Usually research looks at vitamin and mineral supplementation, but in my practice I use herbal supplements as well. While research is mixed¹ about the value of general vitamin supplements, I find that if used appropriately they can be helpful.

First, what are supplements?

• In short, things that you aren’t getting enough of through diet, so you need to take  in addition, or supplementally.
• Vitamins. These are organic compounds that your body needs but can’t make itself. Most vitamins are food based, with a few exceptions like Vitamin D.
• Minerals. These are elements from the earth, like calcium and iron. Plants get minerals from the soil.
• Herbs. There are hundreds of herbs with medicinal qualities. Sometimes I recommend herbal teas or tinctures (water or alcoholic extracts of the plant) and sometimes I prefer a capsular product.

Supplements can come in a variety of forms. Herbs can be used while cooking, made into a tea, or extracted into alcohol or water. Vitamins, minerals and herbs can also be found in capsules, softgels, tablets, liquids, powders, chewables, gummies, etc. Tablets are cheap and concentrated, but may be difficult to swallow, and there are some concerns about their ability to breakdown. Capsules are easier to swallow and can be opened to mix the ingredients into foods. They are more expensive though and have a shorter shelf-life. Capsules are often made of gelatin which is not suitable for vegans and some vegetarians, though there are veggie-cap alternatives. Softgels are one piece capsules that usually contain a liquid. They are easier to swallow and with a longer shelf-life, but more expensive. Powders and liquids are cheap and offer flexible dosing, but often taste bad. Gummies are a popular alternative for children’s vitamins, and some adults, but I think they should be avoided as they can increase risk for cavities.

How do I know if I need to use supplements?²

• In general, a well-balanced diet (a rainbow of foods!) with sun exposure or Vitamin D fortified foods is sufficient for most people. But it doesn’t hurt to take a multivitamin with 1-1.5x the Recommended Dietary Allowance. Higher doses of certain nutrients may be unsafe, and should only be done with medical supervision.
• We also know that our soil is becoming depleted, and even organically grown fruits, vegetables and grains do not contain the same levels of nutrients that they did decades ago.
• There are certain vitamin deficiency syndromes that can result from inadequate intake of specific vitamins. Scurvy for example from no Vitamin C. In the developed world these deficiencies are more likely to be seen in certain folks: elderly, alcoholics, vegans, etc. But we still don’t fully know how nutrients levels can relate to chronic disease and disease prevention.
• There are many different reference tables that try to pinpoint just how much nutrient intake we need to be healthy and to prevent disease. We have Recommended Dietary Allowance (RDA), Adequate Intake (AI), Estimated Average Requirement (EAR), and Tolerable Upper Level (UL). Usually we use the RDA which is the “the average daily intake that is sufficient to meet the dietary requirement of nearly all healthy people.”
• There are blood tests to measure blood levels of nutrients. But these tests may or may not be helpful, as we don’t really know the what the best “normal” value is. People with “low” levels of vitamins may be very healthy, and people with “high” levels may have chronic disease and therefore require more of certain vitamins.
• Some people have certain gene polymorphisms which mean they are unable to metabolize certain nutrients. These folks might benefit from specific vitamin supplementation.
• Some people have poor digestion, meaning they aren’t absorbing the nutrients that they are eating. These folks won’t benefit from supplements until they get their digestion optimized.

Which nutrients do conventional medical doctors recommend?

Conventional medical doctors are quite conservative about vitamin and mineral supplementation. They wait until the research is very clear about who needs it, how much is needed, what if they get too much, what if they don’t get it at all, etc. Right now, conventional medical doctors (per standards of care found at UpToDate) are making the following vitamin recommendations:

• Folic acid for women who are (or are about to become) pregnant. This prevents neural tube defects which could occur in early pregnancy. Folic acid has been associated with increased growth of some cancers, so I don’t recommend this for people who aren’t about to become pregnant.
• Vitamin D, especially for elderly who are at risk for osteoporosis and falls.
• Multivitamin, probably won’t help, but unlikely to cause harm.
• They recommend against Vitamins A, B12, E and C for disease prevention.

For individualized dietary and supplement recommendations, make an appointment.

Read more: (to be updated as they are posted – check back!)

• How to choose good quality supplements.
• Multivitamin.
• Calcium.
• Omega 3.
• Vitamin D.
• Probiotics.

capsule photo credit: selva via photopin cc
tincture photo credit: henna lion via photopin cc
rainbow food photo credit: rageforst via photopin cc
1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309636/
2UpToDate, accessed 5/14/13