Exaggerated claims abound, but these five supplements enjoy good evidence
Take a minute to consider your current state of health.
Are you sleeping as well as you’d like? Is your weight where you’d like it to be? How are your energy levels?
If the answers to these questions feel a bit disturbing, poor nutrition may be partly at fault.
In 2012, just over half of Americans reported using nutritional supplements, either to help with a specific problem, or to provide nutritional “health insurance”.
And those expectations aren't misguided, if the supplements they choose are backed by good evidence of efficacy.
We'll review five “foundational” supplements that offer broad benefits, and point out some things to avoid and look for.
TOP CHOICE #1: MULTIVITAMINS
There isn't much evidence linking supplemental vitamins to reduced risk for cancer or cardiovascular disease.
But significant evidence links deficiencies in B vitamins — especially folate and B12 higher risk for cognitive decline and dementia (Moore K et al. 2018).
And — given the woeful lack of these nutrients in the standard American diet — the fact that supplemental vitamins may not slash the risk of heart, immune, and brain disorders doesn't mean they're unimportant.
Suboptimal intake of vitamins and minerals is linked with higher risk for chronic diseases, especially among the elderly.
According to the CDC, only one in 10 Americans eat enough fruits and vegetables to meet basic vitamin-mineral needs, enable basic and optimal health, and prevent deficiency diseases.
And as the authors of another study wrote, “Most people do not consume an optimal amount of all vitamins by diet alone.” (Fletcher RH et al. 2002)
• Vitamins and cancer risk
A huge amount of epidemiological (population) evidence links diets high in antioxidant-rich fruits and vegetables to reduced risk for several major cancers.
But it's not clear that supplemental vitamins — including antioxidant vitamins (A, beta-carotene, C, and E) — can reduce cancer risk.
The authors of one evidence review put it this way: “Multivitamin/mineral supplement use may [only] prevent cancer [only] in individuals with poor or suboptimal nutritional status.” (Huang HY et al. 2006)
Subsequent evidence reviews haven’t changed the picture, at least with regard to colorectal and breast cancers (Misotti AM et al. 2013; Heine-Bröring RC et al. 2015).
• Vitamins and cardiovascular risk
As with cancer, lots of epidemiological evidence links diets high in antioxidant-rich fruits and vegetables to reduced risk for cardiovascular disease.
But the hope that supplemental vitamins might reduce cardiovascular risk has mostly been dashed by clinical studies.
That said, supplemental vitamins can close any nutritional gaps that might contribute to cardiovascular disease.
• Vitamins and the aging process
Multivitamin-mineral supplements might help decelerate the aging process.
The U.S. National Institute of Environmental Health Sciences reported that the cells of multivitamin users look younger than cells from non-users — see Vitamin Studies Paint a More Positive Prevention Picture.
And many Americans suffer a chronic lack of magnesium, which can accelerate the aging process — see Magnesium Shortage Speeds Aging of America. Supplements aside, some of the best food sources are fish, nuts, and leafy greens.
• What should a multivitamin provide?
Choose a multivitamin-mineral supplement that includes at least 50% of the recommended daily allowances (RDA) for your age and gender.
You will find the RDAs for vitamins and minerals in fact sheets at the Office of Dietary Supplements, which is an arm of the U.S. National Institutes of Health.
A multivitamin-mineral supplement should include:
- Vitamins A, C, D3, E, K, B1 (thiamin), B2 (riboflavin), B3 (niacin and niacinamide), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folate), B12 (cobalamin), biotin, choline, and inositol.
- Calcium, magnesium, potassium, iodine, iron, chromium, selenium, manganese, boron, copper, and zinc. Ideally, a multi should also provide molybdenum and vanadium.
You will likely need to take separate calcium, magnesium, and potassium supplements to meet their high RDAs.
Supplements formulated for men or seniors typically contain either no iron or lower doses, because excessive iron has been linked to health problems in these populations.
Of course, not all multivitamin-mineral supplements are created equal. These are some ingredients and product types to avoid:
• Synthetic vitamins: Mostly fine, but not always
Virtually all vitamin supplements — including “natural” and “food-based” or “food-grown” brands — contain man-made (so-called USP) vitamins.
The only concern is whether the synthetic version of a vitamin is less effective, or less well absorbed, versus the natural version.
With the exceptions noted below, there's no significant difference between the man-made and natural forms of vitamins. And extracting some vitamins from natural substances is much costlier than synthesizing them.
For example, ascorbic acid — better known as vitamin C — is the same molecule whether it’s extracted from a plant such as rosehips, or manufactured.
And there's no evidence that the synthetic ascorbic acid is any less beneficial than ascorbic acid extracted from plant material — or that there is any significant advantage from vitamin C accompanied by bioflavonoids or rosehips.
But there are real differences between synthetic and natural vitamin E. Vitamin E is a complex of eight related compounds — half tocopherols, and half tocotrienols.
Seek out supplements that contain both vitamin E families, because tocotrienols deliver distinct benefits, including anti-cancer properties unrelated to the antioxidant effects of tocopherols or tocotrienols.
Compared with natural vitamin E, synthetic vitamin E isn’t as well absorbed or distributed. One clinical study found that it took only 100mg (149 IU) of natural vitamin E to achieve the same blood levels that required 300mg (448 IU) of synthetic vitamin E.
Synthetic forms of vitamin E are labeled with a “dl-“ prefix, so look for supplements with forms that begin with a “d”, such as d-alpha tocopherol, d-alpha tocopheryl acetate, and d-alpha tocopheryl succinate.
There are also important differences between the synthetic (folic acid) and natural (folate) forms of vitamin B9.
Excessive amounts of supplemental folic acid can mask a vitamin B12 deficiency, and raise cancer risk.
Good sources of folate include leafy greens and lentils. Most multivitamin supplements contain synthetic folic acid rather than natural folate.
To get folate from a supplement, choose ones that contain L-5-methylfolate under the brand names Metafolin and Quatrefolic, or multivitamins that provide L-5-methylfolate, 5-methyltetrahydrofolate, or 5-MTHF.
Finally, some supplements contain only beta-carotene, and no pre-formed vitamin A (retinol), which is not ideal. Although the body can convert carotenes into vitamin A, many people cannot do that very efficiently.
However, prenatal supplements generally provide vitamin A in the form of carotenes, because excessive amounts of pre-formed vitamin A (more than 5,000 IU/day) can harm the fetus.
• Food-grown, whole-food, and food-based vitamins
The makers of these supplements add standard vitamins to yeast, algae, and/or powdered vegetables. (Examples include MegaFood, New Chapter, Rainbow Light, and Bluebonnet brands.)
They claim that because vitamins and minerals should be taken with foods for optimal absorption — which is true — it makes sense to combine vitamins and minerals with foodstuffs in a tablet or capsule.
However, the amounts of food material are minuscule, and there's no good, independent evidence that the vitamins and minerals in these supplements are better absorbed than from standard multivitamin supplements.
“Whole-food” or “food-grown” supplements are typically made by feeding nutrients to yeast, which may include fermentation, while “food-based” supplements are typically made by adding synthetic and/or natural vitamins to powdered plant foods and/or herbs.
While “food-based” supplements provide very small amounts of plant-source antioxidants, they're far lower than the amounts you'd get by eating plant foods, and far too low to be meaningful.
And, because they contain bulky food material, capsules or tablets of “food-based” or “food-grown” supplements typically contain low doses of vitamins and minerals — a shortfall that requires users to take more capsules or tablets to meet or even approach the RDAs.
The makers of these products justify the low vitamin and mineral doses in their products by making the unproven — and biologically implausible — claim that these practices somehow enhance the absorption and/or or efficacy of the vitamins.
Additives can be necessary to facilitate the process of filling capsules completely — but others are inessential, and may be unhealthful.
Common but undesirable additives include:
- Sodium benzoate
- Talc/talcum powder
- FD&C Yellow #6 Lake
- FD&C Red 40 Aluminum Lake
- FD&C Yellow #5 (tartrazine) Lake
- Butylated hydroxytoluene (BHT)
- Hydrogenated palm oil (trans fats)
- Sugar (sucrose, high fructose corn syrup, lactose, etc.)
TOP CHOICE #2: VITAMIN D3
There's good evidence that vitamin D can improve heart and brain health, lower blood sugar, give you more energy, and support weight loss — and it’s been shown to reduce your risk of premature death from all causes.
But about 42 percent of Americans are deficient, while vitamin D insufficiency — levels just below those considered barely adequate — affects 77 percent of Americans.
Sunshine is the major source of vitamin D. But pale-skinned people may not be able to get enough sun exposure without burning and risking skin cancer. You can ensure adequate blood levels by taking supplemental vitamin D in the most bioactive form, called D3 or cholecalciferol.
Aim for 1,000-4,000 IU daily, depending on how much sun exposure you get, and how much fatty fish — especially wild salmon, mackerel, and sardines (the best food sources, by far) — you eat.
TOP CHOICE #3: PROBIOTICS
The term probiotic means “for life” and refers to friendly microbes that support or enhance gut and overall health.
They help digest dietary fibers, produce nutrients (including some B vitamins), protect against harmful bacteria, and strengthen the intestinal barrier against toxins.
According to the Mayo Clinic, probiotics can exert these therapeutic effects, and growing evidence suggests that their benefits extend well beyond these.:
- Treat irritable bowel syndrome (IBS)
- Control diarrhea, especially after you’ve taken some types of antibiotics
- Prevent and treat vaginal yeast infections and urinary tract infections
- Decrease the chances of bladder cancer reappearing
- Prevent and treat inflammation after colon surgery
- Stop the occurrence of eczema in children
Since probiotics aren’t essential nutrients, there are no official minimum dietary intakes.
Take a probiotic supplement containing about 10-20 billion CFU of multiple strains, especially Bifidobacteria and lactobacilli such as L. acidophilus, L. casei, and L. thermophilus.
TOP CHOICE #4: FISH OIL
Omega-3 fatty acids are critical to brain, immune, eye, skin, developmental, and overall health.
The body uses them to resolve runaway inflammation — an underlying promoter and sustainer of cardiovascular disease, depression, brain disorders, arthritis, and many other conditions.
We can’t make omega-3s, and must obtain them from food or supplements.
Omega-3 fatty acids come in two basic forms, with distinctly different health impacts:
- Short-chain omega-3 ALA from plant foods.
- Long-chain omega-3s (EPA and DHA) from seafood and fish oil.
On average, people convert only about five percent of ALA from plant foods into long-chain omega-3s — almost entirely EPA, from which the body cannot easily make sufficient DHA.
So, it’s smart to get ample amounts of DHA, from which the body can easily make ample amounts of EPA.
DHA is particularly critical for brain health, and eye health, while EPA promotes healthy circulation and helps lower blood triglyceride and pressure levels.
And as we said, the body needs both DHA and EPA to resolve inflammation once its purpose has been served.
Last but not least, recent research suggests that DHA and EPA exert anti-aging effects at the DNA level — see Omega-3s' DNA-Telomere Effects vs. Heart Disease and Aging.
Hundreds of studies link higher fish consumption to better health outcomes across the board, so it’s wise to get most of your omega-3 EPA + DHA from seafood — which means partially replacing other animal proteins with fish.
According to the European Food Safety Authority, “long-term consumption of EPA and DHA supplements at combined doses of up to about 5 grams a day” appears safe. You’d be hard-pressed to get more than that, even if you eat fish frequently and take fish oil daily.
Health authorities worldwide recommended consuming 250-500mg of EPA + DHA every day — see our Omega 3 Facts & Sources page — and research indicates that it's normally ideal to consume about one to two parts EPA to one part DHA.
However, if you’re taking supplemental omega-3s for brain health, or you’re a pregnant or nursing women, it makes sense to choose high-DHA supplements.
Most fish, shellfish, and fish oils contain roughly equal amounts of EPA and DHA, though most provide more EPA than DHA.
Take a fish or krill oil supplement that contains both EPA and DHA, with at least 350-400 mg of EPA and 150-200mg of DHA.
TOP CHOICE #5: ANTIOXIDANTS
Antioxidants from foods and herbs influence our genes in ways that reduce free radical damage and harmful inflammation.
Our bodies produce their own powerful antioxidants — but it’s clear that our bodies function optimally only when we’re also getting a steady stream of foodborne antioxidants.
Most foodborne antioxidants get digested before they reach the bloodstream, but the remainder influence our "working" genes — see Aging Theory Gets a Radical Makeover.
The richest sources of antioxidants are fruits and vegetables, but as we’ve seen, most people don’t eat the recommend amounts.
Curcumin is a term that covers the trio of curcuminoid compounds in turmeric root.
In addition to being a potent antioxidant, curcumin has proven anti-inflammatory powers, and has shown great promise as an ally against conditions associated with chronic inflammation, such as arthritis, colitis, diabetes, cancer, and heart disease.
Aim for 400–600 mg of a supplement standardized to contain 95 percent curcumin twice a day, preferably with food that provides some fat, to aid absorption.
And avoid supplements that contain “plain” curcumin, which is very poorly absorbed. Instead, look for highly absorbed forms of curcumin such as BCM-95.
Astaxanthin is another great antioxidant option. It's a fat-soluble member of the carotenoid family found in algae, which passes its red-orange hue up the food chain to shellfish, salmon, trout, and flamingos.
Compared with other carotenoids — beta-carotene, lutein, alpha-carotene, alpha-tocopherol and lycopene — astaxanthin exhibits higher antioxidant capacity.
So, it’s no surprise that astaxanthin has been shown to have powerful brain, heart, eye, weight, and skin benefits: see Salmon's Bold Color Boosts Energy & Slows Aging and Skincare Secrets from the Sea.
Based on the research, it makes sense to take at least 4mg per of astaxanthin per day.
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