Why some protocols have no core supplement

What a protocol page is

A protocol page lists the supplements that have been studied for one condition, with an amount listed for each. As our editorial policy puts it, these pages describe research. They are not treatment plans, and they don't replace care from a clinician.

The list is split in two. The first part, headed "Primary stack" and "The core of this protocol", is the core: the supplements with the best evidence for that condition. The second part, the "Supporting stack", is listed as additions to the core. Each row shows the amount the protocol lists and the grade our evidence database holds for that supplement in that condition.

What makes a supplement core

A core supplement has to clear one bar: an A or B grade for a benefit in that condition, from trials that tested the supplement on its own against a comparison group.

Each part of that matters:

• A or B. On How we grade, A means strong evidence and B means moderate evidence. C means limited evidence that could change, and D means very limited, early research.
• For a benefit. A grade rates how much good evidence there is, not whether the result was good. A finding of "no effect" can have grade A when good trials agree that nothing happens. A strong grade for no effect never makes a supplement core.
• In that condition. A supplement that helps one problem isn't core for another just because they sound alike. On our claustrophobia protocol, for example, the stack's supplements were tested for stress or general anxiety, not in people with this fear.
• On its own, against a comparison group. A blend, a study with no comparison group, or a study in animals doesn't count. These are the same tests a study has to pass before we link it to a finding, which our post on why some supplements show "Studies not yet linked" explains in full.

Why some pages say no supplement has been shown to help

For some conditions, nothing on the list clears that bar. The trials are small, or they disagree, or the best of them found no difference from a placebo. When that is the case, the page has no core.

Most of those pages now say so in their first sentence. The tinnitus protocol opens: "No supplement has been shown to quiet tinnitus." The Raynaud's protocol opens: "No supplement has been shown to prevent Raynaud's attacks." The Alzheimer's disease protocol opens: "No supplement has been shown to slow Alzheimer's disease; medicines and care plans come from the memory clinic." The dandruff protocol says the same about clearing dandruff.

Further down, the stack table on those pages has a single part, titled "Limited evidence", with the note "No supplement here has more than limited evidence". On the tinnitus page, each row starts with the words "Limited evidence", and the evidence section below says what the trials found, including the ones that found nothing.

We still list the supplements because people ask about them and they have been studied. A page that shows what was tried, and how it turned out, is more useful than a blank one. The page labels each amount it lists "not a recommendation". Some pages also say why a well-known supplement is not in their stack. The tinnitus page, for example, says Cochrane reviews found no evidence that oral zinc helps adults with tinnitus, and that ginkgo may make little or no difference.

Why there was a core before

The stacks were first drafted when the site was built, and every one of them had a core. On some pages, that core held supplements whose trials were weak or negative. The first tinnitus stack, for example, had melatonin and ginkgo as its core.

A core reads as "start here; this works". When its supplements have only limited evidence, that message claims more than the trials show. So as each protocol is checked against the rule above, a core supplement that doesn't clear the bar moves out of the core, or off the list when good trials found it made no difference. When none is left, the page has no core.

We are doing this one page at a time. Until a page has been checked against the rule, its core may still be the one the original data named. Read a core supplement's grade on the page, not just its place at the top of the list: a core supplement marked "Not graded yet" hasn't been shown to clear the bar.

Why those pages carry no buy links

A protocol page with a core can show a shop block: product links for its supplements, sometimes a ready-made kit, and a "Get this protocol" link. A page with no core shows none of these. There is no shop block, no kit, no product link in the stack table and no referral disclosure, because there is nothing to disclose.

The reason is simple. A buy button beside a stack suggests that the stack is worth buying for that condition. When no supplement on the page has been shown to help, that suggestion would go further than the evidence does. Our editorial policy says grades and the choice of supplements in a protocol are not influenced by which products earn a commission. Taking the buy links off pages with no core follows from the same idea: a buy link should never say more than the evidence does.

The page keeps everything else: the studies, what they found, the amounts it lists, the safety notes and when to see a clinician.

How a page can gain a core

A page with no core can gain one when the evidence changes. That happens when a supplement on its list gets an A or B grade for a benefit in that condition, from trials of the supplement on its own against a comparison group. New trials are published all the time, and our re-check sets each grade from what the linked studies show, so a grade can rise when good trials are linked.

When a supplement clears the bar, it can move into the core, and the page can then show buy links. The reverse holds too: if new trials show a core supplement does nothing for that condition, it leaves the core.

What "no core" doesn't mean

It doesn't mean nothing helps the condition. Several of these pages name what to try instead, and it is not a supplement. The tinnitus page names hearing aids, sound therapy and talking therapy as the main help. The dandruff page names antifungal shampoo as the first step.

It doesn't mean every supplement on the list is useless. Limited evidence is not evidence of no effect. A small trial that found a benefit is a reason to run a bigger one; on its own, it isn't enough to put a supplement in the core.

And it doesn't mean the supplements are safe. Each page's safety section still applies. If you take medicines or have a health condition, talk to your clinician or pharmacist before adding anything.

How you can help

If you know a trial that should give a supplement a core place on one of these pages, or you think a core supplement on another page doesn't clear the bar, email hello@winnowleaf.com with the page address and the study. Our corrections policy says what happens next, and changes to findings appear in the corrections log.