EPM: Hi everyone, thanks for joining us today. I'm Doctor Emma Pollon-MacLeod.
AL: I'm Adam Livingston, NutriChem PharmD.
EPM: So, we're at Beakers and Botanicals and we're having some technical difficulties with our Facebook live. So, we decided to just do our video on Instagram TV. So, today the topic we wanted to talk about was the argument of expensive pee. So, for those of you out there who have been putting a lot of effort into changing their diet and taking supplements, sometimes that can be expensive for someone to just say to you, oh you're wasting your money it's all coming out in the urine. Not only can it be upsetting and defeating, it's also totally dismissive and can just make people feel like crap when they hear that.
Speaker 2: It's also untrue and it's too much of a generalization just to say, oh yeah you just pee out all supplements. That's not true at all. This statement, I kind of file this statement under the same sort of overly general things you'll hear in health care as ‘diet has no effect on your health’ or yeah, it's something like that. That's kind of a generalization. There's no nuance to that argument when it said what supplement or you've been talking about.
EPM: Exactly. It's super dismissive and it's just really not fair. Because there's so much research coming out. The future of where medicine is that we know we have to heal. We know we need to work on inflammation and from some people who have absolutely no idea about all of the new evidence and literature coming out to just say, it comes out into your urine is just really upsetting.
AL: To say supplements can cause expensive urine is kind of an interesting thing to say. Because just being a pharmacist I'm aware of how expensive drugs are and how many different drugs are very rapidly excreted in urine. I would actually argue that drugs are responsible for even more expensive urine than just supplements.
EPM: Of course, and the body has two main mechanisms of elimination, the urine and through the stool. So, if you're taking things, at one point they're gonna be excreted in the urine.
AL: One thing a lot of people don't realize is a lot of drugs that people take, some of them are 80 to 90 % excreted in the urine totally unchanged. So, you pee out drugs actually, many drugs more than you pee out certain supplements. So, it's an overgeneralization it's like saying ‘diet has no effect on health’ or oh ‘you can get everything you need through your diet’. Well, yeah that's true. But if you look at most North American diets, they're probably pretty lacking and some supplementation is not necessarily a bad idea.
I think one issue, where I sort of agree with the statement that you might just have expensive urine is when you see people kind of just taking things just because they've heard they're good for them. So, we will talk to a lot of people in the pharmacy or the front store kind of just and we'll ask them why are you taking this. A lot of times their answer will sort of be something like, well I was watching a TV show or saw a documentary I saw Dr. Oz and they said “Oh yeah, I've heard it's good for you”. But they're not really taking it for any specific reason. At that point, it's not exactly precise supplementation that actually makes sense. It's not really evidence-based.
EPM: Yeah, I think the argument should kind of encourage people to – and it does, to dial in to kind of understand why they're doing certain things. I say this a lot to people in this goes into what you're saying is, we're not just supplementing to replace vitamins and nutrients in the diet. We use supplements well I mean especially here at NutriChem naturopathic doctors is what we do. We use supplements and vitamins and minerals as therapeutics. So, we're not trying to get our recommended daily allowances, RDA’s, we're not just trying to replace.
AL: Which are unbelievably well by the way. An RDA is basically the dose to prevent a disease or medical condition. It's not the amount to function optimally.
EPM: Yeah, but not even functioning.
AL: Or to get a therapeutic like what we'd call an orthomolecular response. Where you use vitamins or minerals in like a high dose.
EPM: Yeah exactly. So, when we give these high doses of stuff like magnesium, that's for therapeutic effects to have a localized a systemic impact on muscles and nerve fibers you have to get to those higher doses. Talking with things like magnesium when we're talking about minerals, those have active transport mechanisms. They moderate the fluid balance, so not to get into all the nitty-gritty details but that isn't even totally excreted in the urine anyways. So, that argument that people talk about there's only nine water soluble vitamins and 7 of them are, the 2 of them are the B12 and folic acid.
Those have their own mechanisms of absorption completely. We now know with the other water-soluble vitamins, the health of the gut is actually so essential in absorption, activation of these minerals. We used to think that all your vitamins and supplements had to come through the diet. But now we know that some healthy bacteria in the colon actually synthesize vitamins. So, if you don't have that synthesis happening, you're actually already deficient if you're only depending on your diet. Do you know what I mean?
AL: Well that's something you often hear. People say pharmacists’ doctors, oh you can get everything you need through your diet. That's true and nutrients are more bioavailable if you get them from food.
AL: But that's not to say supplements are useless and they're just gonna be excreted as pee.
EPM: Exactly, it's two separate arguments. We're not saying eat crappy food and take a multivitamin, this is where precision and precise medicine comes into play where you have to figure out. You have to calm that got down and there's so much research out there now, right. If someone's inflamed if someone has IBD, they're much more likely to have deficiencies and things like B6 niacin magnesium. It's just so essential to target these things.
AL: Well, this is where we get into like more precise supplementation. So, I wouldn't recommend just supplementing, oh I heard this is good for you I'll just try this for a while. I don't think you're gonna get real results from that. What you'd want to do is do some level of testing, see where your deficiencies actually are. See where your actual clinical symptoms are and then you can decide what will actually work for a specific issue.
EPM: Exactly. Be more directed for sure. But it must be interesting for you as a pharmacist. Because I always think it's funny when people come back and they're like, oh my doctor told me that I'm just making really expensive urine but they're on a diuretic. So, I'm like if that every all your water-soluble vitamin if you're urinating all the time, you're making yourself deficient in things. No one talks about these drug nutrient interactions.
AL: Yeah, well some of the most common deficiencies are caused by drugs. If you're hauling like a diuretic a good example like there goes all your magnesium potassium a lot of your B vitamins very rapidly.
EPM: Oh yeah, vitamin your B1 deficiencies. It’s so important to understand why you're taking something and we need to high your dose things to get therapeutic effects. Just because if you have a tiny little bit of B2 or what we call riboflavin, you're gonna see it in the urine. Your urine will turn bright yellow if you take a b-complex. That doesn't mean all your riboflavin is in the urine. As it travels through your body, it works literally in the mitochondria as an electron donor. So, as it's traveling through the body it has a massive function.
AL: Supplements are not just expensive creating expensive urine, they do have a function
EPM: If you're having an argument at the dinner table, refer someone to watch this video. Tell them to comment and talk to us.
AL: Diet does not have an impact on health.
AL: So, do supplements.
EPM: So, do supplements.
AL: You can get everything you need through your diet, but most more North American diets are quite lacking if you've ever actually tracked your nutrition. So, supplementation is not the worst thing in the world.
EPM: Most files are very inflamed, your gut lining, we see this all days. We don't see the people that are dreaming like optimally they just don't come to see us. So, kudos to you, go.
AL: Well, a lot of that argument comes from the fact that there might not be some perfect randomized controlled trial on a diet to work it into a Canadian guideline. So, that's often the argument I'll hear from pharmacists or medical doctors. But I would argue, it's a bit of a rigged game when you look at the evidence-based hierarchy. Because who's gonna run a randomized control trial on a diet, however they ever gonna get that one.
EPM: But that’s starting now.
AL: But there are clinical trials on diets, it's not like it's completely unfounded.
EPM: Oh yeah and the association between crappy diet and disease, crappy diet IBD inflammatory markers, rheumatoid arthritis, Asthma. If we extrapolate information from those if a crappy diet leads to more inflammatory markers, more incidents of IBD, more incidents of rheumatoid arthritis, more elevations in all your inflammatory markers and cytokines. Then eating healthy or eating a kind of non-inflammatory diet should help the other way. I think that's safe to be able to extrapolate, like we can use our brains here a little bit.
AL: Absolutely. So, if you are interested in more precise supplementation.
EPM: We got not at this; this is so frustrating. I can't imagine how patients must feel hearing not.
AL: Yeah, well you might want to come in and talk to us at NutriChem, where we acknowledge the diet has an impact on your health.
EPM: We're not wasting your money on your supplements, we promise. Get the right ones got the right doses.
AL: Well, you're not wasting your money if you use a more precise dose, which is what we're trying to do where we work here. Let's actually test and see what supplements would actually be better.
EPM: We’re shaking the camera; we're getting so worked up.
AL: Okay, if you're interested in precise supplement dosing, Nutrichem would be a good place to start.
EPM: Okay, well hope you guys enjoyed. comment or share if you liked.
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