Take a walk through any convenience or grocery store and you will find an entire aisle dedicated to dietary supplements. Some stores, like GNC and The Vitamin Shoppe, only sell dietary supplements. How do these places stay in business? Because dietary supplements are a billion-dollar industry. A lot of people dish out their hard-earned cash in hopes that some magical supplement will improve their health.
Unfortunately, the majority of dietary supplements do nothing to improve our health, and some may actually harm it. Unlike food and beverages, dietary supplements are not regulated by a government agency. This means that dietary supplements may, or may not, contain the ingredients listed on the label. They may also be unintentionally contaminated with heavy metals, or other dangerous substances. And since supplement manufacturers don’t have to prove that their products are safe before they hit the shelf, dietary supplements are considered innocent until proven guilty. They can be marketed and sold until adverse health effects are reported. At which point, the FDA will finally step in and intervene.
Despite all of the hazards and inconsistencies within the supplement industry, there are a few dietary supplements worth taking. The following recommendations were not made lightly. I take the opposite approach to the FDA—supplements are guilty until proven innocent. And even if a supplement doesn’t appear harmful, I consider it useless until there is clear and consistent independent data showing that it offers a health benefit. The following three supplements meet this criteria and worth taking:
Vitamin D is considered the “sunshine vitamin” because our bodies can synthesize it from the sun’s UV rays. When early humans were evolving in equatorial Africa, they spent all of their time outside with little clothing. As a result, our ancestors were never short on vitamin D. Flash-forward to current times and most humans are doing the exact opposite. We spend most of our time indoors and would be arrested if we walked around outside naked. Our blood vitamin D levels reflect this, as most people do not reach the estimated “ideal level” of >75nmol/L. Why does this matter?
Observational studies show that low levels of vitamin D are associated with an increased risk of diabetes, obesity, cardiovascular disease, multiple sclerosis, and high blood pressure. But confounding factors and reverse causality are likely responsible for these associations, as interventional studies using vitamin D supplements fail to show a link. There are, however, some interventional studies that do show benefits from vitamin D supplementation.
A 2014 Cochrane review of randomized controlled trials, found that vitamin D supplementation appeared to decrease mortality in elderly people (1). Other reviews report that vitamin D supplementation can reduce falls in those at risk, and reduced the risk of dying from cancer (2-3). This is kind of a big deal. A longer life, a lower risk of dying from cancer, and a lower risk of falling—just from a supplement that, when taken in correct doses, has little, if any, negative side effects.
A dose that would get most people above the ideal 75nmol/L level is 2,000 IU (international units) per day. There are two kinds of vitamin D supplements—vitamin D2 and vitamin D3. Both can raise blood levels, but vitamin D3 appears to be the preferred option. Most vitamin D3 supplements are derived from sheep’s wool, but I would encourage you to choose a “vegan” option because anytime an animal or animal byproduct is treated as a commodity, the animal’s welfare is often sacrificed.
Can’t I just spend some time out in the sun? Yes! And I would encourage you to do so in sensible amounts. In fact, people living near the equator probably don’t need to supplement with vitamin D because they have access to adequate sunshine all year long (this includes the southernmost parts of the U.S.). For those living further from the equator, a vitamin D supplement is probably only needed during the winter months when the sun’s UV rays are less intense (November through February, although this will vary depending on your specific latitude). During the summer months, I would encourage sensible sun exposure on a regular basis, instead of a vitamin D supplement. Just 10-15 minutes of sun-to-skin exposure can produce roughly 10,000-25,000 IU of vitamin D in people with lighter skin (people with darker skin would need to spend a bit more time in the sun). Any excess vitamin D that we generate can be stored (to some extent) for those rainy days.
Reasonable sun exposure may offer some other benefits beyond vitamin D. It can improve our mood, ward off seasonal affective disorder, help regulate our sleep/wake cycle, and may boost beneficial compounds like coenzyme Q10 (an antioxidant) and nitric oxide (a vasodilator). Unfortunately, the sun’s UV rays are not always beneficial. Long-term overexposure can lead to cataracts and skin cancer. To find the sweet spot, get regular, sensible sunshine without getting sunburned or spending hours in direct sunlight. Tanning beds should also be avoided.
Final recommendation: During the winter months, adults living further from the equator should supplement daily (or every other day) with 2,000 IU of vegan vitamin D3. We should still make an effort to get regular, sensible sun exposure throughout the year. Mega doses of vitamin D, excessive sun exposure, and tanning beds should all be avoided.
Vitamin B12 is not produced by plants or animals, but by microorganisms that blanket our natural environment. Animals store B12 in their muscles and organs, with some ending up in their byproducts. Because of this, meat, dairy, and eggs can provide us with vitamin B12 when consumed (although the absorption is extremely poor from some of these products). Animal products, however, are not the ideal source of B12, as consuming large quantities of meat, dairy, and eggs is detrimental to our health.
For most of human evolution, we have consumed a largely plant-based diet similar to the diet of our fellow great apes (sorry paleo folks, but your diet plan is inaccurate). Our early human ancestors obtained their B12 by occasionally scavenging a carcass or hunting large game, which would’ve provided a large, but infrequent dose of B12 (Of note, we store B12 really well compared to other water-soluble vitamins. This is likely an evolutionary adaptation that developed from of our infrequent meat consumption). Regular insect consumption was a much more common source of B12, but probably the most reliable and consistent source for our early ancestors came from the water they drank and the environment they lived in.
B12-producing microorganisms are found all over the natural environment, including untreated water and in the soil. When our early ancestors drank from a stream or ate fruit that had fallen to the ground, they were unintentionally consuming B12. Even to this day, many primitive populations continue to obtain B12 this way. This was noted with the Tarahumara Indians who consume a mostly vegan diet and obtain much of their B12 from untreated water and by consuming crops that are fertilized with manure (a rich source of B12) (4).
Nowadays most people live in a sterile environment (which is not always a good thing). We drink treated water, rarely interact with soil, sanitize everything, and throw away food that has fallen on the floor. Thus, our environmental sources of B12 have become negligible.
If we’re not regularly eating animal products (which we shouldn’t), or food off the ground, or drinking untreated water, where do we get our B12? The healthiest and best way to obtain B12 in today’s world is through supplements and fortified foods. Fortified breakfast cereals and plant-based milks can provide a decent amount of B12, but I would strongly recommend a B12 supplement. Older adults should also supplement with B12, regardless of the amount of animal products in their diet, since we have a harder time absorbing B12 from animal sources as we age.
For adults, the daily recommended intake of B12 is just 2.4 micrograms (mcg). But because our body does a good job of storing B12, a larger dose taken once a week can be sufficient. Plus, there is no upper limit for B12, so any excess that we consume will simply be urinated out. I recommend that adults take a 2,500 mcg supplement of B12 once a week. You’ll likely see two types of B12 in the supplement aisle—methylcobalamin and cyanocobalamin. They’re pretty much the same thing, so either one will work.
Many people started taking omega-3 supplements after a couple of studies suggested they may improve our heart health. Since those initial studies, more studies have been published suggesting they do not. Until more studies sway the pendulum one way or the other, the current evidence does not warrant taking an omega-3 supplement to improve heart health (5). So, why do I recommend one? Because taking an omega-3 supplement does appear beneficial for long-term brain health.
Supplementing with omega-3 fat has been shown to improve executive functioning, slow brain shrinkage (a normal, but modifiable, part of ageing), and improve brain integrity in older adults (6). For this reason, I recommend adults take a daily (or every other day) 250 mg algae-based DHA and/or EPA omega-3 supplement.
Can’t we just eat fish? Yes, but fish and fish oil are some of the most polluted foods we can consume. Fish products may contain any variety of environmental pollutants, such as: dioxins, polychlorinated biphenyls, organochlorine pesticides, polybromainated diphenyl ethers, mercury, lead, and cadmium. So, getting our omega-3 fat from fish is not the healthiest option. Additionally, when we consider the fact that most of the world’s fish species are being overfished, getting our omega-3 fat from fish products is not the most environmentally-friendly option either.
What about plants? Many plants do contain high amounts of omega-3 fat. Some of the best sources include: ground flaxseeds, walnuts, soybeans, hemp seeds, chia seeds, and dark leafy greens. These foods are extremely healthy and should be included in our diet on a regular basis. Unfortunately, these foods contain a form of omega-3 fat called alpha-Linolenic acid (ALA). This form is still good for us, and our body can convert some of it into the healthier forms—eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—but it’s not a very efficient conversion. Since EPA and DHA appear to exhort the most brain-protecting effects, adults, especially those who don’t eat fish, should supplement with an algae-based DHA and/or EPA omega-3 supplement.
Interestingly, the omega-3 fat found in fish is originally produced by algae. Algae are eaten by small fish, who are then eaten by larger fish, who are then eaten by even larger fish, and the omega-3’s bio-accumulate up the food chain. Unfortunately, so do environmental pollutants, which is why algae-based supplements provide the best of both worlds. They provide DHA/EPA omega-3 fat without a side of pollution. It’s a win-win!
In an ideal world, we would spend our days outside in equatorial Africa soaking up all the vitamin D our bodies desire without having to worry about skin cancer. We would get our B12 from drinking untreated spring water without the risk of getting cholera. We could eat fish rich in omega-3 fat without the hazards of environmental pollutants or the environmental burden of overfishing. But none of this is possible in today’s world. Which is why we should consider supplementing our diet with vitamin D (during the winter months), vitamin B12, and algae-based omega-3 fat.
I should point out that these recommendations are for healthy adults. Infants, children, pregnant or breastfeeding women, and other subgroups may have nutrition needs that differ from the recommendations above. For ideal health, these supplements should be taken in addition to a healthy, plant-based, whole food diet. Also, when deciding what supplement to choose, look for a reputable brand from a reputable store.
Peace, Love, Health
- Vitamin D supplementation for prevention of mortality in adults.
- Vitamin D and Falls—Fitting New Data With Current Guidelines
- Vitamin D supplements and cancer incidence and mortality: a meta-analysis.
- The food and nutrient intakes of the Tarahumara Indians of Mexico.
- Fish Oils, Coronary Heart Disease, and the Environment
- Long-chain omega-3 fatty acids improve brain function and structure in older adults.