Aging Forward: The scoop on supplements

With so much information available about supplements, why are they still so confusing? And as older adults, how can we use them to deal with common symptoms of aging and improve our overall quality of life?

On this episode of Aging Forward, we talk with Dr. Brent Bauer about integrating supplements into a holistic health plan. He also gives tips on how to assess if your supplements are working for you.

Purchase Dr. Bauer’s new book, “Mayo Clinic Guide to Holistic Health,” on the Mayo Clinic Press website today.

Find us online at Mayo Clinic Press for more health and wellness articles, podcasts and books.

Do you have feedback, questions or topic suggestions? Email us at [email protected].

Read the transcript:

Dr. Christina Chen: This is “Aging Forward,” a podcast from Mayo Clinic about geriatric medicine and the science of healthy aging. Each episode we explore new ways to take care of ourselves, our loved ones, and our community so we can all live longer, fuller lives. I’m Dr. Christina Chen, a geriatrician and internist at Mayo Clinic in Rochester, Minnesota, and in this episode we are talking about supplement use.

Our guest today is Dr. Brent Bauer. He is the director of research at the Mayo Clinic Complementary and Integrative Medicine Program. His incredible research has tangibly impacted patient care. Some examples include the fact that at Mayo Clinic massage therapy is now routinely offered to postoperative patients. Meditation training is provided to more than twenty-thousand patients each year, as well as programs for our own staff and so much more. Dr. Bauer also has a book titled Mayo Clinic Guide to Holistic Health, which actually was just released recently, and so we really welcome Dr. Bauer here today. Such an honor to have you here with us.

Dr. Brent Bauer: Well, Christy, thank you very much. It’s a pleasure to be with you.

What is the difference between supplements and prescription drugs?

Dr. Christina Chen: You are our expert for all things integrative medicine, supplement use, really understanding what is truly helpful and what can positively impact our health. There’s a lot of confusion usually from people about supplements and the difference between that and prescription drugs. There’s always a wide variety of things to choose from too, like vitamins and minerals and maybe we can start first by defining what is a supplement and how is it different from a prescription drug? 

Dr. Brent Bauer: As with most things, the government made this much easier, correct? Maybe not. Back in 1994, there’s something called DSHEA, D S H E A, or the ​​Dietary Supplement Health and Education Act. And really what it did is clarified things like herbs, botanicals, vitamins and minerals which are now considered this classification known as dietary supplements. They are not drugs and they’re not over-the-counter drugs. It’s really a unique classification.

Because these were mostly things that had been part of our sort of self care for generations and generations, these did not have to be proven safe. They didn’t have to be proven efficacious. When they created this category, they said things like, “Hmm, ginseng’s been around for a long time. It’s a dietary supplement.”

Now, what it does do is it prevents people from making medical claims. I can sell ginseng. I just can’t tell you when I sell it to you that ginseng will cure cancer or treat your hypertension or treat anything. A safe claim might be my herb – maybe I have seen palmetto – will impact men’s prostate health. That’s probably a safe claim. I can’t say palmetto will make you pee less often at night. When you hear the advertisements, it often makes it really confusing.

What are we talking about? What is good? What is bad? What works? What doesn’t work? That’s kind of the underpinning. It’s not quite the wild wooly west, but it’s a little more challenging than going to the store and buying an over-the-counter drug or a prescription drug.

How has supplement use changed for older adults over the years?

Dr. Christina Chen: The supplement world is a billion dollar industry and there’s so many options that promote healthy living. You can get it anywhere nowadays it seems; online, in stores, thousands of companies. How has supplement use changed for older adults over the years?

Dr. Brent Bauer: If we go back into the early nineties, when a lot of complimentary types of therapies were really becoming popular, it was largely driven by younger, healthier people, maybe 35, 45. And now, as we’re seeing aging, and I think aging successfully, meaning we’re still active in our seventies and eighties and nineties, we’re seeing, I think, a renaissance, or at least a return to interest in dietary supplements.

Why do older adults turn to supplements?

 Dr. Christina Chen: How can I use supplements to help me deal with common ailments, common symptoms of aging, arthritis being a very common one, for example? What are some other reasons that older adults are turning to supplements?

Dr. Brent Bauer: I think the reason older adults are turning to supplements are largely the same reasons younger adults, and even some kids are doing it because of trouble with pain of any kind, trouble with sleep and trouble with stress. Those are kind of ubiquitous problems in our culture and unfortunately, we don’t always have a good foundation for dealing with those. I think we sometimes overly simplistically turn to a supplement and hope it’s going to be the answer.

What is Integrative Medicine and how does it relate to supplement use?

 Dr. Christina Chen: Then it’s like, which supplements do I take for what? And do they have any overlap? And is it going to even work?

Dr. Brent Bauer: Yes.

 Dr. Christina Chen: You were the director of the integrative medicine and complementary medicine department at Mayo for numerous years and this is something that you’ve helped coach a lot of your patients with how it is we incorporate safe supplement use into health and wellbeing and what is integrative medicine in relation to that.

Dr. Brent Bauer: I think the important thing when we think about supplements is that they are supplemental to a foundation approach. I think it is the foundation of integrative medicine. We always want to say, what is the best medicine we know? Then what can we bring to that that has an evidence base behind it? Things like massage, meditation, acupuncture, and to some degree supplements.

When we have good evidence and we can say, ginseng, after you have had cancer and you have fatigue, ginseng can be part of an overall approach to helping reduce fatigue, it’s not treating the fatigue. It’s not the answer, but it’s integrated into the best conventional care. 

What role do vitamins and minerals play in the aging process?

 Dr. Christina Chen: Not necessarily a replacement for treatments, but an additive measure to enhance.

Dr. Brent Bauer: People used to make the distinction complementary, meaning you would take something along with what your doctor recommended. Alternative was something you did instead of conventional medicine. For example, I have breast cancer. I’m not going to take chemotherapy. I’ll go take herbs. That would be an alternative approach.

What has evolved over the last decade is that for a couple decades very few people do alternative medicine. They completely forgo conventional medicine and they just go out on their own. And what we found is patients who were getting acupuncture to deal with their arthritis, getting massage after surgery to reduce their pain, using herbs or supplements like glucosamine and chondroitin to help with their arthritis is why we created the program at Mayo Clinic.

As the research grew, those things became obviously beneficial if used appropriately for the individual in conjunction with a comprehensive program. Guided by and always in concert with the best conventional medicine has to offer.

 Dr. Christina Chen: As we move into understanding the supplements a little bit more, can we start with the question of what is the general role of vitamins and minerals in the aging process? 

Dr. Brent Bauer: When I talk to anybody, and particularly my older patients who are trying to optimize their health, I think that one of our key goals as we age is not just longevity. It’s high quality longevity. We always start with what I consider seven major domains: nutrition, how much exercise, mind/body practice, social connectivity or social support, sleep, spirituality, and connection to nature. If we optimize all seven of those domains, if we have an active daily plan, you’ve just reduced your risk of Alzheimer’s, cancer, strokes, Parkinson’s, take your pick.

The answer is never what is the role of the supplement? The answer is, have you built your foundation? I have a lot of people come to me, taking 40 or 50 supplements, and they want to know “what are the next five I should take?” The answer is I don’t know. Let’s go back and figure it out.

Have you built your foundation? But once you build your foundation, once we know you as an individual, what are your other challenges? Do you have cancer? Do you not have cancer? Are you taking prescription meds or not taking prescription meds?

Really I think if we have one takeaway message, it is that there is no one answer and there is no supplement that everybody should take, and just because your neighbors, friends and barber had good results with Herb X does not mean that we should just go take it.

It does mean we can explore and we should do some of our own homework, but then we always want to work with our primary care team to make sure there’s not some hidden risk.

How do you determine which supplements are important for older adults?

 Dr. Christina Chen: I think everything that we do needs to be built around understanding healthy foundations because that’s where we build our habits from. I don’t think we learn that early enough. We learn it later from people like you when we need a little bit of counseling and backtrack to say, “okay, what’s going wrong now?” I have so many of my own patients who, who come in, they may only be on one or two prescription medications, but you ask a little bit more detail and they’re like, I’m on 12 other items here, including XYZ.

I think it’s hard to sort out those items of what’s actually helpful. What’s not, what’s excessive. I think one common question is, out of all the items there are available, what are the ones that are more important for older adults to consider?

Dr. Brent Bauer: Again, not to be evasive, but, what is that person in front of us like? If it’s an 80-year-old who’s extremely healthy and just has joint issues. We might focus a lot more on things like glucosamine and chondroitin, maybe turmeric or curcumin for the anti-inflammatory effect. But we might have a very similar 80-year-old person in front of us who doesn’t have joint pains, but is challenged with sleep. It really comes down to what we are addressing that we haven’t successfully addressed with our comprehensive lifestyle approach.

Is vitamin D important for older adults?

Now, if you say, is there one thing that I always look at in my older adults, one thing I do always check is vitamin D. Vitamin D as in dog. We know vitamin D plays a lot of roles. I think most of us are familiar with it as being important for bone health. And of course, as we get older, both men and women are at risk for osteoporosis or osteopenia. We want to keep the vitamin D normal. Now, there aren’t any studies that suggest that taking super high doses of vitamin D and getting your levels three or four times higher than normal is beneficial.

What are the risks of combining supplements with prescription medications?

But there’s also evidence that having too low of vitamin D can have a lot of negative effects, not just on bone, but possibly on immune function, maybe even muscle function. We have some interesting studies with older people who are low in vitamin D being more prone to falling.

The reason I focus on vitamin D is unlike most other nutrients, most other vitamins and minerals, which the answer is usually going to be to eat more of the foods that have those vitamins, right?

The answer isn’t vitamin C is good for me. I’ll take a vitamin C tablet. No, maybe if we can, we should eat more of the citrus fruits. We get a lot more bang for our buck when we do that. But vitamin D is one of the few vitamins that’s very hard to find in the food at levels that can actually fix us if we’re low.

That’s one, but there’s no way to know, right? You can’t feel if you’re high or low in vitamin D and you don’t want to just guess. You don’t want to just go out and take 10,000 international units. If you’re already high on your vitamin D, you take more.

That can lead to kidney stones. It may have some other negative effects. That is one that I pretty much test every patient when they’re older because that’s the only way I’ll know. Are they too high, too low or just where they should be?

Dr. Christina Chen: For high dose vitamin D, that’s often a prescription medication where they can’t just get over-the-counter. Are there any other cases where people need prescriptions for supplements versus just grabbing over-the-counter and taking a large dose of that on their own?

Dr. Brent Bauer: There’s a few. I mean, there is a prescription form of highly purified fish oil, taking a much higher dose than we might just get from a couple of capsules. Of course, fish oil has kind of gone from super wonderful. It’s the best thing in the world to know. It’s the worst thing in the world to know.

It’s back somewhere in the middle. I think just like everything else out there, research is going to continue to evolve. What is good this year may not be good next year. That’s why I think we have to do our homework. That’s something very important for anyone who’s listening. That’s where I think we can do a lot of this work on our own. There are reliable resources on the internet, but more and more, our clinical care teams are getting smarter about this too.

As you know, ​​Mayo Clinic has a number of online resources where if somebody presents to me with an herb I’ve never heard of, I can usually, in about three clicks, be into a database that tells me if it is safe. What’s the efficacy? Does it interact with other drugs?

 Dr. Christina Chen: What are some things that patients should be aware of in terms of supplement use with their drug use? And are there key things to consider when we prescribe supplements and the risks associated?

Dr. Brent Bauer: I see a lot of patients who well-intentioned physicians have prescribed too many drugs. And this is not a criticism, this is just a reality of our system. If that patient happens to see a cardiologist and they have to see a rheumatologist, they happen to see their primary care doctor.  It’s sometimes in our current system, very hard to coordinate all that. All of a sudden, the patient’s on seven or eight different prescription drugs, some of which interact with each other, some of which may cancel each other out. And when you start to put that much through the liver and the kidneys, we’re going to see the potential for not only interactions, but also just too much drug going through the system.

What supplements help with arthritis and joint health?

On the other hand, we sort of have that mindset in our culture that natural means safe. If it’s a dietary supplement, if it’s an herb, if it’s been around for a thousand years, I can take as much as I want. I think as I look at many of the patients coming to Mayo who are on 10, 20, 30, 40, sometimes hundreds of supplements, we know that that’s not a good strategy either. It isn’t even that hard to think about, right?

If I have one herb and I add a second herb, there’s a potential interaction. Does that happen significantly? Very often the answer is no. But what if I take two or three or four or five? And then if I’m already on three or four or five drugs, now you can start to do the math. Well, there’s potential inaction one, two, three.

Now we start to see where people do get into trouble. Sometimes it’s interactions. There’s a couple, I don’t know if it’s famous or infamous, cases of women getting pregnant who were taking oral contraceptives very successfully, felt a little depressed, and they said, “Gee, you know, I think St. John’s wort, very natural, it’s often used for depression, often very successfully, and they said, “I think I can take that,” and they took it, and of course that revved up the metabolism of the oral contraceptives to the point where they weren’t protected, and now we have a baby because of St. John’s wort. 

There’s also cases where patients have experienced heart transplant rejection, because again, heart transplant is a hard thing to go through. Maybe I’m a little depressed, of course, I can take St. John’s wort because it’s natural.

I don’t have to talk to my care team, and that revved up the metabolism of the anti-rejection drugs, and that led to heart transplant rejection in a couple different cases. These are the drastic examples. These are ones we don’t want to see. But there’s milder ones where it might just slightly increase your risk of bleeding because you’re already on a blood thinning type medication.

Maybe that little bit of increase is just enough that when you do take a tumble and bump your head, we now have a major bleed instead of what might not have been a problem. There is no free lunch. Natural, it does not mean safe, and really, it does require us to be much better, detectives. We really want to think strategically, if I’m going to add herb X, why am I adding it? What’s my goal? How do I know if it’s reached that goal? I always try to have my patients have a plan.

 Dr. Christina Chen: Let’s say you have a patient who believes they have arthritis. What does the supplement plan look like for that?

Dr. Brent Bauer: We’ve talked about the pros and cons. There’s no contraindications. Let’s try glucosamine and chondroitin. But I always ask them to start before the first tablet to rate their arthritis. Where is the arthritis the worst? It’s in your knees. How bad is it? It’s eight out of ten. How much does it bother you? It bothers you eight hours a day. Okay, great. Now in two to three months, let’s re-ask that question. And if in two or three months, your knees are much better, you only have pain for half an hour here and there, you can walk around the park again, then we can say that’s at least pretty indicative that you’re getting a good response.

Which supplements should you avoid when taking blood thinners?

But I think that way it sort of avoids the hundred supplement problem where people just keep adding more and more, not sure if it’s working. you’ll take another one so you almost have to become like a little scientist. And that means you are the scientist and also the subject. And if you’re going to take anything, you’re having a discussion with your primary care team. You know why? I think CBD might help your sleep.

Very reasonable to try for many people, then to maybe have that patient come back in three months and say, “You know, this is working, my arthritis is better, my sleep’s better,” whatever the goal was. And then I can say, “Well, this herb does have a 5 percent chance of irritating the liver. Let’s take a blood test.

Now we can get a chance to say, okay, with only one change, we didn’t add 10 things, I can look at the liver test, maybe a blood count, and I can be reasonably certain that this is not affecting the patient negatively. They’re getting a good response, and therefore, it goes on to the list of things that we’re going to keep using.

 Dr. Christina Chen: I remember a lecture you gave a while ago as far as risks associated with supplements to avoid taking with other prescription medications. You mentioned the three G’s: ginseng, ginkgo and Garlic. To really try avoid taking these with any anti-coagulants. 

These “G” supplements have blood thinning properties as well, so if you’re taking both at once, it can really add to the risk of bleeding. And since then, I believe others have been recognized, including turmeric, and other supplements with these  anti-inflammatory properties out there.

Do they also add to bleeding risk if you’re already on anticoagulants?

Dr. Brent Bauer: As the research grows, some of those things have kind of upped and downed a little bit. Garlic. There’s a couple of cases where people had pretty significant bleeding at the time of surgery. I’m still pretty cautious. I have my patients stop the garlic. Ginseng. It’s more theoretical than I’ve seen before, but again, unless there’s a strong reason not to, I do try and get most of those herbs that might cause increased bleeding. We try to stop those long before surgery just to kind of clear the deck.

Do supplements improve cognitive function or prevent cognitive decline?

 Dr. Christina Chen: Dr. Bauer, I’d love to talk a little bit more about the specifics of supplements and the specific purposes, pertinent in the healthy aging realm. What do we know about supplements that can help improve cognitive function or prevent cognitive decline, especially with Alzheimer’s rising in prevalence and people wanting to take care of their brains? What’s out there?

Dr. Brent Bauer: The honest answer. Not much, right? There’s a lot of research right now looking at all kinds of interesting supplements. Nicotinamide Riboside is a big one right now. One of the B vitamin derivatives, a lot of intriguing stuff. Nothing yet that says go out there and take it because it will prevent Alzheimer’s. Vitamin D. We know people with very low vitamin D seem to have an increased incidence of cognitive problems.

Can supplements like Resveratrol and Quercetin help with anti-aging?

It doesn’t mean that everybody should go out and take vitamin D. It does mean that if I’m concerned about my brain, I do want to get my vitamin D level checked. And if it’s low, I want to take vitamin D to get it up to a normal level. There’s some name brands that are quite heavily advertised and would improve memory and so forth. But I think do a little due diligence and look at the studies, for some of these claiming to be helpful.

I would say some of the more famous ones, the studies are very small, done in younger people and the outcomes are pretty, pretty suspect, or at least maybe not as robust as you might like before you invest money in it. Again, it’s not to say that there’s not a role for supplements. I think if you ask, how do I treat my Alzheimer’s, I think, I don’t know.

There’s no supplement that will do it. How do I prevent my Alzheimer’s? Well, I’m gonna put all my money on getting out every day and doing 35 to 45 minutes aerobic activity. I’m gonna eat the Mediterranean diet. I’m gonna do at least 30 minutes of mind-body practice every day. I will get a good sleep. I will stay socially connected.

I’ll get out and that’s where you’re gonna get the bang for your buck. Now, if you do all that and then with your reading and with your care team maybe. I’d like to try X, Y, or Z, I think that’s reasonable. But at this point in time, it’s not reasonable to say that’s my strategy. I’m still smoking, drinking, I’m not exercising, I eat junk food, but I’m going to take X, Y, or Z and that’s going to make my brain good. That is, I think, a very dangerous fallacy that a lot of patients still seem to think is maybe true.

 Dr. Christina Chen: What do you make about all the new anti-aging claims out there about supplements like Resveratrol and Quercetin? And just for listeners,​​ Resveratrol and Quercetin have been studied for their antioxidant properties, and that in theory, can help with our cellular health. What’s your take on them and their efficacy?

Dr. Brent Bauer: Resveratrol has been around for a long time. Remember the studies? They showed you that really fat mouse and the little skinny mouse and how the fat mouse ate the resveratrol and then the fat mouse outlived the skinny one and could climb mountains and do all kinds of great stuff. Turns out resveratrol was very, very helpful for mice.

How can you choose a safe and high-quality supplement?

If you’re a mouse and you don’t want Alzheimer’s and you want to live long and have good muscles, there’s no question. I think what we’re seeing with resveratrol is you can’t translate what we see in mice every time into what might happen to humans, and it hasn’t fallen away completely, but it’s not the bright, shining star.

I think we are seeing things like Quercetin, Rapamycin, the chemotherapy drug. These are all ones that seem to be targeting, at least partly, their effects against senescent cells. Some cells that are old, they’re damaged. They’re not bad enough that the body’s going to clean them up, but they kind of sit there and they leak some inflammatory things and they’re just not good for us.

It seems like at least partly how things like Quercetin and Rapamycin and a couple other new ones that I can’t quite think of right now, but they all seem to at least partly work by getting rid of senescent cells. There’s an interesting plausible kind of mechanism of action that makes us think there might be something here and again some of the work done at Mayo in our aging program seems to be pointing us in a direction.

These may be very helpful, but I think at this point, if you said what should I do? Should I go out and buy Quercetin and start taking it? The answer is no.

 Dr. Christina Chen: Have you optimized everything else we currently know with solid science about how to prevent Alzheimer’s? And then on top of that, if there’s no contraindications, you’re not taking other drugs and supplements, then it may be an individual decision where you say, yeah, I’m going to take it, not as a treatment, not as the answer, but boy, I built a great foundation. I just want to do one more thing. That’s a good conversation to have with your care team.

Arthritis is a big problem for older adults. We talked a little bit earlier about the benefits of glucosamine chondroitin for joint health and musculoskeletal health. Are there any other supplements out there that have good evidence backing?

Dr. Brent Bauer: The curcumin, I think, especially if you say it’s an inflammatory component to my arthritis, then I have a lot of patients get great success by adding or even just by curcumin alone by itself. A lot of people seem to benefit from collagen. And again, most of these have very limited side effect profiles of drug-herb interaction opportunities. They’re not a free lunch. We can’t just give them like candy in the water, but we can kind of be a little more. Glucosamine and chondroitin. I always give my patients a trial with it because probably a third to maybe even up to half will come back after two or three months and say it made a difference.

But that’s another key challenge. Glucosamine chondroitin. We don’t fully know the mechanism. It probably does help build cartilage to some degree, but that’s probably not the only thing it’s doing. But for whatever reason, it seems to take about two, three, even four months before most people see the full effect.

Again, knowing the supplements and knowing what the expected return on investment is, so to speak. If you’re going to take glucosamine chondroitin, let’s commit to a three to four month trial with the idea of measuring your joint problems at the beginning, measuring the joint problems at the end. Then, if it seems to be working, working again with your care team, make sure nothing else has changed, but that becomes a nice foundation for helping many people with arthritis.

 Dr. Christina Chen: What’s a good process for choosing a safe and high quality supplement? It can be so hard to know especially if you’re just getting information from advertisements or social media.What’s your goto strategy?

Dr. Brent Bauer: Unfortunately we don’t get that tempered nuance when we hear it on the evening news or when we see it advertised, right? Everything is promoted as, “Wow, this new supplement is going to be the answer for Alzheimer’s.” We hear that, but then we don’t hear the follow up over there several weeks later where, A, the study wasn’t done properly, or it was only done in mice, and we can’t, but we hear the sensationalized stuff, and as consumers, I don’t think this is our fault.

Are there resources for learning more about supplement quality?

This is the fault of the system trying to promote things, and let’s face it, we’re all a little worried. We don’t want Alzheimer’s. We don’t want cancer. If something sounds too good to be true, the right response is, it probably is. Unfortunately, the market is not our friend in this regard. It’s gotten better. There is something called ​​C. G. M. P. current good manufacturing practices.

That is the law. If I manufacture or sell a supplement in the United States, I must by law.

If I say I have 500 milligrams of curcumin and nothing else on the label, then in that bottle, there should be 500 milligrams of curcumin in each tablet. Now, having said that, that sets the bar fairly high, but unfortunately, if you go to the internet, there’s a lot of people selling things and the FDA does not have the person power to police all of those out there.

There’s still some bad actors out there. Everything on the market, even though it’s much better than it was 20 years ago, there’s still a lot of room for challenge. One of the first things I encourage my patients to do is a little homework. If I’m going to invest in glucosamine and chondroitin, I’ll probably be on it for the rest of my life, right?

That means part of our homework is we have to look at the companies. 

 Dr. Christina Chen: Do you have recommendations for how they would go about doing that?

Dr. Brent Bauer: The nice thing is there are companies that kind of stand out. I think part of what you can figure out just with a little homework is if they are certified by the credentialing agencies in Europe? The European folks have a pretty stringent dietary supplement certification. There’s a couple companies in the United States that will do a third party verification.

 NSF. And the ​​United States Pharmacopeia are two companies where I can take my supplement to them. They’ll analyze it. If I pass, they’ll put their name on the label. There’s also really stringent criteria in Australia. If you can find those types of independent validation certifications.

 Dr. Christina Chen: What if someone has an unexpected reaction? Do companies typically have a place where you can report adverse events or negative experiences from their product? 

Dr. Brent Bauer: The other thing that most companies don’t do, but there’s a few out there, and those are the ones I tend to like to work with the most, is do they have an independent adverse event reporting mechanism? What I mean by that is as a manufacturer, you have to have a place where people can call and say, I took your product and my toenails fell off. That has to be reported. It has to be collected.

But most companies do that in-house. It’s kind of like the fox watching the chickens. I can report at the end of the year. We had very few adverse events. I don’t worry about it. If you have an independent company do that for you, where you don’t have an ability to hide the data or kind of push it to the side, I think that’s another marker of excellence, because that’s a company that is going to look at those things. And I know from personal experience working with a couple where when things started to show up, like we are seeing patients who are getting elevated liver function tests. Well, what’s going on? Is there something in the supply chain? Did something change? And they go back and they look at the quality of their products..

 Dr. Christina Chen: I do recall a resource, a website called ​​Natural Medicines Database. Is that right? Is that something that the general public can access or is it just for providers?

Dr. Brent Bauer: Anybody can access it, but it’s a subscription. You could subscribe to it as an individual. It’s got a lot of data that probably isn’t useful for a non-medical person. But if you said, look, this is my life, I really want to learn about supplements. I want to know the drug herb interaction.

What emerging trends in supplements are on the horizon for healthy aging?

That happens to be a database that we use here at Mayo Clinic. There’s also  ​​consumerlab.com, and that’s another subscription. That’s only about 30 bucks a year. That’s a little more. I think it’s still medically oriented, but that’s one where 50 brands of glucosamine are off the shelf and they will go through and do an independent analysis. Does brand X have the exact amount of glucosamine in each tablet that they say they do.

Are there any contaminants? Is there any trouble with how the tablets dissolve? And then they also give you a price per dose or price per capsule. And they don’t do it for every single herb on the market, but for many, they will go through and show you where the quality is, where the costs are.

Then there is some, a fairly detailed summary under each of those headings of what they’ve seen in the market, what to look out for, have there been adverse things happening that maybe we should be aware of. Again, they both cost money, so I don’t generally endorse them or recommend them. But for those who want to go to that next level I think those are very reasonable 

 Dr. Christina Chen: Any emerging trends or new research in the field of supplements for healthy aging that you’re aware of?

Dr. Brent Bauer: I think a lot of it’s going to keep focusing on the brain. We sort of answered one question. Can we live longer? Right. Cause when I was growing up, if somebody was 80, it’s like, oh my gosh, that’s unbelievable. And now 80 is like, I don’t know the new 60 or whatever. We are now, I think, starting to think a little more in our 60s and 70s. How do I think of my brain in my 70s and 80s? Or if I’m in my 70s, what do I think of that next 10 years?

What is Dr. Brent Bauer’s personal approach to healthy aging?

This is great because it is causing patients to ask questions about “how do I protect my brain?” And guess what? We have the answers. It’s lifestyle, lifestyle, lifestyle. And then, because there’s so many of us aging, there’s a lot of people investigating how we can treat the brain. Everything from the Nicotinamide Riboside, the niacin type drugs we’ve talked about, ketones, a lot of interest in the ketogenic diet.

Also, you’re seeing a growing interest in ketone supplements. I mean, a lot of cool things happen in the brain. We don’t fully understand all of them. At least I don’t, but certainly there are some people with epilepsy, for example, who seem to do better on a ketogenic diet. Some people seem to have better memory.

These are intriguing trends. None of them are ready for prime time where you should go out and start buying X, Y, or Z, but I think you’re going to see a ton of research in the next five to 10 years all focusing on this question of if you built the best foundation you can, what else can you do from a supplement standpoint? And I suspect there will be some new things coming down the pike.

 Dr. Christina Chen: That’s really great to hear. And what is your secret to aging well, Dr. Bauer? What’s your own approach, and what are some things that you like to do? 

Dr. Brent Bauer: I’m a plant that grows deep roots, grows tall, and spreads like wildfire and kills off everything else. Rather than going to the gym this year, I’ve been going out and pulling buckthorn, chopping buckthorn, chainsawing buckthorn, and it turns out that’s very therapeutic because when you yank a big buckthorn out of the ground, there’s a certain mind body application there.

It’s very peaceful. And you feel like you’ve accomplished something. I’m using my muscles. I’m out in nature. So, buckthorn is what I’m doing in 2024.

 Dr. Christina Chen: I’m going to have to give that a try or at least pull more weeds from my own backyard. I’ll start with that.

Dr. Brent Bauer: You should come to my house. There’s still plenty of buckthorn. I won’t even charge you for the therapeutic opportunity.

 Dr. Christina Chen: Dr. Bauer, thank you so much for spending time with us today. I always learn so much from you. I think your leadership and research has really paved the way for a lot of people to benefit from integrative medicine. It’s taking the time to talk about the foundations of healthy aging. I’m really glad that this conversation is now preserved in the podcast-listening sphere for all to learn from—including all that you’ve already done in terms of publication, research, and your new book. Make sure you get out there and buy Dr. Bauer’s book.

Dr. Brent Bauer: Christy, thank you very much. It’s always great to talk to you. I always learn stuff when I talk to you too. We should get together more often and have great talks of wisdom and erudition.

Dr. Christina Chen: Absolutely.

That’s all for this episode. Hopefully you’re feeling a little bit more informed, inspired, and empowered. If you have a topic suggestion for a future episode, you can leave us a voicemail at 507-538-6272. We might even feature your voice on the show. You can find more information about Dr. Bauer’s book, Mayo Clinic Guide to Holistic Health, in the show notes online. For more “Aging Forward” episodes and resources, head to mayoclinic.org/agingforward.

Thanks for listening, and until next time, stay curious and stay active.

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