Supplement Plan v1 — 5-supplement stack, ~$60-80/month
Frame: Conservative stack with real evidence behind each item. Each supplement maps to a specific finding in [[2026-05-21-founder-health-assessment-v1]]. Flag berberine and creatine to Dr Ambrose before starting (one has pharmacologic activity, the other confounds creatinine labs).
Not a prescription. Founder + Dr Ambrose decide. Where doses match published trials, the trial is cited.
1. The 5-supplement stack
1. Vitamin D3 + K2 — 2,000 IU/day
- Target finding: No 25-OH-D test in 7 years of FHIR records. Indoor-worker pattern, New England light environment. Likely insufficient (<30 ng/mL).
- Dose: 2,000 IU vitamin D3 + 100 mcg K2 (MK-7 form). Take with a fatty meal (D is fat-soluble; bioavailability ~40% lower fasted).
- Brand options: Thorne D3+K2 (1,000 IU per drop, dose 2 drops) OR NOW Foods Vitamin D-3 2,000 IU + separate K2-MK7 100 mcg.
- Cost: ~$8-12/mo.
- Evidence: Endocrine Society 2024 guideline supports supplementation for adults with low intake. Cardiovascular benefit signal modest in VITAL trial but bone, mood, and immune benefits are well-established. K2 co-supplementation directs calcium toward bone and away from arterial wall (Rotterdam Study + RCTs).
- Monitoring: Recheck 25-OH-D at 3 months (target 40-60 ng/mL). Dose down if >70.
2. Magnesium glycinate — 300 mg/day, bedtime
- Target finding: Fasting glucose creep (105) + variable sleep (median 6.72 hrs) + occasional gout flares (mag plays in renal urate handling).
- Dose: 300 mg elemental magnesium (note: 300 mg "elemental" is different from 300 mg "magnesium glycinate compound" — check label for elemental mg). Bedtime.
- Form: Glycinate specifically (NOT oxide, NOT citrate). Glycinate has highest absorption + calming effect from the glycine moiety. Citrate is laxative-grade absorption; oxide is poorly absorbed.
- Brand options: Doctor's Best High Absorption Magnesium Glycinate 200mg (take 1.5 tabs OR adjust); NOW Foods Magnesium Glycinate 200mg (same).
- Cost: ~$10/mo.
- Evidence: Asbaghi et al meta-analysis 2020 (J Trace Elem Med Biol): magnesium supplementation reduced fasting glucose -4.6 mg/dL in insulin-resistant subjects. Multiple sleep RCTs show modest but consistent sleep-quality benefit (Abbasi 2012, others).
- Monitoring: None specifically required. If loose stool develops, switch back to glycinate (oxide/citrate are the culprits there).
3. Omega-3 EPA+DHA — 2 g combined/day
- Target finding: LDL 108 + HDL 45 (low-normal) + MASLD + general anti-inflammatory cover.
- Dose: 2 g combined EPA+DHA per day. Read the label — many fish oils are 1g of oil with 300 mg EPA+DHA. You want pills delivering 1,000 mg combined EPA+DHA per serving so 2/day hits the target.
- Brand options: Carlson Elite EPA + DHA Gems (1,600 mg EPA+DHA per 2 softgels) OR Nordic Naturals Ultimate Omega (1,280 mg EPA+DHA per 2 softgels). Both third-party tested for heavy metals + freshness (oxidation is a real issue in fish oil).
- Cost: ~$20-25/mo.
- Evidence: REDUCE-IT trial used 4 g icosapent ethyl (Rx) for CV outcomes in elevated TG; that dose is not OTC-supplement-replicable. 2 g/day OTC fish oil consistently reduces triglycerides 10-20% and shows modest LDL-particle benefit. Also relevant for MASLD: omega-3 PUFA supplementation improved liver fat % in meta-analyses [PMC6471235].
- Monitoring: Liquid form refrigerated. Check label for total omega-3 vs total oil; the ratio matters.
4. Berberine — 500 mg, 2x/day with meals → ⚠️ FLAG TO DR AMBROSE FIRST
- Target finding: Fasting glucose 105 + HbA1c 5.4% (rising trend). Berberine is the strongest non-Rx glycemic intervention available.
- Dose: 500 mg with breakfast + 500 mg with dinner. Start with ONE dose/day for the first week to assess GI tolerance (bloating, loose stool in first 2-3 days is common, usually resolves).
- Brand options: Thorne Berberine-500 (third-party tested, COA available). Alternatives: NOW Foods Berberine Glucose Support, Designs for Health Berberine HCl.
- Cost: ~$25/mo.
- Evidence: HIMABERB pilot trial + multiple meta-analyses show berberine has glycemic efficacy approaching metformin in prediabetes [PMC10483788, ijbcp.com 2024 comparative study, PMC11562588 2024 meta-analysis]. Mechanism: AMPK activation, intestinal microbiome shift, modest insulin sensitization.
- ⚠️ Why flag to Dr Ambrose first: Berberine has real pharmacologic activity. Drug interactions: CYP3A4 inhibition (affects statins, calcium channel blockers, some antibiotics, cyclosporine, others). P-glycoprotein interaction. Contraindicated in pregnancy + breastfeeding. May potentiate hypoglycemic agents if started later. NOT just "another vitamin." Dr Ambrose should know it's in the stack.
- Monitoring: Fasting glucose + HbA1c at next routine panel. If glucose drops below 85 on multiple readings, dose down.
5. Creatine monohydrate — 5 g/day → ⚠️ FLAG TO LAB BEFORE BLOOD DRAW
- Target finding: Lean-mass preservation during 22-lb deficit + muscle is the largest glucose sink + cognitive benefit signal.
- Dose: 5 g/day, any time (no need to time around training). No loading phase needed (loading is faster saturation, not better outcomes).
- Form: Creatine monohydrate with Creapure designation (German-manufactured, highest purity standard). Skip "creatine HCl," "buffered creatine," "creatine ethyl ester" — all more expensive, no better evidence.
- Brand options: Thorne Creatine, BulkSupplements Creapure, Optimum Nutrition Micronized (look for Creapure on the label).
- Cost: ~$8-10/mo.
- Evidence: ISSN position stand 2017 (Kreider et al): creatine monohydrate is the most-studied supplement in sport science; ironclad evidence for strength, lean mass, power output, plus emerging signal for cognitive performance + age-related muscle preservation. Safety data spans 30+ years, no harm at 5 g/day.
- ⚠️ Why flag to lab: Creatine elevates serum creatinine 0.1-0.3 mg/dL via the same metabolic pathway. This is a benign elevation — NOT renal dysfunction — but it confounds the creatinine-based eGFR estimate. Pause creatine 5 days before any blood draw OR explicitly tell the phlebotomist "patient on 5g creatine daily" so Dr Ambrose can flag the result. See [[2026-05-22-lab-order-list-v1]] section C.
- Monitoring: No specific monitoring needed beyond the eGFR caveat.
2. Total monthly cost
| Supplement | Monthly cost |
|---|---|
| Vitamin D3 + K2 | $10 |
| Magnesium glycinate | $10 |
| Omega-3 (2g EPA+DHA) | $22 |
| Berberine | $25 |
| Creatine monohydrate | $9 |
| Total | ~$76/mo |
Range: $60-80/mo depending on brand. All available on Amazon Subscribe-and-Save (typical 5-15% subscription discount).
3. Stack-and-skip phasing (don't start everything Week 1)
The goal is to identify which (if any) supplements cause GI or sleep side effects. Stacking 5 new compounds at once means you can't attribute a side effect to a specific supplement.
| Week | Add | Cumulative stack |
|---|---|---|
| Week 1 | Vitamin D3+K2, Magnesium glycinate, Creatine | 3 (low side-effect profile) |
| Week 2 | Omega-3 | 4 |
| Week 3 | Berberine 500mg/day (one dose) | 5 (titrating) |
| Week 4 | Berberine 500mg 2x/day (full dose) | 5 |
Rationale:
- D3, magnesium, creatine: low side-effect risk, start together
- Omega-3: only common issue is fishy burps; introduce next
- Berberine: highest side-effect potential (GI), titrate over 2 weeks
If GI issues appear in Week 3, hold berberine at 500 mg/day instead of jumping to 1,000 mg total. If GI issues persist after 2 weeks, stop and report to Dr Ambrose.
4. Reorder rhythm
- Monthly via Amazon Subscribe-and-Save. All 5 supplements. Set the schedule once.
- Quarterly re-evaluation: check against most recent labs. Does fasting glucose response justify continuing berberine? Did D3 push 25-OH-D to target?
- Brand swap permission: if a brand goes out of stock or quality issues surface (heavy-metal report, etc.), swap to the alternate listed above. Don't pause the stack waiting for a specific SKU.
5. Supplements deliberately NOT in the stack
| Supplement | Why skipped |
|---|---|
| NAD precursors (NR, NMN) | Preliminary evidence in humans. Strong mouse data; mixed/null in early human RCTs. ~$50-80/mo, too expensive for the evidence quality. Revisit in 2-3 years if data matures. |
| Resveratrol | Disappointing in human trials. Mouse longevity signal did not replicate at typical supplement doses in humans. |
| Multivitamin | Not needed with the Mediterranean diet pattern in [[2026-05-22-nutrition-plan-v1]]. Adds cost, no clear benefit, some formulations have excessive vitamin A/iron. |
| Vitamin E (for MASLD) | AASLD 2023 supports 800 IU RRR-alpha-tocopherol ONLY for biopsy-proven NASH (not all MASLD). Founder has not had biopsy/FibroScan to know fibrosis stage. Discuss with Dr Ambrose if FibroScan shows NASH or F2+ fibrosis. |
| Curcumin / turmeric | Modest anti-inflammatory signal, low bioavailability without piperine, easy to get via food (turmeric in cooking). Skip the pill. |
| Ashwagandha | Some sleep + anxiolytic evidence but the cleanest signal is at high doses (600+ mg KSM-66 daily). Re-evaluate if magnesium + sleep hygiene don't get sleep median above 7 hrs. |
| Collagen peptides | Hair/skin/joint marketing claims, weak evidence beyond general protein intake. The protein floor in [[2026-05-22-nutrition-plan-v1]] already covers this. |
| MCT oil, exogenous ketones | Not relevant for the Mediterranean / low-glycemic plan. |
| Allicin / garlic extract | Modest BP signal, conflicts with the "discuss BP with Dr Ambrose if home log shows elevation" pathway. Add later if Tier 1 lifestyle BP intervention insufficient. |
| CoQ10 | Evidence-strongest indication is statin-induced myalgia. Founder is not on a statin. Re-evaluate if one is prescribed. |
6. Citations
- Endocrine Society Vitamin D Guidelines 2024
- VITAL trial vitamin D: Manson et al NEJM 2019
- Magnesium + glycemic control: Asbaghi et al 2020 J Trace Elem Med Biol
- Magnesium + sleep: Abbasi et al J Res Med Sci 2012
- Omega-3 + MASLD: Lee et al meta-analysis [PMC6471235]
- REDUCE-IT (Rx icosapent ethyl): Bhatt et al NEJM 2019
- Berberine + glycemic control: HIMABERB [PMC10483788]
- Berberine vs metformin comparative: ijbcp.com 2024
- Berberine + lifestyle meta-analysis 2024: [PMC11562588]
- Creatine ISSN position stand: Kreider et al JISSN 2017 [PMC5469049]
- Vitamin E + NASH: AASLD 2023 practice guidance [PMC10735173]
- NAD precursor human trials review (mixed): Mehmel et al Nutrients 2020
7. Cross-references
- Clinical findings driving each supplement: [[2026-05-21-founder-health-assessment-v1]]
- Diet that pairs with stack: [[2026-05-22-nutrition-plan-v1]]
- Training the creatine supports: [[2026-05-22-workout-plan-v1]]
- Pre-blood-draw discipline (creatine, berberine notes): [[2026-05-22-lab-order-list-v1]]
- Reorder rhythm + logging: [[2026-05-22-execution-system-v1]]
End of v1. Reassess at 12 weeks (2026-08-14) against follow-up labs. Drop any supplement that lacks evidence of effect at the individual level.