If you're like nearly half of all Americans, you take at least one supplement to boost your health. But are you spending your money on the right ones? For that matter, do you need to take vitamins at all? It can be hard to know.
With the help of top nutrition experts, we've combed through the research and pored over the products to create an information-packed, easy-to-use guide to what to take (and skip) to protect your health for years to come.
Q: I think I eat pretty well. Do I really need supplements?
Possibly. Some experts, like Marion Nestle, PhD, MPH, a professor of nutrition at New York University and author of What to Eat: An Aisle-by- Aisle Guide to Savvy Food Choices and Good Eating, say that if you eat a wide variety of fruits and vegetables, whole grains, lean protein and low-fat dairy products, you can skip the supplements. (Ideally, it's better to get the vitamins, minerals and nutrients you need through real food, since all the nutrients in the food often work together to enhance absorption.)
However, other experts say that most of us overestimate how well we're really eating and that taking a multivitamin couldn't hurt. In fact, according to a recent USDA report, most Americans are consuming too few fruits and vegetables, high-fiber whole grains, seafood, and low-fat milk and dairy products—all of which are crucial to ensuring that we're getting essential vitamins, minerals and nutrients. "Supplements can provide a base, an insurance of sorts, in case you don't get certain nutrients that day," says David Heber, MD, director of the UCLA Center for Human Nutrition and author of What Color Is Your Diet?
Many doctors give multivitamins in particular a thumbs-up, for the variety of essential vitamins, minerals and other nutrients they provide. (See "Multi Musts" at the bottom of the page.) Photo: Thinkstock
Q: Are there supplements that every woman should take?
In addition to a multi, many healthcare practitioners now recommend omega-3s, extra calcium and vitamin D, because it's tough to squeeze the right amounts of these into your diet every day. They're all linked to strong health benefits, ranging from lower risk of cancer and heart disease to better mood. Of course, check with your doctor before starting a supplement regimen.
OMEGA-3s should be sourced from either fish oil or algae (check the label); experts recommend 1,000 mg daily. The key fatty acids in omega- 3s are DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). DHA is the more potent, but older formulas will often have more EPA. You just want to be sure to pick a supplement with a combination of the two—which will be indicated on the label. Some companies will also add a little bit of vitamin E (it's often on the label as tocopherol), since it can help prevent omega-3s from becoming rancid.
Calcium is crucial for strong bones— especially for women, who are five times more likely than men to develop bone-weakening osteoporosis. According to the USDA, pre-menopausal women under 50 need about 1,000 mg a day; those over 50 or who've gone through menopause need 1,200.
Most doctors recommend at least some supplementation, since a glass of milk only provides about 300 mg, and we also lose a lot in other ways. "Dark-colored sodas, alcohol, acidic foods, meats and coffee all deplete our stores of calcium," says Mark Hyman, MD, founder of The Ultra- Wellness Center and author of Ultrametabolism: The Simple Plan for Automatic Weight Loss. Keep in mind that vitamin D aids in calcium absorption (which is why it's often added to milk), so look for supplements that combine the two, or be sure to take your D and calcium pills at the same time.
Vitamin D may help stave off a multitude of health problems such as cancer, depression and heart disease. "We recommend extra because most multivitamins don't contain enough," says Dr. Heber. In part, that's because this past November, the RDA was increased from 400 to 600 IU (800 if you're over 71). Though foods like fatty fish, liver and eggs do contain a small amount, it's almost impossible to get all your D from food. Our bodies make it naturally when exposed to sunlight, but thanks to weather variability and sun protection to lower skin cancer risk, that may not be happening as often as it should. There's some disagreement among experts about whether we get enough D, so ask your doctor to check your D levels with a simple blood test before taking a pill. (If you do supplement, look for D3, which is the variation best absorbed by the body.) Photo: Shuttersock
Q: Can probiotics help with my stomach issues?
Maybe. These "healthy" bacteria that naturally live in your gastrointestinal system help your body better absorb nutrients and reduce or prevent inflammation—both of which affect how well you process and metabolize food. The best way to maintain healthy levels of probiotics is to eat a diet full of fiber-rich, nutrient- dense foods including whole grains like brown rice and oatmeal, and fruits, vegetables and legumes. (Yogurt contains one type of probiotic, but it's often killed during the processing.)
If you feel that your stomach is compromised, however, you could consider taking a supplement, says Susan Levin, RD, a nutritionist with the Physicians Committee for Responsible Medicine in Washington, DC. Studies have shown that probiotics can help treat a variety of gastrointestinal symptoms, from diarrhea and intestinal infections to irritable bowel syndrome (IBS). Ask your healthcare provider or a nutritionist to recommend a reputable brand, and follow the dosage directions on the label. Photo: Shuttersock
Q: Can certain supplements boost my energy?
Research suggests that B vitamins (especially B12 ) play a key role in helping your brain function, boosting energy, and strengthening your immune and nervous systems—all big reasons they're so commonly found in energy drinks and hangover remedies. One study suggests that as many as two-fifths of us have low B levels, but to bring them up we don't need much more than what's in a regular multi.
There are, however, a few exceptions: Excessive alcohol use, heartburn and ulcer medications, and some autoimmune disorders can make a dent in your B reserves over time. Also, B levels can drop as we age. The Institute of Medicine (the arm of the National Academy of Sciences that advises government agencies on how much we should be getting of various nutrients) recommends B12 supplements (ask your doctor if your multi has enough) or foods fortified with vitamin B12 (such as cereals and soy foods) for people over 50, since our bodies become less adept at absorbing it as we get older. Photo: Shuttersock
Q: What vitamins and minerals should I be concerned about if I'm going through menopause?
In addition to B12 , also pay attention to calcium. Estrogen levels drop during this time, which makes you more vulnerable to osteoporosis, so as we said earlier, you should up your calcium intake to 1,200 mg (from 1,000). Photo: Shuttersock
Q: I want to have a baby in the next few years. What should I make sure I get enough of?
In addition to enhancing brain health and cellular function, folate (also known as B9) is critical to fertility and fetal development during pregnancy. Research shows a direct link between folate deficiency and neural tube defects (when the neural tube protecting the spinal cord doesn't form and close properly in the third or fourth week of pregnancy). This is why the government has long fortified breakfast cereals and other foods with folic acid, a synthetic form of folate.
"But even so, most young women don't get enough," says Martha Morris, PhD, a researcher at Tufts University who studies the effects of vitamins on the body. "So if you're thinking about getting pregnant, it's doubly important to take a prenatal vitamin or a multi that meets the folic acid RDA of 400 micrograms."
Because many pregnancies are unplanned and neural tube defects happen early on, Dr. Morris recommends that you start early—if possible, years before you want to conceive. Added benefit: In the Harvard Nurses' Health Study, women who took a multivitamin containing folic acid over 15 years had a 75 percent lower risk of colon cancer. The USDA also suggests a diet rich in iron (found in lean red meats, seafood, beans, and vegetables including broccoli) along with vitamin C, which helps your body absorb iron. Photo: Thinkstock
Q: I'm a vegetarian. Are there any supplements I need?
Maybe. You could be low in vitamin B12 and iron, since both are mostly found in meat. Taking a multi should ensure that your B12 levels stay where they should be. But depending on how much you exercise and how heavy your periods are (frequent, strenuous exercise and losing a lot of blood monthly can deplete iron stores), you may need more iron than what's in a multi.
To check your iron levels, ask your doctor for a serum ferritin test (more sensitive than a standard iron test), especially if you're feeling run-down. In general, up until menopause, you should be getting about 18 mg of iron a day, says nutritionist Elizabeth Somer, RD, author of Eat Your Way to Happiness. But too much iron isn't good either, so don't try to supplement on your own beyond what you'll find in some multis.
The tannins in coffee and tea inhibit iron absorption, so try to avoid drinking those around meals or when you take your multivitamin. Also, if you're vegan, you'll want to be doubly sure to take calcium and D, or make sure you're getting them from fortified soy milk. Photo: Shuttersock
Q: Do supplements that claim to boost your mood really work?
Studies have shown that people with low levels of vitamin D and omega- 3s are more likely to have symptoms of depression, so making sure you're getting enough of both may help protect against it. Experts say there's one more nutrient that could be essential: magnesium. "I call it the relaxation mineral. It's a natural calcium channel blocker—it blocks calcium from entering nerve cells and 'exciting' them—so it calms you," says Dr. Hyman. According to the USDA, many of us are deficient, so 200 mg can be a good addition for just about anybody. Photo: Shuttersock
Q: Can you overdose on vitamins?
When it comes to multivitamins it's almost impossible to overdose; the amounts in a multi are usually well below the tolerable upper intake level, so it's hard to get too much unless you're also taking many other supplements on top of it. In the case of individual vitamins and supplements, yes, you can theoretically get too much—but it's tough to do because you'd have to take several times the recommended amount over a long period of time. "Problems mainly come from overdosing on single nutrients, not from taking a multi or eating too many vegetables," says Dr. Nestle.
Generally speaking, iron and fat-soluble vitamins such as A and E have been linked to bad reactions, so be sure not to take these separately unless your doctor specifically recommends that you do this. Because D works as a hormone and is fat-soluble (meaning the body doesn't readily eliminate it when there's too much), it's technically possible to get too much, but that seems to happen only if you're getting high levels for several months. This is another reason why it's always important to talk to your doctor before taking any supplements.Photo: Shuttersock
Q: I've seen some vitamins that say they're plant-based, not synthetic. Are they better?
A plant-based vitamin is one that's made by grinding up whole foods— ranging from broccoli to goji berries— and pulverizing them into pills and powders. (Country Life and Alive! are brands you might find in the drugstore.) The claim is that you're getting the nutrients in a more natural form, almost as if you were eating the foods they're found in. (But note that some also contain synthetic vitamins.)
These vitamins don't work any better than others, but one possible advantage of this type of pill is its potential extra antioxidant content. Berries, cocoa, green tea and curcumin are believed to be extra--strong sources, so if you're interested in trying one, consider looking for products with one or more of these.
Q: I always feel a little nauseated when I take my vitamins. What can I do?
Taking a vitamin on an empty stomach (especially if it contains iron) is what usually causes this, so be sure to coat your stomach by eating and drinking water with your supplements. You can also try to find smaller pills with fewer additives, as fillers can also cause nausea or an upset stomach. If you're still having issues, consider switching to chewable pills or powders you can mix with water. All are just as effective as a hard pill but may be less irritating. Photo: iStockphoto
Multi Musts
Be sure your multi contains the following vitamins: A (at least half of it as betacarotene or mixed carotenoids), B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (panthothenic acid), B6 (pyroxidine), B7 (biotin), B9 (folic acid), B12, C, D, E and K. Minerals should include: copper, chromium, magnesium, manganese, molybdenum, selenium and zinc. The multi should have around 100% of the recommended daily allowance (RDA) for most of these vitamins and minerals.
Also, pre-menopausal women should take a formula with iron. Postmenopausal women (and men) should take one without iron; their needs are much lower and easier to meet with food.
Sara Reistad-Long is a freelance writer who specializes in health and well-being. She also blogs about food at SvelteGourmand.com.
