The Essentials Shelf

Form that was studiedWHEY outperformed other protein types head-to-head in a network meta-analysis. Plant blends are a reasonable substitute if dairy is a problem — pair pea with rice to cover the amino acid profile.

Dose as studied20-40 g per serving to reach a daily target of roughly 1.2-1.6 g per kg body weight; the trials that worked ran AT LEAST 24 WEEKS

The honest readReal but modest. In sarcopenia the gains in grip strength and muscle mass were statistically significant yet SMALL — one meta-analysis noted the difference did not exceed the minimum considered clinically meaningful. Protein is an amplifier of resistance training, NOT a substitute for it: the same reviews find nutrition plus exercise beats either alone.

Who should skip thisSkip it if you are already hitting your protein target from food — there is no bonus for exceeding it. And note the honest negative: in PRE-FRAIL AND FRAIL elderly, a controlled trial found neither whey, nor soy, nor leucine, nor creatine improved training adaptations. Frailty is not the same population as sarcopenia.

Form that was studiedMONOHYDRATE. It is the form studied in essentially all of the literature, and it is the cheapest — the exotic forms carry a price premium and no advantage.

Dose as studied3-5 g daily (about 0.3 g/kg). NO LOADING PHASE REQUIRED — trials show taking it only on training days still works. Carbohydrate co-ingestion adds nothing.

The honest readTwo findings that surprise people. FIRST, MEMORY: a meta-analysis found creatine enhanced memory performance in healthy people, most clearly in ADULTS AGED 66-76. A 2026 trial in perimenopausal and menopausal women found improved clinical outcomes and raised brain creatine. SECOND, THE HAIR MYTH IS TESTED AND FAILED: a 12-week RCT directly examining hair-follicle health found strong evidence AGAINST the claim that creatine causes hair loss.

Who should skip thisSkip if you have significant kidney disease — not because creatine has been shown to cause harm in healthy kidneys, but because it raises creatinine on lab tests and can muddy monitoring. Tell whoever orders your bloodwork that you take it.

Form that was studiedLeucine or an EAA blend; HMB is a leucine metabolite sold separately.

Dose as studiedleucine ~2.5-3 g with a protein-containing meal; HMB 3 g/day in the sarcopenia trials

The honest readA systematic review named LEUCINE as having the best evidence for muscle mass in older people with sarcopenia, and an RCT found HMB enhanced the strength, performance and muscle-quality gains from resistance training. But whey already contains leucine — for most people a protein shake is the simpler and cheaper way to get it.

Who should skip thisSkip if you are already using whey — you are buying the same active ingredient twice. Same frailty caveat as protein.

Form that was studiedD3 (cholecalciferol). Taking it WITH magnesium may raise blood levels more than D alone.

Dose as studiedrepletion dosing guided by a blood level — this is one of the few supplements worth TESTING rather than guessing

The honest readTHE EVIDENCE HAS NARROWED, AND WE FOLLOW IT DOWN. The Endocrine Society's 2024 guideline suggests empiric vitamin D for defined groups — ages 1-18, ADULTS OVER 75, pregnancy, high-risk prediabetes — not for everybody. Meanwhile a 2026 BMJ meta-analysis found little to no benefit from vitamin D, calcium, or both for preventing FRACTURES AND FALLS, and VITAL found no fracture reduction in adults not selected for deficiency. Where it does earn its place: correcting a documented deficiency, and alongside whey protein in older adults, where the benefit appears to come from fixing insufficiency.

Who should skip thisSkip the reflexive high-dose habit if your level is normal. Vitamin D is not an analgesic — the VITAL pain analysis found no effect on pain prevalence or severity at consumer doses.

Form that was studiedNot a single product: whey protein, a fiber supplement (psyllium), electrolytes, and — the non-negotiable part — resistance training.

Dose as studiedprotein toward 1.2-1.6 g/kg/day, which is HARDER on a drug that suppresses appetite; fiber titrated up slowly with fluids; resistance training 2-3x weekly

The honest readTHE FINDING THAT MATTERS AND ITS CORRECTION. Potent GLP-1 medications produce greater weight loss but a SIGNIFICANT REDUCTION IN LEAN MASS. The crucial 2026 nuance is that lean-mass loss is BROADLY COMPARABLE between these drugs and lifestyle-based weight loss — so it is a consequence of losing weight fast, NOT a poison in the drug. And the actionable half of the same review: MUSCLE MASS CAN BE SIGNIFICANTLY PRESERVED BY INTEGRATING RESISTANCE TRAINING. Protein and lifting are how you make sure the weight you lose is fat. Fiber and fluids address the GI side effects that are the main reason people quit.

Who should skip thisNothing here replaces the medication or the follow-up. If you are not doing the resistance training, the protein powder alone is not the protocol — it is the smaller half of it.

Form that was studiedUbiquinone is the form most of the outcome data used; ubiquinol is marketed as better absorbed but one comparison recommended plain CoQ10 on the strength of its trial record.

Dose as studied100-300 mg/day with a fat-containing meal

The honest readWHERE IT EARNS ITS PLACE, AND IT'S RELEVANT HERE: a 2024 systematic review found CoQ10 significantly improved STATIN-INDUCED MUSCLE SYMPTOMS — with or without lowering the statin dose, and without side effects of its own. In a pain practice this matters, because statin muscle pain is common and routinely mistaken for something else. Second, MIGRAINE: a meta-analysis found reduced attack duration and frequency. Third, HEART FAILURE, which is genuinely contested — a Cochrane review found no convincing evidence while a 2024 meta-analysis reported reduced mortality and hospitalisation.

Who should skip thisSkip it as a general energy supplement — that is not what the evidence supports. If you take warfarin, tell us: CoQ10 can reduce its effect.

Form that was studiedBeta-alanine (the tingling is harmless), citrulline malate, beetroot juice or nitrate, caffeine.

Dose as studiedbeta-alanine 3-6 g/day; caffeine 3-6 mg/kg pre-exercise; nitrate per product

The honest readA useful piece of curation: a 2024 review naming the supplements with strong evidence for performance came up with a SHORT list out of an enormous market — CREATINE, BETA-ALANINE, NITRATES, CAFFEINE and PROTEIN. Two of those you already have on this shelf. Almost everything else marketed for performance did not make the list.

Who should skip thisSkip nitrate/beetroot if you take nitrates for angina or PDE5 inhibitors — the blood-pressure effect can stack. Skip caffeine late in the day if sleep is any part of your problem, which for pain patients it usually is.

Form that was studiedPsyllium husk is the best-studied for regularity; food-first is still better where possible.

Dose as studiedstart LOW and increase over weeks with plenty of fluid — going fast is what causes the bloating people blame the fiber for

The honest readThe British Dietetic Association published the first comprehensive GRADE-based dietary guidelines for chronic constipation in 2025, and fiber recommendations sit at their core. Particularly relevant for anyone on a GLP-1, where constipation is a leading reason people abandon an otherwise effective medication.

Who should skip thisSkip rapid dose escalation. If you have a known stricture or motility disorder, ask first.

Form that was studiedPowders or tablets; read the sodium content, because that is usually the active part.

Dose as studiedper situation — heat, heavy sweating, illness, or a medication that suppresses appetite and thirst

The honest readTwo groups on our own list have a real reason for this. FIRST, ANYONE ON A GLP-1 MEDICATION: reduced appetite and thirst plus GI side effects make dehydration easy, and it is a common reason people feel awful on an otherwise effective drug. SECOND, PEOPLE WITH POTS or orthostatic intolerance — often alongside hypermobility — where increased salt and fluid is standard advice rather than a supplement fad.

Who should skip thisSkip if you have high blood pressure, heart failure or kidney disease and nobody has told you to increase salt — in those conditions this is exactly the wrong move. Ask first.

Form that was studiedA standard broad-spectrum multivitamin. ⚠ AVOID formulas containing BETA-CAROTENE.

Dose as studiedone daily with food

The honest readTHE CLAIM WE WILL MAKE AND THE CLAIM WE WON'T. Will: the COSMOS program — a large randomized trial with multiple substudies — found daily multivitamin use IMPROVED MEMORY in older adults and produced a more favourable two-year change in episodic memory, with meta-analysis across its substudies supporting benefit for global cognition. Won't: the USPSTF evidence report found little or no benefit for preventing cancer, cardiovascular disease or death. So this is a COGNITION-and-insurance product, not a disease-prevention product, and anyone selling it as the latter is ahead of the evidence.

Who should skip this⚠ AVOID BETA-CAROTENE-CONTAINING FORMULAS: the same USPSTF review found beta carotene associated with an INCREASED RISK OF LUNG CANCER. Skip the megadose 'high-potency' versions — more is not better here.

Form that was studiedFish oil, or ALGAL oil for vegetarians and vegans. Prescription icosapent ethyl is a different product with a different evidence base.

Dose as studied1-2 g/day EPA+DHA for general use; triglyceride lowering is dose-dependent and near-linear

The honest readFORMULATION AND POPULATION DECIDE THIS ONE. Prescription icosapent ethyl at 2 g twice daily reduced ischemic events in people with high triglycerides already on statins (REDUCE-IT) — but a different high-dose formulation tested against corn oil showed NO cardiovascular benefit (STRENGTH). Consumer fish oil reliably lowers triglycerides and improves CRP, TNF-alpha and IL-6. It does NOT reliably do much for pain: the VITAL trial found no effect on pain prevalence or severity over more than five years.

Who should skip thisSkip if you are taking it FOR PAIN — that is the one thing a large long trial specifically ruled out at consumer doses. Discuss timing before procedures.

Form that was studiedGLYCINATE (gentlest, best for sleep) or CITRATE (better absorbed than oxide, mildly laxative). ⚠ MAGNESIUM OXIDE is the cheap default in drugstore bottles and is POORLY ABSORBED.

Dose as studied200-400 mg elemental in the evening

The honest readWHERE IT HELPS: magnesium supplementation reduced inflammatory markers including CRP, and a randomized trial found short-term magnesium alleviated moderate stress and reduced the pain experience in FIBROMYALGIA. WHERE THE EVIDENCE IS WEAK: sleep — a systematic review concluded the literature is SUBSTANDARD for making firm recommendations. WHERE IT LIKELY DOESN'T WORK AT ALL: a Cochrane review found magnesium unlikely to help muscle cramps, which is probably the single most common reason people buy it.

Who should skip thisSkip magnesium OXIDE specifically. And skip it for cramps — Cochrane looked and did not find it.

Form that was studiedFERROUS BISGLYCINATE. It raised haemoglobin at least as well as older salts while causing FEWER GI side effects — which matters because nausea and constipation are why most people stop taking iron.

Dose as studiedper your lab results; alternate-day dosing is often better absorbed and better tolerated than daily

The honest readThis is a TEST-FIRST supplement, not a guess-first one. In iron-deficient female athletes, about 100 mg elemental iron daily or alternate-daily improved endurance performance. Ferritin is the number to ask for.

Who should skip this⚠ DO NOT take iron without a documented deficiency. Iron overload is genuinely harmful, men and postmenopausal women rarely need it, and hereditary haemochromatosis is far more common than people realise. Test, then treat.

Form that was studiedHydrolysed collagen peptides taken WITH vitamin C, which is required for collagen synthesis.

Dose as studied10-15 g collagen with ~50 mg vitamin C, roughly 60 minutes BEFORE loading exercise

The honest readThe timing detail is the interesting part — the rationale is to have amino acids available when the tendon is being loaded, which is why 'before exercise' appears in the protocols rather than 'any time of day'. Treat it as an adjunct to the loading program, which is the actual treatment.

Who should skip thisSkip if you are not doing the loading exercise — the supplement is the smaller half of that pairing.

Form that was studiedOral works for most people, including many with absorption problems, at adequate doses. Injections are for confirmed severe deficiency or malabsorption.

Dose as studiedper your level; maintenance doses vary widely by cause

The honest readTHIS IS A TEST-AND-TARGET SUPPLEMENT, NOT A GUESS ONE. Deficiency is common in older adults, in vegans and vegetarians, and — the group people forget — in anyone on METFORMIN or a long-term ACID-REDUCING MEDICATION (a PPI), both of which impair absorption. Untreated, it causes nerve damage that can become permanent, which is why we would rather check than assume.

Who should skip this⚠ MORE IS NOT BETTER, AND THIS ONE SURPRISES PEOPLE: persistently elevated B12 above 1,000 pg/mL on two measurements has been associated with solid tumours, blood cancers and increased cardiovascular death. A high B12 is a reason to investigate, not a sign you are winning. Don't megadose it indefinitely without a reason.

Form that was studiedGluconate, sulphate or citrate. Lozenges for colds are a different product from a daily capsule.

Dose as studied8-11 mg/day covers normal needs; short courses at higher doses for a cold; long-term high doses need copper attention

The honest readThe common-cold evidence is where most people meet zinc, and it is messier than the marketing: a 2024 review found substantial variation in what was given and how outcomes were measured, plus incomplete reporting, which should temper confident claims about shortening a cold.

Who should skip this⚠ TWO REAL INTERACTIONS. Zinc can REDUCE ABSORPTION of ciprofloxacin, doxycycline and risedronate — separate the doses by several hours. And sustained high-dose zinc causes COPPER DEFICIENCY, which can itself cause neurological problems, so long-term high doses are a conversation, not a habit.

Form that was studiedPlain ascorbic acid is fine; the expensive liposomal versions have not shown they earn the premium.

Dose as studied500 mg/day is plenty for most purposes; ~50 mg is enough when pairing it with collagen before exercise

The honest readTHE PAIRING IS THE POINT: collagen taken WITH vitamin C improved rate of force development in trained movements — vitamin C is required for your body to build collagen, which is why we pair them rather than selling collagen alone. It also improved work motivation and attentional focus in people whose baseline vitamin C status was INADEQUATE, which is the honest framing: correcting a shortfall, not boosting a normal level.

Who should skip thisSkip the megadoses. Above roughly 1,000 mg/day you mostly make expensive urine, and large doses can cause diarrhoea and, in susceptible people, kidney stones. It is also not a cold cure — that claim outran the evidence decades ago and never caught up.

Form that was studiedOral; the intravenous trials are a different intervention and their results don't transfer.

Dose as studied600 mg/day is the most-studied oral dose, with a dose-dependent effect on symptoms

The honest readA meta-analysis found oral ALA improved neuropathic symptoms with a clear dose-response. The honest limitation, stated by the reviewers themselves: the trials were at HIGH RISK OF ATTRITION BIAS, meaning enough participants dropped out to make the results less certain than the numbers suggest. Note also that for CHEMOTHERAPY-induced neuropathy specifically, a review could not recommend any supplement at all.

Who should skip thisSkip if you're hypoglycaemic or on insulin without telling us — ALA can lower blood sugar further.

Form that was studiedMyo-inositol, often combined with D-chiro-inositol in a 40:1 ratio.

Dose as studied2-4 g/day in the PCOS trials

The honest readA CLEAN EXAMPLE OF WHY WE HAVE A DEBATED LABEL. The systematic review commissioned to inform the 2023 International PCOS Guideline concluded the evidence is LIMITED AND INCONCLUSIVE. A different 2023 systematic review concluded inositol is effective and safe, and non-inferior to metformin on most outcomes. Both are real reviews by real teams. We are not going to pick the flattering one for you.

Who should skip thisNot a substitute for the medical management of PCOS. If you're being treated, this is a conversation to have with that clinician, not a replacement for them.

Form that was studiedBerberine HCl.

Dose as studied500 mg two to three times daily in most trials

The honest readThere is a real clinical literature here on glucose and lipid effects, and reviews of dozens of human studies exist. But the internet comparison to GLP-1 medications is not supportable: the effect size, the outcome data and the safety record are not in the same category, and no trial has tested them head to head for weight.

Who should skip this⚠ BERBERINE IS A MEANINGFUL DRUG-INTERACTION RISK — it inhibits the liver enzymes that clear many medications, so levels of other drugs can rise. If you take anything prescribed, especially blood thinners, immunosuppressants or diabetes medication, check with us before starting. Skip in pregnancy.

Form that was studiedNicotinamide riboside or nicotinamide mononucleotide.

Dose as studied250-500 mg/day in most human studies to date

The honest readLABELLED THEORY, DELIBERATELY. These reliably raise NAD+ levels in the blood — that part is real and measurable. What has not been shown is that raising that number produces the outcomes people are buying it for: more energy, slower ageing, better muscle. Human trials so far are small, short, and focused on safety and biomarkers rather than on whether anyone actually feels or functions better.

Who should skip thisIf you buy this, buy it knowing you are funding a hypothesis. That is a legitimate choice — it just isn't the same as buying a proven product, and we would rather say so.

Form that was studiedMelatonin in LOW dose; glycine 3 g; L-theanine 200 mg.

Dose as studiedmelatonin 0.5-1 mg taken 1-2 hours before bed — the 5-10 mg tablets sold everywhere are far above the studied physiological range

The honest readAmino acids, vitamin D and melatonin showed benefit for sleep quality in meta-analysis, though with high heterogeneity. The honest framing: these help at the margins, and NONE of them outperforms fixing sleep timing, light exposure and alcohol. This atlas screens sleep in every patient for a reason — a secondary analysis found baseline sleep disturbance blunted pain-treatment response REGARDLESS of the treatment given.

Who should skip thisSkip high-dose melatonin — more is not better and the studied doses are small. If you snore, stop breathing at night, or wake unrefreshed despite enough hours, you need an apnea screen rather than a supplement.

Form that was studiedStandardized root extract; withanolide content is what varies between products.

Dose as studied125-600 mg/day — a 2024 trial found stress reduction at a LOW dose of 125 mg/day, dose-dependently

The honest readTwo independent systematic reviews found beneficial effects on stress and anxiety with limited adverse effects, and a further review found benefit for sleep. The consistent caveat across all of them is that SAFETY DATA ARE LIMITED and higher-quality studies are still needed.

Who should skip this⚠ UPGRADED WARNING (2026-08-30): a published CASE SERIES describes ashwagandha-induced liver injury presenting as CHOLESTATIC HEPATITIS, which can progress to acute-on-chronic liver failure with HIGH MORTALITY IN PEOPLE WHO ALREADY HAVE LIVER DISEASE. Do not take this if you have any liver condition. Stop immediately and call us for dark urine, itching, yellowing of the eyes or skin, or unusual fatigue. Also skip in pregnancy, in thyroid disease without supervision, and with immunosuppressants.

Form that was studiedTHE STRAIN IS THE PRODUCT. B. coagulans performed best in one network meta-analysis; Bifidobacterium and Lactobacillus dominate the trials. A bottle that lists only 'probiotic blend' with a CFU count is telling you nothing that matters.

Dose as studiedper the studied strain; 4-8 week trial then reassess

The honest readCONTESTED TIER AND WE MEAN IT. A Gastroenterology systematic review found some combinations may be beneficial in IBS but that GRADE certainty was LOW TO VERY LOW across almost all analyses, and that the most effective strain or combination REMAINS UNCLEAR. Prebiotics and synbiotics did not show significant improvement in the same body of work.

Who should skip thisSkip if you are immunocompromised or have a central line without asking us first. Skip any product that will not name its strains.

Form that was studiedFood first — dairy, fortified alternatives, tinned fish with bones, leafy greens.

Dose as studiedaim for total intake ~1000-1200 mg/day from FOOD PLUS supplement, not supplement alone

The honest readDOWNGRADED HERE ON PURPOSE. A 2026 BMJ systematic review found little to no benefit from calcium, vitamin D, or the combination for preventing FRACTURES AND FALLS at thresholds considered clinically meaningful, and a Cochrane review concluded no further studies are needed in the general population of premenopausal women. Bone density responds far more to RESISTANCE AND IMPACT EXERCISE than to a calcium tablet.

Who should skip thisSkip high-dose calcium supplements if your diet is already adequate. If you have osteoporosis, the conversation is about prescription therapy and loading exercise — not about which calcium to buy.

Form that was studiedMK-7 is the long-acting form used in most bone trials.

Dose as studied90-180 mcg/day, typically alongside vitamin D

The honest readA meta-analysis in postmenopausal women found K2 improved lumbar-spine bone density and reduced fracture incidence, and a separate meta-analysis found vitamin K PLUS D together increased total bone density more than D alone. The honest counterweight: a broader review of bone supplements called the K2 data INCONCLUSIVE. So: promising, mechanistically sensible, not settled.

Who should skip this⚠ DO NOT TAKE THIS IF YOU ARE ON WARFARIN without talking to whoever manages it. Warfarin works by blocking vitamin K — supplementing it directly opposes the medication and can put your INR somewhere dangerous. This is the single most important interaction on this whole shelf.

Form that was studiedGlucosamine SULFATE 1500 mg/day is the form and dose with the supporting data — not the hydrochloride.

Dose as studied1500 mg/day, judged over a 3-6 month trial

The honest readWE TIER THIS DEBATED BECAUSE SERIOUS SOURCES GENUINELY DISAGREE. Systematic reviews in 2023 and 2025 found glucosamine more effective than placebo for knee osteoarthritis pain and well tolerated long-term. The 2019 American College of Rheumatology and Arthritis Foundation osteoarthritis guideline — the major society guideline — recommends AGAINST it. Same molecule, opposite verdicts, and anyone who tells you it's settled is choosing the study that suits them.

Who should skip thisSkip if you have a shellfish allergy (most glucosamine is shellfish-derived). And set a stop date: if you feel nothing after 3-6 months, that is your answer, and continuing is just cost.