Unit 3: Advanced Topics & Disease Prevention¶

Chapter 3.15: Supplements for Longevity¶

[CHONK: 1-minute summary]

What you'll learn in this chapter:
- Why supplements are a coaching challenge. Why being an "island of sanity" matters
- The evidence hierarchy for supplement claims: Strong, Moderate, Preliminary, and Speculative
- What the Core Stack (Vitamin D, Magnesium, Omega-3s, Creatine) actually shows in research
- How to discuss advanced molecules (NMN/NR, Berberine) without prescribing
- Third-party testing: what certifications mean and why quality matters
- Scope-safe language patterns for supplement conversations

Figure: Strong/Moderate/Preliminary evidence categories

The big idea: In a world drowning in supplement marketing, your clients need a guide who can help them separate signal from noise. This chapter won't tell you which supplements to recommend. That's outside your scope. Instead, it equips you to educate clients about what the evidence actually shows, help them evaluate claims critically, and know when to refer to healthcare providers. The fundamentals (sleep, nutrition, exercise, connection) deliver far more than any supplement stack. Your job is to help clients understand that supplements are, at best, marginal additions to a solid foundation, not shortcuts that compensate for missing basics.

[CHONK: The Supplement Reality Check]

The supplement reality¶

Walk into any health food store, scroll any wellness influencer's page, or listen to popular health podcasts, and you'll encounter an overwhelming message: supplements are essential for health and longevity.

The marketing is compelling. The testimonials are passionate. The promises are dramatic.

And most of it outpaces the evidence by a considerable margin. (This is the part that rarely makes it into the marketing.)

Here's the reality you'll face as a coach: your clients are interested in supplements. Many already take them; about 75 percent of U.S. adults use dietary supplements regularly. They'll ask your opinion. They'll want to know what you think about the latest molecule they heard about on a podcast. They'll wonder if they're "missing out" on something important.

If that sounds like a minefield, you're not wrong. But here's the good news: you don't need to be a pharmacologist. You don't need to memorize every study. You just need to be what we call an "island of sanity": someone who can help clients navigate the gap between marketing claims and actual research, without being either dismissive or gullible.

The marketing-evidence gap¶

Here's something that might surprise you: in the supplement industry, marketing routinely runs years ahead of evidence. Sometimes decades.

Why? Because of how supplements are regulated. Under the Dietary Supplement Health and Education Act (DSHEA), supplements are regulated as foods, not drugs. They don't require FDA approval for safety or efficacy before hitting store shelves. Manufacturers can make "structure/function" claims ("supports immune health") without randomized controlled trials to back them up.

Think of it like this: pharmaceutical drugs have to prove they work before you can buy them. Supplements just have to prove they probably won't kill you.

This creates an environment where excitement spreads faster than data. Here's the typical pattern:

1. A promising mechanism is identified in cell cultures or animal models
2. Early, small human studies show interesting biomarker changes
3. Marketing departments run with it
4. By the time large, well-designed trials publish results, often showing much smaller effects than expected or no effect at all, millions of people are already taking the supplement

And here's the really frustrating part: research shows that in four out of five cases, negative clinical trial results have little or no effect on supplement sales. Once people believe something works, evidence to the contrary rarely changes behavior.

This isn't because people are foolish. It's because hope is powerful, marketing is sophisticated, and critically evaluating scientific claims takes skills most people were never taught. (Including, honestly, most of us.)

If this feels a bit unsettling, that's completely understandable. You're not doing it wrong; you're just seeing how the industry actually works.

The fundamentals-first hierarchy¶

Okay, before we go any further into supplement specifics, let's establish one key idea. (This might be the most important thing in this chapter.)

Fundamentals deliver far more than supplements. It's not even close.

Figure: When supplements may be appropriate

Large studies consistently show that combined healthy diet, physical activity, adequate sleep, and weight management can extend disease-free life expectancy by approximately 8 to 10 years.

Eight to ten years. Let that sink in.

Now compare that to the best-supported supplement findings:
- Vitamin D supplementation: about 5 percent reduction in all-cause mortality
- Omega-3 supplementation: about 7 percent reduction in cardiovascular mortality

Those are meaningful numbers. But look at the difference in magnitude. We're talking about supplements that might add single-digit percentage improvements versus lifestyle changes that add a decade of healthy life.

Here's the mental image that might help: Think of health like building a house. Sleep, nutrition, exercise, stress management, connection: those are the foundation, the walls, the roof. Supplements? They're more like nice curtains. Curtains can make a house look better, but they can't hold up a house that's falling apart.

So when a client is obsessing over their supplement stack but sleeping five hours a night, eating mostly ultra-processed foods, and never exercising? You already know the answer. The curtains aren't the problem.

Key phrase to remember: "This is nice-to-have, not need-to-have."

What this means for your coaching¶

So when a client asks about supplements, here's a good first instinct: get curious about their fundamentals.

• How's their sleep? (Seven to nine hours? Consistent timing?)
• How's their nutrition? (Adequate protein? Vegetables making regular appearances? Mostly whole foods?)
• Are they exercising? (Any strength training? Regular movement?)
• How's their stress? (Chronic overwhelm? Or managing okay?)
• Are they connected? (Real relationships? Or isolated?)

You don't need to grill them. Just stay curious. Because if any of these fundamentals are significantly off, that's where your coaching attention belongs first.

Supplements are "extra credit": meaningful only after the basics are solid. And honestly? For most clients, addressing fundamentals will be so much more impactful that the supplement conversation becomes almost irrelevant.

(They'll still ask. So let's make sure you know what to tell them.)

[CHONK: The Core Stack: Evidence-Based Supplements]

Understanding evidence levels¶

Before we look at specific supplements, let's talk about evidence. (Stay with us here; this matters more than you might think.)

Not all evidence is created equal. A study in mice doesn't mean the same thing as a study in humans. A study of 12 people doesn't mean the same thing as a study of 12,000. And "promising early research" is a very different claim than "proven to work."

Here's a simple approach to help you think about it.

Most supplement marketing presents preliminary evidence as if it were strong. Your job is to help clients understand the difference.

If these categories feel a bit abstract right now, that's okay. You'll get more comfortable with them as we keep coming back to them throughout the chapter.

Vitamin D¶

Evidence Level: Moderate (for mortality); Strong (for deficiency correction)

Let's start with the supplement that probably has the most research behind it: Vitamin D.

What research shows¶

Here's what large studies tell us: Vitamin D supplementation reduces all-cause mortality by about 5 percent. That's based on a 2023 meta-analysis of 80 randomized trials with roughly 163,000 participants.

Five percent might not sound dramatic, but for a supplement, it's actually meaningful. (Remember, we're comparing to fundamentals that deliver 8-10 years of additional healthy life. Supplements play in a different league.)

Interestingly, vitamin D doesn't seem to help cardiovascular mortality specifically. The benefit appears to come from other pathways, possibly cancer, respiratory illness, or other causes. We don't fully understand the mechanism yet. (Science is messy like that.)

Who benefits most? People who are actually deficient. Blood levels below 20 ng/mL are considered deficient, and deficiency is surprisingly common, especially in northern latitudes, darker-skinned individuals, older adults, and anyone who doesn't spend much time outdoors. (So... most of us.)

Protocol reference¶

Research typically uses doses of 2,000 to 5,000 IU daily for adults. This aligns with what many longevity-focused physicians recommend. However, individual needs vary based on baseline status, sun exposure, body weight, and other factors.

What this means for your client¶

Vitamin D is one of the more evidence-based supplements, particularly for people who are deficient or at risk of deficiency. But it's not a magic bullet. The effect size is modest, and it doesn't replace fundamentals.

The coaching conversation might sound like: "Vitamin D has some of the better evidence among supplements, especially if you're low. Many people benefit from having their levels checked by their doctor, who can recommend an appropriate dose based on your specific situation."

But here's what makes this hard¶

Even when clients intellectually understand that vitamin D is one of the more evidence-based options, they often face practical barriers. Some struggle to remember a daily supplement. Others get overwhelmed by the variety of forms and doses. And many don't have a clear path to getting their levels tested.

If your client knows they "should" take vitamin D but isn't doing it, get curious: Is it a skills issue (they don't know which form to buy or how much)? A motivation issue (they're not convinced it matters for them personally)? Or a conditions issue (no routine to anchor it to, no access to testing)?

The barrier diagnosis tells you where to focus.

Magnesium¶

Evidence Level: Moderate (for specific outcomes); Mixed (for mortality)

Magnesium is involved in over 300 enzymatic reactions in your body. (Yes, 300. It's doing a lot behind the scenes.) Energy production, muscle function, nervous system regulation: magnesium touches all of it.

And deficiency is surprisingly common. Surveys suggest a substantial portion of the population doesn't meet recommended dietary intake.

What research shows¶

This is where it gets interesting, and a bit humbling.

The evidence differs dramatically depending on whether we're talking about dietary magnesium or supplemental magnesium.

Magnesium from food: Higher dietary intake is associated with lower all-cause mortality, about 6 percent lower risk for every additional 100 mg per day from food. That's meaningful.

Magnesium from pills: No significant association with all-cause mortality.

Wait, what? Same mineral, different outcomes?

Here's the likely explanation: dietary magnesium comes packaged with other nutrients and fiber from whole foods. People who eat magnesium-rich foods (leafy greens, nuts, seeds, whole grains) tend to have overall healthier diets. The magnesium itself might not be the active ingredient; it might just be a marker of diet quality.

(This is a recurring theme in supplement research, by the way. What works in food doesn't always work in pill form.)

However, magnesium supplementation does show benefits for specific outcomes in randomized trials:
- Blood pressure: Reductions of approximately 3-4 mmHg in trials
- Cardiometabolic markers: Improvements in various risk factors
- Sleep quality: Some evidence of improvement, particularly with magnesium glycinate or threonate forms

Forms matter¶

Magnesium comes in many forms with different absorption and effects:
- Magnesium glycinate: Well-absorbed, often used for sleep and relaxation
- Magnesium threonate: Marketed for cognitive function; crosses blood-brain barrier
- Magnesium citrate: Good absorption; can have laxative effect
- Magnesium oxide: Poorly absorbed; primarily laxative effect

If keeping track of all these forms feels confusing, you're not alone. Clients don't need to memorize every type; they just need help asking good questions of their healthcare provider about what might suit their situation.

Protocol reference¶

Research and longevity protocols typically reference doses of 300 to 600 mg daily, depending on form and individual needs.

What this means for your client¶

Magnesium supplementation may help people who are deficient or seeking specific benefits like blood pressure support or sleep improvement. But the mortality benefit seems to come primarily from dietary sources, not pills.

The coaching angle: "Getting magnesium from food (leafy greens, nuts, seeds) seems to be associated with better outcomes than supplements. If someone's interested in supplementing, that's a conversation for their healthcare provider, especially regarding form and dose."

Omega-3 fatty acids (EPA/DHA)¶

Evidence Level: Moderate (for cardiovascular outcomes)

Omega-3s are probably the supplement you hear about most for heart health. So what does the research actually show?

What research shows¶

The good news: A large meta-analysis of randomized trials found that omega-3 supplementation:
- Reduced cardiovascular mortality by about 7 percent
- Reduced risk of nonfatal heart attacks and coronary heart disease events
- Showed stronger effects for EPA-only formulations (about 18 percent reduction)

The not-so-simple news: There are real tradeoffs.
- Omega-3 supplementation increased risk of atrial fibrillation by about 26 percent
- Bleeding risk also increases

The benefit-risk calculation varies by individual. Someone with cardiovascular risk factors and no history of arrhythmia might benefit. Someone with atrial fibrillation might be made worse.

This is exactly why supplement decisions, even for something as well-studied as omega-3s, often need medical input. It's not as simple as "fish oil is good for you."

Dose matters¶

Most of the positive cardiovascular trials used doses of 1 to 4 grams of EPA/DHA daily, which is far more than what most over-the-counter fish oil capsules provide. A standard fish oil capsule might contain only 300-500 mg of combined EPA/DHA.

Protocol reference¶

Longevity-focused protocols typically reference 2 grams of combined EPA/DHA daily. Achieving this often requires multiple capsules or concentrated formulations.

What this means for your client¶

Omega-3s have meaningful cardiovascular evidence, but the benefit-risk calculation is individual. The dose in most supplements is often too low to match what trials used.

For clients interested in omega-3s: "This is definitely one to discuss with a healthcare provider, who can consider your cardiovascular risk, any history of arrhythmias, and whether the dose you're taking actually matches what the research used."

Creatine¶

Evidence Level: Strong (for muscle); Preliminary (for cognition)

Here's a supplement that actually has strong evidence behind it. (Yes, they do exist.)

Creatine has decades of research on muscle performance and strength. It's one of the most studied supplements in sports nutrition, and the research largely supports the hype.

What research shows¶

For muscle: The evidence is genuinely strong. Creatine supplementation improves strength, power, and muscle mass when combined with resistance training. This is well-established across numerous studies and meta-analyses. Not "promising," but established.

For cognition: This is newer and more preliminary, but intriguing. A 2024 meta-analysis found small but significant improvements in short-term and working memory. The effects appear larger in:
- Older adults
- Vegetarians/vegans (who get less creatine from diet)
- People under stress or sleep-deprived

One important caveat: there's no mortality data for creatine. We know it helps muscles and possibly helps cognition, but we don't know if it helps people live longer. The cognitive benefits are intriguing but based on smaller, shorter studies.

Protocol reference¶

Standard dosing is 3 to 5 grams daily for maintenance (some protocols reference up to 10 grams). A "loading phase" of higher doses isn't necessary. It just reaches saturation faster.

What this means for your client¶

For clients doing resistance training, creatine has solid evidence for muscle-related benefits. The cognitive angle is interesting but still developing.

Unlike some supplements where evidence is thin, creatine actually has strong research behind it for its primary use case. The emerging cognitive research is intriguing, particularly for older adults, but needs more confirmation.

B-Vitamins¶

Evidence Level: Context-dependent (Moderate for deficiency; Weak for general supplementation)

B-vitamins (B6, B9/folate, B12) are essential for energy metabolism, neurological function, and red blood cell formation. Deficiency can cause significant health problems.

What research shows¶

B-vitamin supplementation is most clearly beneficial when deficiency exists:
- B12 deficiency is common in older adults (reduced absorption), vegans/vegetarians (dietary source is animal products), and those taking certain medications (metformin, proton pump inhibitors)
- Folate deficiency during pregnancy increases risk of neural tube defects
- B6 deficiency can cause neurological symptoms

For the general population without deficiency, evidence for B-vitamin supplementation reducing disease risk or mortality is weak. Large trials have generally found no cardiovascular or cognitive benefit from B-vitamin supplementation in non-deficient populations.

Protocol reference¶

Protocol content references B-vitamins (especially B6, B9, B12) as part of the core stack, recognizing that suboptimal intake is common.

What this means for your client¶

B-vitamin supplementation makes most sense for people at risk of deficiency: older adults, vegans/vegetarians, those on certain medications, and pregnant women (for folate specifically). For others, a diet including animal products, legumes, and leafy greens typically provides adequate B-vitamins.

CoQ10 (Coenzyme Q10)¶

Evidence Level: Moderate (for specific populations); Weak (for general use)

CoQ10 is a compound involved in cellular energy production, particularly in the mitochondria. It also has antioxidant properties.

What research shows¶

CoQ10 has meaningful evidence in specific contexts:
- Statin users: Statins reduce CoQ10 production, and some studies suggest supplementation may help with statin-related muscle symptoms
- Heart failure: Meta-analyses show CoQ10 may improve symptoms and reduce hospitalizations in people with heart failure
- Older adults: CoQ10 levels naturally decline with age

For healthy adults without these specific concerns, evidence of benefit is limited.

Protocol reference¶

Optional supplements in longevity protocols often include CoQ10 at 100-300 mg daily.

What this means for your client¶

CoQ10 has a reasonable rationale for people taking statins or those with heart failure, though it should be discussed with their healthcare provider. For generally healthy adults, the evidence is much weaker.

Coaching in practice: "What supplements should I take?"¶

The scenario: Your client comes in excited (and a little overwhelmed) after listening to several health podcasts.

Client: "I keep hearing about all these supplements on podcasts. What should I be taking for longevity?"

What NOT to do:

❌ Immediately start listing specific products, doses, or brands.

Why it doesn't work: You'd be stepping outside your scope, and you'd also be skipping over the fundamentals that matter far more for their long-term health.

What TO do:

✅ Validate their interest, then gently redirect to the fundamentals-first hierarchy.

Sample dialogue:

Coach: "That's a great question, and I appreciate you asking. Before we talk about specific supplements, I'm curious: what's drawing you to supplements right now?"

Client: "I don't know... I feel like everyone's taking something, and maybe I'm missing out on something important? I keep hearing about all these molecules that slow aging."

Coach: "That makes total sense. There's so much information out there, and it can feel like you're behind if you're not doing what the podcasters are doing. (pause) Can I share something that might take some pressure off?"

Client: "Sure."

Coach: "When I look at the actual research, the biggest returns come from sleep, nutrition, exercise, and stress management. Supplements are more like extra credit once those are solid: nice-to-have, not need-to-have. How's your sleep been lately?"

Client: "Honestly? Not great. I'm up late most nights and probably get about five or six hours."

Coach: "Got it. That's really common, by the way, you're definitely not alone there. Here's the good news: improving sleep can do far more for your longevity than any supplement stack. The effect sizes aren't even close. If we focus there first, then later we can talk about how to have a good conversation with your doctor about whether any supplements make sense for you. How does that sound?"

Client: "That actually makes me feel better. I was kind of dreading adding more pills to my routine."

Coach: "Totally understandable. Let's make this simpler, not more complicated."

Key takeaway: This approach:
- Validates their interest without dismissing it
- Redirects to the fundamentals-first hierarchy
- Opens a conversation about where coaching can actually help
- Stays within scope (no supplement recommendations)

[CHONK: Advanced Molecules: Education Without Recommendation]

The "biohacking" world¶

Now we enter the territory of "advanced" supplements: the molecules that generate the most excitement on longevity podcasts, fuel extensive online discussion, and often carry premium price tags.

Fair warning: the evidence here is preliminary at best. But your clients will ask about these, so you need to understand what the research actually shows, and what it doesn't.

A critical mindset shift¶

Before we discuss any of these molecules, let's be really clear about one thing:

No supplement has been proven to extend human lifespan.

Not one. Zero. Nada.

The excitement around these compounds comes from animal studies, mechanistic reasoning, and short-term biomarker changes in small human trials. None of them (not NMN, not resveratrol, not metformin, which isn't even a supplement) have demonstrated that they help humans live longer.

We're not being pessimistic here. We're being accurate. And when discussing these with clients, this context matters enormously. They need to understand the difference between "promising early research" and "proven to work."

If this feels anticlimactic after all the podcast hype, you're not alone. Many people are genuinely surprised to learn how limited the evidence still is.

NAD+ precursors (NMN and NR)¶

Evidence Level: Preliminary

This is probably the supplement you'll hear about most in longevity circles. Let's break it down.

NAD+ (nicotinamide adenine dinucleotide) is a coenzyme essential for cellular energy production. It's involved in hundreds of metabolic processes. And here's the hook: NAD+ levels decline with age. That fact has generated enormous interest in boosting them back up.

NMN (nicotinamide mononucleotide) and NR (nicotinamide riboside) are precursors, molecules the body can convert into NAD+.

What research shows¶

The clearest finding: both NMN and NR supplementation increase blood NAD+ levels. This is well-established. They do what they claim to do, at least in terms of raising a biomarker.

But here's the more important question: Does raising blood NAD+ actually translate into meaningful health benefits?

This is where the evidence gets murkier.

A 2022 trial of NMN in 80 adults over 60 days found improved 6-minute walk distance at the highest dose. That's encouraging, but it's a single study. Multiple reviews conclude that while these supplements reliably increase NAD+ in blood, clinical benefits are "limited or inconsistent." Some trials show improvements; others don't.

Expert consensus from a 2025 scientific conference was pretty clear:
- Current research is limited by lack of tissue-specific NAD+ measurement
- No head-to-head trials comparing NMN versus NR
- More large clinical trials are needed before broad recommendations

If the details of NAD+ metabolism feel overwhelming, don't worry. You don't need to master every mechanism to help clients keep their expectations grounded. The key message is simpler: promising, but still preliminary.

Safety¶

Both compounds appear safe in short-term studies at tested doses (100-1,250 mg/day for NMN; similar ranges for NR). No serious adverse events have been reported in published trials.

What podcasts say versus what research shows¶

What this means for your client¶

If clients are already taking NAD+ precursors, there's no strong evidence they're causing harm. But there's also no strong evidence they're providing meaningful benefit for most people.

These are expensive supplements with preliminary evidence. For clients considering them: "The research is interesting but still early. No one has shown these extend human lifespan. If you're curious, it's worth discussing with your healthcare provider, and making sure your fundamentals are solid first, since those have much stronger evidence."

Why these conversations are hard¶

Here's the uncomfortable truth: it's genuinely difficult to tell someone that the expensive supplement they're excited about doesn't have the evidence to match the marketing. They want it to work. They've already spent money on it. And the podcasters they trust sound so confident.

You're not here to crush their hope. You're here to give them an honest assessment so they can make informed choices. Some clients will appreciate the clarity. Others may feel deflated. Both reactions are okay. Your job is to share what the evidence actually shows, redirect to what does have evidence (fundamentals), and let them make the final call.

A note on antioxidant supplements¶

Evidence Level: Weak to Harmful

Given the marketing focus on "fighting free radicals" and "oxidative stress," we need to address antioxidant supplements directly.

What research shows¶

This is where marketing and evidence diverge dramatically. The Cochrane Collaboration's systematic review of antioxidant supplements for mortality prevention found:
- No protective effect from antioxidant supplements (beta-carotene, vitamins A, C, E, selenium) on overall mortality
- In the most rigorous trials (low bias risk), beta-carotene increased mortality by about 5 percent
- Vitamin E also increased mortality by about 3 percent in low-bias trials

This finding has been consistent across multiple large reviews. High-dose antioxidant supplementation may actually cause harm.

It's understandable if that feels counterintuitive given how often antioxidants are marketed as "anti-aging." Many clients are surprised to learn that more isn't always better here.

Why might antioxidants cause harm?¶

Paradoxically, some oxidative stress appears beneficial. The body uses reactive oxygen species for signaling and adaptation. Exercise, for example, creates oxidative stress that triggers beneficial adaptations. Taking high-dose antioxidants might blunt these adaptive responses.

What this means for your client¶

Clients taking antioxidant supplements "for health" may be surprised to learn the evidence suggests they're either useless or potentially harmful. Getting antioxidants from food (fruits, vegetables, spices) doesn't carry the same concerns. Food-based antioxidants come in balanced amounts with other beneficial compounds.

This is a clear case where the fundamentals (eating colorful vegetables and fruits) outperform the supplement shortcut.

Berberine¶

Evidence Level: Preliminary to Moderate (for metabolic markers); No longevity data

Berberine is a compound found in several plants and has been used in traditional Chinese medicine for centuries. It's often marketed as "nature's metformin" because of its effects on blood sugar.

What research shows¶

For metabolic health specifically, berberine has more human evidence than most advanced supplements:
- Meta-analyses show significant improvements in fasting blood glucose, HbA1c, and insulin resistance in people with type 2 diabetes
- When combined with metformin, berberine showed additive benefits
- Lipid improvements (lower triglycerides and LDL, higher HDL) are also documented

However:
- Most studies are relatively short-term
- Studies are geographically concentrated (primarily from China)
- No longevity or hard clinical outcome data exists

Safety¶

Generally well-tolerated, with gastrointestinal side effects being most common. However, berberine can interact with multiple medications, including those metabolized by the same liver enzymes.

What this means for your client¶

Berberine has more metabolic evidence than many "biohacking" supplements, but it's still not a substitute for evidence-based medical treatment for diabetes. Anyone with blood sugar concerns should be working with a healthcare provider, not self-treating with supplements.

Other Optional Supplements¶

The supplements below appear in various longevity protocols and have emerging research interest. Evidence levels range from preliminary to moderate for specific outcomes. As with all supplements, these are "extra credit" after fundamentals are solid, and any decisions should involve a healthcare provider.

Curcumin¶

Evidence Level: Preliminary to Moderate (for inflammation)

Curcumin is the active compound in turmeric. It has anti-inflammatory properties and appears in many longevity protocols.

What research shows:
- Meta-analyses show modest reductions in inflammatory markers (CRP, IL-6) in various populations
- Poor bioavailability without enhancement (black pepper/piperine or lipid formulations)
- Most benefits seen in populations with elevated baseline inflammation

Protocol reference: 1g daily with black pepper or an enhanced-absorption formulation.

What this means for your client: Curcumin may have a role for people with elevated inflammation markers, but it's not a substitute for addressing root causes of inflammation (sleep, stress, diet quality, body composition). Discuss with a healthcare provider, especially if taking blood thinners or other medications.

Vitamin K2¶

Evidence Level: Preliminary (for bone/cardiovascular health)

Vitamin K2 (menaquinone) is distinct from K1 and plays a role in calcium metabolism, helping direct calcium to bones rather than arteries.

What research shows:
- Observational studies link higher K2 intake to lower cardiovascular and all-cause mortality
- Limited RCT data for hard outcomes
- May work together with vitamin D for bone health

Protocol reference: 200mcg daily (MK-7 form most studied).

What this means for your client: K2 has theoretical appeal for bone and cardiovascular health, particularly alongside vitamin D. Evidence is preliminary. Anyone on blood thinners should discuss with their physician, as vitamin K affects clotting.

Sulforaphane¶

Evidence Level: Preliminary

Sulforaphane is a compound found in cruciferous vegetables, especially broccoli sprouts. It activates Nrf2, a pathway involved in cellular defense and detoxification.

What research shows:
- Activates cellular stress-response pathways in human studies
- Some evidence for reducing inflammatory markers and improving metabolic parameters
- Highly variable between supplements; whole-food sources (broccoli sprouts) may be more reliable

Protocol reference: 60-120mg daily (or equivalent from broccoli sprout consumption).

What this means for your client: Sulforaphane is one of the more interesting emerging compounds, but eating cruciferous vegetables likely provides similar benefits with additional nutrients. Supplements vary widely in quality and actual sulforaphane content.

Taurine¶

Evidence Level: Preliminary (for longevity); Moderate (for specific functions)

Taurine is an amino acid with emerging interest in longevity research after a 2023 Science paper showed taurine supplementation extended lifespan in mice and improved healthspan markers.

What research shows:
- Taurine levels decline with age in multiple species
- Animal studies show lifespan extension and improved function
- Human studies show benefits for cardiovascular markers and exercise performance
- No human longevity data yet

Protocol reference: 500-3000mg daily.

What this means for your client: Taurine is generating significant research interest, but human longevity data doesn't exist. It appears safe at typical doses and may benefit cardiovascular and exercise performance. The longevity claims are extrapolated from animal models.

Lion's Mane¶

Evidence Level: Preliminary (for cognitive function)

Lion's Mane (Hericium erinaceus) is a medicinal mushroom with interest in cognitive health and neuroprotection.

What research shows:
- Contains compounds (hericenones, erinacines) that stimulate nerve growth factor in cell studies
- Small human trials show modest cognitive improvements in older adults with mild impairment
- Most studies are small, short-term, and in specific populations

Protocol reference: 1-2g daily of fruiting body or extract.

What this means for your client: Lion's Mane has intriguing mechanisms but limited human evidence. May be worth exploring for clients interested in cognitive support, but expectations should be modest. As always, discuss with healthcare provider.

Ashwagandha¶

Evidence Level: Preliminary to Moderate (for stress/cortisol)

Ashwagandha (Withania somnifera) is an adaptogenic herb traditionally used in Ayurvedic medicine for stress and vitality.

What research shows:
- Meta-analyses show reductions in cortisol and self-reported stress/anxiety
- Some evidence for improved sleep quality
- May support testosterone levels in men (modest effect)
- Generally well-tolerated; rare reports of liver issues at high doses

Protocol reference: 300-600mg daily of root extract (KSM-66 or Sensoril forms most studied).

What this means for your client: Ashwagandha has reasonable evidence for stress reduction. May be useful for clients with elevated stress, though addressing root causes of stress remains more important than supplementation.

Sleep Support Supplements¶

Several supplements have preliminary evidence for sleep support:

Glycine (3-5g before bed): May improve subjective sleep quality and next-day alertness; works by lowering core body temperature.

L-Theanine (100-200mg): Promotes relaxation and alpha brain waves without sedation; often combined with magnesium for sleep.

Apigenin (50mg): A flavonoid found in chamomile that acts as a mild sedative; popularized by Andrew Huberman but limited human trial data.

What this means for your client: These are generally well-tolerated options for clients struggling with sleep. However, sleep hygiene fundamentals (consistency, environment, light exposure, caffeine timing) should be addressed first. Any persistent sleep issues warrant medical evaluation.

Zinc¶

Evidence Level: Moderate (for deficiency correction); Weak (for general supplementation)

Zinc is an essential mineral involved in immune function, wound healing, and hundreds of enzymatic reactions.

What research shows:
- Deficiency is relatively common, especially in older adults, vegetarians/vegans, and those with GI conditions
- Supplementation benefits those who are deficient
- Excessive intake can impair copper absorption and immune function
- No longevity-specific data

Protocol reference: 15-30mg daily (if indicated by deficiency risk factors).

What this means for your client: Zinc supplementation makes sense for those at risk of deficiency. For others, a varied diet typically provides adequate zinc. More is not better: excessive zinc causes problems.

Rapamycin¶

Evidence Level: Speculative (for human longevity)

Rapamycin is actually a prescription medication, an immunosuppressant used in organ transplant recipients and certain cancers. It's received attention in longevity circles because of its dramatic effects on lifespan in animal models.

Brief context¶

Rapamycin inhibits a pathway called mTOR (mechanistic target of rapamycin), which is involved in cell growth and aging processes. In various animal models, rapamycin has extended lifespan more consistently than almost any other intervention.

Some physicians in longevity medicine use low-dose rapamycin off-label, typically under careful monitoring.

Critical points¶

• This is a prescription medication with immunosuppressant effects
• Human longevity data doesn't exist
• Side effects include increased infection risk and metabolic effects
• This is absolutely not something coaches should discuss as if it were a supplement option

We mention it here only because clients may ask about it after hearing podcast discussions. The appropriate response: "That's actually a prescription medication, not a supplement. It's something that would need to involve a physician with specific expertise in this area."

Coaching in practice: When clients bring up podcast claims¶

The scenario: A client comes in quoting an attention-grabbing promise from a popular health podcast.

Client: "I heard on [popular health podcast] that NMN can reverse aging by 20 years. Should I be taking it?"

What NOT to do:

❌ Roll your eyes or dismiss it with, "That's just marketing; it's all nonsense."

Why it doesn't work: The client feels judged or shut down, and you miss an opportunity to teach them how to think critically about claims.

What TO do:

✅ Acknowledge their interest, then separate the hype from the actual evidence.

Sample dialogue:

Coach: "I've heard similar claims. Let me share what we know so far from the research. NMN does reliably increase NAD+ levels in your blood; that part is well-established. What's less clear is whether that translates into meaningful health benefits. The studies so far are small and short-term, and no one has shown it extends human lifespan. The claims about 'reversing aging' are extrapolating way beyond what's been demonstrated."

Client: "So it's not really proven to make you younger?"

Coach: "Right now, no one has shown that in humans. If you're interested in exploring it, that's definitely a conversation for your doctor. I'd also ask how your fundamentals are, because sleep, exercise, and nutrition have far more evidence for healthy aging than any supplement. Would you be open to starting there?"

Key takeaway: This approach:
- Doesn't dismiss the client's interest
- Distinguishes what's proven from what's claimed
- Maintains scope (educates without prescribing)
- Redirects to evidence-based fundamentals

[CHONK: Navigating the Supplement Industry]

Quality matters more than most people realize¶

Here's a problem most people don't think about: even when a supplement has evidence behind it, the actual product on the shelf might not contain what it claims.

The quality problem¶

The data on supplement quality is not reassuring.

• Independent testing finds that 14 to 50 percent of sports and weight-loss supplements contain undeclared or prohibited substances
• About 48 percent of domestic supplement facilities received citations for violations in FDA inspections (2023)
• The most common violation? Failing to even verify what's in the product
• Heavy metals (lead, cadmium, arsenic, mercury) are commonly detectable across supplement categories

And here's the kicker: the FDA historically inspected only about 10 percent of supplement facilities annually. After the pandemic? That dropped to around 4 percent.

If those statistics feel alarming, that's a reasonable response. The supplement industry has very different oversight than pharmaceuticals. A drug has to prove it works before you can buy it. A supplement just has to not obviously kill anyone.

The goal here isn't to create fear. It's to help you and your clients become smarter consumers. Because quality really does vary enormously.

Third-party testing: What the certifications mean¶

Because regulation is limited, independent third-party testing programs have emerged to fill the gap (think of them as extra sets of independent eyes on the manufacturing process). These programs audit manufacturers and test products for quality, purity, and accuracy.

USP Verified (United States Pharmacopeia)
- Requires Good Manufacturing Practice (GMP) audits
- Tests products against established USP standards for identity, strength, and purity
- Includes contaminant screening
- Periodic off-the-shelf retesting

NSF Certified (NSF International)
- Formula and toxicology review
- Contaminant screening (heavy metals, microbes, pesticides)
- Annual facility audits
- NSF Certified for Sport: Additional screening for hundreds of banned substances (relevant for athletes)

ConsumerLab Approved
- Independent off-the-shelf testing
- Tests for identity, strength, purity, and disintegration
- Publishes methods and criteria
- Often uses stricter contaminant limits than other programs (up to 40 times stricter for lead, according to their statements)

An important note on certifications¶

These programs aren't identical: their criteria differ, and a product might pass one certification while failing another.

And here's something important to understand: certification doesn't guarantee a product is effective. It only means it contains what it claims and meets certain purity standards. Those are different things.

Also, absence of certification doesn't necessarily mean a product is poor quality. Many reputable manufacturers don't seek certification due to cost or other business reasons. It's one signal, not the whole story.

Red flags in supplement marketing¶

Help clients recognize warning signs:

Language red flags:
- "Clinically proven" (for supplements, this is often based on very limited data)
- "Revolutionary breakthrough"
- "Doctors don't want you to know"
- "No side effects" (everything has potential side effects)
- Testimonials as primary evidence

Business model red flags:
- Multi-level marketing (MLM) distribution
- Proprietary blends that hide actual doses
- Claims to treat, cure, or prevent disease (illegal for supplements)
- Celebrity endorsements as primary selling point

What this means for your client¶

Clients interested in supplements should:
1. Look for third-party certification (USP, NSF, or ConsumerLab)
2. Be skeptical of dramatic marketing claims
3. Check that doses match what research actually used
4. Discuss any supplements with their healthcare provider, especially if taking medications

The conversation might be: "Quality varies a lot in supplements. One way to increase confidence is to look for third-party certifications like USP or NSF. They indicate the product has been independently tested for quality and purity."

The cost consideration¶

Supplements add up financially. A client taking multiple premium supplements might spend $200-500 per month or more. For many people, that money would deliver far more health benefit if spent on:
- Higher-quality whole foods (more vegetables, better protein sources)
- A gym membership or fitness equipment
- Sessions with a registered dietitian for actual nutrition guidance
- A sleep specialist consultation if sleep is an issue

When helping clients think about supplements, encouraging them to consider opportunity cost is valuable. What else could that money do for their health?

[CHONK: Coaching Supplement Conversations]

Scope-safe language patterns¶

Here's the reality you'll face: clients will ask you about supplements. Constantly. And as covered in Chapter 1.5, you can't prescribe or recommend them.

The NBHWC scope of practice explicitly states that coaches may share evidence-based information from reputable sources but do not provide nutrition consultation, create meal plans, or recommend supplements.

This boundary exists for good reasons: client safety, legal protection, and professional integrity.

So what can you do when clients ask? Let's get practical.

What you can do¶

Share evidence-based information:
"Research shows that vitamin D supplementation has modest benefits for mortality, especially in people who are deficient. Meta-analyses suggest about a 5 percent reduction in all-cause mortality."

Help clients evaluate claims:
"When you hear claims like that, it's worth asking: what kind of evidence is this based on? Animal studies? Small human trials? Large randomized controlled trials? The evidence level matters."

Support implementation of provider recommendations:
If a client's doctor has recommended a supplement, you can help them remember to take it, problem-solve barriers, and integrate it into their routine.

Encourage disclosure to healthcare providers:
"Whatever supplements you're taking or considering, it's really important to let your doctor know. Some supplements interact with medications."

Redirect to fundamentals:
"Instead of starting with supplements, I'm curious about your foundation. How's your sleep? Are you hitting your protein targets? Getting regular movement?"

What you cannot do¶

Recommend specific supplements:
- ❌ "You should take vitamin D"
- ✅ "Research suggests vitamin D may benefit people who are deficient. Your doctor can check your levels and recommend an appropriate dose."

Suggest specific doses:
- ❌ "Take 2,000 IU of vitamin D daily"
- ✅ "Research typically uses doses of 2,000 to 5,000 IU. Your healthcare provider can recommend what's right for you based on your levels."

Interpret lab work:
- ❌ "Your vitamin D is low, so you need to supplement"
- ✅ "I see you have those lab results. That's something to discuss with your doctor, who can interpret what they mean for you."

Advise on medication interactions:
- ❌ "That supplement should be fine with your blood pressure medication"
- ✅ "Since you're taking medications, definitely run any supplements by your doctor or pharmacist first. Interactions can be tricky."

When to refer¶

Supplement conversations should trigger referral when:
- Client asks for specific dosing recommendations
- Client has symptoms possibly related to supplement use
- Client takes multiple medications (drug-supplement interaction risk)
- Client has a medical condition that supplements might affect
- Client is pregnant or nursing
- Client wants lab interpretation to guide supplementation

The referral might be to a physician, registered dietitian, or pharmacist depending on the question.

Drug-supplement interactions are real¶

Here's something that doesn't get enough attention: supplement-drug interactions can be clinically significant. And about 75 percent of U.S. adults use supplements, many without telling their healthcare providers.

That combination creates real risk. Some examples:

• St. John's Wort reduces effectiveness of many medications including birth control, antidepressants, and blood thinners
• Green tea extract reduced bioavailability of the blood pressure medication nadolol by 85 percent in one study
• Ginkgo biloba increases bleeding risk, especially with blood thinners
• Calcium can reduce absorption of certain antibiotics and thyroid medications
• High-dose fish oil may enhance blood-thinning effects of anticoagulants

Among older adults, 23 to 82 percent concurrently use supplements with prescription medications. In cancer patients, 37 percent had supplement combinations with potential liver interaction concerns.

This is why the referral question isn't just about scope. It's about client safety. Any client on medications should discuss supplements with their healthcare provider or pharmacist.

If trying to remember all these potential interactions feels overwhelming, don't worry. You're not expected to be a pharmacologist. Your role is simpler: notice when supplements and medications overlap, and encourage clients to loop in their pharmacist or physician. That's it.

Coaching in practice: Handling requests for specific recommendations¶

What NOT to do:

❌ Immediately list your personal supplement stack or specific products and doses.

Why it doesn't work: It blurs your scope boundaries, turns you into a de facto prescriber, and ignores important individual factors like lab values, medications, and health history.

Client: "Just tell me what you would take. What's your supplement routine?"

Coach: "I really appreciate you asking. That tells me you trust my judgment. What works for me, though, might not be right for you. Our situations are different, and recommending specific supplements isn't something I can do as a coach. That's really a conversation for your healthcare provider who knows your full health picture."

Client: "So you can't just tell me what to take?"

Coach: "I get why that would feel easier. If I just told you what I take, though, I'd be doing you a disservice. Supplements can interact with medications, and what you need depends on things like your lab values, health history, and current prescriptions. What I can do is share what the evidence generally shows and help you think through what questions to ask your doctor. Would that be helpful?"

If the client persists:

Coach: "I know it might seem easier if I just gave you a list, but your safety comes first. Your doctor is really the right person for deciding which specific supplements and doses, if any, make sense for you."

Key takeaway: This structure lets you honor the client's trust, stay clearly within scope, and still be genuinely helpful by focusing on evidence and referral rather than product lists.

The hierarchy conversation¶

One of the most valuable things you can do, maybe the most valuable, is help clients see supplements in proper perspective.

When a client comes in excited about the latest supplement they heard about on a podcast, try:

"Before we talk supplements, let's take stock of the foundation..."
- Sleep: Are you getting 7-9 hours consistently?
- Nutrition: Adequate protein? Vegetables? Minimally processed most of the time?
- Movement: Regular exercise including strength training?
- Stress: Is chronic stress being addressed?
- Connection: Are you maintaining social relationships?

"Here's what the research shows about effect sizes..."
- Combined healthy lifestyle: ~8-10 additional disease-free years
- Best-supported supplements: ~5-7 percent relative risk reductions

"Supplements are nice-to-have, not need-to-have..."
- They're extra credit once fundamentals are solid
- They're not substitutes for sleep, nutrition, or exercise
- The fundamentals deliver the biggest returns

For many clients, hearing this is a relief. It means they don't have to chase every new supplement to support their health.

Why this conversation is hard (and why it matters)¶

Scope boundaries around supplements can feel frustrating, both for you and your clients. They want a simple answer. You want to help. It would be so much easier to just say "take this."

But staying in scope isn't about being unhelpful. It's about being appropriately helpful. Your value isn't in recommending products. Your value is in helping clients think clearly, separate hype from evidence, and make decisions with their healthcare team. That's actually more valuable than a supplement list, and it's the help only a skilled coach can provide.

Avoiding supplement anxiety¶

Some clients become anxious about all the things they're "supposed" to be taking. They've heard so many recommendations that they feel overwhelmed or like they're failing.

Your job is to provide relief:
- The fundamentals matter most
- Most supplements have modest or unclear benefits
- Not doing "advanced" protocols doesn't mean they're missing out
- Any progress is meaningful; perfection isn't the goal

What podcasts say versus what research shows¶

This table summarizes common claims versus actual evidence for several popular supplements:

Deep Health integration¶

Supplements intersect with multiple Deep Health dimensions, and not always in the ways you'd expect.

Physical: This is the obvious one: nutrient status, deficiency correction, metabolic support. But here's the perspective that matters: physical health depends far more on fundamentals than supplements. Those ~8-10 additional disease-free years from combined healthy lifestyle behaviors? That vastly exceeds any supplement benefit. Not even close.

Environmental: Quality and sourcing are environmental concerns. Contamination, heavy metals, supply chain issues: these affect what's actually in the bottle. Where supplements are manufactured, how they're stored, what quality controls exist. Your clients are consuming whatever is actually in that capsule, not what's on the label.

Mental: This one often gets overlooked. Supplement culture can create genuine anxiety. The fear of "missing out." The complexity of conflicting information. The expense of stacking multiple products. Some clients develop what we might call "orthosupplementation": an unhealthy fixation on taking the "right" supplements that paradoxically increases stress. (Sound familiar? It's similar to orthorexia, but for pills.) You can help reduce this anxiety by providing perspective: no supplement is essential for most people.

Existential: Here's a question worth sitting with: What matters more for longevity than supplements? Connection. Purpose. Meaning. Relationships. These aren't sold in capsule form, and they matter more for longevity than any supplement stack. When clients ask about longevity supplements, it's worth gently exploring what they're really seeking. Often, the desire for a "longevity stack" reflects deeper concerns about aging, mortality, or control that are better addressed through reflection and connection than through capsules.

Common supplement myths¶

Before we wrap up, let's tackle some persistent myths that clients will bring to coaching conversations. (And they will. Repeatedly.)

Myth: "If some is good, more is better"¶

This is genuinely dangerous thinking. Many nutrients have U-shaped dose-response curves: too little causes problems, but too much also causes problems. High-dose vitamin E actually increases mortality risk. Excessive vitamin A can cause toxicity. More is not better. Sometimes more is worse.

Myth: "Natural means safe"¶

This one sounds intuitive but doesn't hold up. Arsenic is natural. Hemlock is natural. Poison ivy is natural. "Natural" is a marketing term, not a safety guarantee. Supplements can cause side effects, interact with medications, and have quality issues regardless of their "natural" origin.

Myth: "Supplements can replace a poor diet"¶

No. Full stop. No amount of supplements compensates for a diet of ultra-processed foods. Whole foods contain fiber, phytonutrients, and nutrient combinations that supplements simply can't replicate. Supplements are, at best, a complement to good nutrition, never a replacement.

Myth: "My favorite health influencer takes these, so they must work"¶

Celebrity and influencer endorsements are marketing, not evidence. Often, influencers are paid to promote products. (Even when they disclose it, the bias remains.) Even when they're sincere, personal anecdotes don't equal scientific evidence. N=1 doesn't generalize.

Myth: "Expensive supplements are better"¶

Price often reflects marketing budgets more than quality. Some excellent products are affordable; some expensive products fail quality testing. Third-party certification is a better indicator than price point. Don't let clients confuse cost with effectiveness.

Coaching in practice: Helping clients evaluate supplement claims¶

When a client comes to you excited about a supplement claim they've heard, you can turn it into a chance to think things through together.

The scenario: A client brings in an article about a supplement that supposedly "cuts disease risk in half" and wants to know whether to start taking it.

What NOT to do:

❌ Immediately say "Go for it" or "That's bogus" without exploring anything about the claim.

Why it doesn't work: You either become a cheerleader or a skeptic, instead of helping the client build their own critical thinking skills.

What TO do:

✅ Walk them through a few simple questions about the evidence behind the claim.

Sample dialogue:

Coach: "It definitely sounds appealing. Rather than jumping in or writing it off, want to look at the claim together for a minute?"

Client: "Okay, sure."

Coach: "First, what kind of evidence is this based on? Is it animal studies, small human trials, or large randomized controlled trials? Cell culture and mouse studies often don't translate to humans."

Coach: "Second, what were the actual outcomes they measured? Did it affect things that really matter (like death, disease, or quality of life) or just surrogate markers like blood levels of some molecule?"

Coach: "Third, how large was the effect? A 50% increase sounds dramatic, but 50% of a tiny number is still tiny. What's the absolute risk reduction, not just the relative one?"

Coach: "Fourth, who funded the research? Industry-funded studies of industry products deserve extra scrutiny. That doesn't mean they're wrong, but bias is possible."

Coach: "And finally, what do authoritative reviews say? Single studies can mislead. It's helpful to see what systematic reviews and meta-analyses conclude."

Client: "I’ve never thought about it that way. That makes the claim seem a lot less clear-cut."

Coach: "Exactly. You don't have to become a scientist, but asking these questions helps you make more informed choices instead of just accepting a headline."

Key takeaway: Guiding clients through these questions teaches them to think critically rather than automatically believing every supplement claim they hear.

[CHONK: Study guide questions]

Study guide questions¶

Here are some questions that can help you think through the material and prepare for the chapter exam. They're optional, but we recommend you try answering at least a few as part of your active learning process.

1. Why is the "fundamentals-first" hierarchy important when discussing supplements with clients?

2. What's the difference between "strong" and "preliminary" evidence, and why does this distinction matter for supplement claims?

3. A client is excited about a new supplement they heard about on a popular health podcast. What questions would you encourage them to ask about the evidence?

4. What do third-party certifications like USP and NSF indicate about a supplement product? What don't they indicate?

5. What are three situations that should trigger a referral to a healthcare provider when discussing supplements?

6. How would you explain to a client why you can't recommend specific supplements or doses?

Self-reflection questions:

1. Look at your own supplement routine (if you have one). Can you articulate the evidence level for each supplement? Are any of them "sand" that you're taking before solidifying your "Big Rocks"?

2. Where do you get your supplement information? How do you evaluate whether a source is trustworthy versus marketing-driven?

Chapter exam¶

Open-book exam. Select the best answer for each question.

1. According to large meta-analyses, vitamin D supplementation shows:
a) Strong reduction in cardiovascular mortality
b) Modest (~5%) reduction in all-cause mortality
c) No effect on any mortality outcome
d) Benefit only in people with normal vitamin D levels

2. What is the key difference between dietary magnesium and supplemental magnesium regarding mortality?
a) Supplemental shows stronger benefit than dietary
b) Dietary is associated with lower mortality; supplemental shows no association
c) Both show equal benefit
d) Neither shows any mortality association

3. Omega-3 supplementation has been shown to:
a) Reduce cardiovascular mortality but increase atrial fibrillation risk
b) Have no cardiovascular effects
c) Eliminate heart disease risk
d) Reduce all-cause mortality by 25%

4. What does the evidence show about NAD+ precursors (NMN/NR) and human longevity?
a) They extend human lifespan by 10-20%
b) They reliably increase NAD+ levels but haven't been shown to extend human lifespan
c) They have no effect on NAD+ levels
d) They only work in people over 60

5. Under DSHEA, dietary supplements:
a) Require FDA pre-market approval for safety and efficacy
b) Are regulated as drugs with strict requirements
c) Are regulated as foods and don't require FDA pre-market approval
d) Must prove they extend lifespan before marketing

6. Which statement best describes what third-party certifications (USP, NSF) indicate?
a) The supplement is guaranteed to be effective
b) The product contains what it claims and meets certain purity standards
c) The FDA has approved the supplement
d) Clinical trials support the product's health claims

7. A client asks, "What supplements should I take?" The scope-appropriate response is:
a) Share your personal supplement routine
b) Recommend specific products and doses
c) Share evidence-based information and encourage discussion with their healthcare provider
d) Dismiss the question since supplements don't work

8. What proportion of sports and weight-loss supplements may contain undeclared or prohibited substances, according to testing research?
a) Less than 1%
b) About 5%
c) 14-50%
d) Over 75%

9. The "fundamentals-first" principle suggests that:
a) Supplements should be the first intervention
b) Sleep, nutrition, exercise, and stress management deliver greater benefits than supplements
c) Only fundamental supplements like multivitamins matter
d) Clients should avoid all supplements until fundamentals are perfect

10. A client taking multiple prescription medications wants to start a new supplement. The appropriate coaching response is:
a) Help them research which supplements are safe with their medications
b) Recommend they discuss with their healthcare provider or pharmacist before starting any supplement
c) Tell them supplements are natural so interactions don't occur
d) Create a supplement plan that avoids their medication times

11. What evidence level would be appropriate for a supplement claim based only on animal studies and mechanistic reasoning?
a) Strong
b) Moderate
c) Preliminary
d) Speculative

12. Creatine has strong evidence for which benefit?
a) Extending human lifespan
b) Improving muscle strength and power with resistance training
c) Curing cognitive decline
d) Replacing exercise

13. The phrase "nice-to-have, not need-to-have" in supplement discussions means:
a) Supplements are luxury items only wealthy clients should consider
b) Supplements are marginal additions to a solid foundation, not essential requirements
c) Supplements are nice but never have any benefits
d) Clients need to take supplements to have nice health outcomes

14. Which of the following is an appropriate way to share supplement information within coaching scope?
a) "You should take 2,000 IU of vitamin D daily"
b) "Research suggests vitamin D may benefit people who are deficient; your doctor can check your levels"
c) "Your vitamin D is low based on this lab work, so start supplementing"
d) "I take vitamin D so you probably should too"

15. Combined healthy lifestyle factors (diet, exercise, sleep, weight management) have been associated with approximately how many additional disease-free years?
a) 1-2 years
b) 4-5 years
c) 8-10 years
d) 15-20 years

Works cited¶

References¶

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23. About ConsumerLab.com Testing. Available from: https://www.consumerlab.com/about/

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