by David H. Rahm, M.D.
Q: If I took every supplement that I read about, I would be taking dozens of nutrients. How do I know what dietary supplements I should take?
In the 30 years I’ve practiced medicine, this is one of the most commonly asked questions I hear from patients. Unfortunately, the answer isn’t simple. But, below you’ll find my guidelines as it relates to this topic.
Just to clarify, patients often use the catch-all term “vitamins” when referring to supplements. A more accurate term is nutritional supplement but technically speaking, the FDA uses the term dietary supplement which includes vitamins, minerals, phytonutrients, Omega-3s, accessory nutrients, botanicals, protein supplements, etc.
Before I answer what supplements to take, let’s first review whether you need to take supplements.
Supplements Cover Gaps in the Diet
Ideally you should obtain all of the nutrients your body needs from the foods you eat. A healthy diet features plenty of fruits and vegetables, along with lean protein sources and unsaturated fats. These foods provide many of the vitamins, minerals, Omega-3s and phytonutrients our bodies need for overall health and optimal wellness. Studies have shown that populations who follow this type of diet, live longer without chronic disease and have lower mortality rates.
The reality is that with today’s lifestyle, most Americans are not getting these nutrients from the foods they eat. Just 14% of adults and fewer than 10% of teens eat the recommended servings of fruits & vegetables daily. Even if you eat plenty of these healthy foods, produce is often picked unripe to reach distant markets. By the time these foods reach your local supermarket the nutrient content is not at its peak. Also, through selective breeding, fewer varieties of fruits and vegetables are available and these genetically modified foods are not as chock-full of nutrients as their wilder and older genotypes.
While they can’t make up for an unhealthy lifestyle, nutritional supplements can help fill the gap in your nutrient intake.
The Nutritional Supplement Pyramid
If you’ve visited the drug store or health food store lately, you’ve probably noticed that a wide range of nutritional supplements are available. This can be somewhat overwhelming even for the most nutritionally informed.
That’s why over 20 years ago I developed the Nutritional Supplement Pyramid to ensure a logical approach to nutritional supplementation. The Pyramid is based on four recommendations to establish a sound nutritional supplementation program: 1) take a multiple-vitamin & mineral to cover gaps in the diet; 2) add an Omega-3 supplement; 3) take extra phytonutrients for free-radical protection; and 4) use accessory nutrients to address specific health issues. I cover each of these in greater detail below.
Take a High-Quality Multiple-Vitamin & Mineral
As the name implies, a multi provides a broad range of vitamins & minerals to enhance health. While most of these nutrients can be taken separately (e.g., B-complex, calcium, vitamin D), a multi offers the convenience of taking a wide range of vitamin and minerals all at once.
A high-quality multi-vitamin will be formulated with vitamin A (from palmitate and/or carotenoids), vitamin C and bioflavonoids, vitamin D, vitamin E, vitamin K, the B-complex, inositol and choline. The mineral part of a multi should include nutrients including calcium, magnesium, zinc, selenium, copper, boron, manganese, chromium, molybdenum and potassium.
For mass market brands in order to reach a lower price, quality can be sacrificed (e.g., natural vitamins like natural vitamin E or natural carotenoids are not used). These mass market brands often contain artificial dyes and colorants.
Health food store brands are generally of better quality than mass market brands. Physician brands such as VitaMedica are also formulated using better quality ingredients, generally at amounts above the Daily Values.
To learn more about how to find a good quality multi, read: How do I Find the Best Multivitamin for Women?
Add an Excellent Source of Omega-3 Fatty Acids
The next step in your daily supplement regimen is to add an Omega-3 supplement. If your diet includes plenty of deep, cold water fish like salmon and mackerel, walnuts, flax and chia seeds, you probably don’t need to take an Omega-3 supplement. But, the average American gets far too little of these health-promoting fats and way too much Omega-6 fats, saturated fats and transfats. Hence the need for supplementation.
The most common types of Omega-3 supplements include fish oil and flax seed oil. If you want supple skin, then I suggest taking a flax seed oil supplement. If you’re looking for heart and brain health benefits of Omega-3s, then I suggest a fish oil supplement. Ideally, you’ll want to take both as flax seed oil and fish oil provide different health benefits.
If you’re unsure about the difference between flax seed oil versus fish oil, refer to this infographic: The Best Omega-3 Supplements: What to Look For.
Finding a good quality flax seed oil supplement is less complicated than finding a good quality fish oil supplement. Look for brands like VitaMedica that offer organically grown flax seeds, cold-pressing and carob coated capsules to protect the delicate flax seed oil. Other quality brands include Barleans, Flora, Omega Nutrition and Spectrum.
Fish oil supplements require more knowledge of fats specifically DHA and EPA. The Omega-3 fat DHA is associated with brain health whereas the Omega-3 fat EPA is associated with heart-health. Depending on what benefits you’re looking for will determine the best fish oil supplement for your needs.
If a fish oil supplement contains both EPA and DHA you’ll need to look for the amount provided per capsule. Most fish oil supplements from the Whole Foods brand to Country Life to Health from the Sun contain a total of 300 mg of combined EPA (180 mg) and DHA (120 mg) per capsule. Products like VitaMedica’s Super EPA/DHA Fish Oil offer a concentrated formula with just one capsule containing 750 mg of Omega-3s (500 mg of EPA and 250 mg of DHA), requiring fewer capsules per day.
Some brands like Carlson Labs offer cod liver oil supplements. While health-promoting, cod liver oil tends to have a lower amount of EPA and DHA per serving and a higher amount of vitamin A. Post-menopausal women should be careful not to obtain more than 5,000 IUs of vitamin A (retinyl palmitate) through diet and supplementation on a daily basis.
By the way, all age groups can benefit from taking an Omega-3 supplement. In fact, pregnant and nursing women not only benefit by taking fish oil but their babies do too. From preventing infant eczema to supporting brain development, fish oil supplements are a safe way to obtain these important fats without worrying about ingesting mercury and other harmful contaminants.
Take Extra Phytonutrients for Free-Radical Protection
If you’re not eating 5-9 servings of fruits & vegetables daily, your diet may be lacking in phytonutrients, plant chemicals that have antioxidant, anti-inflammatory & other health benefits.
Phytonutrients, also referred to as phytochemicals (“phyto” meaning “plant”), are the chemical compounds that give fruits, vegetables, grains, nuts, teas, legumes and spices their color. To learn more about the beneficial role that phytonutrients play in health, read 5 Phytonutrient Color Groups to Target.
While over 900 types of phytonutrients and more than 5,000 different phytochemicals have been identified, most can be classified according to their color: blue-purple, red-pink, orange-yellow, dark green and brown-white. Eating foods from each of these color groups ensures that you obtain a wide range of these phytochemicals.
Phytonutrient supplements can be sold as powders, capsules or tablets. Hundreds of products are available, ranging from Murad’s Pomphenal supplement which is formulated with one ingredient to Juice Plus’s Garden Blend or Orchard Blend which as the name implies, is formulated with a blend of fruits and vegetables.
VitaMedica’s Phyto-5 supplement is formulated with fruits, vegetables, spices & tea from the 5 major color groups. The supplement features acai, cranberry, pomegranate, papaya, kale, spinach, broccoli, cauliflower, Cinnulin®, turmeric, ginger and Rooibos tea.
Phytonutrient supplements are also offered as “green” or “red” superfoods. If you live near a juice bar or smoothie store, you can buy a shot of green juice pressed from wheatgrass. While health-promoting, these shots can be unpalatable for some.
Other phytonutrient supplements are sold as beverages and include everything from POM Wonderful found in mainstream stores to Mona Vie Juices sold through the multi-level marketing (MLM) channel. With juices, you’ll need to watch the calorie and sugar content. With MLM products, you’ll need to watch your wallet, as these products tend to be more expensive due to multiple distribution levels.
Use Accessory Nutrients to Address Health Issues
If you’re taking a good quality multi-vitamin & mineral, an Omega-3 supplement and a phytonutrient, you’re in good shape. At this point, if you’re considering taking any other supplements, then most likely it would be to address a specific health issue.
Condition-specific supplements include glucosamine sulfate to support joint health; black cohosh to relieve menopausal symptoms; homeopathic Arnica Montana to minimize bruising; and probiotics to support digestive health.
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.