[user_7832]

I think the important distinction is whether someone is already very healthy or not.

> Like nearly every trendy non-rx supplement that has been around for this long, if there were any substantive medical benefits that could be demonstrated empirically in clinical drug trials, a prescription variant would have emerged

This is unfortunately not completely correct. Vitamin D supplements don't appear to do anything to me, even though my doc prescribed it. But NAC (for example) is not commonly prescribed even though many people have reported a reduction of OCD behaviour. L Tyrosine can be almost as effective as ADHD medication for some, yet even though it is well known in nootropic circles the doctor will rather prescribe a medical stimulant.

The reason is probably just "FDA approval"/safety in most cases, but make no mistake, current prescriptions are years to decades behind current medical research. (I can expand more if you'd like.)

[nextos]

There are serious clinical trials with randomization and placebo that have repeatedly shown vitamin D supplementation reduces autoimmune disease rate. For example [1].

Obviously, the effect of a compound that does not require prescription and has few side effects is modest. But we are talking about a two digit % reduction in incidence, which is pretty respectable. At individual level, it is of course hard to see any effect. And if you are in trouble already, you will typically need, something stronger, a drug.

[1] https://www.bmj.com/content/376/bmj-2021-066452.full

[Aurornis]

That's one of the weaker study outcomes I've seen. The Vitamin D arm just baaarely reached their definition of being significant. If the numbers had differed by only a single patient they would have had to call it "not significant"

Whenever studies test multiple things in parallel and single in on one of them as significant with a p-value of 0.05, it's not really a bulletproof conclusion.

[crackedbassoon]

That study actually did NOT find that Vit D reduced autoimmune disease rate. P=.05 means not significant (it needs to be <.05). Pretty gigantic blunder by the researchers to be honest.

[briHass]

Doctors prescribe stimulant medication for ADHD because it is remarkably effective, well-understood, and reasonably safe, if doses are controlled and potential addiction is managed. Why would a doctor mess around with a less effective (arguably, not effective), poorly tested supplement?

If the traditional medications don't work or have intolerable side effects, maybe that's the time to explore uncommon approaches, but that generally is not the case for the stimulant meds.

[user_7832]

I fully agree with your point of prescribing well known meds. (By the way tyrosine as a natural ammino acid is fairly "safe"). What I meant was as a response to the OP where they talked about how "if it worked, they'd be selling it as a medicine". It may be much "lighter"/less effective for sure, but there may be some patients (for example with depression, or those hesitant to take stimulants) who may still benefit.

> If the traditional medications don't work or have intolerable side effects, maybe that's the time to explore uncommon approaches, but that generally is not the case for the stimulant meds.

It may not be the case for probably 70-80% of patients, but a lot of people complain of reduced appetite. I would experience annoying joint/muscle pain that can apparently be a "very common" (more than 1 in 10) side effect. (This is not specific to tyrosine, just replying to your comment specifically. I didn't realize that different stimulant meds can reduce/stop side effects altogether to such an extent until some time back.)

[Aurornis]

> Vitamin D supplements don't appear to do anything to me, even though my doc prescribed it.

Vitamin D shouldn't do anything noticeable, unless you have a severe deficit. Health influencers have been trying to exaggerate the effects of Vitamin D and exaggerate how many people might be deficient for a long time. Too many people taking too high of a dose without ever even trying to test their blood levels.

> But NAC (for example) is not commonly prescribed even though many people have reported a reduction of OCD behaviour.

NAC is actually routinely used as medicine: It's used to great effect in cases of Tylenol overdose.

However, NAC is another compound for which the effects have become greatly exaggerated and the potential downsides ignored. You can find scattered reports on Reddit about NAC having life-changing properties on the first dose, it's hard to untangle that from placebo effect. It's much harder to find people who have continued taking it for a long time with great effect.

It has actually been studied multiple times over for OCD, but the studies haven't been great quality and haven't revealed the same miraculous effects reported by health influencers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4423164/

> L Tyrosine can be almost as effective as ADHD medication for some, yet even though it is well known in nootropic circles the doctor will rather prescribe a medical stimulant.

This is just false. L-Tyrosine on an empty stomach can have a minor modulating effect on dopamine, but the effect is nowhere near as potent as stimulant medication, fades quickly, is prone to rapid tolerance, and can't be repeated unless the person has an empty stomach (~2 hours since last meal).

If you don't believe me, look up the L-Tyrosine content of some common meat and dairy products. You can get nearly 1 gram of L-Tyrosine from a glass of milk or 2 grams from a chicken breast.

This is another one where people miss the fine print about empty stomach, take 1000mg (2 pills, commonly) with a meal, and then report glowing experiences only because they've been primed to expect them. Once you explain that they've been consuming grams of L-Tyrosine every day for their entire lives, the placebo effect starts to make sense.

Taking it on an empty stomach can produce certain effects, but they're minimal.

> current prescriptions are years to decades behind current medical research. (I can expand more if you'd like.)

Given the examples you provided, I think you're overestimating your own knowledge of supplements. You're also underestimating the effects of prescription medication if you think L-Tyrosine is on the same level as Schedule II prescription stimulants.

[user_7832]

> Vitamin D shouldn't do anything noticeable, unless you have a severe deficit. Health influencers have been trying to exaggerate the effects of Vitamin D and exaggerate how many people might be deficient for a long time. Too many people taking too high of a dose without ever even trying to test their blood levels.

Agreed. However when I was prescribed it my levels were several times lower than the minimum normal values. However physiology and biology affects a lot of things, so it is tough to say why I didn't feel anything.

> NAC is actually routinely used as medicine: It's used to great effect in cases of Tylenol overdose.

(Yep, I'm aware of this! :) What I meant is as a supplement though, not in the ER.

> However, NAC is another compound for which the effects have become greatly exaggerated and the potential downsides ignored. You can find scattered reports on Reddit about NAC having life-changing properties on the first dose, it's hard to untangle that from placebo effect. It's much harder to find people who have continued taking it for a long time with great effect.

> It has actually been studied multiple times over for OCD, but the studies haven't been great quality and haven't revealed the same miraculous effects reported by health influencers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4423164/

That's certainly possible, I myself haven't felt anything from NAC. However iirc anti depressants like SSRIs have been shown to barely be more effective than placebos in many cases, but that doesn't stop doctors from prescribing them willy-nilly. (Example link I found https://www.nature.com/articles/ncpneuro0803)

Lithium for example too, benefits some people but not all equally. So why not try NAC if the risks are low and potential benefits are high?

> This is just false. L-Tyrosine on an empty stomach can have a minor modulating effect on dopamine, but the effect is nowhere near as potent as stimulant medication, fades quickly, is prone to rapid tolerance, and can't be repeated unless the person has an empty stomach (~2 hours since last meal).

I was a bit scarce on the details for privacy reasons, but I am "some people" :)

It's probably helpful to note that folks with ADHD like me probably have some other wonkiness in the dopamine pathways, but I legitimately cannot differentiate between a l tyrosine tablet (forget the dose) and a normal-low dose of methylphenidate. (Yes, 20mg of methyl. will not be the same, but given the side effects the lower doses are slightly better for me.)

I'm aware of the quantities in food, I agree that the empty stomach part and low tolerance also very likely played a role in my experience.

> Given the examples you provided, I think you're overestimating your own knowledge of supplements. You're also underestimating the effects of prescription medication if you think L-Tyrosine is on the same level as Schedule II prescription stimulants.

I most certainly do not think I have anywhere close to the fraction of the knowledge an expert who truly understand the brain would have. However, I think neither do most people, and I also think doctors are too overworked/pessimistic/old-fashioned/underpaid (take your pick) to actually learn about new substances and prescribe them. I have also witnessed first hand the need to advocate for yourself in front of doctors, and read about the sometimes fatal risks of not doing so. I don't assume malice, but I do assume other issues in the healthcare system at large in today's world.