Do I need to take supplements is one of the most common questions I am asked and with the global market in vitamin and mineral supplements ever growing, last year is was valued at £135 billion and it is predicted to grow around 10% each year from now until 2030, it is hardly surprising that this is something of interest.
Around 30% of adults and a mere 12% of children currently reach the at least 5 a day recommendation for fruit and vegetables in the UK, and with other key nutrients such as iron, folate and Vitamin D found to be nutrients of concern by the latest NDNS data (2020). Many are investing in an ‘insurance policy’ with daily supplements. A 2018 Food Standards Agency report found about half of all UK adults took food supplements on a regular basis, but will this policy pay off?
It is important to be aware that most supplements are covered by laws relating to food, not medicines, so they have to be careful not to make any medical claims. Claims of supplements (or foods) to ‘boost’ your immune system would be false claims as in fact they are ‘supporting the normal function of the immune system. Why is this important, well there are a lot of people (including nutritional professionals) who are trying to make money out of supplements, so at least if you are aware of potential false or over inflated claims you can be more savvy about who and where to buy or not to buy these products from!
So, does this mean my supplements are a waste of money?
This depends!
Firstly we should consider are they safe!
Consumers do not generally perceive there to be any risks associated with food supplements. Most people think ‘why not’ when it comes to supplements as they are seen as harmless, but this is not always the case.
Warfarin and Aspirin are medications. Vitamin E and ginkgo biloba are supplements, but all of these are blood thinners and if any are taken in combination you could be at risk of internal bleeding or stroke.
St Johns Wort can reduce the effectiveness of many medications including some used for depression, the contraceptive pill and heart disease.
Vitamin A can be toxic if combined levels of food and supplements reach over a certain level and supplements with vitamin A in should not be taken by those wanting to become pregnant or who are pregnant.
These are just a few examples to highlight that just because something says “natural” this doesn’t always mean safe so please consult your health care professional before starting on any supplements and ensure they are aware of the doses you are taking.
So, back to the question;
Do I need to take supplements to be healthy?
This answer needs context as there is no ‘one size fits all’ answer.
There has been a lot more discussion around the ‘food matrix effect’ in recent years and this in simple terms describes how nutrients interact with each other in foods and the health effects we get from a food are a result of both the food’s structure and nutrient composition.
This means if we isolate certain nutrients and take them individually outside of the food matrix, we may not gain as many health benefits as eating the whole food itself. This makes sense when you think of a multivitamin providing you with a specific vitamin or mineral compared with for example, an apple providing the vitamins and minerals plus fibre and phytochemicals (active compounds in plants) and antioxidants that together offer a much wider range of health benefits if consumed regularly.
Most of us in the UK should be able to get the nutrition we need from the foods that we eat and if you are following a balanced diet based on the Eatwell guide then evidence suggests you should be getting the full complement of vitamins and minerals that you require. However the cost of living crisis is making this more difficult for some and of course this may impact on your decision regarding supplements. However, we don’t need expensive ‘superfoods’ (that term is just marketing- it’s meaningless!) to have a balanced diet and it can be done on a budget, so again, don’t be sold that you need instagram worthy plates of food filled with goji berries and cacao in order to get your nutrition. If you can get your nutrients through food, this is probably the way to go to get the most impact on your health. Check out this BDA info sheet if you want more support with budget friendly meals.
If for some reason you are unable to eat a healthy balanced diet or you are working on improving the health of your diet and you are not currently getting all your nutrition your body needs through the foods that you eat, then taking a supplement is certainly a better option than becoming deficient in any nutrients, so a multivitamin to bridge the gap would be beneficial in these circumstances.
In the UK adults who take supplements are more likely to already meet nutrient recommendations than those who don’t take them, i.e. it is often the ‘worried well’ that are accessing supplements. Studies have looked at this concept and found that those who are already gaining the nutrition they need from their diet do not benefit further from supplements- so more is not more when it comes to supplements.
How do I know if I’m deficient in a vitamin or mineral?
Supplements are not there to treat deficiencies, so if you have cause for concern, then ask your GP for a blood test and they can run tests based on your symptoms or as they feel appropriate. This is much more advisable than a home testing kit as your Doctor can safely interpret these results in context with tests that are safe and accurate. They will prescribe any supplements that are required, possibly in larger doses until the deficiency is corrected.
Can a multivitamin prevent a deficiency?
Yes! As mentioned above, they can bridge a gap that may be there in your nutrient requirements for varying reasons, but of course so too can a healthy balanced diet, so they are not required in many of our lives and they should not be seen as a replacement or easy option. I have heard people say ‘I don’t need fruit and veg as I take vitamin tablets’, I have explained above why this is certainly not the case and this approach could lead to increased risk of varying diseases such as certain cancers and cardiovascular disease.
If I take more of a vitamin, will I get more benefit?
Certain Vitamins like Vitamin C are water soluble and you will excrete any excess, another reason why if you already get enough of this vitamin through your diet paying for a tablet, will not mean any more benefit. Vitamins A, D, E and K are fat soluble and there is a potential for stores to build up with large doses over time, so always check doses with your health professional as this can potentially be dangerous.
If I pay more will I get a better quality supplement?
In general, no. Again, keep in mind this is a big money making business! In the UK supplements have to pass quality and safety tests and so if it is on the shelf it meets the requirements, paying three times for the branding won’t get you a different product.
What about antioxidants?
Antioxidants are substances that prevent cell damage from free radicals, which are unstable molecules either created by the body or from the environment e.g. pollution or cigarette smoke.
Vitamin E and C are examples of antioxidants. Fruit and veg are excellent sources of antioxidants and vitamin E can be found in olive or rapeseed oil or nuts.
There is currently no evidence to support the use of antioxidant supplements in the general population and there can be some risks as mentioned with Vitamin E, so it is best to get antioxidants through the food that you eat.
Fizzy (effervescent) tablets
Effervescent vitamin supplements or effervescent painkillers can contain up to 1g of salt per tablet. Consider changing to a non-effervescent tablet or whether you need the supplement at all, particularly if you have been advised to reduce your salt intake or have high blood pressure. We are all advised to aim for less than 6g salt/day to support our cardiovascular health.
Should I take a probiotic?
Current evidence does not support that healthy individuals gain any benefit from taking probiotics. Rather than taking a general probiotic, there are specific strains that have seen to be helpful in certain circumstances such as for travellers diarrhoea or antibiotic-associated diarrhoea, IBS or IBD, but the impact on otherwise healthy individuals appears to be negligible.
Getting a variety of fibre filled foods such as fruit, veg, wholegrains, beans, pulses and legumes is the best known way to support the gut microbiome through nutrition.
What about IV Vitamins?
IV Vitamins have been touted by celebs to be a great way to boost our vitamin intake to help with skin, jet lag, immunity, mood and anything else they can think of. This is a dangerous, unregulated practice. If you ever need nutrition via an IV route, this would be because you are unwell and a qualified medical team would be prescribing and administering this under strict supervision in a healthcare setting, it’s not something to buy off the internet.
This is not something that is needed and some of the mega dose courses available are dangerous and leave you with mineral levels outside of normal ranges and risk you getting serious infection from the IV administration. As mentioned above, the water soluble vitamins that your body doesn’t need will just be excreted, so this if nothing else is a really expensive wee!
This is never a good idea and run from anyone that advises it!
Are there any supplements you would recommend we do take?
There are a few exceptions to the rule and there would be certain circumstances where supplementation would be recommended.
Vitamin D
Everyone in the UK is recommended to take Vitamin D at 10mcg/day from October to April. Vitamin D is important to bone health as it helps regulate calcium and phosphate but also may have other roles too such as in immune and brain health.
Known as the ‘sunshine vitamin’, our bodies can produce this when exposed to sunlight. It is very difficult to get enough Vitamin D from the foods that we eat and there are not enough available UVB rays in winter months to be able to produce enough via our skin and this is why we are recommended to take a supplement during these months. For more information on Vitamin D, see my recent blog post.
Calcium
Considering bone health is important to men and women of all ages, but as women age, especially as they head through menopause bone health can become more of a cause for concern as the protective effects of oestrogen are lost.
We can get calcium from more than just dairy foods but also green leafy veg, tofu, figs, fortified foods such as cereals, nuts, bread and tinned fish (with bones).
If you are using dairy alternatives then look for fortified versions and note that organic dairy alternatives are not allowed to fortify their products, so are not the best option if used regularly. Make sure to shake these ‘milks’ before use to ensure the additional vitamins and minerals have not sunk to the bottom.
If you are going to take a calcium supplement, one combined with vitamin D may be beneficial to support bone health as described above.
Supplements are generally not needed on top of a healthy balanced diet, but for individuals who are struggling to get enough calcium, they can be helpful to top up, although too much calcium can also impair health, so perhaps speak to your doctor before starting anything new.
Omega 3
This is a type of fatty acid that is really important to brain and heart health. Omega 3’s are what we call ‘essential’ fatty acids which means our bodies can’t synthesise this itself, it must be obtained through the foods that you eat.
In order to get enough Omega 3 in your diet you would need at least 1 portion (140g) oily fish a week. Oily fish includes herring, mackerel, sardines, sprats, pilchards, salmon or trout (this can be fresh, frozen or tinned). If you are eating this amount of oily fish a week then you do not necessarily need to supplement.
If you do not like fish or don’t eat fish for ethical reasons then it would be advised to supplement with an omega 3 tablet at a dose of 250-450mg/day (EPA/DHA combined) as plant based sources of omega 3’s need converting in the body and the conversion rate is low so often this means we would not get enough for our bodies needs. You can use fish oil supplements or algae based supplements for vegetarians and vegans.
There is emerging evidence for supplementing omegas 3’s for Alzheimer’s prevention, but the research is not strong enough to recommend this yet, but it is an interesting area to keep an eye on and if advice changes on this, I will keep you up to date!
The NHS does warn pregnant women or those trying to conceive not to take fish liver oil supplements due to the high levels of vitamin A. Omega 3 supplements can be contraindicated if on blood thinning medication, so again do check with your GP.
Vitamin B12
As we get older our ability to absorb Vitamin B12 can be reduced. Vitamin B12 is found in foods such as meat, fish, eggs and dairy foods. Vitamin B12 is involved in red blood cell production, keeping our nervous system healthy and releasing energy from food.
If we don’t get enough we can suffer limb weakness, numbness, tingling and in some cases memory and brain function issues.
Most of us are able to get enough of this vitamin through our diet, but if you notice any of the symptoms above, speak to your GP about testing for deficiency, this is especially important in older adults.
Also if you are Vegan or vegetarian i.e. you do not include meat, fish, dairy foods in your diet, then you will struggle to get enough Vitamin B12. The vegan society advises to take a vitamin B12 supplement of at least 10mcg per day.
Sometimes medications can reduce nutrient absorption and an example of this is the commonly used Metformin, which is known to reduce Vitamin B12 levels, so if you take this medication do request regular tests from your GP to avoid deficiency.
Folic Acid/Folate
Folic acid is important in the production of red blood cells and reduces the risk of neural tube defects in babies while they are developing in the womb.
We find folic acid in foods such as fruit and veggies- especially the green leafy ones, beans, peas, fortified cereals, wholegrains, nuts, dairy, eggs and meat. Due to the wide range of foods this can be found in again most will not need to supplement this nutrient if you are eating a varied and balanced diet.
If you are trying to conceive or are pregnant then you are advised to take a 400mg supplement until the twelfth week of pregnancy.
Iodine
Iodine is involved with the production of thyroid hormones, which helps to keep our cells and metabolism healthy. An iodine imbalance can lead to an over or under active thyroid.
Food sources include fish, seafood, seaweed, dairy foods. This again means that those who are not consuming these foods, namely vegetarians and vegans are at risk of deficiency. This can be especially true in pregnancy too. Some women in pregnancy will benefit from a supplement starting three months prior to conceiving. These should be taken with medical advice and supervision. Kelp or seaweed supplements can provide excess iodine, so these should be avoided.
Children under the age of 5
Children aged 6 months to 5 years should take vitamin supplements containing vitamins A, C and D every day.
Find out more about vitamins for children or ask your health visitor for advice.
You can get Healthy Start vitamins for free if you qualify for Healthy Start.
The supplement industry plays into the rhetoric that ‘Food is medicine’ but this statement is really a fallacy and shouldn’t be bought into as it can lead to at worst, dangerous or at best, uninformed choices. Vitamin and mineral supplements can not compete with the health benefits of whole foods and they are certainly not a silver bullet – supplements are meant to ‘supplement’, not replace.
Many of us take these supplements ‘just in case’, but studies have shown that those taking vitamins are not necessarily healthier, probably because they are already getting what they need from their diet. Of the 400,000 people in this review, those taking vitamin pills were not seen to reduce chronic diseases like heart disease or cancer and did not live longer either. However, if you are struggling with getting a healthy balanced diet for some reason in your life then supplementation may be a useful way to ensure you are getting the recommended daily amounts of the nutrients you are lacking.
Some supplements may be harmful for example Vitamin E has been shown to increase lung cancer risk in smokers and may increase risk of further heart attack in those with heart disease so do be aware that not all supplements are benign.
There are certain situations as outlined above where taking supplements is definitely advised for specific dietary restrictions or circumstances such as pregnancy, but overall getting your vitamins and minerals from a healthy balanced and varied diet is considered best.
DISCLAIMER: This information does not constitute individual advice and advice may differ for certain health conditions, especially those where nutrient absorption is affected such as chrons and coeliac disease. Please seek advice from your medical professional before starting any supplements to ensure they are safe and appropriate for you and will not interfere with any medications.
National Diet and Nutrition Survey Rolling programme Years 9 to 11 (2016/2017 to 2018/2019) (2020). PHE
Food Standards Agency consumer research (2018). [Accessed online 11/11/2022]
https://www.food.gov.uk/research/behaviour-and-perception/food-supplements-consumer-research
FDA (2022) Mixing Medications and Dietary Supplements Can Endanger Your Health [Accessed Online 11/11/2022]
Fortmann et al., (2013) Vitamin and vitamin supplements in the primary prevention of cardiovascular disease and cancer. An updated systematic evidence review for the U.S. preventative services task force.
