Last week we talked about temperature and sleep and a few of you wrote back asking what else I do. So this week I'm opening the medicine cabinet (or drawer, such as it is).

I've spent some time putting together a guide to my supplement stack, but it's a decision framework, not a shopping list. The list matters less than the filter, because once you can sort a supplement yourself, you can evaluate anything a wellness influencer sends your way without needing me.

The most important thing to remember is that unless you are deficient, supplements are not going to move the needle before you get the big levers in order. Stress, sleep, movement, strength training and nutrition are the biggest contributors to your health. I like to think of supplements as the cherry on top...only to be added once you've made progress on those health pillars.

Here's the filter: before something gets into my stack it has to clear five questions. Is there human data, not just a mechanism in a petri dish or a mouse? Am I actually deficient or at risk? Would food get me there first? Does the effect size matter in real life, because statistically significant and meaningful are different things. Finally, what does it cost per month and what am I giving up to buy it? Most things that fail two or more won't make the list, no matter how good the marketing is...although due to the nature of my job I sometimes test things that fall outside of these questions.

Now here is something most people don't know. I didn't for a long time either!

The two most universally recommended supplements in the world have large, well-run trials showing they did NOT do the main thing they're sold for.

The VITAL trial randomized 25,871 adults to 2,000 IU of vitamin D or placebo for a median of 5.3 years. Published in the New England Journal of Medicine, it found no reduction in invasive cancer and no reduction in major cardiovascular events. A companion analysis in the same journal found no reduction in total, nonvertebral or hip fractures either. The same trial gave 1 gram a day of marine omega-3 and found no reduction in major cardiovascular events or cancer.

Read that carefully, because it does not mean what the headlines said it meant. Those participants were not selected for deficiency. It means that in adults who already had enough, topping up did not prevent the things everyone assumes it prevents. If you're deficient, correcting it is worth doing. If you're not, you're buying insurance against a risk you don't have.

That's the whole argument for testing instead of guessing and it's why I run panels through OneTwenty and Hundred on a regular basis.

I still take both, by the way. I'm just not going to tell you they're proven to prevent heart disease when a 25,000 person randomized trial says otherwise. However, I feel these are low risk supplements and many people are deficient in these two. For example, if you live about the 27th parallel, it's nearly impossible to get enough vitamin D in the winter. If you're inside working most of the summer, that's an issue for vitamin D too. If you don't eat fish or grass fed beef and consume seed oils, Omega could be deficient or out of balance as well.

The guide has a page called "what I take anyway, knowing the evidence is thin." Some of what's in my supplement drawer is an experiment I'm running on myself with my own money. That's a legitimate reason to take something, but it's a different reason than evidence.

However, the single biggest change in my routine wasn't a supplement at all. I've been on hormone replacement therapy (HRT) since 2020 and between that and cooling the bed, those two did more for my sleep than every capsule in the guide combined.

It would be dishonest to hand you a supplement list without saying there are other things that could be producing results. The supplement stack could be working, but hormone therapy is sitting in the background at the same time, along with consistent strength training.

HRT depends on your history and your symptoms but it's definitely something to discuss with your health care provider if things are feeling off. If you've been wondering whether what you're feeling is hormonal, ask someone qualified rather than just suffering through it. Finding the right person can be difficult though, I couldn't find a local provider who's actually current on the latest HRT best practices. It's harder than it should be and too many peolple get told their labs are normal and sent home with nothing.

That's why I get my own prescribing and monitoring through Thrivelab. Three things make them worth your time...they take insurance, which is very unusual in the hormone telehealth world where cash-pay memberships are the norm (I did that for a few of those years), so it's worth checking with them if their services are covered by your insurance. Second, all of your appointments are completed by video online with labs at your local Quest or Labcorpso it's very convenient and time saving. Finally, you can take their free symptom quiz before committing to anything, which tells you whether you're even a candidate. My link gives you a first month free, for men and women both. They also offer weight loss and nutrition services as well, which may also be covered by your insurance.

If you want my supplement guide, it's free and you can grab it here.

It covers my actual doses, the two supplements I take knowing the evidence is thin, the five things I skip entirely and why and where to buy what's in it without getting counterfeits or contaminants.

Hit reply and tell me what's in your cabinet right now or what you've been wondering whether to stop. I read every response and I'd be happy to give you my thoughts on what you're taking.

Have a great weekend!

P.S. I'm running my final biomarker panel before I leave for Greece next week, which closes out the protocol I've been on since July. When the results land I'll update the article with what actually moved and what didn't, variables held as steady as I could manage. If you want to see how that turns out, the running write-up is here.