Library · Supplements

Supplements, weighed against the evidence.

From vitamin D to creatine, we summarize what randomized trials and meta-analyses actually show — including the unflattering parts. Each entry lists effective dose ranges, common interactions, and population-specific caveats.

Reviewed by
Biosphere Medical Advisory Board
Last updated
May 2026

Key takeaways

Dose matters

Effect sizes for most supplements depend heavily on baseline status and dose. A deficient population responds; a replete one usually doesn't.

Form matters

Bioavailability differs sharply between salt forms (e.g., magnesium citrate vs. oxide). Trial outcomes don't transfer across forms.

Interactions are common

St. John's Wort, vitamin K, and high-dose calcium each meaningfully affect prescription drug levels. Always disclose to your prescriber.

Quality varies

Independent third-party testing (USP, NSF, ConsumerLab) is the simplest signal. Label claims alone are not regulated for accuracy.

Articles in this topic

Vitamin · RCT

Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease (VITAL)

25,871 adults randomized to 2,000 IU/day vitamin D₃ vs placebo for a median 5.3 years; no reduction in invasive cancer or major cardiovascular events overall. Largest definitive trial dampening enthusiasm for routine supplementation in replete adults.

Manson et al., NEJM, 2019

Agrade
10 min
Mineral · Review

Magnesium in Man: Implications for Health and Disease

Comprehensive physiology review covering serum vs intracellular status, bioavailability of common forms (citrate, glycinate, oxide, chloride), and effect sizes for sleep, cramps, and blood pressure. Foundational reference for clinical magnesium use.

de Baaij et al., Physiol Rev, 2015

B+grade
9 min
Amino acid · Position stand

International Society of Sports Nutrition Position Stand: Creatine Supplementation

Comprehensive position paper concluding creatine monohydrate (3–5 g/day, no loading required) is the most effective ergogenic supplement for high-intensity exercise and lean mass, with an excellent long-term safety record. Emerging evidence in cognition and recovery from concussion.

Kreider et al., JISSN, 2017

A−grade
10 min
Botanical · Meta-analysis

An Updated Systematic Review and Meta-Analysis on the Effects of Withania somnifera (Ashwagandha)

Pooled RCT data show standardized ashwagandha extract (KSM-66, 300–600 mg/day) modestly reduces self-reported anxiety and morning cortisol vs placebo. Effect sizes are real but small; caution in hyperthyroidism.

Akhgarjand et al., Phytother Res, 2022

Bgrade
7 min
Lipids · RCT

Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia (REDUCE-IT)

8,179 statin-treated patients with elevated triglycerides; 4 g/day prescription EPA reduced major ischemic events by 25% over 4.9 years. STRENGTH (mixed EPA/DHA) was negative — formulation matters.

Bhatt et al., NEJM, 2019

Agrade
12 min
Vitamin · Review

MTHFR Polymorphisms and Folate Metabolism: Clinical Implications

Reviews mechanism of C677T/A1298C variants and rationale for 5-MTHF (methylated folate) over folic acid in homozygous carriers, particularly during preconception. Effect on hard outcomes outside neural tube defect prevention remains modest.

Liew & Gupta, Eur J Med Genet, 2015

C+grade
9 min