The dietary supplement industry brings in $30 billion dollars per year, with 90,000 products on the market. Understanding the benefits of supplements can be very difficult, as one year we may see an article that touts the benefits of a certain supplement, and the next year the data is debunked. Some studies also shows that high doses of some supplements can actually cause harm.
Dr. JoAnn Manson and Dr. Shari Bassuk authored an article in the Journal of the American Medical Society on February 5, 2018. The purpose of their article was to help physicians understand which supplements had value and which did not, and which could possibly be harmful.
The key point that physicians should stress to their patients is the importance of obtaining micronutrients from food sources. When obtained through food, micronutrients are absorbed better and there is a lower chance of side effects. A diet which is well-balanced will provide an optimal balance of nutrients and is preferred to taking isolated compounds in concentrated forms.
For the general population dietary supplements are not recommended, but there are certain high-risk groups for whom it is difficult to meet nutritional requirements through the diet. For example, pregnant women are encouraged to take folic acid and prenatal vitamins.
Adults at midlife and beyond may benefit from supplements of Vitamin B12, vitamin D and calcium.
Adults older than age 50 may not absorb vitamin B12. Vitamin B12 levels can be checked through routine blood work, and may need to be supplemented with food sources or supplementation. Pernicious anemia requires even higher doses of vitamin B12.
Requirements for vitamin D are 600 IU/day for adults under age 70, and 800 IU/day over the age of 70. Many physicians recommend 1000-2000 IU/day, but the benefit of this supplementation has been debated. There are ongoing studies to prove the benefits of this supplement. Vitamin D levels can also be tested in routine blood work.
Recommended daily intake of calcium is 1200 mg per day in women over the age of 50.
It is recommended that calcium is obtained mostly through food sources, with supplementation to reach a total of 1200 mg per day. There have been some concerns that excessive calcium may increase the risk of kidney stones or heart disease, so excessive doses are not recommended. There is data that suggests that supplementation with a moderate dose of calcium, less than 1000 mg/day, plus vitamin D greater than 800 IU/day may reduce the risk of bone loss and fractures in adults over the age of 65.
Multivitamin supplements are not recommended for generally healthy adults. There are studies underway that will clarify whether multivitamin supplements are related to decreases in cancer and heart disease.
Physicians are advised to take a complete medication and supplement history for their patients, as supplements can adversely effect the benefits of certain medications.
Patients are advised that the US FDA does not regulate the safety and efficacy of supplements. Many supplements are certified by independent testing agencies and these are less likely to contain harmful toxins or heavy metals. Such certifying agencies include ConsumerLab.com, US Pharmacopeia, NSF International, and UL.
Here are some conditions that require special consideration:
Osteoporosis and other bone issues: supplement with calcium, Vitamin D, and magnesium
Age-related macular degeneration: specific combination of antioxidants, zinc and copper
Bariatric surgery: fat-soluble vitamins, B vitamins, iron, calcium, zinc, copper and multivitamins
Inflammatory bowel disease and celiacs: iron, B vitamins, vitamin D, zinc and magnesium
Pernicious anemia: vitamin B12
It is obvious from this article that considering all of the supplements out there, very little is recommended for the average menopausal women who is generally healthy and eats a well-balanced died. So save your money, and eat well!!
Marilyn Jerome, MD
The Journal of the American Medical Association. Viewpoint: Vitamin and Mineral Supplements. What Clinicians Need to Know. JoAnn Manson, MD, DrPH, Shari Bassuk, ScD