Elizabeth Somer, M.A.,R.D.

Introduction:

More than one in every two of us are popping nutritional supplements - that makes them the most popped pills in America. How do we know if the $3+ billion worth of supplements sold in this country every year is doing us any good? Would we be just as well, or better, off without them, or would everyone benefit from a daily vitamin pill? Even if supplements are a good idea, how do you know what and how much to take, what to avoid, and how to even read those labels? Is time released and chelated better than regular supplements? Does it matter what time of day you take your vitamins? Here to tell us how to supplement is Elizabeth Somer, R.D., author of The Essential Guide to Vitamins and Minerals and Nutrition for Women.

1. Should I take supplements?
   Yes, almost everyone would benefit from a well-chosen supplement. You’re probably heard the first commandment of nutrition that states "Thou shalt meet all your nutritional needs from a balanced diet." That means, all you have to do is consume daily 5 to 9 fresh fruits and vegetables, 6 to 11 whole grains, 3 glasses of low-fat milk, and 2 servings of extra-lean meat, chicken, fish, or legumes. Sounds reasonable, but there’s a catch - only one in every 100 of us are meeting even the minimum standards of a balanced diet. On the majority of days when people don’t meet their basic nutritional needs, a well-balanced, moderate-dose multi can help fill in the gaps.

2. Is a multi vitamin all I need?
   You’ll probably need to supplement your supplement with a calcium/magnesium pill. All one-pill-a-day multis are low in these two minerals. Unless you consume the calcium equivalent of at least 3 glasses of milk a day and eat lots of magnesium-rich whole grains, legumes, nuts, and seafood, your diet is probably marginal to down-right deficient in these minerals. Don’t think you’ve got your bases covered by taking a Tums, since this source of calcium is lacking in vitamin D and magnesium, so you’ll still need to supplement with this mineral, too. Viactiv is a great way to get your calcium and vitamin D, which is essential for calcium to be absorbed and deposited into bone.

3. What are the guidelines for choosing the best multi? Do you recommend a particular brand?
   Forget the claims that a product is "complete," "balanced," "high potency," or specially formulated. This hype has little to do with the real formulations. Claims that a supplement will cure, treat, or even prevent any health condition are more hype than fact. Ignore the packaging and go straight to the nutritional information on the back of the label.

   Select a broad-range multiple that supplies as close to 100%, but no more than 300%, of the Daily Value for a wide variety of vitamins and minerals. For men and post-menopausal women, select a multi with little or no iron. For quality sake, stick with the major brands, such as Centrum or Nature Made, or with a product with the USP quality seal that guarantees high standards. Another great multi is made by a company right here in Oregon - Metabolic Maintenance in Sisters, Oregon makes "Basic Maintenance." To visit their website click here

4. Does it matter when I take my supplements? For example, I’ve heard I should take calcium at night, is this true?
   The time of day is not as important as what you take them with. Most nutrients are best absorbed when taken with meals. Nutrients are best absorbed when taken in small doses throughout the day. But the inconvenience of taking divided doses might make a one-pill-a-day product more appealing. For maximum absorption, take a multiple with iron at a different meal than your calcium supplement, since these two minerals compete for absorption. When it comes to calcium, a recent study from Creighton University in Omaha found that taking calcium at night was no more effective than any other time of the day when it came to absorption.

5. Are there any vitamins, minerals, or herbs that will help me lose weight?
   Don’t get your hopes up. While you need a multi when calories drop below 1,800 calories a day, any supplement that claims to curb hunger or boost metabolism bases those claims on scanty evidence. Some ingredients in these products have proven unsafe, such as ephedra or ma huang, which can produce modest weight loss, but at a cost, including an increased risk for nausea, vomiting, anxiety and mood changes, and heart palpitations. A few deaths, heart attacks, seizures, and serious psychiatric illnesses possibly attributed to ephedra caused FDA to ban these supplements for weight loss. Bitter orange (i.e., citrus aurantium) contains synephrine, a compound structurally similar to epinephrine, which might increase blood pressure and should not be taken by people with heart disease, hypertension, or glaucoma. Safety for the general public is unknown at this time.

   Two popular diet aids are chromium picolinate (CP) and conjugated linoleic acid (CLA). The most recent meta-analysis of CP’s effects show a slight benefit for weight reduction of up to a half pound a week. No adverse side effects have been noted with either CP or chromium nicotinate. CLA appears to reduce fat mass and increase lean tissue in animals, but little evidence supports its use for people. Ironically, even if CLA aids in fat loss, it does not appear to have any effect on body weight or body mass index (BMI).

   Other supplements for weight loss have little or no evidence to support their use, including garcinia cambogia, glucomannan, guar gum, beta-hydroxymethylbutyrate, pyruvate, yerba mate, and yohimbe. There also is no credible evidence that chitosan aids in weight loss by decreasing fat absorption. If you want on-going information on dietary supplements, contact the NIH Office of Dietary Supplements website: click here . The FDA website, click here, provides information on updates and warnings on dietary supplements.

6. Will my appetite increase if I take supplements?
   There is no scientific evidence that appetite increases when a person takes supplements, unless you are correcting a very severe deficiency. For instance, zinc has been show to renew lost sense of taste in many people, or even sharpen it. Beyond that, appetite is somewhat subjective. Perhaps a person’s renewed interest in diet has merely sharpened their appreciation of food.

7. I’m a vegetarian. What supplements should I take?
   If you still eat eggs, milk products, or fish, then your supplement needs are the same as anyone else. However, if you are a strict vegetarian who avoids all animal foods and only eats grains, vegetables, fruits, nuts, and legumes, then there are several nutrients likely to be low in your diet. Make sure your multi contains iron, zinc, calcium, magnesium, vitamin B6, vitamin B12, and vitamin D. These nutrients are either low in your diet or are poorly absorbed from only vegetable sources.

8. How much should I pay for a supplement? Any tips for saving money when buying supplements?
   First, steer clear of supplements that contain "extra" ingredients, such as lipoic acid, enzymes, primrose oil, or inositol, to name only a few. Avoid time-released vitamins and chelated minerals. These extras only add cost, not value, to a product since they are either worthless, no better absorbed and used than other nutrients, or supplied in amounts too low to be of use. Also, avoid the "natural" products; they’re costly and usually provide no added benefit over other supplements. (Exceptions to this rule are natural vitamin E, selenium, and chromium, which are better absorbed or less toxic in their natural or organic forms.)

   Second, purchase bigger or "economy size" bottles when the unit price saves you money. However, make sure you can use the supplements before the expiration date on the label to ensure they retain their potency. Also, consider purchasing store-brand multiples.

9. I’ve heard that less expensive supplements aren’t digested and pass right through you. Is this true?
   Often generic supplements are manufactured by the same companies who make the brand-name products, and are just as well-absorbed. But, as I mentioned earlier, if you choose major brands, you are most likely to be getting a higher-quality supplement since these companies are closely scrutinized by the FDA. If you want to test your supplement, pour some vinegar into a bowl, drop your tablet in and see how long it takes to dissolve. A supplement that hasn’t dissolved after 20 minutes might not be breaking down in your stomach either.

10. Do vitamins and minerals lose their potency when stored for long periods of time?
    Minerals do not lose their potency, but vitamins do. Minerals are tough as a rock. Even if the tablets crumble, the potency doesn’t fade. However, when vitamins and minerals are together in one supplement, the storage rules are stiffer. Because minerals may cause a faster rate of breakdown, combination tablets should follow the rules for vitamin storage: Keep in a cool, dry place in a tightly closed container. Vitamins begin to lose their potency after their "use by" date, but still have some activity.

Final Word: Nutrition and supplements is not an either-or issue, but rather the two enhance each together. You can’t always get optimal amounts of all the vitamins and minerals from food, just as pills don’t contain everything that food has to offer. To stack the deck in favor of optimal health, eat really well AND supplement responsibly.