Do I Need Supplements?
Are you considering taking vitamin or mineral supplements? Do you think you need them? Or that they “can’t hurt” so you may as well take them? Here are some questions to ask before you decide to take them.
1. Do I really need them?
First and foremost, nutritional needs should be met by eating a variety of foods as outlined in the Dietary Guidelines for Americans. In some cases, vitamin/mineral supplements or fortified foods may be useful for providing nutrients that may otherwise be eaten in less than recommended amounts. If you are already eating the recommended amount of a nutrient, you may not get any further health benefit from taking a supplement. In some cases, supplements and fortified foods may actually cause you to exceed safe levels of intake of nutrients.
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(Note that fortified foods are those to which one or more essential nutrients have been added to increase their nutritional value.)
The Dietary Guidelines for Americans makes these recommendations for certain groups of people:
- People over age 50 should consume vitamin B12 in its crystalline form, that is, from fortified foods (like some fortified breakfast cereals) or as a supplement.
(Note that older adults often have a reduced ability to absorb vitamin B12 from foods. However, crystalline vitamin B12, the type of vitamin B12 used in supplements and in fortified foods, is much more easily absorbed.)
- Women of childbearing age who may become pregnant and adolescent females should eat foods that are a source of heme-iron (such as meats) and/or they should eat iron-rich plant foods (like cooked dry beans or spinach) or iron-fortified foods (like fortified cereals) along with a source of vitamin C. Women of childbearing age who may become pregnant and those who are pregnant should consume adequate synthetic folic acid daily (from fortified foods or supplements) in addition to food forms of folate from a varied diet.
- Older adults, people with dark skin, and people who get insufficient exposure to sunlight should consume extra vitamin D from vitamin D-fortified foods and/or supplements.
It is important to note that vitamin/mineral supplements are not a replacement for a healthful diet. Remember that in addition to vitamins and minerals, foods also contain hundreds of naturally occurring substances that can help protect your health.
Here are some questions that the Food and Drug Administration recommends asking yourself and discussing with your doctor when considering whether you should take a vitamin/mineral supplement:
- Do you eat fewer than 2 meals per day?
- Is your diet restricted? That is, do you not eat meat, or milk or milk products, or eat fewer than 5 servings of fruits and vegetables per day?
- Do you eat alone most of the time?
- Without wanting to, have you lost or gained more than 10 pounds in the last 6 months?
- Do you take 3 or more prescription or over-the-counter medicines a day?
- Do you have 3 or more drinks of alcohol a day?
2. Should I talk to my doctor about taking vitamin/mineral supplements?
Yes, you and your doctor should work together to determine if a vitamin/mineral supplement is right for you. If you are already taking dietary supplements, you should inform your doctor.
3. Where can I find scientifically sound information about vitamin/mineral supplements?
Your doctor is a good place to start. In addition, pharmacists and registered dietitians are helpful.
The NIH Office of Dietary Supplements has a series of Vitamin and Mineral Fact Sheets that provide scientifically-based overviews of a number of vitamins and minerals. They can provide a good basis for a discussion with your doctor about whether or not you should take a vitamin/mineral supplement.
The Food and Drug Administration (FDA) has a variety of articles and consumer advisories to help consumers inform themselves about dietary supplements, including warnings and safety information, labeling, evaluation information, and FDA’s role in regulating dietary supplements.
4. What should I do if I suspect I may be having a side-effect from a dietary supplement?
First, stop taking the supplement. Next tell your doctor or health care professional. The MedWatch Reporting Program also gives you information about how to report a problem to the Food and Drug Administration.
In summary, check with your doctor or a registered dietitian about which, if any, vitamin or mineral supplements might be right for you. And remember that while there are circumstances when it may be appropriate to take vitamin/mineral supplements, they are not a replacement for a healthful diet.
|Some nutrient-dense foods*|
*Foods that have a lot of nutrients relative to the number of calories.
Careful planning and extra D
Both di Bonaventura and Dr. Delichatsios say that a woman can meet her nutrient needs through food alone even if she eats 1,500 calories (or less) per day. “It’s not an issue of food quantity but rather food quality. Even a low-calorie diet can have the needed vitamins and minerals,” says Dr. Delichatsios. The only exception is vitamin D. Most experts now recommend a daily intake of 1,000 international units (IU), an amount that’s difficult to get through foods or sun exposure (unless you live in the lower half of the United States and spend time outdoors). So plan to take a vitamin D supplement.
Getting the rest of your micro-nutrients through diet requires planning, patience, and knowledge about the foods that will help you meet your daily requirements. Such nutrient-dense foods, as they’re called, are packed with vitamins and minerals and have relatively few calories. (See examples above.)
Nutrient-dense foods are the foundation of the sample menu (see box below) that di Bonaventura devised at our request to meet the daily vitamin and mineral needs of a healthy postmenopausal woman consuming 1,500 calories or less a day. “You’d probably eat more salmon on this diet than most people. You’d have an occasional egg, because that’s the easiest way to get a lot of vitamins for a low number of calories,” says di Bonaventura. Our menu covers all the bases at about 1,200 calories. This leaves some discretionary calories for additional nutrient-dense foods and a treat — say, a piece of chocolate, a dish of sorbet, or a glass of wine. Notice that the menu provides more than 1,200 mg of calcium, the amount recommended for women over age 50 — thanks to the calcium in nutrient-dense foods such as nonfat dairy products and bok choy.
|1,200-calorie sample menu that meets the daily DRIs* for a woman 51 to 70 years of age|
|Breakfast8 oz nonfat yogurt½ cup sliced papaya½ cup sliced kiwi1 oz (14 halves) walnuts4 oz skim milk|
|Lunch1 small whole-wheat pita filled with green salad:|
Salad dressing made with 1 tbsp. olive oil, balsamic vinegar, and pepper
|Dinner4 oz broiled wild salmon and yogurt sauce (1 tbsp. Greek-style nonfat yogurt, 1 tsp. lemon juice, 1 clove chopped garlic) ¼ cup cooked barley and ¼ cup cooked lentils with spices to taste1 cup steamed baby bok choy * Dietary reference intakes.|
|Menu provides 1,155 calories:|
|Vitamins and minerals and their amounts in the sample menu, above (DRIs are listed in parentheses)|
|Note: Biotin, choline, and chromium are not precisely measured in foods and thus not included in our analysis.Source: Ellen di Bonaventura, R.D., clinical dietician, Massachusetts General Hospital, Boston, MA.|
What you can do
One way to set up a plan that precisely meets your nutritional needs is to work with a registered dietitian, who can take into account your food preferences and allergies or other health issues (such as lactose intolerance). Many dietitians have access to computer programs and databases that ease the most difficult calculations, such as nutrient analyses of menus. You can ask your clinician for a referral (check to see if your insurance covers the cost of nutritional counseling), or ask at a local hospital or medical center. But if you have the time and the inclination to do the work yourself, there are free tools and calculators on the Web that can help. Here are some questions you’ll need to ask and some of the Web sites where you can find the answers:
How much of what vitamins and minerals do I need? Most healthy postmenopausal women ages 51 to 70 require the same amounts of vitamins and minerals. The government’s nutrient recommendations are called dietary reference intakes (DRIs); these replace the old RDAs, or Recommended Dietary Allowances. The quantities listed on the label of a multivitamin bottle may be more than you need, so don’t use them for guidance. Instead, consult the DRI tables found at www.iom.edu/Object.File/Master/21/372/0.pdf.
How many calories do I need? It depends on your age, height, weight, and activity level. You can calculate the number of calories you need per day at several Web sites, including these: www.caloriecontrol.org/healthy_calculators.html, www.calorieking.com/tools, and www.bmi-calculator.net/bmr-calculator. (The last of these Web sites takes a two-step approach, first calculating your basal metabolic rate — the number of calories you’d need if you did nothing but rest — then linking you to a second page that takes your activity level into account.)
What do I eat? For a list of nutrient-dense foods you can incorporate into your meal plan, go to www.whfoods.com/foodstoc.php. To look up the nutrient and calorie content of specific foods — or to find out which foods contain specific nutrients — go to the U.S. Department of Agriculture (USDA) National Nutrient Database for Standard Reference, www.nal.usda.gov/fnic/foodcomp/search. Another good source of information on specific foods (including brand-name and fast-food items) is Calorie King, www.calorieking.com. To get an idea of how much you’ll need daily from each of the basic food groups, see the chart below.
|Daily amounts of basic food groups meeting recommended nutrient intakes at four different calorie levels|
|Fruits+||1 cup||1.5 cups||1.5 cups||1.5 cups|
|Vegetables+||1.5 cups||1.5 cups||2 cups||2.5 cups|
|Grains||4 ounce equivalents*||5 ounce equivalents||5 ounce equivalents||6 ounce equivalents|
|Lean meat and beans||3 ounce equivalents**||4 ounce equivalents||5 ounce equivalents||5 ounce equivalents|
|Dairy (choose fat-free or low-fat)||2 cups***||2 cups||3 cups||3 cups|
|Oils||17 g||17 g||22 g||24 g|
|+Choose a wide variety of colorful fruits and vegetables.*1 ounce equivalent = ½ cup cooked rice, pasta, or cooked cereal; 1 ounce dry pasta or rice; 1 slice bread; 1 small muffin; 1 cup ready-to-eat cereal flakes.**1 ounce equivalent = 1 ounce of lean meat, poultry, or fish; 1 egg; ¼ cup cooked dry beans or tofu; 1 tablespoon peanut butter; ½ ounce nuts or seeds.***1 cup = 1 cup milk or yogurt; 1.5 ounces natural cheese or 2 ounces processed cheese.Source: USDA Food Guide, Appendix A-2, Dietary Guidelines for Americans, 2005, www.health.gov/dietaryguidelines.|
How do I know if my diet provides what I need? You can track your daily intake and have it analyzed at the USDA’s My Pyramid Tracker, www.mypyramidtracker.gov. (This program is free, but you’ll need to register first.) Entering everything you eat can be cumbersome, but if you try it for just a few days, you’ll learn a lot about food quality and how to get the best nutritional return on the calories you consume. All in all, if you avoid saturated and trans fat, take a daily 1,000 IU vitamin D supplement and eat a balanced diet
Shop All Vitamin & Mineral Products! — one that contains a variety of colorful fruits and vegetables, whole grains, legumes, and nonfat dairy products — you probably don’t need a multivitamin on your plate.