bauer: We are blessed because not only do we have really good nutrition folks, we’ve also got a lot of pharmacists who actually make this an area of expertise so that they can look at somebody who’s on a complicated medical regimen like a heart transplant patient, using very important drugs and if we mess them up because of the wrong herb, we’re all unhappy.

We have a lot of expertise. But to your point, that’s not always available in the community. Sometimes you just have to ask, and there is often somebody within a health system that has some knowledge. If not, a lot of this does become personal work, and it’s harder, but again, it’s very important that we don’t get into the, “Well, it’s natural, so therefore it’s safe, so I can take these 20 herbs and not think about it.”

Tara Schmidt: Integrative medicine encompasses a lot of practices, treatments, and therapies that might not be considered ‘capital M’ medicine but can complement conventional medicine and support overall health. When we talk about health, we don’t just mean ‘are you sick’ — it’s nutrition, exercise, sleep, social connectedness, spirituality, and connection to nature. The best way to fulfill those areas is different for everyone because we are bio-individuals, or biologically unique. For example, eating raw garlic might be one person’s helpful health practice and another person’s digestive nightmare.

Integrative medicine and more personalized, holistic care can help just about everyone. For example, just imagine if you could talk about food with me once a month, regardless of a diagnosis. Wouldn’t that be great? And speaking of dietetics, let’s go deeper into the nutrition part of integrative medicine.

In your work, what do you tell people can truly be improved by diet? Do you consider any disease state or diagnosis or condition can be at least improved by diet? Are there some that you focus on the most?

Dr. Bauer: I see patients, I just saw a nice young lady who has a new diagnosis of cancer. I see people who are here because they’re execs and I want to keep my brain strong for the next 20 years. I see the spectrum from what I would consider healthy, but room for improvement all the way to people who are struggling with life-threatening illness.

Every one of them can and should be informed about what nutrition can help with, what to avoid, what we might want to overemphasize because of the specific need. Really, I don’t think there’s anybody who wouldn’t benefit from thinking about an integrative approach to their nutrition.

Tara Schmidt: There’s a few specific diagnoses that we don’t always associate with nutrition. We know that if you have high blood pressure, you would benefit from a DASH diet or a low sodium diet. If you are worried about heart health, then you should consider Mediterranean. We know those and the world knows that.

But what about conditions like chronic pain? Inflammation, gut health, they’re not new, but newer topics that everyone’s talking about.

Dr. Bauer: We’re attuned to those things better than we were 25 years ago. Certainly, when you think of inflammation, that can have a huge contribution from diet, both plus and minus. We think of processed foods, we think of artificial sugars, we think of regular sugar as kind of inflammatory things.

Those are things when I see a patient who has autoimmune disease, inflammation, joints that are hot inflamed, that approach is not going to be just diet, but part of the approach will be, let’s look at what you’re eating that’s increasing inflammation, and then what might you want to emphasize to help decrease inflammation.

That might be more fatty fish, getting the omega 3s, that might be getting some turmeric, as opposed to maybe taking the curcumin supplement, maybe we can cook with more turmeric. There are a lot of opportunities to think about things like that. Gut health, we know so much more now about probiotics, and yet we’re really just scratching the surface. But eating the foods that are good sources of probiotics, the fermented foods, obviously yogurt’s been around for a long time.

Tara Schmidt: High fiber.

Dr. Bauer: A lot of the chronic problems diets are always going to be part of and what we should focus on and try to optimize.

Tara Schmidt: Like you said, there’s both sides to it. There are foods or patterns of eating that can cause or worsen a condition. There are, of course, foods that may put you at decreased risk or lessen your symptoms, etcetera. A lot of them are also, if I can say, individualized, right?

For someone who knows that gluten is inflammatory for them, that’s true. I’d like them to experiment and not just make that assumption based on Google. But people can look me in the eye and say, “Yeah, I don’t feel well. I don’t respond well. It doesn’t work for me.” Then I don’t want the rest of the population to assume that eating whole wheat bread is a bad thing because there’s a lot of people who would benefit from eating whole wheat bread instead of the other types of starches that they’re eating. It can even be different for two people, or a hundred people, like you said.

Dr. Bauer: Making a good case for bio-individuality that we talked about before, I deal with this on a fairly regular basis. People come in and they’ve been tested and they don’t have the biomarkers that suggest that they’re gluten sensitive or that they have gluten sensitivity. Yet, when they go off gluten for a month they feel better, their joints are better. Then I don’t really worry too much about what the blood test says, I worry what the patient says. That’s the idea that, as an individual, I should always think of myself as an experimenter with a group of one. If I think gluten might not be good for me, right where you’re at today, my joints are swollen, my gut isn’t good, I feel yucky.

Then go off gluten for a month and then reassess those things. Now you get a much better idea of whether you truly are. Whether you’re allergic to, or sensitive to, or just don’t do well with. But you’re right, you can’t just hear it on the news, gluten’s bad, and then change your diet, because you may be missing elements that are actually very beneficial for you.

If you’re going to change something, do it with a rational approach, and really think of yourself as an experimenter.

Tara Schmidt: One variable at a time, right? You can’t take out lactose and fructose and gluten and then reintroduce them all back in.

Dr. Bauer: Right. You’ve learned nothing. Right. But now we’re also Americans and Americans generally don’t want to take time. We want an answer today. You really have to take time for each of those eliminations and then reassess before you can make an informed decision about: “Whether I will not eat this for the rest of my life.” Those are big decisions. They shouldn’t be made casually or just because you heard something on the internet.

Tara Schmidt: Sometimes I feel like people take what I would believe is the harder route, more difficult route of, “I’m just going to eliminate all three.” Taking weeks, honestly, to eliminate and then reintroduce and then wait. We do things quite immediately.

Dr. Bauer: But you know what, I find a lot of people who do that, when you go on that restrictive diet, one of the things you’re certainly getting rid of is a lot of processed food.

Tara Schmidt: I agree with that completely.

Dr. Bauer: At some point, you’re going to recognize that for a lot of people, it wasn’t really the gluten elimination. It was the elimination of the high sugar stuff, the stuff with lots of processing, the dyes, all that stuff, the artificial sugars, you get rid of that stuff when you go restrictive. That’s where a lot of people feel great.

If they’ve gotten to a point where now they’re focusing on whole foods and they’re eating more fruits and vegetables because they can’t eat the junk stuff, you can go around the house twice. As long as you come in the front door, we’re all happy.

Tara Schmidt: We all know that we can’t really go wrong with almost all fruits and veggies and those making up the majority of our diet. Are there other specific types of foods or nutrients that can improve some medical conditions?

Dr. Bauer: We alluded a little bit. If you have heart disease, you’re probably going to want to include more fatty fish. You’re probably going to want the oats, fibers, the beans and so forth. Each individual disease probably has some element of that. But also there’s a one size fits all, so everybody who has heart disease should eat beans, right? I mean, that’s a good place to start exploring.

Tara Schmidt: Yes, but how do we actually personalize that or get back to that individuality? There is where you want your team, preferably somebody with nutrition information, your primary care team and bring all that together.

Back to an integrative approach to nutrition. What do you expect first before you treat someone in this way? Do you expect that they have tried the integrative options before we go to medication?

They’ve tried all medication options and now we can go to more integrative things. Does it all get married together at once? It’s sort of like when you think of integrative medicine, it’s really not different from just really good medicine. At the end of the day, what we’re talking about is honoring your spirituality.That’s kind of what medicine is or should be. Well, the same thing with integrative nutrition.

Dr. Bauer: We’re not talking about something really bizarre, far out there. It’s really just emphasizing that more holistic approach, which opens up the door, right. Maybe if I’m wearing my conventional hat it’s going to be, “Let’s talk about the Mediterranean diet. Let’s focus on that. If I wear my integrative medicine hat and I hear you saying, “I can’t eat that way.”

Maybe we do talk about the keto diet. Maybe we do talk about intermittent fasting. We start to open up the opportunities and that gets back to what works for you as an individual, not what I think is the right approach. That’s where I think we start to have fun with this concept of integrative nutrition.

It’s that there is bio-individuality. Also to recognize that I’ll give you some great thoughts. I may be right. I may be wrong, but you’ll tell me in a month full when you say, “I tried it your way. Here’s what I found. This was negative. Great. We’ve learned something. You don’t respond to whatever we tried. We’ll try something different.

Tara Schmidt: You’re not necessarily arguing against conventional medicine. This is not just for patients who don’t want to take a prescription. Okay, you don’t wanna take a prescription, you’re gonna take a supplement. This is part of it. It’s all rolled into one.

Dr. Bauer: Again, much of what we’re talking about from a nutrition standpoint, isn’t really that funky. It’s not really that different. It’s just that I think we get a little more time to think about it if we sit down and say, let’s call this integrative nutrition.

Well, that then helps me think a little more broadly. Like I’ve got to think about the person, where do they live? What is the food available? What are their limitations? What’s their spirituality? Maybe there’s something in their religious background that restricts certain foods. Now we get a little more chance to bring the whole person into the discussion of what we are going to do to optimize that individual’s nutrition?

Tara Schmidt: What I’m picturing is with more integrative medicine and nutrition, you’re saying, “Okay, this is part of

the protocol,” or “this is what the guidelines say,” but let’s also work on the outside of that as well and add some more, subtract some more, whatever is appropriate.

Dr. Bauer: Absolutely. Just about everyone can benefit from integrative nutrition — with the right expectations. It’s highly unlikely that how you eat will cure or treat a condition. But knowing what foods can do things like reduce inflammation versus aggravate it, for example, can be an important part of your overall treatment plan.

Your most important dataset is how you feel as a unique individual. What foods make you feel energized and full? Which ones make you feel sluggish? Your answer will be different from the next person’s, and that’s expected.

Last, but not least, if you want to test how you react to foods by eliminating them from your diet, have patience. If you take out three potential food types at once and feel better, you won’t know which one was the culprit. Start slow and take your time to eliminate and reintroduce before making big decisions about what to stop eating forever.

Now we’re going to talk about a big topic: supplements — what should you be getting from food, and what should you be adding in, and all the gray areas in between.

Tara Schmidt: You might enjoy this topic more than I do, because I just feel like it’s so overwhelming, but let’s talk about supplements. Let’s talk about vitamins and enzymes and minerals. What I’m hearing is that Mayo Clinic is studying them. You are looking at the research, but you’re listening to the values and the preferences of your patients. It doesn’t sound like there’s necessarily a protocol for adding supplements. Where do those fit in in integrative medicine?

Dr. Bauer: The supplements are kind of like phase two. Phase one is to build the foundation.

Where I would start with the patient in front of me is always first, what’s your nutrition, what’s your exercise, what’s your mind, body, what’s your sleep, what’s your spiritual, what are we doing? That’s the foundation. If you start with, “I think I’m going to take this supplement to make this thing better,” and you haven’t built the foundation, that’s a disservice.

People often come with 30 or 40 supplements. Their question is what are the next five I should add? Okay. I used to kind of maybe yell at them a little bit, like, “That’s not very smart,” and then I got a little smart and realized, you know what, that’s a marker for somebody who’s actually trying to be healthy.

When I do an herbal consult, usually 80 percent of the time is spent back over on, let’s build that foundation. Now, if you’ve got a great foundation, and then you still have vitamin B12, B12 deficiency, of course you’re going to take vitamin B12. Maybe once you’ve built a foundation you say, “My arthritis is still really bad. Have you tried glucosamine and chondroitin?” Or if you have an inflammatory arthritis, “have we tried curcumin?” Now we start to target our use of supplements,

Where’s the evidence that a certain supplement would fit for you as an individual as opposed to, “I saw something on TV last night, I should start taking that.”

And then again, I always try it as an experiment. If I think you could benefit from glucosamine for your joints, I have them rate all their joints, like, “Oh, my knees are eight out of 10 pain” and then write it down and then take the glucosamine for three months.

Now re-rate all those same joints, and if you see, “Gee, my knees were eight out of 10. Now they’re three out of 10.” It’s not proof that the glucosamine did that, but it’s a pretty good indication that you’re getting benefit.

We might do some blood tests to make sure there’s not any idiosyncratic or weird reaction. But that’s a good way to say, okay, for you, you do respond to glucosamine. We don’t see any negative effects. That becomes part of your integrative approach. It’s not replacing good nutrition. It’s not replacing weight loss.

It’s not replacing physical therapy, but it’s an evidence-based adjunct applied to you as an individual.

Tara Schmidt: You were your own guinea pig. When we say the word supplement, I like to remind people to think about that word. You shouldn’t just jump to taking calcium. You can take calcium if necessary to supplement your diet because you don’t have enough calcium in your diet. That’s okay. But I’ll likely do an actual math equation to see how far away you are before I say, “Okay, I understand you don’t do any form of dairy. I get that that’s a heck of a lot of broccoli to get down. Okay. Maybe. Maybe.”

But also please talk to a medical provider so that they can look at your other medication lists, your medical history, etcetera. I really actually like pulling up one of the databases that we use and saying, “Okay, these are the 10 studies that have been done on this supplement. Most of them say there is limited evidence to support X, Y, and Z.”

I actually feel like that’s a good educational experience for the patients to say, “I don’t even know.” We’re at Mayo Clinic and we pay for the subscription to this giant database of all the supplements in the world.

Dr. Bauer: But you’re hitting one of the challenges, right? Because most of the supplements are not things that can be patented. Whereas if we have a new drug, there’s probably a drug company that’s invested hundreds of millions of dollars, and so they will pay a lot.

Tara Schmidt: Thousands of people.

Dr. Brent Bauer: Many of the trials we’ve done with supplements we’re happy if we get a hundred or two-hundred patients. They can still teach us something. But they’re not going to be definitive. You can’t say, “Well, we did a study of 200 patients and always, everybody will exactly get this result.” We really need thousands and thousands of patients.

We’re really going to get that, and until we do, we have to recognize the limitations of the knowledge in front of us. That’s why individualizing, not every patient gets that response and maybe a vanishingly small number get adverse events that I’ve never heard of before.

That’s why I approach everything just like with a new medication. I give you a new pill for your blood pressure, you get a cough, well that’s probably an ACE inhibitor effect. I’m going to put you on a non ACE inhibitor so we can get the benefits without getting the side effects. We should approach supplements the same way.

Tara Schmidt: How often do you see supplements, let’s say, backfire. We know we have this excellent vitamin E example from a while back. Do you still see that type of thing happen where the supplement has absolutely no positive effect, only negative, or supplements that we thought were going to be beneficial, but actually did the opposite?

Dr. Bauer: I don’t know if it’s a supplement per se, but coffee enemas, were in the news for quite a while and we still have a few patients going to Mexico for those, we’ve seen some patients actually get in real serious trouble with electrolyte imbalances, so there’s always going to be those things out there that people are going to try and do.

There’s also things that probably, if used correctly, were okay. But then we take and say, “Well, gee, if two’s good, 50 must be better. We’ve seen liver transplants as a result of what we remember when the ephedra was very big. Ephedra is a little herb that’s actually not bad for weight loss if used very carefully and very appropriately with supervision, but we’re Americans. We want to lose weight. They say take two, but I’m going to take 20. All of a sudden we had people get liver damage.

St. John’s wort, very popular for depression, actually works fairly well for mild depression in some cases, but it’s got a real predilection for changing the metabolism of a lot of other drugs. Women on oral contraceptives, not pregnant, take the St. John’s wort, they get pregnant because the oral contraceptive has been rendered so low it’s not effective.

There is that element that we have to kind of push back a little bit. It’s a natural thing. It’s from nature. Therefore, it’s safer than a pharmaceutical drug. Sometimes that’s true. Sometimes it’s not. That’s where we have to have that stop, learn, talk to your primary care team, talk to a professional who’s got extra information before you just bring things on board.

Tara Schmidt: I actually fell into a rabbit hole fairly recently from Instagram. It was talking about a nutritional supplement. I just wanted to learn more and all of the reviews were just raving and everyone’s life changed, blah, blah, blah. Then I came to find it’s a multi-level marketing thing.

Dr. Bauer: Yeah.

Tara Schmidt: But not everyone’s going to have a realization or take the time to really dig that far to say, “Oh. Maybe this was fabulous for lots and lots of people and I’m happy for you. But there’s also a high chance that it’s not.”

Dr. Bauer: Sometimes the things that are out there are actually things we should know about or should be doing. I think of vitamin D, right? 20 years ago, vitamin D was big in the quote alternative end quote world. Generally conventional medicine, we weren’t too excited about.

Then we started seeing some studies where vitamin D deficiency could actually impact your immune function, could obviously impact bone function, might impact the brain. All of a sudden we went from something that was out there. Now it’s one of the more commonly ordered tests at Mayo Clinic.

Again, the pendulum’s kind of gone the other way. It went from we don’t think about it to maybe we taking too much of it.

Tara Schmidt: We’re over-supplementing.

Dr. Bauer: But again, this is where I know there’s no benefit to taking extra. Don’t do that. If I’m deficient, get it to the normal level. But again, we learn sometimes from the things that are maybe a little fringe-appearing, and I’ve tried to not immediately say, “Oh, that could never be true.” I always try and step back to see, have they figured out something that we as conventional physicians have not? Then half the time, it’s a money-making scheme, and it’s good to shut it down and go away from it. But every once in a while, that’s where we learn something like, “I never would have thought of that before.”

Tara Schmidt: I’ll say to patients a lot that research is always moving. There may have been some mistakes that we’ve made in the past because we didn’t have enough information. We being on the more conventional kind of conservative side of medicine may not have yet accepted something that we absolutely will scream from the rooftops in 10 years, but it’s complicated, and you’re welcome to do your own research. If I or Mayo or the Academy of Nutrition doesn’t recommend something, you are still welcome to do research, and I’ll probably do a little bit too. Hopefully we can come up with a good answer.

Dr. Bauer: Anybody that thinks medicine is infallible hasn’t talked to me enough because I started medical school at Mayo Clinic 40 years ago, and I can tell you a lot of things that were taught, kind of like, this is gospel. This is how we do things. We no longer do that, and I don’t think that’s a reflection on, “Boy, they were stupid back then,”or what it is, is we learn.

Tara Schmidt: In the years of my career, I’ve become a little bit more neutral to hearing about integrative medicine because at first, I felt like it was a little bit black and white and that’s what I was taught to do and to practice and evidence-based. As time has gone on, I have felt myself just being more open. Because I’m not going to argue with how someone feels.

Especially in this world of nutrition and supplements specifically, I will just kind of use a scale and say, “Okay, is this harmful? Well, Sometimes they are. Is this neutral? Is this helpful? Where’s the risk in it?” There’s always going to be some risk. You have to just kind of weigh that out.

Dr. Bauer: Well, there’s a nice little grid. I mean, the four squares, what works and what’s safe? We should use it. What works, but has risks, we might use it, but we have to really think. What doesn’t work, but it’s safe, that might be an individual choice. What doesn’t work and what isn’t safe, we have to say no.

Tara Schmidt: I explained that so much better than I did. Thank you.

Dr. Bauer: But that’s kind of the thought process. If there’s evidence and it’s relatively safe and if it’s improving our care, what we offer to our patients or what we do for ourselves, we can endorse that. If it’s a risk, but there’s still a benefit, that’s an individual choice. We have to think more.

If it’s not helping, but it’s not dangerous, I don’t have to fight with my patient if they want to use it. Homeopathy, when they get the sniffles, that’s how I fight my colds. I know that there’s really not much risk with it. There may not be strong evidence that it works, but that’s a much better conversation than, “I have the sniffles, I want an antibiotic.”

Then there’s things that are definitely harmful and don’t have any evidence to work. Those are ones we have to, from a conventional standpoint, say no, we think that’s wrong and not to do it, because there’s risk and there’s not enough benefit.

Tara Schmidt: When we talk about experimenting essentially with our own health and with these pillars, etcetera. How does someone know if the approach is working for them? Is this, like you said, kind of on a scale of 1 to 10? Is there an improvement or is there a positive change? Is that as easy as it is?

Dr. Bauer: That question goes back to the individual. Whatever your interest is, whatever you might be reaching to the shelf or clicking on whatever website you order your things through, ask yourself, why would I want that? Well, I want to take X because I heard on the radio that it will lower my cholesterol. I want that because it’s supposed to help my joints. I want that because it’s supposed to improve my sleep. Okay, let’s look at the information. Is it plausible? Is there any existing evidence to say it might work?

Is there any evidence about its safety? If we get, “Well, it looks pretty safe. There’s something intriguing here. It might work.” Now your homework is, get your baseline. I’m going to take this because I think it’ll improve my sleep. Well, what’s wrong with my sleep? It takes me two hours to fall asleep.

I wake up six times, I wake up unrefreshed. Okay, that’s my baseline sleep. Take it for a month, take it for six weeks. How’s my sleep? Then look back at those same outcomes and just measure, and if it hasn’t changed at all, it doesn’t mean it’s a bad supplement, it just means individually, it’s not working for you.

Then we make a little note. I always try to get people to write down, “I tried melatonin, I do not respond,” so that two years from now we won’t say, “Well, why don’t we try melatonin?” The idea of recording what works and also what doesn’t work, then we can say, “Okay, well, if that didn’t work, what’s the next thing we should try?”

Tara Schmidt: You talk about the other six pillars, though. Would you prefer that they work on their stress management first? Are they exercising and are they having caffeine too close to when they’re going to bed? The question would be, do they adapt things with the other six pillars before we do the experiment with the supplement?

Dr. Bauer: First and foremost sleep is such a common problem. Conventional HAT, we always talk about, are you drinking caffeine too late in the day? What’s your amount of aerobic exercise? Are you using a device before bed? Let’s first of all, get rid of all those, take an hour before bed, get an old-fashioned book, soft light, read the book, maybe do a meditation or something, so we’re preparing the brain to get natural melatonin, to get natural sleep cycles.

I really try to get people to do really aggressive sleep hygiene for about three months. Then, if they say, “Look, I did all that, I’m sleeping a little better, but I’m still having struggles,” now we have an opportunity to say, maybe this is where we’d explore melatonin, or theanine, or valerian. Some people seem to benefit from it. But again, now we’re going to do the experiment, keep the foundation, we don’t get rid of the foundation, keep the foundation. But on top of that we add in melatonin. But again, we rate before and after.

Tara Schmidt: I completely agree. We also know that with some supplements, you can buy these super large doses, way more than you would get from eating food. That reminds me of what happened with Vitamin E a while back. What can we learn from these cautionary tales?

Dr. Bauer: We know vitamin E is important. We need vitamin E. It’s not a bad vitamin. But somewhere along the line, maybe 20 years ago, we got the idea that, well, if a little’s good, a lot’s got to be better. People who have diets that are rich in vitamin E seem to have lower heart disease, we simplistically said, ah, it must be the vitamin E. Let’s take a lot of vitamin E and really push that heart disease down.

Actually what turned out is heart disease went up. I think it’s the same trouble with, take your pick, beta carotene, antioxidants. When we eat the foods, we generally get these really cool things that happen.

But for Americans and Americans saying, “Well, I could change my entire diet and eat these really healthy foods.

Dr. Bauer: Or, I’ll just take super doses, and I’ll get the same benefits, and unfortunately, it almost never works, and in some cases, like vitamin E, it actually leads to bad things. Before I take a supplement, I really try to get patients to optimize what they’re getting in their diet. Can we get enough vitamin C in our diet without having to take vitamin C? Most of us can. Can we get enough vitamin D when we’re older? Sometimes no. If you’re low, I’m going to have you take a vitamin D supplement, but I’m going to do it at a range that brings us to a normal level, not super high.

Tara Schmidt: You can’t get the amounts of these nutrients in excess in your diet in most cases, right? If you eat that many carrots, you will actually start to turn orange, like your hands, it will be orange and people don’t eat that many carrots. I would actually love them if they started eating that many carrots. There’s just such a difference between the amount that you would generally consume via diet and then the amount that’s in these supplements.

Dr. Bauer: The perfect example is water. We can die if we drink too much water. We can dilute our electrolytes and we can die. There is no such thing as a safe. This is all, everything, it really comes down to dose and how you use it. But it’s pretty hard for most of us to get into trouble like I’m getting too many antioxidants because I ate 14 pounds of grapes. I guess you could try and do it that way, but you’re going to get stopped. We’re going to get full. I’m sick of grapes. It’s pretty hard to get in trouble from a food standpoint, but it’s relatively easy to get into trouble when we start indiscriminately, not with guidance, not with good science, not with an evidence-based approach, but indiscriminately, “Oh, I heard this is good. I’ll take five. I’ll take 10. I’ll do it at super high doses. Again, there’s no free lunch.

Let’s be really thoughtful about all seven domains of how we optimize your health and then let’s do it right.

Tara Schmidt: It has to be hard sometimes, right? The easy thing would be to just go to your local pharmacy or drugstore and grab it off the shelf and take it. That’s 0.1 second out of your day.

Dr. Bauer: If I find that you won’t be talking to me again because I’ll be so rich.

Tara Schmidt: That’s what I say about weight loss, Dr. Bauer. Yes, I haven’t found the secret yet, you guys. I will not be here if I do. Thank you so much for all of your time today, Dr. Bauer. You are an absolute wealth of knowledge, and we are so happy that you agreed to come on.

Dr. Bauer: I appreciate it very much. I hope everybody does a great job with those seven domains.

Tara Schmidt: If you’re considering supplements, remember there’s no magic pill to get you out of healthy habits. Before and even during taking supplements, it’s important to have a solid foundation of a healthy lifestyle. That includes eating a balanced diet, and giving yourself a chance to get nutrients from food rather than relying on a capsule.

When you do decide to take a supplement, do your research and involve your care team. Sometimes our current research won’t be able to predict if something can help you — but we can decide if there’s minimal risk and if it’s worth a shot. Or if it’s too risky to pursue. It’s ultimately your decision, but you should walk into that decision being informed, while still being open-minded.

Once you’ve done your research, you should also record your baseline. How can you measure how you feel now, so you’ll notice changes? That way, weeks later, it’ll be easier to tell if a supplement is doing what you’d hoped. Don’t forget to keep your care team informed of your progress as well. We want to know!

That’s all for this episode. But if you’ve got a question or topic suggestion, you can leave us a voicemail at 507-538-6272 — we might even feature your voice on the show.

For more “On Nutrition” episodes and resources, check us out online at mayoclinic.org/onnutrition. If you found this show helpful, please subscribe, and make sure to rate and review us on your podcast app — it really helps others find our show. Thanks for listening! Until next time, eat well and be well.