Dr. Osborn's Top Ten Supplements

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The Logical Choices

1. Omega-3 Fatty Acids

If you could choose one, this would be it!

It is by far the best supplement out there for all-around health benefit. There are literally volumes of data demonstrating the beneficial effects of omega-3’s stemming from their robust anti-inflammatory and antioxidant capacities. An integral part of your cell membranes (walls surrounding your cells), omega-3 FA (fatty acids) are vital to your health and particularly beneficial to your heart and brain. You truly are what you eat. All fish oil is not created equal. Do not buy the first “fish oil” supplement you come across.

In fact, stay clear of such supplements, as most are laden with omega-6 FA. And while these fatty acids are needed to mount an inflammatory response (immune system response, wound healing, and muscle repair), I can assure you that your diet supplies surplus amounts. Remember the omega-6:omega-3 ratio of the American diet is 20:1; optimal is 1:1 (Japan is closest with 4:1). Instead, purchase purified omega-3 FA capsules. Pay particular attention to the quantity of omega-3 per capsule and dose accordingly.

In the event that you are unable to find purified preparations and have to buy “fish oil,” attempt to find those capsules that have the most omega-3 FA per capsule and the least omega-6. Your goal is to minimize intake of omega-6 FA and maximize omega-3 FA intake. Do not assume that your “Fish Oil 1200” has 1200 mg of omega-3 fatty acids per capsule. It doesn’t. Likely it has 300 mg.  So don’t be fooled! Read your labels carefully, twice.

Daily Dosage: In order to optimize the critical omega-6:omega-3 ratio, take this supplement liberally. I recommend a minimum of 3 grams (3,000 mg) daily in divided doses. Many individuals take 10 to 15 grams daily without adverse effects (Eskimos eat a lot of fish, right?).

Caution: Omega-3 fatty acids may interfere with blood clotting particularly at high dosages (> 3,000 mg daily). Accordingly, alert your surgeon if you have a procedure scheduled. Those with allergies to fish should use precautions when taking omega-3FA. Discuss these with Dr. Osborn prior to starting the supplements.

And here’s a trick. Bloating, belching, and diarrhea are common side effects of omega-3 supplements. Simply store your capsules in the freezer; the fatty acids will be released in a more delayed manner and these side effects diminished. This may not be a bad idea anyway as it slows down the oxidation process (fish oil can be oxidized prior to its consumption).

2. Resveratrol

The subject of much ongoing research, resveratrol is one of the compounds found in wine thought to confer protection against coronary events in people consuming a high-fat diet. Remember the French Paradox? There are numerous animal studies demonstrating its life-extending effects. And the biochemistry has, to a great degree, been elucidated. In addition to providing robust anti-inflammatory effects, resveratrol influences the expression of several gene products which influence metabolism.

I’ve talked elsewhere about the inflammatory effects of insulin, particularly excess insulin. Remember, the more circulating insulin, the more bodily inflammation, resulting in more inflamm-aging. People suffering from type II diabetes are ravished by the effects of elevated circulating insulin. They are the poster children for accelerated aging (particularly those who are poorly controlled). Hmm… so what happens when we attenuate the insulin signal? The opposite occurs theoretically: we age slower. And this is precisely the line of logic utilized by those practicing caloric restriction or CR. By no means is this an easy protocol (30 percent reduction in caloric intake); it is not for the  faint-hearted. Yet it potentially offers life-extending benefits (studies are obviously difficult to perform given the endpoint: death). Don’t worry! You can derive similar benefits from resveratrol supplementation. Mark my words, a chemical modification of resveratrol will be launched one day as an “anti-aging drug.” Diabetics, this is an extremely important supplement for you.

Daily Dosage: 20 mg daily. For the record, 20-mg resveratrol supplements provide approximately 220 times the amount of resveratrol found in one fluid ounce of that red wine the French are drinking! Is it really better to consume more? Would we derive similar benefits from a smaller dose? We simply do not know, as longitudinal studies in humans have not been performed (and likely will not be for lack of pharmaceutical funding).

glass of red wine falling with liquid flying gracefully out of the glass

3. Green Tea

colorful cup of green tea in clear glass cup with green tea leaves scattered around teh cupLikely a factor in the enhanced longevity of the Japanese, green tea is a robust antioxidant that has anti-cancer effects probably through its epigallocatechingallate or EGCG content. EGCG works by protecting cells from lipid peroxidation and DNA damage thought to be integral to atherogenic and neurodegenerative processes. Yes, green tea may slow the progression of Alzheimer’s disease by inhibiting plaque formation. Its anti-cancer effects are due to inhibition of tumor angiogenesis (tumor blood vessel formation) and its ability to induce apoptosis (programmed cell death) in tumor cells.

Daily Dosage: Take a minimum of 900 mg daily in divided doses. Ideally, one should drink several cups of green tea daily if possible (and in this case, scrap the extract).

4. Vitamin D3

You may not realize it, but Vitamin D3 is actually a hormone. That’s right, it’s a vital bodily hormone acting directly on the genome. Once thought to be solely important for bone health and calcium regulation, vitamin D3 has a multitude of additional functions. It likely confers protection against a variety of cancers, is integral to our immune response, has anti-inflammatory properties, influences skeletal muscle growth, and maintains vascular health.

Sadly, the importance of vitamin D3 has gone unrecognized until relatively recently, likely resulting in many needless deaths. In doubt? Here’s proof. A large prospective study including 18,225 men free of diagnosed cardiovascular disease assessed whether plasma vitamin D3 concentrations are associated with risk of coronary heart disease over a 10-year period. After adjustment for family history of myocardial infarction, body mass index, alcohol consumption, physical activity, history of diabetes mellitus, hypertension, ethnicity, region, marine omega-3 intake, LDL and HDL cholesterol levels, and triglyceride levels, the relative risk of nonfatal myocardial infarction or fatal coronary heart disease was more than double in those individuals with low vitamin D3 levels relative to those with normal levels.

Considering the high prevalence of vitamin D3 deficiency in the United States, normalization of serum levels would result in more than 100,000 lives saved yearly. And this only reflects the reduction in fatal coronary events. What about cancer-related deaths? You see my point. Take your vitamin D3! Do not assume for a second that you get adequate sun exposure. You don’t. Society is spending more time indoors, as Wii Tennis replaces outings on the clay court. Sunscreen too, while reducing skin cancer risk, can interfere with vitamin D production in the skin.

Daily Dosage: 1,000 -10,000 International Units (I.U.) daily. Ask your doctor to check your vitamin D3 level (a simple blood test). Tailor your daily dosage to attain a level of
60-100 ng/mL. Contrary to popular belief, it is extremely unlikely that you will overdose on vitamin D3.

5. Curcumin

mound of golden colors curcumin on a white backgroundIt is suspected that the incidence of Alzheimer’s disease in India is approximately 50 percent lower than that in the United States because of the high quantities of turmeric consumed, a main ingredient of curry powder. Fifty percent! Curcumin (a derivative of the turmeric spice) has powerful antioxidant and anti-inflammatory properties, both of which thwart the formation of amyloid plaque. With regard to the latter, curcumin has been utilized to treat osteoarthritis and inflammatory bowel disease. Researchers are now pursuing its potential anti-cancer (chemopreventive) effects. Here’s the issue. The bioavailability of curcumin is low (i.e. it is poorly absorbed) at oral doses < 4 grams. To remedy this, choose a curcumin preparation with piperine (a black pepper derivative), which has been demonstrated to enhance bioavailability in the first several hours after ingestion. Taking your curcumin with a fish oil supplement may also increase bioavailability by promoting absorption.
Daily Dosage: 800-1,000 mg.

Caution: Curcumin may interfere with platelet function and therefore blood clotting. Please discuss usage with your doctor particularly if you are taking blood thinners (warfarin) or other medications that interfere with platelet function (aspirin, for example). Alert your surgeon preoperatively as well!

6. B-Complex

These days, you always hear about B-complex vitamins in the context of energy drinks (sheer nonsense!). B-complex vitamins are important for what is termed “methylation,” a cellular process that occurs a billion times per second. It’s a complicated process involving the transfer of a “methyl” group from one molecule to another. It is critical to the regulation of protein function and gene expression, without which, well, we’d all be goners. Deficient or “hypo” methylation is associated with a variety of diseases such as cancer, coronary artery and cerebrovascular disease, and neural tube defects to name a few. Faulty methylation is associated with elevated homocysteine levels in the blood (assayed in your baseline bloodwork).  This often can be remedied by supplementing with B vitamins (“complexed” to include the eight chemically distinct forms). I typically stick with the preparations that have the most folic acid per tablet (with a little bit of searching you will find those with 400 mcg or more).

Daily Dosage: 1 tablet daily.

And when, not if, your urine turns bright yellow and quite frankly “stinks,” do not equate this to inefficacy or malabsorption of the product. The former is an effect of riboflavin (the Latin word “flavus” means yellow or golden) and the latter, pyridoxine in the preparation.

7. Vitamin C

close up of beautiful oranges cut so you can see the insidesNobel prize winner Linus Pauling alerted us to the vast role that vitamin C plays in the human body. It is integral to numerous biological processes such as tissue repair, the quenching of free radicals (antioxidant), and the formation along with the maintenance of skin, tendons, ligaments, and blood vessels. With regard to the latter, Pauling asserted that chronically low levels of vitamin C (“chronic scurvy”) are a cause of atherosclerosis.

In the same vein, it has been postulated that a bear’s ability to thwart off atherosclerotic disease (despite elevated inflammatory markers and high cholesterol levels during prolonged periods of hibernation) is causally related to their high circulating levels of vitamin C. Why? Because they synthesize it! And guess what? Humans don’t. We must obtain it from our diet or through supplementation. Do not neglect your vitamin C. It is protective of your cells and particularly your vascular endothelium. Statistically, you are likely to die of vascular disease, right? So get a jump on it.

Daily Dosage: 2-5 grams. Those of you who smoke, err on the high end of that range. Better yet, scrap the cigarettes now. Don’t be an idiot.

8. Vitamin E (mixed tocopherols and tocotrienols)

Firstly, vitamin E does not cause prostate cancer, as a recent study suggested. I’m calling nonsense on this one (as is every respectable scientist vaguely familiar with the flawed study). The poorly designed SELECT study published in JAMA utilized 400 IU/day of all rac-α-tocopheryl acetate, instead of a complete vitamin E supplement, with mixed tocopherols and tocotrienols..

This better emulates the vitamin E found in fruits and vegetables. Do fruits and vegetables cause prostate cancer? The benefits of vitamin E are numerous. For example, supplementation has been demonstrated to reduce atherosclerotic plaque burden and improve one’s lipid profile in the context of complete preparations. You will not derive the benefits with α-tocopherol alone. In fact, α-tocopherol, given in isolation, which is standard for commercial vitamin E preparations, reduces γ-tocopherol levels by 30-50 percent. And guess which one is the far more powerful antioxidant? γ-tocopherol! Do you now see why the SELECT study is ridiculous? The results are spurious. This also highlights the importance of a complete vitamin E supplement from which you will derive a variety of protective effects.

Daily Dosage: Select a preparation of mixed tocopherols and tocotrienols. I would shoot for one that has a minimum of 250 mg in total of these eight vitamin E components (Vitamin E historically has been α-tocopherol only).

Caution: Vitamin E may interfere with platelet function and therefore blood clotting. Please discuss usage with Dr. Osborn particularly if you are taking blood thinners (warfarin) or other medications that interfere with platelet function (aspirin, for example). Alert your surgeon pre-operatively as well. Prior to brain operations, my patients are advised to stop both fish oil and vitamin E supplements (it is extremely rare that I find an individual on curcumin).

9. Magnesium

Ok, there is no arguing about this one: magnesium stabilizes the heart muscle and prevents arrhythmias. It lowers blood pressure by relaxing blood vessels, plays a role in carbohydrate metabolism and reduces one’s risk of osteoporosis by augmenting bone density.

And what caliber neurosurgeon would exclude exciting new data on magnesium’s effects on the brain? A recently published study suggested that elevation of brain magnesium exerts substantial protective effects in a mouse model of Alzheimer’s disease. Specifically, magnesium-L-threonate conferred protection against plaque formation and synaptic (neuron-neuron connection) loss, characteristic of Alzheimer’s disease. And this may have treatment implications for humans. 68 percent of Americans are deficient according to a government-sponsored study.

Daily Dosage: 1,000 mg. Take your magnesium supplement at night, preferably before bed; it will help you sleep.

10. Probiotics

African American woman enjoying a spoonful of yogurtThis is the good bacteria that most of us lack in our gut. Yes, there are “good” bacteria that maintain the health of our bowels, the interface between our bodies and the outside world. Unfortunately, our guts are often overpopulated with “bad” bacteria that interfere with normal physiologic processes, leading to illness.

Case in point is antibiotic-associated colitis or “c diff” due to overgrowth of the pathogenic bacteria clostridium difficile. Antibiotics eradicate the protective bacteria of the gut. The “bad” bacteria seize the opportunity to multiply, evoking an inflammatory response that can prove fatal (20,000-30,000 Americans succumb annually to c. difficile colitis).

There is a very complex bacterial microcosm in one’s gut composed of trillions of bacteria. The interactions between the bacteria and the lining of the bowel modulate, via chemical messengers, our immune response and various metabolic processes, which in part dictate insulin sensitivity. Alterations in gut integrity for these reasons can prove disastrous. Unfortunately, this has been underappreciated until relatively recently. If the gut is inflamed, you are inflamed. Just because the bowel in actuality is external to the body, does not permit you to neglect it. Nurture it instead for optimal health. Try eating yogurt daily for a week. You’ll feel better, guaranteed!

Daily Dosage: (for those not in favor of yogurt) Buy a preparation with at least 2 billion CFU (bacteria essentially) per serving. Take one to two servings daily. Double your daily dosage while on antibiotics, or for five days pre-and post-operatively in the event you are having surgery. Another tip: always store your probiotics in the refrigerator. These are live cultures. Would you leave your yogurt out of the fridge for days on end? I think not.

Multivitamin or not?

Several of the above may be found in multivitamin preparations. In that vein, choose a multivitamin that is just that, “multi,” multiple capsules or tablets per day. I personally steer clear of the single tablet preparations for two reasons:

  1. The dosages of the individual components are fairly low. Vitamin C quantities for example, position one just over the threshold of scurvy. Multi-tablet preps typically contain higher quantities of the micronutrients. My preference is Life Extension® Mix tablets (9 pills daily).
  2. Serum levels of the micronutrients are inconsistent throughout the day. A steady supply of micronutrients (theoretically provided by a multi-tablet prep) increases the probability of your cells being saturated with vital cofactors around the clock.

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sideview of waterline in clear container

While water is not considered a supplement, it should be. The majority of people are dehydrated, plain and simple. You may not think you are, but you are. Yes, you!

Do you drink 10-12 cups of water daily? Doubtful. Well, this is your water requirement under normal conditions; in extreme conditions, it can be double that amount. Even mild dehydration can affect mental and physical performance. Gastrointestinal function may also be impaired, resulting in delayed transit times and constipation. And while the latter may be unpleasant, even more unpleasant is your prolonged exposure to potential carcinogens as their passage through the gut is delayed. A common cause of constipation is dehydration.

Optimal hydration is associated with a reduced incidence of fatal coronary artery disease, stroke, hypertension, diabetes-related complications such as ketoacidosis, kidney stones and urinary tract infections. Those bouts of dizziness you experience when standing up too abruptly? That may be a function of dehydration. Hydration also affects the fullness of your skin and more importantly its integrity and efficacy as a barrier to pathogens. Remember, you are 60 percent water! It is absolutely essential to life and therefore not to be neglected, although often is.

So “supplement” aggressively with water, 1 gallon per day as a rule (unless instructed otherwise by your doctor), bodyweight aside.  Similarly, you could opt for an IV treatment should you feel dehydrated, run down or are gearing up for your next competition.

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