Multivitamins, single-nutrient supplements or healthy diet alone?
You do your best to eat right. You stay away from junk food, and you eat fruits and vegetables as often as possible. But is your diet possibly falling short of essential vitamins and minerals? Should you be taking dietary supplements?
“Normally, when it comes to nutrients, I — and most dietitians — take a food-first approach,” says Carrie Dennett, a Pacific Northwest-based registered dietitian nutritionist and owner of Nutrition by Carrie, “because when you’re getting your nutrients through food, you’re getting those nutrients in a complete package with other vitamins and minerals, phytochemicals and maybe fiber.”
That said, not everyone is able to meet their nutritional needs through food alone. Dietary supplementation for specific nutrients is recommended depending on factors including:
— Your age and life stage.
— Appetite issues.
— Geographic location.
“Infancy, puberty and the start of menstruation, pregnancy and lactation are periods in time where women may benefit from supplementation of certain vitamins and minerals,” says Cassie Vanderwall, a registered dietitian in the department of clinical nutrition at UW Health in Wisconsin.
Keep in mind, dietary supplements are intended to supplement the diet, not to cure, prevent or treat diseases or replace the variety of foods important to a healthy diet. These experts share their insights on multivitamins and specific nutrient supplements.
Should you supplement individual nutrients or turn to a multivitamin? If you’re looking for overall disease prevention, multivitamins may not particularly help:
— To gauge the association between multivitamin use and cancer risks, researchers evaluated nearly 490,000 participants ages 50 to 71 in the NIH-AARP Diet and Health study and found little evidence to support a cancer-preventive role in women or men, with the exception of colon cancer. A slightly higher risk of oropharyngeal cancer was seen in women who used more multivitamins, according to the study published in the January 2022 issue of the Journal of Nutrition.
— A systematic analysis encompassing 18 studies and more than 2 million participants found that multivitamin use did not affect the risk of dying from cardiovascular disease, according to data published in the July 2018 issue of Circulation: Cardiovascular Quality and Outcomes.
For the general population overall, evidence doesn’t support claims that multivitamins lead to better health outcomes, Dennett says, pointing to long-running research like the multi-phased Nurses’ Health Study.
However, “Some women might need a multivitamin,” Dennett adds. “As we get older, some adults find they have reduced appetite or they have other reasons they’re having trouble eating enough food or enough variety of food.” In those cases, a multivitamin might bridge that gap, she says.
In addition, women considering pregnancy or who are pregnant have specific supplemental needs addressed by prenatal vitamins, a multivitamin aimed at providing vitamins and supplements needed for a healthy pregnancy.
If you’re focusing on individual vitamins and minerals, rather than multivitamins, the following supplements are among the most recommended to address specific deficiencies:
B vitamins are water-soluble vitamins that work in concert to maintain a variety of bodily functions. Although you can take in enough of most of the B vitamins through food, two B vitamins in particular may require a boost from supplements.
Vitamin B12 is one example. Your central nervous system requires vitamin B12 to develop and function, and you also need vitamin B12 for healthy red blood cell formation and DNA synthesis.
Vitamin B12 is naturally found almost exclusively in animal products. Eating B12-fortified foods or taking vitamin B12 supplements is typically advised for people following vegan or vegetarian diets, pregnant women and older adults.
“I do recommend vitamin B12 to my clients who are over the age of 50,” Dennett says, in line with Institute of Medicine recommendations.
Top food sources of vitamin B12 include:
— Red meat.
— Milk, yogurt and cheese.
— Fortified breakfast cereals.
— Fortified nutritional yeast.
Age and life stages: Women ages 14 and older need 2.6 micrograms of vitamin B12 daily, 2.6 micrograms while pregnant and 2.8 micrograms while breastfeeding. Older adults may have changes in requirements, as well. “As the body ages, it makes less intrinsic factor, which is needed in the body to use vitamin B12,” Vanderwall explains. “As this factor decreases, the person may need more vitamin B12 in supplemental form.”
Folate/folic acid (vitamin B9)
“Folate is a vital B vitamin in metabolism — the body’s use of food for energy — and helps to build a healthy brain and spinal cord during pregnancy,” Vanderwall says.
Folic acid is a synthetic version of folate that helps the baby develop and reduces the risk of having the baby being born with a spinal cord problem like spina bifida.
Folate is naturally present in a wide variety of foods, including:
— Vegetables (especially dark green leafy vegetables).
— Beef liver.
— White rice.
— Raw spinach.
— Black-eyed peas.
— Fortified breakfast cereals.
— Fortified breads and pastas.
Age and life stages: Even if you’re healthy and maintain a diet rich in folate, if you’re pregnant or plan on becoming pregnant, folic acid supplements are recommended. Women of childbearing age need 400 micrograms (0.4 milligrams) of folic acid every day, according to the National Institutes of Health Office of Dietary Supplements. This daily amount increases to 600 micrograms (0.6 milligrams) for pregnant women and 500 micrograms (0.5 milligrams) for breastfeeding women.
Vitamin D is essential for bone health. It also promotes calcium absorption in the intestines.
Good sources of vitamin D include salmon, trout, mushrooms and fortified milk, juices and cereals. With the help of sunshine, most of the vitamin D you get is made in the skin, but if you’re almost always indoors and get little or no sunshine on your skin, you may need to consult your doctor or dietitian about your vitamin D needs.
“Vitamin D is important for anyone who has a darker skin tone, because their skin may not make enough of it,” Dennett says. In addition, “Some people take vitamin D in the winter months, especially people who live in the more northern states where it’s getting cold and cloudy.”
Age and life stages: Women need 600 IU of vitamin D daily. The recommended daily intake increases to 800 IU after age 70.
“Calcium and vitamin D work together to maintain healthy bones in the body,” Vanderwall explains.
In addition to keeping strong bones, calcium is also important for healthy muscles, nerves and the heart. Women should be careful to get enough calcium throughout life, but you especially want to build bone density in your 20s because your body loses some of that bone in later years.
You need 1,000 milligrams of calcium per day from age 19 through 50, according to the ODS. Consider taking a calcium supplement only if you don’t receive enough calcium from your diet through dairy products or nondairy calcium sources such as calcium-fortified orange juice and cereals, beans, leafy greens, almonds and salmon.
Age and life stages: As you approach menopause, your body produces less estrogen, putting you at increased risk for heart disease, osteoporosis and other complications. To build and maintain healthy bones, weight-bearing and muscle strengthening exercises are important. In addition to exercise, be sure to get the recommended daily allowance of calcium, which is 1,200 milligrams for women over 50. If you have a bone condition such as osteoporosis or osteopenia, your doctor may recommend taking more.
Magnesium supports hundreds of functions throughout the body, including tooth and bone formation, growth, physical and cognitive development, ensuring a healthy pregnancy and even good sleep.
Good magnesium sources include:
— Whole grains.
— Fortified cereals.
— Leafy green vegetables like spinach.
Age and life stages: Magnesium needs vary across your lifetime. Magnesium is especially important for women older than 40 years, because it prevents bone loss that may lead to osteoporosis. Women ages 31 and older need 320 milligrams. Pregnant women ages 31 to 50 need 360 milligrams — and women need 320 milligrams while breastfeeding. Women ages 19 to 30 need 310 milligrams.
“Iron supports healthy red blood cells and energy throughout the body,” Vanderwall says, making it a critical mineral for women’s health. “Adequate iron intake can support losses from menstruation.”
Iron comes from animal sources (heme iron) and plant sources (non-heme iron). Heme iron is better absorbed than iron from plant sources. However, the absorption of iron can be improved when these iron-rich foods are eaten in combination with foods rich in vitamin C — such as orange juice, strawberries or green, yellow or red peppers.
Animal-based iron sources include:
Plant-based iron sources include
— Dark leafy green vegetables.
Age and life stages: Women 19 to 50 years of age need 18 milligrams of iron daily. Pregnant women need 27 milligrams of iron daily and breastfeeding women need up to 10 milligrams. Women 51 years and older need 8 milligrams every day.
Vitamin C (ascorbic acid)
Vitamin C is a water-soluble vitamin that’s a natural antioxidant. Antioxidants help protect the body from chronic inflammation. Vitamin C is also important for skin, hair, bone and joint health and eye health. It also plays a role in absorbing iron in the body. Fortunately, most women get enough vitamin C from food alone.
Although vitamin C deficiency can lead to a disease called scurvy, that’s rare in developed countries like the U.S. And while vitamin C has been touted for an ability to help people get over colds, you don’t necessarily need it as a supplement.
“If somebody is eating a healthy, varied diet, there’s really no advantage to taking supplemental vitamin C,” Dennett says. It’s probably not harmful, she adds: “It is water-soluble, so it’s not likely that somebody would develop a toxicity or end up eating too much.”
Fruits rich in vitamin C include:
— Citrus fruit like oranges and grapefruit.
— Green and red peppers.
— Tomatoes and tomato juice.
Vegetables rich in vitamin C include:
— Swiss chard.
— Brussels sprouts.
Ages and stages: Women (or men) who smoke require more vitamin C than nonsmokers, the ODS advises. Women 19 and older should have 80 milligrams of daily vitamin C, increasing to 85 milligrams during pregnancy and 120 milligrams while breastfeeding.
Before taking supplements
“Too much of a good thing isn’t a good thing,” Vanderwall says. “Most vitamins and minerals have established upper limits, and supplements can make it easy to exceed our needs and have toxic effects. It is important to discuss all supplements with your medical team before starting.”
Your health care provider will take health conditions you have into account when discussing which supplements, if any, are right for you.
“Specific medications can alter how vitamins and minerals are used in the body and therefore increase the need, which may surpass what one can take in through food,” Vanderwall notes. “For example, certain antibiotics deplete the body of several B vitamins. Levodopa used in Parkinson’s disease decreases potassium and vitamin B6 in the body. Long-term metformin use for Type 2 diabetes has been associated with lower levels of vitamin B12.”
Prescription medications may interact with certain foods, vitamins or minerals, which is another consideration.
If you’re choosing a brand of multivitamins, look carefully at nutrient balance. Steer clear of those containing amounts of specific nutrients that can be astronomically higher than recommended daily amounts. “Try to find ones where the levels of the nutrients are closer to 100%,” Dennett says.
Vitamins and minerals for women
Depending on your health status, age and stage of life, these nutritional supplements might help meet your needs:
— Vitamin B12.
— Folic acid.
— Vitamin D.
— Prenatal vitamins.
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Update 03/07/22: This story was previously published at an earlier date and has been updated with new information.