That Extra Something

Our diets aren’t perfect. Taking a supplement may make up for what they lack—but know the risks before you pop that first tablet, capsule or gummy.

Most of us try to eat right to give our bodies the nutrients they need. And if we don’t accomplish that task perfectly, we figure, that’s why supplements exist—hundreds of pill bottles in your local pharmacy that promise an extra dose of vitamins or other compounds to compensate for what we ought to eat, but don’t. Most supplements require no prescription, but you do need to bone up on the pros and cons before you take one.

Explains Nora Zabel Tossounian, M.D., a Lodibased internist with Hackensack Meridian Health: “Most vitamins come from the food we consume, and some people don’t get enough because of their diets. For instance, a vegetarian may not be getting vitamins most people get from eating meat.”

Some supplements provide a vitamin or a multivitamin combination. Others include, for example, post-workout protein powders and herbal preparations such as turmeric.

“Traditionally,” says Jari Becker, a registered pharmacist and director of women’s health at Town & Country Compounding Pharmacy in Ramsey, “you take vitamins and supplements because you need to put something into your body that it isn’t getting, maybe because of the foods you’re eating or the exercise you’re doing, because your body uses it more quickly than other people or because your body processes it differently.”

But supplements should be considered medicines. “Many people don’t realize that vitamins and supplements have drug interactions with prescription medications, over-the-counter medications and each other,” says Becker. “They can interact badly, or just cancel out benefits. With antidepressants, blood thinners and blood-pressure medication, you need to be particularly careful.”

Adds Dr. Tossounian: “Mention any supplements you take every time you seek health care, whether in the emergency room, the office of a primary care physician or a specialist, or in an urgent-care facility. They count. We need to know about them.”

What else should you understand? BERGEN asked our experts about common supplements:

• Calcium. As you may remember from those famous “Got Milk?” ads, this is the building block for strong and healthy bones. Dairy products are the most common source, and Dr. Tossounian suggests starting there. “I don’t encourage calcium supplements unless blood work specifically indicates low calcium in the blood,” she says. “This is something better absorbed in the diet, because supplements can cause calcium buildup in the body.” This buildup can lead to kidney stones or stiffening arteries. “If you want to boost your calcium intake, opt for cheese, milk or yogurt,” says the doctor. “If you need a non-dairy version of those, make sure it’s fortified.”

“Taking calcium can also affect the absorption of certain antibiotics and thyroid medications,” says Becker. “And use caution if you’re taking a medication for osteoporosis, because you can overload your system.”

• Collagen. Always buzzy in the beauty space, collagen is what keeps your skin bouncy and supple. Your body produces it naturally, but as you age it produces less and breaks it down faster. Taking oral collagen can help. “It improves skin elasticity and can help reduce wrinkles, though you need to take it consistently for two to six months before you see improvement,” says Dr. Tossounian. “I also like it for reducing joint pain and boosting bone health.”

Becker cautions: “Not every collagen product is just collagen. Sometimes there are added products, and you need to know what you’re taking.” Another thing to keep in mind? “These supplements are derived from beef and chicken,” says Dr. Tossounian. “If a patient is allergic or does not wish to use animal products, it’s not for them.”

• Coenzyme Q10. Also known as CoQ10, this is an antioxidant your body also makes. It helps give you energy and protect your cells. However, some things deplete it faster than your body can replace it—things like cholesterol-lowering statin medications, says Becker. “In my experience, they are among the most commonly prescribed medications,” she says. “And people don’t realize that, when taking one, they need to put CoQ10 back in their body or they’re depriving their cells of something they need.”

“Statin drugs can cause muscle pain,” says Dr. Tossounian. “When CoQ10 is taken with them, it reduces that pain enough that patients can continue taking the medicine. We also use it preventatively for migraines, and I sometimes suggest it to patients who are trying to fight off an infection or an illness such as COVID-19.”

• Omega-3s. These fatty acids, often taken as fish-oil tablets, are superstars for brain and heart health. “Some studies show that they can reduce your chances of death from cardiovascular disease and some geriatricians like them because they’re neuroprotective,” says Dr. Tossounian. Becker adds: “They’re important for your brain health and eye health; they can help with inflammation and with hormone balance in premenopausal or menopausal women.” One thing to watch out for? “This one has mild blood-thinning effects,” Dr. Tossounian says. “I’ve seen patients on blood thinners such as baby aspirin [compounding these effects] start taking this and also start bruising easily.”

“Remember, anti-inflammatories such as ibuprofen are also blood thinners,” says Becker. “And some people don’t like taking Omega-3s because they cause indigestion and can give you the burps. Medical-grade brands often won’t give that reaction.” Dr. Tossounian advises starting at a low dose and gradually building up.

• Iron. Found in red meat; dark, leafy greens and beans, iron plays an important role in making red blood cells. You probably shouldn’t reach for this one unless it’s recommended by a doctor. “Women and girls who are still cycling and are losing excess blood sometimes need it,” says Becker, as do people with anemia, a condition most often caused by an iron deficiency. Some women in the later stages of pregnancy also develop iron deficiency and require it. Fortunately, red-blood-cell count is part of most standard blood work and is tested for often.

Dr. Tossounian says: “If you are a postmenopausal woman or a man, you must speak to your doctor before starting iron supplements. I actually suggest a colon-cancer screening and a colonoscopy or an upper endoscopy with a gastroenterologist before taking iron.”

• Magnesium. Leafy green vegetables, whole grains and seafood are great sources of magnesium, which offers many benefits. “It’s good for your cardiovascular system, nerves, muscles and bones,” says Becker. And Dr. Tossounian says, “Magnesium is very helpful for easing leg cramps. Many cardiologists like to use it at a low dose for patients with heart palpitations, and neurologists use it as part of a holistic approach to migraine prevention.”

Adds Becker: “There are multiple types of magnesium. When you look at a magnesium bottle, it always has a salt after it. There’s magnesium citrate, magnesium oxide, magnesium glycinate— they all target different things.” Magnesium citrate can be used to treat constipation, for instance, while magnesium oxide helps prevent migraines. “It’s important to double-check which magnesium you’re taking to make sure you’re getting the proper benefit,” she adds. And one population should avoid it entirely. “No one with kidney disease should take magnesium,” says Dr. Tossounian. “Kidney dysfunction because of the accumulation of magnesium can easily occur in those patients and cause problems.”

• Probiotics. Rather than a mineral or a vitamin, this supplement consists of live bacteria and yeasts that help maintain the “microbiome” of your body. “I love probiotics!” says Becker. “They balance out the microflora in your gut, which keeps you healthy. They’re important for your immune health, digestive health and vaginal health in women. As with magnesium, there are different types of probiotics that target different things.”

“They’re useful to take after using an antibiotic,” says Dr. Tossounian. “If someone is treating pneumonia, a sinus infection or a urinary-tract infection, a probiotic can keep the gut bacterial balance intact, because sometimes the antibiotic can also kill the good bacteria your body needs.” That’s why people sometimes experience nausea and vomiting as a side effect of antibiotic use. “There’s discussion in the medical community about whether you should wait between taking a probiotic and an antibiotic so that they don’t interact with each other,” she adds. “I’ve never found it to matter much but, if you’re worried, wait two hours between taking them.”

• Fiber supplements. Fiber is a mainstay in treating constipation, which is important for more than just comfort. “We eliminate toxins through bowel movements, so if you’re not having them regularly, you definitely want to be taking a fiber supplement,” says Becker. It’s very possible to get all the fiber you need via your diet but, as more and more of our food becomes ultra-processed, meeting those needs without a supplement can become difficult.

Fiber is also good for more than just digestion. “Some patients with mild cholesterol elevations use it to bring that number down,” says Dr. Tossounian. “And certain blood thinners may not be absorbed properly, so it’s smart to wait between taking fiber and taking any traditional medications. Again, about two hours.”

• Vitamin B12. This vitamin helps convert your food into glucose, which is what gives you energy, Becker explains. “It combats fatigue.” That fatigue can be a symptom of a deficiency, Dr. Tossounian adds, particularly when combined with “anemia and memory impairment, especially in an older population. Doctors don’t screen for the deficiency very often because there are so many sources of it our diets.” They include fish, meat, poultry, eggs and dairy products—which does put persons avoiding animal products at risk of not getting enough. “The deficiency is also common in people who use proton-pump inhibitors for acid reflux,” the doctor says.

She also adds a tip: “Here’s the one vitamin you don’t want to take as a gummy or a pill. Look for a form you can put under your tongue, like a spray or a pill that dissolves. B12 can actually be rendered ineffective by stomach acid if swallowed.”

• Vitamin D. Sometimes called “the sunshine vitamin,” D comes to us mostly through sun exposure— which means it’s a supplement Bergenites may wish to consider. “Here in the Northeast, we don’t always get enough sunlight to provide that vitamin D we need,” says Becker, “but it’s also important that you don’t take it in excess. Happily, most doctors test for vitamin D levels regularly.”

“There’s good evidence that vitamin D helps with bone support, reduces the risk of osteoporosis and osteopenia and has great antioxidant effects,” says Dr. Tossounian. “A recent British study indicated that daily intake of vitamin D in winter can lower your risk of the flu. However, you need to be very careful with the dose—too much vitamin D over months and years can cause kidney stones.”

Our experts agree that it matters where you buy supplements. “You need to buy vitamins and supplements from trusted sources,” says Becker. “If not from a pharmacy, then from a direct-toconsumer, medical-grade brand. Do not order vitamins and supplements on Amazon—you have no way to know what you’re actually getting.”

“This is part of your health care,” says Dr. Tossounian. “Talk to your doctors and your care team and be open about what you’re taking—or even just trying. It can be vital to your health.”