During my childhood, I have vivid memories of my morning routine, which included savoring a delicious orange juice while simultaneously consuming a mysterious multicolored pill. This particular red pill fell into the same category as my daily rituals of tooth brushing, vegetable consumption, and outdoor adventures – all seemingly interconnected with the pursuit of well-being.
Interestingly, it appears I was not the only one following this routine. The use of supplements is widespread in the United States, with a 2014 study revealing that one-third of Americans embrace the daily ritual of ingesting a multivitamin and mineral (MVM) supplement.
Now, the real question arises: Why do we do this?
For most individuals, the anticipation is that a daily multivitamin will enhance their overall health, ward off common ailments, and grant them a sense of vitality. However, the scientific support for these assertions remains shrouded in uncertainty. Does the act of consuming a daily multivitamin genuinely bolster our immune defenses, or could it potentially bring more harm than good to our well-being?
Multivitamins: A modern dilemma
In the annals of history, vitamin and mineral supplements emerged as guardians against deficiency-related diseases. Yet, in the contemporary United States, deficiencies of these vital nutrients have become rather rare. Our diet landscape is now dominated by processed foods, liberally fortified with essential vitamins and minerals. An illuminating report from the Centers for Disease Control and Prevention proudly proclaims that fortification efforts, particularly with folate (a B vitamin), have slashed deficiency rates to less than 1 percent. Even the scarcity of vitamins A and E deficiencies stands out as an exception.
Nonetheless, there remain outliers. Those ensnared by the clutches of poverty often grapple with food insecurity, leading to unreliable access to high-quality nourishment. The elderly population faces an elevated risk of deficiency. Vegans frequently find themselves in need of vitamin B12 supplementation. Among the ranks of the vulnerable, we encounter kids, menstruating women, and expectant mothers who bear the brunt of iron deficiency. Nevertheless, these isolated instances aside, the majority of us luxuriate in the abundance of essential nutrients. And should we find ourselves deficient, it tends to be in a solitary nutrient.
So, what impels us to part with our hard-earned money for the allure of Multivitamin and Mineral supplements?
For the frenetic pace of modern life leaves little room for meticulously crafting a diet that meticulously delivers every required vitamin and mineral. Thus, many opt for the convenience of a Multivitamin and Mineral regimen as a safety net. However, the enigmatic question that lingers is whether this insurance policy genuinely pays dividends.
What the studies are saying
A prevailing hope among many is that Multivitamin and Mineral supplements (MVMs) will serve as formidable guardians against a myriad of ailments. However, the body of research paints a rather nuanced picture, particularly in the context of American adults.
In 2009, data culled from the Women’s Health Initiative (WHI), a comprehensive and extensive national health study involving postmenopausal women, revealed that the habitual use of MVMs failed to wield any substantial influence on longevity, the incidence of cardiovascular diseases, or several prevalent cancers. It was a resounding null result.
Moreover, the prospect of enhancing cognitive and cardiovascular health through the medium of multivitamins appears to be a chimera. Two pivotal studies published in the Annals of Internal Medicine in 2013 offered stark evidence to disprove these notions. They revealed that multivitamins did not enhance cognitive function in elderly men and did not mitigate cardiovascular events in patients following a recent myocardial infarction.
Yet, amid the labyrinth of findings, there emerges a glimmer of hope for older individuals battling the specter of cancer. A study in 2013 involving postmenopausal women, who were aged between 50 to 79 and part of the WHI, unveiled a curious twist. Among women diagnosed with invasive breast cancer and who had been taking MVMs around the time of diagnosis, the risk of succumbing to breast cancer plummeted by a staggering 30 percent compared to their non-MVM-taking counterparts.
For those fortunate enough to maintain a well-balanced diet, the allure of MVMs appears to wane. However, the intricate dance of biology and the socioeconomic shifts that accompany aging render older adults more susceptible to nutritional deficiencies. In such cases, while MVMs may not serve as the fortresses against the initial onslaught of cancer, they could potentially assist older women in fortifying their defenses against the relentless assault of this formidable adversary.
In 2012, a study that diligently followed 14,000 male physicians aged 50 and older over more than a decade delivered a mixed verdict. A daily multivitamin, specifically Centrum Silver, managed to diminish the incidence of new cancer cases by 8 percent, yet it did not wield influence over the number of fatalities.
Nevertheless, it is imperative to heed a cautionary note: the adage that “more is better” does not hold true in the realm of nutrients. While deficiency can cast a shadow on one’s well-being, the excessive intake of certain vitamins and minerals, particularly the fat-soluble ones like vitamins A, E, and K, can metamorphose into a toxic predicament, accumulating within the body and causing unintended harm.
Should you take a multivitamin?
The decision to embark on a Multivitamin and Mineral supplement (MVM) journey is far from one-size-fits-all, contingent upon your age and current state of health. Let’s embark on this nuanced exploration.
For the youngest among us, children, the consensus leans towards eschewing vitamin and mineral supplements. Their vibrant growth and development usually thrive on a balanced diet without the need for additional supplements.
However, the picky eaters in our midst may find solace in a daily children’s multivitamin, a mediator in the ongoing food battles, ensuring they receive the vital vitamins while maintaining family harmony. And for exclusively breastfed babies, the recommendation stands firm: a daily dose of 400 IU of vitamin D from the tender age of 2 months until they venture into the realm of solid foods.
The spotlight now shifts to pregnant and breastfeeding women, as well as those contemplating motherhood. For them, the prescription is clear: embrace prenatal vitamin supplements, fortified with the indispensable folic acid. This nutrient plays a pivotal role in ensuring the proper development of the nervous system, a non-negotiable for the health of both mother and child.
Now, enter the domain of healthy and well-nourished adolescents and adults. The consensus here veers away from the allure of MVMs. The majority of health professionals stand by the assertion that whole foods reign supreme over supplements. The rationale lies in the remarkable complexity of food, particularly plant-based fare, which harbors a treasure trove of nutrients that transcend the limited scope of what you’d find in a pill.
However, should any doubt or uncertainty cloud your supplement journey, the guiding star remains your healthcare provider. Through tests, they can unveil whether you harbor deficiencies in specific vitamins or minerals, offering tailored guidance to meet your unique needs.
Now, as the spotlight dims on MVMs, it’s essential to acknowledge the vast landscape of dietary supplements that extends far beyond the realm of multivitamins and minerals. This realm encompasses single vitamins and minerals, amino acids, essential fatty acids, hormones, herbal extracts, and a cornucopia of other offerings.
These specialized supplements may find their place in the prevention or treatment of specific illnesses or conditions. In these instances, your trusted confidant is your physician, whose guidance will illuminate the path best suited to your individual health journey.
The puzzle of super supplements
The quandary of whether to embrace dietary supplements and, if so, which ones to incorporate, is a multifaceted puzzle with no simple solution. As we tread the path of safeguarding our own health and that of our loved ones, we must strike a balance between our well-being aspirations and the prospect of spending a small fortune and swallowing an array of pills.
The fundamental truth is that if your daily menu predominantly consists of high-quality whole foods, your digestive system operates with precision, and your overall health is robust, the necessity for dietary supplements is remarkably diminished. In such a scenario, the need for supplementation is relatively modest.
Nevertheless, there are certain nutrients that stand as either indispensable or profoundly advantageous, and our daily diets might come up short in delivering them in adequate quantities. Even those among us who strive for a wholesome lifestyle can find themselves teetering on the precipice of “ideal” health and nutrition. The harsh realities of time constraints, budget limitations, or a simple lack of inclination to craft perfectly nutritious meals daily can nudge us toward nutritional gaps.
As the sands of time flow and ailments cast their shadows, our intestines may falter in their ability to efficiently absorb essential nutrients. Additionally, acute and chronic illnesses may raise the stakes, demanding an increased intake of specific nutrients.
To be clear, the precise supplement requirements can vary greatly from one individual to the next, but there are five stalwart contenders that consistently find themselves on the recommended list of dietary supplements.
However, a cardinal rule reigns supreme: when embarking on the journey of supplementation, always seek the counsel of your trusted healthcare provider. Their expertise and insight will shed light on the unique path best suited to your specific health needs, ensuring you navigate the realm of supplements with wisdom and discernment.
Calcium, a mineral indispensable to the symphony of our bodily functions, plays a multifaceted role in supporting bones, nerves, muscles, hormones, and enzymes. It is a vital player in maintaining our blood’s equilibrium, and should its levels waver, our bodies resort to extracting calcium from our precious bone reservoirs. The imperative here is clear – we mustn’t allow a prolonged deficiency to take root.
When it comes to the dosage, the recommended dietary allowance (RDA) for adults stands at 1,000 mg daily. However, this quota increases to 1,200 mg per day for women over the age of 50 and men over the age of 70.
In an ideal world, we should be able to meet our calcium requirements through a well-balanced diet. The bounty of nature provides ample sources, with experts championing cruciferous vegetables (particularly dark-green leafy ones), dairy products, sardines, peanuts, sesame seeds, sunflower seeds, dried beans, figs, and even seaweed as calcium-rich options.
Yet, reality often diverges from the ideal, especially for individuals past the age of 70 who tend to fall short of the recommended calcium intake without the aid of supplements. For instance, women aged 50 to 70 typically ingest about 780 mg of calcium from their food, a figure that raises concerns about long-term deficiency and the heightened risk of osteoporosis.
The tale of calcium supplements is one marked by a complex interplay of pros and cons. For decades, physicians routinely prescribed calcium supplements, primarily noting relatively minor side effects such as constipation and bloating. On the flip side, the prospect of mitigating osteoporosis-related bone fractures by a significant 12 percent with calcium and vitamin D supplementation added allure to these supplements.
However, the narrative shifted in 2010 when two reports raised alarms, linking calcium supplementation with a 24 to 31 percent increased risk of heart attacks. Subsequent research has provided a mixed bag of findings regarding cardiovascular risks.
In the ideal scenario, acquiring calcium from natural food sources is the recommended route. For those unable to do so, two types of calcium supplements come into play: calcium carbonate and calcium citrate. The former, while more cost-effective and boasting a higher calcium percentage (40 percent), is more prone to causing constipation and bloating.
Adequate absorption of calcium carbonate necessitates ample stomach acid, which diminishes with age. Thus, for individuals over the age of 60 or those taking antacids, calcium citrate emerges as the preferred option. The typical calcium citrate dosage ranges from one 1,000-mg tablet two to three times a day, or an equivalent of 420 to 630 mg of calcium daily. It’s imperative not to surpass a total of 2,500 mg of calcium from both food and supplements in a single day.
In the realm of calcium supplementation, as with any nutrient, an individualized approach guided by expert medical counsel remains paramount to ensure the optimal balance between health benefits and potential risks.
In the intricate tapestry of our bodily functions, magnesium stands as a major mineral, akin to calcium, and plays a multitude of roles. It contributes to the framework of our bones, participates in numerous chemical reactions, orchestrates nerve and muscle function, facilitates protein synthesis, fuels energy production, regulates blood pressure and heart rate, and assumes the mantle of controlling blood sugar levels.
As we delve into the realm of magnesium, it’s crucial to consider dosage, which varies depending on age and gender. For men aged 19 to 30, the recommended dietary allowance (RDA) hovers at 400 mg, with a slight uptick to 420 mg thereafter. Women aged 19 to 30 find their RDA set at 310 mg, while those nursing a baby or surpassing the age of 31 should aim for 320 mg, with a further increase to 360 mg during pregnancy.
When it comes to sourcing magnesium, nature provides an array of options, with green leafy vegetables, legumes, whole grains, avocados, seeds, and nuts standing as particularly rich food sources.
Yet, a concerning trend emerges from national health surveys, revealing that nearly half of both children and adults fall short in consuming adequate dietary magnesium. Among teenagers aged 14 to 18 and adults over the age of 70, more than two-thirds fail to meet their magnesium needs.
Those most vulnerable to magnesium deficiency include individuals grappling with kidney disease, intestinal disorders (such as celiac disease and Crohn’s disease), type 2 diabetes, alcohol dependency, and the elderly. Furthermore, long-term use of certain medications like diuretics and proton pump inhibitors (such as Nexium and Prevacid) can induce magnesium deficiency.
While severe magnesium deficiency is relatively rare in most individuals, early signs may manifest as a reduced appetite, nausea, vomiting, fatigue, and weakness. Prolonged suboptimal magnesium intake, however, poses a growing risk of high blood pressure, cardiovascular disease, stroke, type 2 diabetes, osteoporosis, and migraines.
The world of magnesium supplements reveals its own nuances. When perusing the supplement aisle, you’ll notice that magnesium is typically bound to another chemical. Magnesium bound to aspartate, citrate, lactate, and chloride forms are superior in absorption and bioavailability compared to magnesium oxide and magnesium sulfate. These supplements have the potential to correct low blood levels of magnesium, as detected through blood tests.
Studies offer a mixed yet intriguing glimpse into the benefits of magnesium supplementation. Some research suggests that higher magnesium intake, whether from food or supplements, reduces the risk of developing type 2 diabetes. Furthermore, magnesium supplements show promise in enhancing insulin sensitivity in individuals already grappling with type 2 diabetes. Beyond diabetes, these supplements hold potential for addressing migraines, premenstrual syndrome (PMS), high cholesterol, and coronary artery disease.
When considering magnesium supplementation, it’s vital to tailor your dosage to factors such as your dietary intake, age, gender, specific health conditions, and whether or not you suffer from magnesium deficiency. Caution prevails, as exceeding the recommended dietary allowance is unwise.
Although our kidneys adeptly eliminate excess magnesium, overconsumption from supplements can usher in unpleasant side effects such as diarrhea, intestinal cramping, and nausea. Interestingly, some commercial laxatives rely on magnesium. On a positive note, magnesium counteracts the constipating effect often associated with calcium supplements.
Vitamin D, often regarded as the unsung hero of the nutrient world, orchestrates a symphony of essential functions within the body. Among its many roles, vitamin D facilitates the absorption of calcium from the intestines, contributes to bone mineralization, supports cell growth, and wields the power to reduce inflammation. Beyond these, it plays a pivotal part in nerve and muscle function, as well as bolstering the immune system.
When it comes to dosage, the recommended dietary allowance (RDA) offers a roadmap tailored to various age groups. Infants under the age of one should target 400 IU, while children and adults can set their sights on 600 IU. Those aged 70 and beyond ought to aim for 800 IU.
Nature’s primary source of vitamin D is the sun’s UVB rays, which activate the skin’s ability to synthesize this vital nutrient. However, this process is not without its caveats. Sunscreen usage can thwart the synthesis, and individuals with darker skin require extended UVB exposure to generate sufficient vitamin D. Moreover, as we age, our skin’s efficiency in this process dwindles, and in many parts of the northern United States, winter sunlight lacks the potency to stimulate vitamin D production.
While only a handful of foods naturally contain substantial vitamin D, there are fortification heroes that come to our rescue. Oily fish, eggs from vitamin D-fed hens, sun-exposed mushrooms, and fortified products like dairy, soy milk, orange juice, and cereals offer a dietary lifeline.
The shadow of deficiency looms globally, affecting approximately 1 billion individuals, characterized by blood levels falling below 20 ng/mL. In children, vitamin D deficiency leads to skeletal deformities, while in adults, it can manifest as the painful softening of bones known as osteomalacia or the brittle condition of osteoporosis.
Beyond bone health, vitamin D deficiency raises the risk of falls, fractures, cardiovascular disease, some cancers, respiratory infections, asthma, autoimmune disorders such as multiple sclerosis, depression, diabetes, reduced fertility, and Alzheimer’s type dementia.
Certain groups remain particularly susceptible to insufficiency, including breastfed infants, older adults, those with limited sun exposure, individuals with obesity, liver or kidney disease, intestinal disorders, or surgeries impairing fat absorption. Pregnant women, too, require adequate vitamin D for normal fetal bone development.
The complex realm of vitamin D supplementation necessitates careful consideration. Given that dietary sources provide just around 200 IU daily, many health authorities recommend supplements, even beginning in infancy. The Endocrine Society provides guidance on daily supplementation as follows:
Infants aged 0 to 12 months: 400 to 1,000 IU (not exceeding 2,000 IU)
Children and adolescents aged 1 to 18: 600 to 1,000 IU (not exceeding 4,000 IU)
Adults aged 18 and above: 1,500 to 2,000 IU (not exceeding 10,000 IU)
For individuals at risk of deficiency, a blood test for 25-hydroxyvitamin D can fine-tune the optimal supplement dose. Nevertheless, it’s crucial to remain vigilant about excessive vitamin D intake, which can elevate blood calcium levels and potentially damage the kidneys, heart, and blood vessels. Remarkably, sun exposure does not pose a risk of vitamin D overdose.
Fish oil, often hailed as the treasure trove of omega-3 fatty acids, is a vital component that fuels the symphony of fetal development and sustains health throughout one’s lifetime. Within these fishy oils lie the omega-3 fatty acids: docosapentaenoic acid, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). These compounds weave their way into the very fabric of our bodies, notably within cell membranes, and wield the transformative power of anti-inflammatory effects.
When contemplating dosage, expert counsel frequently suggests indulging in fatty fish at least once or twice weekly, or resorting to supplements. The government refrains from setting recommended dietary allowances (RDAs) for fatty acids, but research studies commonly explore fish oil doses ranging from 1 to 4 grams daily. For pregnant and nursing women, a keen eye on adequate EPA and DHA intake takes precedence, given their pivotal role in fetal and infant development.
Fatty fish reassert their dominance as the prime dietary source for preformed EPA and DHA. However, the emergence of algal sources is transforming the landscape, offering alternative avenues to harness these essential fatty acids.
In the arena of deficiency, a tale of two omega fatty acids unfolds: omega-3 and omega-6. Modern diets tend to tip the balance in favor of the latter, relegating omega-3 to a less prominent role. The warning signs of essential fatty acid deficiency include stunted growth and development in infants and children, dry and scaly skin, heightened vulnerability to infections, and sluggish wound healing.
Furthermore, low levels of EPA and DHA are intimately intertwined with inflammatory conditions, cardiovascular disease, diminished cognitive function, and a spectrum of psychological disorders, including attention deficit hyperactivity disorder, depression, and bipolar disorder.
Yet, the journey through the world of fatty acids is laden with complexities. On one hand, consuming fatty fish appears to carve a path to a reduced risk of heart disease. However, recent studies cast a shadow over the benefits of fish oil supplementation, revealing no substantial reduction in the risk of death, heart attack, or stroke in individuals predisposed to cardiovascular disease.
In those already grappling with heart disease, supplements exhibit a capacity to reduce mortality but appear less effective in shielding against cardiovascular events, such as heart attacks and strokes.
Fatty acids emerge as vital agents in the realm of inflammation and brain health. Initial research hints at the potential of fish and fish oil supplements in curbing the risk of breast cancer. Moreover, the brain relies heavily on a steady supply of omega-3 fatty acids, especially the formidable DHA. Diets rich in these oils stand as sentinels against age-related cognitive decline and the onset of Alzheimer’s disease.
Promising tendrils of evidence emerge, suggesting potential benefits (as complementary components to conventional treatments) of dietary fish and fish oil supplements in conditions such as attention deficit hyperactivity disorder, asthma, and age-related macular degeneration. In the realm of side effects, fish oil supplements may occasionally conjure fishy-tasting burps, heartburn, or nausea, but they generally pose no grave health risks.
Probiotics, those minuscule yet mighty microorganisms, akin to the residents already inhabiting our intestinal domain, constitute an unsung hero in the realm of gut health. Our ordinary “gut flora” is more than mere tenants; they serve as stalwart allies, vanquishing disease-causing microbes, bolstering immune function, fortifying mucous membranes, optimizing digestion, and even moonlighting as vitamin manufacturers.
When it comes to dosage, there is no official recommended dietary allowance (RDA) to guide the way. Instead, we navigate by the number of colony forming units (CFUs) per capsule, with daily regimens typically spanning a range of 1 to 10 billion CFUs, divided as needed.
Beyond supplements, nature bestows a wealth of probiotic goodness within fermented foods like yogurt, kefir, cultured buttermilk, unpasteurized sauerkraut, kimchi, miso, natto, and tempeh, each a natural repository of these beneficial microbes.
While the notion of a “probiotic deficiency” remains elusive, disturbances in the ecological balance of gut flora are far from uncommon. Scientific links draw connections between these imbalances and an array of health issues, including diarrhea, asthma, irritable bowel syndrome, both types 1 and 2 diabetes, obesity, and potentially cardiovascular disease.
Delving into the pros and cons, it becomes apparent that the landscape of probiotics teems with promise. Preliminary research frequently homes in on specific strains of bacteria, such as Lactobacillus or Bifidobacteria, and yeast like Saccharomyces boulardii.
Positive findings abound in contexts such as viral diarrhea in children (specifically rotavirus), diarrhea triggered by antibiotics and chemotherapy, Clostridium difficile-related diarrhea, traveler’s diarrhea, eczema management, bacterial vaginosis, soothing infantile colic, and alleviating the distress of inflammatory bowel disease and irritable bowel syndrome.
Prophylactic use of probiotics stands as a shield against the severity and frequency of respiratory infections. Moreover, the safety record of probiotics appears reassuring when adhering to recommended dosage guidelines. For parents grappling with a colicky baby and contemplating the potential benefits of probiotics, a conversation with a pediatrician can provide valuable insights and guidance.
In the end, remember that eating a balanced diet with lots of whole foods is the best way to get these nutrients. Supplements can be useful, but they should be an addition to, not a replacement for, good food choices.
This article has been written by James H. Redford MD for Prepper’s Will.
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