Q: In America, where many people have access to nutritious foods, are dietary supplements really necessary?
Ward: Dietary supplements are typically necessary. Although we have a bountiful, nutritious food supply, most Americans do not eat perfectly every day. And in many cases, they may leave out entire food groups, which means missing out on beneficial nutrients. Research shows Americans don’t get enough whole grains, fruits, vegetables, and dairy. According to the 2015 Dietary Guidelines for Americans Committee (DGAC) report, kids and adults often fall short on calcium, vitamin D, potassium, and fiber. Iron is a nutrient of concern for women in their childbearing years. In addition, the DGAC report says most Americans have a low intake of vitamins A, C, and E, folate, and magnesium.
Low Dog: The short answer is yes. The Centers for Disease Control and Prevention estimates that 30 million Americans are deficient in vitamin B6, 18 million are deficient in vitamin B12, 66 million have insufficient vitamin D, and approximately 10 percent of women between ages 12 and 49 years are deficient in iron. These are staggering statistics.
Q: Who should consider taking a supplement?
Bowden: Supplement regimens can be designed to support any health condition or concern. There are wonderful formulas for the brain, there are nutrients you can take to enhance heart health, and anyone with hepatitis will find many supplements that help the liver. Healthy people can benefit from supplements, as well—almost no one gets enough magnesium or vitamin D, for example.
Low Dog: Women planning on becoming pregnant, women who are pregnant or breast-feeding, people over the age of 50, low-income kids and adults who may be at higher risk for a low-nutrition diet, vegetarians and vegans, competitive athletes, as well as those taking drugs that can deplete key nutrients. Anyone who falls in these groups should take a basic multivitamin/mineral.
Ward: People who leave one or more food groups out of their diets, overweight people, chronic dieters, and anyone who fails to get the recommended servings from each of the food groups every day, particularly teens.
Q: What should be considered before starting a supplement regimen?
Low Dog: Look up what someone your age and gender should be taking. Aim to get 50–100 percent of the Daily Value (DV) in your supplement for most vitamins and minerals, with the exception of iron, calcium, and magnesium. Calcium and magnesium are minerals that are taken in milligrams (mg), not micrograms (mcg). So these won’t be found in large quantities in a one-daily kind of supplement. And, unless your health care provider specifically recommends it, only young children, menstruating women, and pregnant or breast-feeding women should take iron supplements.
Bowden: You should consider what you’re trying to accomplish. If you’re basically healthy and taking a supplement for insurance, you probably don’t need dozens of supplements. If you’re pregnant, older, under a lot of stress, or if your liver or heart is compromised in some way, then it’s a different story and you should work with a competent, nutritionally educated health provider to come up with an individualized supplement plan that works for you.
Q: Is a multivitamin a good choice for most people? Why or why not?
Low Dog: I’m an advocate for people taking a very basic multivitamin that provides 50–100 percent of the DV for most vitamins and the trace minerals.
I recommend people consider taking a multivitamin/mineral, additional vitamin D, and possibly additional calcium and magnesium based upon their diet. You should also consider taking an omega-3 supplement if you don’t consume fish or seafood regularly, especially during pregnancy and while breast-feeding.
Ward: Multivitamins with 100 percent of the DV or less cover most of the bases and fill in gaps in a balanced diet. I take a multivitamin every day, as well as calcium and vitamin D.
Q: Are there health risks associated with taking supplements?
Ward: It is possible to take too many supplements, just like it’s possible to eat too much. Health risks depend on what you are taking. There are no known health risks associated with a multivitamin that contains reasonable amounts of vitamins and minerals and no botanicals or other substances.
Low Dog: You can overdo taking supplements. When people take too much iron, for instance, it is stored in the pancreas and liver and other areas of the body where it can cause damage. High intakes of vitamin B6 (>150 mg/day) may harm the nerves. There remain issues regarding quality, particularly with herbal products. People taking prescription drugs that are critical for their health may be at risk for drug-supplement-herb interaction. So, yes, there are risks. But there are also significant risks associated with being deficient in key nutrients, especially during pregnancy and early childhood development.
Q: How can people make safe decisions about which supplements to take and how much?
Low Dog: You have to learn to be a savvy consumer. Many health care professionals are not adequately trained to provide counseling about dietary supplements. Check out the websites of the Linus Pauling Institute at Oregon State University or the Office of Dietary Supplements for reliable, unbiased information.