Vitamins, Minerals, and Dietary Supplements for Optimum Health
I highly recommend 1000 - 2000 IU/day of supplemental vitamin D from October – May in northern climates (multivitamins typically contain 400 - 2000 IU of vitamin D). Vitamin D should be taken with food.
I suggest taking a multivitamin with mineral daily as a form of health insurance, in addition to eating a healthy diet. I am aware though that published studies of daily multivitamin with mineral consumption in healthy individuals generally fail to document beneficial health effects. Multivitamins should be taken with food. Read the label when choosing a multivitamin, and consider choosing one with a maximum of 3000 IU of preformed vitamin A, and no iron (unless you are a menstruating woman). Many multivitamins have small amounts of a variety of botanicals or herbs – I recommend choosing a multivitamin without these additional ingredients. With regard to quality, Consumer Reports has reported that as long as multivitamins are not purchased at “deep discount” stores, quality of virtually all brands tested was good. The multivitamin I personally take is VitaPrime®, marketed by Klaire Labs/ProThera. Locally, this multivitamin can be purchased at Pine Pharmacy. I suggest only one tablet per day of VitaPrime, half of the daily dose which is suggested on the label. For information on how to choose a high quality multivitamin, I consider this website a good resource.
Effective October 2017, based on the content in a presentation on clinical environmental medicine by Joseph Pizzorno, ND, I recommend supplemental NAC (N-acetyl cysteine) 500 - 600 mg daily, as this dietary supplement increases glutathione levels in the body, and glutathione facilitates detoxification in our bodies of a wide variety of environmental toxins, and supports immune system function. NAC is ideally taken on an empty stomach, but it is acceptable to take with food.
I suggest supplemental magnesium 100 - 200 mg/day, either with food or on an empty stomach. Most multivitamins contain relatively small quantities of this mineral (it is bulky, and thus a small quantity takes up a lot of physical space in a multivitamin) and a USDA survey has concluded that 62% of Americans don’t obtain the RDA of 400 mg daily of magnesium!
In addition, I suggest intake of 200 micrograms (mcg) daily of selenium. Selenium content of multivitamins is variable, with some containing as much as 200 mcg. Brazil nuts are an excellent food source of selenium - each Brazil nut contains approximately 100 mcg of selenium. Data published in 2007 indicates that selenium intake of 200 mcg daily may increase the risk of developing diabetes. Nonetheless, I believe that for most individuals, the benefits of selenium 200 mcg per day outweigh the risks.
For many years I recommended supplemental fish oil as part of a daily supplement regimen for a healthy person. However, based on multiple high-quality clinical trials published between 2010 - 2019 which failed to show benefit from fish oil supplements, effective in January 2019, I stopped recommending fish oil supplements for general health. Note fish oil supplementation is very safe and I am not opposed to individuals taking fish oil - I just no longer recommend this supplement for a healthy person. If taken, fish oil should be consumed with food. I do highly recommend consumption of fatty fish at least twice a week. Fish which are rich in omega 3 fatty acids include salmon, sardines, anchovies, mackerel, trout, and tuna. Beware though of eating king mackerel (canned mackerel is fine) and tuna (including canned tuna) frequently, as these fish do contain mercury.
NEW INFORMATION 1/4/24: For women who are menstruating, I generally recommend iron supplementation (and the specific multivitamin which I recommend for general health does not contain any iron). It is reasonable to take 18 mg (this is 100% of the RDA) of iron daily; for my patients I often often order a ferritin blood test to measure iron stores in the body, and determine the dosage based on the blood test value.
For women, I recommend calcium 300 - 500 mg daily in supplement form (it is fine to take a combined calcium/magnesium supplement or a combined calcium/vitamin D supplement). I don’t recommend supplemental calcium for most men, based on data that calcium intake in men in excess of 1200 mg/day is correlated with an increased risk of prostate cancer. I concur with Walter Willett, MD, DrPH that for those eating a healthy diet, the RDA for calcium is currently set too high and that with optimum nutrition and sufficient intake of vitamin D, total intake (dietary + supplement) of 800 - 1000 mg of calcium per day in men and women is adequate. Dr. Willett in Chapter 9 of his superb book, Eat, Drink and Be Healthy, fully explains the rationale for a lower RDA for calcium. Green leafy vegetables are an excellent food source of calcium. Calcium carbonate is much better absorbed if taken with food (and is not absorbed if one takes a proton pump inhibitor medication); calcium citrate can be taken with food or on an empty stomach, and is absorbed in those taking proton pump inhibitor medication.
For individuals over age 50, the amount of vitamin B12 in a multivitamin may not be sufficient. Most individuals produce less stomach acid as they get older, and thus absorb less of the protein-bound vitamin B12 in food (B12 is found only in animal foods, so vegans obtain no vitamin B12 from their diet). If one’s multivitamin does not contain 100 mcg of vitamin B12 per serving, consider additional vitamin B12 100 - 1000 mcg daily. Vitamin B12 can be taken with food or on an empty stomach.
Coenzyme Q10 (CoQ10), which is consumed in our diets and can be synthesized in the body, is an essential cofactor for energy production in our bodies at a cellular level. It is also a potent antioxidant. The amount of Co Q10 which we synthesize steadily decreases with age. Thus, if affordable, all individuals over age 50 should consider taking a supplemental dose of 50 - 100 mg daily of Co Q10. UPDATED INFORMATION 7/2/23: Based on a recent scientific publication, I now suggest taking Co Q10 as Crystal-free (CF) Co Q10 in lipid based softgels, based on superior bioavailability of the Crystal-free formulations. Brand name Crystal-free products include the following: (1) Co Q10 100 mg ubiquinone [Thorne - formerly named Q-Best], (2) Co-Q-sol-CF 100 mg ubiquinone [Biospec Nutritionals], and (3) HiSorb 100 mg [Life Extension Super Ubiquinol]. Co Q10 should be taken with food.
If finances permit, I suggest that everybody also take a ‘green supplement’ daily, with food or on an empty stomach. With regard to the oxidative stress to which we are all subject as a byproduct of energy production in each of our cells and from exposure to the sun (as well as exposure to environmental pollutants), I have come to realize that the antioxidant vitamins (beta-carotene, vitamin C, and vitamin E) and the anti-oxidant minerals (copper, manganese, selenium, and zinc) are ‘the tip of the iceberg’ with regard to antioxidants which we obtain from our food and/or dietary supplements. The ‘iceberg’ is the hundreds and thousands of antioxidants found in the dozens of different fruits and vegetables. Thus, along with eating a variety of fruits and vegetables every day, I suggest a ‘green supplement’ daily. The green supplement which I take is Fruit4Life and Veggies4Life, marketed by Swanson®. This whole food product is produced via high quality manufacturing practices, including a low heat process which does not destroy the phytonutrients present in the fruits and vegetables. Another high quality 'green supplement' is Juice Plus +®, available through network marketing or on their website. Juice Plus + is also a whole food product produced via high quality manufacturing practices, including a low heat process. Furthermore, there is a substantial body of published research in peer-reviewed journals showing a variety of health benefits associated with Juice Plus +.
NEW INFORMATION 10/16/24: For individuals over age 40, I suggest 5 mg daily of lithium orotate, to slow down the cognitive decline that occurs in all adults with aging, and possibly to reduce the risk of Alzheimer disease. Based on a presentation at a national meeting by James Greenblatt, MD, I am reading his book Nutritional Lithium: A Cinderella Story, and the information in the book has persuaded me to add lithium orotate to my daily supplement regimen. Dr. Greenblatt in his book recommends that lithium as a low dose supplement is initiated only after thyroid function is checked via a blood test, and he suggests that those taking low dose lithium also supplement with zinc (citrate or picolinate) 30 mg daily and with vitamin E and essential fatty acids. My opinion is that in conjunction with a healthy diet, the quantities of zinc and vitamin E in a multivitamin is sufficient, and that a healthy diet provides sufficient quantities of essential fatty acids. Dr. Greenblatt states on page 32 of the book, “Despite the low risks associated with nutritional doses of lithium, anyone interested in lithium supplements should be monitored by a health professional.” At the time this book was written in 2016, low dose lithium (as lithium orotate or lithium aspartate in capsules; lithium citrate or lithium chloride as liquid) was available in the U.S. as a dietary supplement, but not available without a prescription in many other countries in the world.
My thoughts on supplemental vitamin C and vitamin E have shifted. I no longer recommend supplemental vitamin C for a healthy adult, although I do recommend high dose vitamin C (500 - 1000 mg every 3-4 hours) short-term at the onset of upper respiratory symptoms, with food or on an empty stomach. Vitamin E exists in nature (in the oil of plants, to prevent oxidation of the oil in the plant) as a complex of 8 compounds – alpha, beta, gamma, and delta tocopherols and alpha, beta, gamma, and delta tocotrienols. Most vitamin E on the market is in the biochemical form of alpha tocopherol (only one of the one of the 8 forms that exist in balance in nature). ‘Natural’ vitamin E, which in the test tube has greater anti-oxidant effects than synthetic vitamin E, is d-alpha tocopherol, whereas synthetic vitamin E is d, l-alpha tocopherol - natural vitamin E also contains only one of the one of the 8 forms that exist in balance in nature. I do suggest vitamin E supplementation at a dose of 400 IU once or twice a week of a product in which all 8 compounds are present. E Gems Elite®, marketed by Carlson Labs®, is a vitamin E product containing all four tocopherols and four tocotrienols in each capsule; the quantities of each of the 8 forms of Vitamin E in the Carlson product are similar to the quantities in the Solanova product. I now take the Carlson product, 400 IU strength, which is available at Pine Pharmacy. While 400 IU every day of a ‘mixed’ vitamin E product is probably safe, I believe daily supplemental vitamin E intake of 100 - 150 IU per day is sufficient, which means taking the 400 IU capsule twice a week. Since the VitaPrime multivitamin which I take daily has approximately 60 IU of mixed tocopherols per pill, I take extra vitamin E 400 IU just once a week. Vitamin E should be taken with food.
While I don’t recommend collagen as a supplement for healthy adults, I do not have concerns with healthy adults taking a high quality brand (I do not have a brand preference). In 2023-2024, I find that many of my patients are taking this supplement, and reporting subjective benefit. In the September 2024 issue of Consumer Reports (pages 24-33), collagen is listed as one of the “7 supplements to consider for anti-aging.” As per this article, “Collagen is a protein that helps form connective tissue, including skin, bones, cartilage, muscles, ligaments, and tendons.” Supplementation may improve skin and/or joint health - Types I and III collagen are for skin health; Type II collagen is for joint health.
Difficulty swallowing pills and capsules? If you experience difficulty swallowing pills and capsules, you are not alone - as per a Consumer Report on Health article on this topic (February 2020 newsletter), as many as 10-40% of adults experience difficulty (this statistic references an article in the journal Patient Preference and Adherence). Difficulty swallowing pills is more common as people get older, in part because dry mouth is more common as people get older. This Consumer Report on Health article offers six suggestions, and below I will add my commentary, and one additional suggestion.
Cut or crush pills - most dietary supplements are not designed to be cut. To crush a pill, wet it with a few drops of water, let it soften for 5 minutes, crush it between two spoons, and mix it with applesauce (beware of the sugar load in applesauce) or yogurt (preferably plain yogurt to avoid a sugar load).
Address dry mouth - review with a health care professional whether you are taking medications which might be contributing to dry mouth, and if so whether these medications are absolutely needed. Consider chewing sugarless (xylitol) gum and/or using OTC artificial saliva sprays. Be aware that caffeine may exacerbate dry mouth.
Certain techniques facilitate swallowing of pills - both methods are significantly more effective than simply trying to swallow with a sip of water, according to a study published in the 2014 Annals of Family Medicine. In addition to the below techniques, there are pill-swallowing cups and straws on the market that mimic these techniques.
Place the tablet on your tongue, close your lips around a bottle of water, and use a sucking method to swallow some water and the pill.
Place a capsule on your tongue, take a sip of water, tilt your chin toward your chest, then swallow.
Try using warm water with pills instead of cold water, or use a thickened liquid such as a smoothie (beware of sugar content). Thick-it is an over-the-counter thickener. Applesauce contains a pectin which makes it slippery (beware of sugar content).
Consider whether the supplement exists as a high quality powder (to be mixed with water), liquid, or in a form that can be applied to the skin. There are brands of liquid and powder multivitamins, and some brands of magnesium can be applied to the skin.
Evaluate with your health care practitioner whether you can simplify your supplement regimen.
For some dietary supplements in powder form in a capsule, you may be able to empty the content of the capsule by pulling the two halves apart, or (for vitamin E or Coenzyme Q10 poking a sterile pin into the capsule and squirting out the content). Beware though that with some supplements, if you empty the contents of a capsule, the taste may be unbearably bitter. In addition, certain supplements are patented formulas and/or slow release, such that modifying the contents may interfere with the efficacy. A pharmacist at a compounding pharmacy is likely to be knowledgeable in this regard.
Disclaimer: the preceding is intended as educational material and not as individual treatment recommendations. The dosing information provided is for healthy adults - for a variety of symptoms and chronic conditions, in the context of an office visit I may recommend fish oil and/or higher doses of the above-listed supplements.
Page Updated October 16, 2024