What supplements should I take?

The rise of dietary supplements 

Dietary supplements have boomed in recent years to become an extremely lucrative business. The supplement industry targets several different age groups and demographics, however older adults in particular make up a big part of supplement sales. In fact, a survey of adults aged over 60 years found that 70% take a daily supplement, over half take one or two supplements and just under one third take at least four supplements.(1) 

The question is, are supplements necessary? Or are they just a waste of money? Why do people take them and if they are helpful, which supplements should you take? One thing is for sure, supplements should never be a substitute for a healthy and balanced diet. 

Much like you cannot “out-exercise a bad diet”, you also shouldn’t aim to “out-supplement a bad diet”! In fact, focusing on attaining health through supplements can take the attention away from healthy lifestyle habits which can be much more beneficial for your health. 

The term supplement is a generic name that encompasses a myriad of different products from vitamins and minerals to botanicals, hormones and biosimilars. In general however, supplement refers to a single vitamin or mineral pill or a multivitamin which by definition contains at least 10 vitamins and/or minerals. 

Conflicting evidence 

Despite their popularity, supplements are not “miracle pills” and do not always live up to their claims. Indeed, a group of researchers investigated the effects of supplemental vitamins and minerals on cardiovascular disease prevention. They found that the top four most commonly used supplements: multivitamins, calcium, vitamin D and vitamin C did not offer significant protection against the risk of cardiovascular disease.(2)

Conversely, there is some evidence that certain supplements may confer some benefits. For example, Harvard researchers looked at the effects of a daily multivitamin in men over an 11 year period. They found that those who took the multivitamin had an 8% decreased risk of cancer and a 9% lower risk of developing cataracts compared to a placebo group.(3)

The conflicting evidence makes it challenging to make absolute claims regarding supplements. However, there are other factors at play, from marketing tactics to psychological beliefs which continue to steer people towards supplements. 

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A highly unregulated industry 

Interestingly, despite the lack of solid evidence to support significant benefits of many supplements, many people continue to take them. Why is it that if the health benefits are not guaranteed for an average healthy person, so many people take certain supplements? 

Part of the reason may be a placebo effect. In fact, people feel “healthier” if they believe they are actively doing something that they think is beneficial for their health. Moreover, many people believe that taking supplements is somewhat of an “insurance policy”. In other words, by taking a supplement they think they can cover any nutritional gaps in their diet that food alone is not fulfilling.  

Moreover, a major concern with supplements is that, unlike medical drugs, an overarching governing body does not strictly regulate them. In fact, almost anyone can launch a supplement brand without any legitimate science or safety and efficacy controls to support it.

What’s more, given the limited amount of regulation, it can be challenging for consumers to know exactly what ingredients are contained in the supplement and if there are any contaminants. Transparency is not guaranteed in many cases and manufacturers do not give away all of the information about their product. 

Vulnerable targets 

Young people are some of the most vulnerable when it comes to marketing tactics utilized by supplement manufacturers. This is especially true for supplements aimed at weight loss. In fact, Professor Austin from the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health says that this is a matter of concern. He states that young people grow up believing that their physical appearance is their defining characteristic. This in turn “sets them up for escalating weight control methods, and for any kind of pill or potion they can find that will keep them from gaining weight”. 

Austin is also the director of STRIPED, Strategic Training Initiative for the Prevention of Eating Disorders. Austin and his team led a study which found that the use of diet pills amongst women and girls increases the risk of developing eating disorders. Healthcare professionals do not recommend diet pills or laxatives to manage weight in a healthy way. In fact, using such products can lead to negative health outcomes such as high blood pressure, liver and kidney damage.(4)

Beware of misleading marketing 

It’s important to note that there is a lot of marketing jargon involved when it comes to the supplement industry. This makes it confusing for people to understand which supplement they should take. 

Christine Rosenbloom is a professor of nutrition and spokesperson for the American Dietetic Association. She advises to use caution when reading supplement labels. In fact, supplements that claim to have all “natural” ingredients are likely to contain some synthetic ingredients. However, “synthetic” does not equal inferior. Indeed, if a pill contained exclusively “natural” ingredients, its size would be much larger than a pill.(5)

What’s more, in order for our bodies to absorb the contents of a pill, it needs to dissolve and disintegrate in our stomach. It’s important to check that the supplement brand conducts independent testing to ensure that  your body will absorb the supplements. 

Moreover, many supplements boast over 100% of daily values for nutrients, with some providing up to 300% of the daily recommended intake in a single pill! This is merely just a marketing gimmick and it serves no extra benefit to your health to consume such high doses if you are a healthy individual. 

In fact some supplements such as iron, zinc and vitamin A, can be toxic at high doses. Claims such as “high potency”, “ stress formula” or “laboratory approved” are not regulated and often made without scientific substantiation. 

Overall, a “food first” approach is preferable when possible. In fact, foods are more than nutrients in isolation. For example, fruits and vegetables contain vitamins and minerals which supplements also contain however they also contain phytochemicals. These plant chemicals are key in the fight against the development of many chronic diseases and are available at your local grocer or farmer’s market, no fancy supplements required!

Nutritional deficiencies and high-risk individuals 

There are cases in which supplements may be beneficial, and these should be individually discussed with your healthcare professional who can advise the most appropriate option for you. 

For example, post-menopausal women who are diagnosed with osteoporosis may be prescribed vitamin D and calcium supplements because their intake from diet is not enough to cover their clinical needs. For best absorption, calcium supplements should be taken separately from tea and coffee which can inhibit calcium absorption. Check with your doctor before taking calcium supplements as they must only be taken if advised by a healthcare professional. 

Some people also have malabsorption issues, meaning their gut struggles to absorb all nutrients like a healthy functioning gut does. For example, people with Crohn’s disease or celiac disease whose stomach lining is affected by a medical condition, may need dietary supplements. 

Moreover, strict vegan mothers who breastfeed their children almost always need a B12 supplement. In fact, it can be extremely dangerous to breastfeed your child on a vegan diet without ensuring that you are meeting all of your nutrient requirements. 

Iron deficiency is one of the world’s most widespread nutrient deficiencies, especially amongst women of childbearing age, vegetarians and vegans.(6) For this reason, your doctor may prescribe iron supplements based on blood test results if you have iron-deficiency anaemia. For best absorption, it’s best to take iron supplements with a source of vitamin C such as citrus fruits. Speak to your doctor before self-administering iron supplements as high doses can be toxic. 

So the bottom line is that for people with certain medical conditions, supplements prescribed by a doctor or dietitian (not self-prescribed!) can be helpful. In most other cases, it’s best to get your vitamins and minerals from food rather than from a pill.

A note on pregnancy 

Pregnant women are considered high-risk individuals when it comes to health because an expectant mother’s diet directly impacts the health of her unborn child. For this reason, it’s important to take all the necessary steps to ensure the healthiest possible pregnancy. 

Folic acid is a particularly important nutrient to consider when planning for a healthy pregnancy. In fact, most countries around the world urge women of reproductive age to consume 400 mcg of folic acid per day. Therefore, women should begin supplementing with folic acid before they fall pregnant. Given that many pregnancies are unplanned, if you are of reproductive age and not on contraception, it’s advisable to take 400 mcg of folate daily.

In addition to consuming folate from a verified diet, supplementation is important to prevent major birth defects of the baby’s spine and brain, known as neural tube defects. These abnormalities occur in the first few weeks of pregnancy, often before a woman finds out that she is pregnant. By the time a woman realises she is pregnant, it may be too late to prevent neural tube defects, which is why it’s best to start supplementation if you are of childbearing age. 

Folate is naturally found in beans, peas, lentils, broccoli, asparagus and dark leafy green vegetables. However, it is challenging to get enough folate through food alone, thus fertile women should discuss supplementation with their doctor or dietitian. There is no evidence to suggest that taking more than 400 mcg of folic acid per day has any additional health benefits or is more effective for preventing neural tube defects. Unless a doctor recommends taking a higher dose due to other health conditions, 400 mcg is considered standard practice. 

Common sense goes a long way

The world of health and nutrition is confusing enough with so much misinformation out there. Add supplements to