What Your Doctor Knows About Supplements … And You May Not

What Your Doctor Knows About Supplements ... And You May Not
What Your Doctor Knows About Supplements ... And You May Not

New guidance for doctors is out on vitamins and supplements. You might be surprised that a lot of the ones you might be taking are missing from the list.

Your physician may be the exception, but most medical schools barely teach their doctors-in-training about nutrition, much less vitamins and mineral supplements. Add to that the legitimate concerns that exist about the manufacturing quality of supplements and your doctor might look like a deer in the headlights when you ask if Vitamin C can help fight your cold.

Doctors have been given new guidelines on vitamins and minerals and you should know what they are. Vitamin and Mineral Supplements: What Clinicians Need to Know was developed by 2 doctors — JoAnn E. Manson, MD, PhD, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, and Shari Bassuk, SciD, Department of Epidemiology, Harvard T.H. Chan School of Public Health — and recently published in JAMA.

You know what vitamins are missing from the recommended list? Old standbys like Vitamin C, zinc and fish oil (Omega-3 fatty acids). Despite a lot of research, there’s no support for most vitamins and minerals. Instead, the list has a few very specific recommendations for people with particular conditions (like Crohn’s or age-related macular degeneration) or time of life (pregnancy, seniors) or to make up for what medicines take or block from you body (PPIs, metformin).

You know what else is missing? Any supplements for generally healthy people, including multivitamins. Where are we supposed to get our vitamins and minerals from? Eat complete (whole) foods in a varied diet.

I emailed Dr. Manson and she told me that for those who are generally healthy, routine supplementation is not necessary.

One last thought, if you are taking any supplements make sure that your doctor knows and that you choose a brand that is certified by independent testers like ConsumerLab.com, US Pharmacopeia, NSF International, or UL who all test if supplements contain the labeled dose(s) of the active ingredient(s) and don’t contain microbes, heavy metals or other toxins.

Key Points on Vitamin and Mineral Supplements 

(source: JAMA, March 6, 2018, p. 859-860)

General Guidance for Supplementation in a Healthy Population by Life Stage

  • Pregnancy: folic acid, prenatal vitamins

  • Infants and children: for breastfed infants, vitamin D until weaning and iron from age 4-6 mo

  • Midlife and older adults: some may benefit from supplemental vitamin B12, vitamin D, and/or calcium

Guidance for Supplementation in High-Risk Subgroups

  • Medical conditions that interfere with nutrient absorption or metabolism:

    • Bariatric surgery: fat-soluble vitamins, B vitamins, iron, calcium, zinc, copper, multivitamins/multiminerals

    • Pernicious anemia: vitamin B12 (1-2 mg/d orally or 0.1-1 mg/mo intramuscularly)

    • Crohn disease, other inflammatory bowel disease, celiac disease: iron, B vitamins, vitamin D, zinc, magnesium

  • Osteoporosis or other bone health issues: vitamin D, calcium, magnesiuma

  • Age-related macular degeneration: specific formulation of antioxidant vitamins, zinc, copper

  • Medications (long-term use):

    • Proton pump inhibitorsa: vitamin B12, calcium, magnesium

    • Metformina: vitamin B12

  • Restricted or suboptimal eating patterns: multivitamins/multiminerals, vitamin B12, calcium, vitamin D, magnesium

a Inconsistent evidence.

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