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.

The problem is that many people don’t eat a balanced diet,” says Swapnil Patel, M.D., a board-certified internist and vice chairman of the Department of Medicine at Jersey Shore University Medical Center in Neptune. “Diets are often low in fruits, vegetables, whole grains and fiber, which can lead to deficiencies. In addition, some people have higher needs for certain vitamins, such as those pregnant, aging or with a chronic illness. Also, certain conditions and medications reduce absorption of things a body needs.” The doctor says: “Any kind of vitamin or supplement is best viewed as a gap filler, not a substitute for a healthy diet.”

A supplement is a broad term that includes things not necessarily essential for your health but that may give you benefit in the short or long term. It can refer, for example, to a multivitamin, a postworkout protein powder or something herbal like turmeric. Says Ibram Atalla, a licensed pharmacist at the Oceanport Pharmacy in Oceanport: “I always remind everyone that many things sold or promoted as supplements are not FDA [Food and Drug Administration] approved. You can’t trust everything you hear a podcaster or see a YouTube video promoting. Read the label, look at active ingredients and, if you’re in doubt, ask a pharmacist or physician.”

A supplement is a broad term that includes things not necessarily essential for your health but that may give you benefit in the short or long term. It can refer, for example, to a multivitamin, a postworkout protein powder or something herbal like turmeric. Says Ibram Atalla, a licensed pharmacist at the Oceanport Pharmacy in Oceanport: “I always remind everyone that many things sold or promoted as supplements are not FDA [Food and Drug Administration] approved. You can’t trust everything you hear a podcaster or see a YouTube video promoting. Read the label, look at active ingredients and, if you’re in doubt, ask a pharmacist or physician.”

“Always ask if you’re unsure about taking things together,” adds Atalla. “There are many interactions you may not know about, and letting an expert know exactly what’s in your body is always best practice.”

What else do you need to know? MONMOUTH asked our experts about common supplements:

• Calcium. As you may remember from those famous “Got Milk?” ads, this is the building block for strong, healthy bones. “It also plays a critical role in muscle contraction and nerve signaling,” says Dr. Patel. In your diet, calcium mostly comes from dairy products such as milk and cheese. However, “postmenopausal women, older adults with low dietary intake and individuals with osteoporosis or increased fracture risk may benefit from calcium supplements,” the doctor says. “In general, calcium intake should increase after age 50 in women and after age 70 in men, but blood tests are recommended before starting supplementation.”

Atalla agrees. “A lot of seniors take calcium supplements,” he says. “We recommend a low dose of about 600 milligrams to start, and people can work up from there. Often, it’s combined with vitamin D to help with absorption. However, if you’re on an antibiotic, wait two to four hours before taking calcium. When taken together, they tax the body and neither works as it should.” Adds Dr. Patel: “If you have a history of kidney stones, avoid taking supplementary calcium.”

• Collagen. Always buzzy in the beauty space, collagen keeps your skin bouncy and supple. “It’s a structural protein that supports the health of skin, joints, tendons and connective tissue,” explains Dr. Patel. Your body produces collagen naturally, but it makes less and breaks it down faster as you age. “Some adults may notice modest benefits for joint discomfort or skin elasticity when taking collagen,” adds the doctor. Generally, you need to be taking it consistently for a few months before you start seeing improvement. “Collagen is not considered an essential supplement,” says the doctor.

Atalla says, “It can help with skin, hair and nail health. It can help reduce wrinkles. But it’s produced in your body and found in meat products—it’s worth considering that you may already be getting enough, and adding more will provide little benefit, though it also won’t hurt you. If someone is interested in trying it, there’s usually no harm.” Something else to keep in mind: These supplements are usually derived from beef and chicken, so vegans, vegetarians and patients who are allergic to those meats should skip them.

• Coenzyme Q10. Also known as CoQ10, this is an antioxidant your body makes. It helps give you energy and protect your cells. “It’s also good for the heart,” says Atalla, “and it’s really recommended for anyone on a statin.” Statins are drugs that help control cholesterol. They are commonly prescribed, but can also cause muscle pain. “Taking CoQ10 may benefit patients who experience those muscle symptoms,” says Dr. Patel, “though, in general, healthy adults without symptoms generally do not benefit from CoQ10 supplementation.”

“Make sure you mention any heart medication you take when you start out with CoQ10,” says Atalla. “Particularly beta blockers. Both will be more effective if they are taken at separate times, usually by two to four hours.

• Omega-3s. These fatty acids, often taken as fishoil tablets, are superstars for brain and heart health. (Atalla also likes them for an immune-system boost.) “Omega-3s have anti-inflammatory properties and can help lower elevated triglyceride levels,” says Dr. Patel. High levels of triglycerides in the blood can increase the risk of heart disease and other illnesses. The doctor adds: “People with high triglycerides or those who rarely consume fatty fish [such as salmon, sardines or tuna] may benefit from taking this supplement.” One thing to be aware of, he says: “Omega-3s can increase bleeding risk. Those with bleeding disorders should be cautious.” That also means you should avoid mixing it with blood thinners, such as aspirin.

“People don’t always like taking this one because it can smell bad and cause some stomach upset,” says Atalla. “Taking it with a lot of water or with a full meal can help.”

• Iron. Found in red meat; dark, leafy greens and beans, iron plays an important role in making red blood cells. This is a supplement you shouldn’t reach for unless it’s recommended by a doctor. “While many people need more iron,” says Atalla, “at too high a dose iron is very toxic.” Dr. Patel agrees: “Iron should only be started when a deficiency is confirmed, because excess iron can cause serious health complications.” People most likely in need of that supplementation are, he says, “menstruating women, pregnant individuals and those with documented iron deficiency.” Iron deficiency, and the related condition called anemia, is screened for in most standard bloodwork.

If you do need to take a supplement, Atalla says, “take it on an empty stomach and by itself—it can cause some upset if taken with food and can affect the way other medications are absorbed, particularly proton-pump inhibitors and antibiotics. Likely you’ll start off with a low dose and work up as needed.”

• Magnesium. Leafy green vegetables, whole grains and seafood are great sources of magnesium, which can offer you a lot of benefit. “Magnesium supports muscle and nerve function, helps regulate heart rhythm and contributes to bone health,” says Dr. Patel. It can also help ease muscle cramps in the legs. The doctor says, “People with low dietary intake, certain gastrointestinal conditions or symptoms such as migraines or constipation may benefit from supplementation.”

Atalla adds that “many people take magnesium to help them fall asleep. But there are different types of magnesium, so make sure you’re picking the one that targets the issue you want to address.” Magnesium citrate can be used to treat constipation, for instance, while magnesium oxide is used to prevent migraines. Dr. Patel adds a warning. “Be aware,” he says, “that higher doses can cause diarrhea and gastrointestinal discomfort.”

• Probiotics. This supplement consists of live bacteria and yeasts that help maintain the “microbiome” of your body. “Probiotics influence the gut microbiome and can affect digestive health,” says Dr. Patel. Atalla recommends them for people who were just on an antibiotic. “The most common side effects of antibiotics are stomach upset, nausea and vomiting,” he says. “Taking a probiotic ensures that you still have that good bacteria in your stomach and can prevent those side effects. But don’t take it before you take the antibiotic, because then they can sort of cancel each other out. Take it at least two hours after.”

Dr. Patel agrees that “they may be helpful for antibiotic-associated diarrhea,” in addition to helping with “certain cases of irritable bowel syndrome (IBS), depending on the specific strain used.” Probiotics are typically chosen based on symptoms, and their effects are strain-specific—not all probiotics provide the same benefits. Keep an eye on that as you choose one.

• Fiber. This is a mainstay in treating constipation, which is important for more than just comfort. “Fiber is one of the most consistently useful and evidence-supported supplements,” says Dr. Patel. “Many adults may benefit from fiber supplementation because dietary fiber intake is commonly below recommended levels, particularly in those with constipation, IBS or metabolic disease. Fiber can also help improve digestion, lower cholesterol levels and support blood-sugar control.”

“It’s a great way to regulate your gastrointestinal system if you don’t eat enough fiber-rich foods,” agrees Atalla. “However, it can affect the way many other medications are absorbed, particularly blood thinners and seizure medications. Again, make sure you space out taking them by at least two hours.”

• Vitamin B12. Dr. Patel calls this vitamin “essential for red-blood cell production, neurologic function and DNA synthesis.” Dietary sources of it include fish, meat, poultry, eggs and dairy products, which means that some people are at a higher risk of not getting enough—including, says the doctor, “vegans and vegetarians.” He also says that “older adults and individuals with malabsorption or prior gastric surgery may benefit from supplementation. Deficiency of vitamin B12 can lead to anemia and neurologic complications if untreated.”

Warns Atalla: “Always talk to your provider first with this one, because it really affects your blood flow and blood sugar. It can also interact with blood thinners, blood-pressure medication and many heart medications.”

• Vitamin D. Also called “the sunshine vitamin,” D comes from sun exposure—which means it’s a vitamin many in the Northeast need to consider. “If you work indoors and don’t get enough sun, it’s likely going to be recommended to you,” says Atalla. Dr. Patel agrees. “Vitamin D deficiency is common, and blood testing can help guide appropriate use and dosing,” he explains. “Individuals with limited sun exposure, older adults and those at risk for bone loss may benefit from taking it. It’s necessary for calcium absorption and plays an important role in bone and muscle health.”

“If you lack vitamin D, you feel sluggish and tired. Your whole body feels like it isn’t working correctly,” says Atalla. “If you have a deficiency, adding this supplement really does make a difference in how you feel.”

Each expert offers a parting cautionary note. “Your physician can help determine whether supplementation is necessary, safe and appropriately dosed,” says Dr. Patel. “This should always be a conversation with them.”

“Be careful where you’re buying supplements,” adds Atalla. “If you’re buying online, make sure that it’s from an accredited company and you know what you’re getting.”