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Supplements: To take, or not to take: that is the question.

One of the most common questions that I get from patients is if they should be taking x, y, z supplement. This is a high level overview of supplements with a few highlighted with details.

I have found that most people take supplements as a way to improve health in some way. But just as with traditional pharmaceuticals, supplements are not always safe or free of side effects and when deciding to take a medication or supplement a good risk/benefit evaluation is needed.

Before we get into that, lets take a high-level look at the goal. When taking a supplement, most people say their goal is to improve their health. With a goal of optimal health, all intake into the body should be evaluated. Food and drink are by far the largest component of our intake. Optimizing our food and drink intake by maximizing the nutrients, vitamins, minerals in our diet and minimizing the inflammatory components will produce the best health. After that, supplements or pharmaceuticals can be helpful but this is 'fine tuning' as compared to our diet. For medical reasons, certain supplements or pharmaceuticals may be needed but true health starts (or ends) with our daily habits.


What is a risk/benefit analysis?


A risk/benefit analysis is a great tool. It is as simple as it sounds: Weigh the risks of an action versus the benefits of the action. Equally as important: weight the risks of INaction versus the benefits of INaction. Have I lost you? I hope not. Lets look at an example:

An example: A patient is deficient in iron. It was recommended that she take a supplement (in addition to the workup with her physician). Risks (drawbacks): Having to take a pill daily, risk of abdominal discomfort or constipation.

Benefits: Treating her iron deficiency so her body has enough iron to make blood cells thus preventing further stress on her cardiovascular system

Analysis: This patient already has a known deficiency so the benefits greatly outweigh the risks of taking the supplement. Without supplementation her medical condition can worsen quicker and she can end up in the hospital or needing a transfusion. With the supplement she has a better chance of stability while workup is ongoing.

But what if someone has normal levels? It changes the ratio of risk to benefit: Taking iron when it is not medically necessary is dangerous, can lead to iron overload, increasing dementia risk and possibly masking a severe medical condition and still have the risks of having to take a pill, abdominal discomfort or constipation. The benefits would be minimal. This is the necessity of evaluating supplements before we put them in our body. Below are two supplements that I recommend more commonly to patients but as will all substances please evaluate your individual need, risks and benefits.


Vitamin B12


Benefits of taking: Avoiding/protection against vitamin B12 neurologic symptoms. No known side effects from taking too much.

Risk of taking: Cost of the supplement.

Vitamin B12 is critical to neurologic processes in our body. Some symptoms of low vitamin B12 are brain fog, memory loss, weakness, other unusual neurologic complaints (numbness and tingling of feet among others). Note that sometimes people can still have vitamin B12 deficiency with a normal blood level - this is rare and requires an expensive blood test to confirm. Most people under 65 years old will get sufficient vitamin B12 intake with 1000 mcg once weekly (some prefer to take a smaller amount every day which is fine too) but over 65 years old or if taking an acid reducing medication or metformin (a common diabetes medication) the risk of B12 deficiency is significantly higher. Please get a vitamin B12 level checked. Most labs will note it is low if under 200 (this is deficiency which is very low!) but more often the level is between 200-400 which is “insufficiency” and people can have symptoms of B12 deficiency at this level. Sublingual or chewable is easiest to absorb (or oral spray) and the commonly found form, cyanocobalamin is perfectly good to take except in rare causes when other forms are necessary. In rare situations people are unable to absorb the medication thru their gut and require vitamin B12 injections. ** Please note - if you are on a whole foods, plant based diet you will need to take vitamin B12 1000 mcg once weekly or you can take 50 mcg daily.


Vitamin D


Benefits of taking: To treat low vitamin D especially if symptomatic.

Risk of taking: Possible to take too much, cost of the supplement.

Vitamin D deficiency is increasingly more common although we are still determining optimal levels and the "normal" range. Vitamin D deficiency shows up most commonly on routine blood tests and the symptoms can be: fatigue, bone and muscle pain, depression, bone loss or hair loss. Vitamin D levels of around 50 seem to have some protective benefits against skin cancer and dermatologists often recommend supplementation to patients. The best way to check is the 25-OH-vitamin D blood test with a reported normal range of 30-100 but the more accurate goal for optimal health is 40-50. For optimal vitamin D3 production getting outside for 15 minutes mid-day (11am-2pm) at least a few days a week is helpful but keep in mind that sunscreen inhibits the process. This is one vitamin that you want to check with a blood test before supplementing as it is possible to overdose.

People have many other questions regarding supplements and I am happy to help. Please feel free to message me or reply to this blog if you have general questions but often a conversation with your primary doctor, especially one who is educated on the different supplements, will be the most fruitful.


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