What Supplements Should I Take?

What supplements should i take?

What supplements should you take? If you are eating healthy nutritious meals, why would you need vitamins? Aren’t we absorbing all our vitamins through our food? Unfortunately, this may not be the case.

Do we get enough nutrients in our food?

The World Health Organization (WHO) published data of over 12 years of research showing that approximately half of the 1.62 billion cases of anemia worldwide are due to iron deficiency [1] .

Vitamin D deficiency occurs all over the world, mainly in the Middle East, China, Mongolia, and India. Adequate vitamin D status, defined as serum 25-hydroxyvitamin D greater than 50 nmol/L, is present in less than 50% of the world population, which means that 50% are considered low in vitamin D [2].

Dietary deficiency of vitamin B12 due to vegetarianism is increasing around the globe and causes hyperhomocysteinemia. The breast-fed infant of a vitamin B12-deficient mother is at risk for severe developmental abnormalities, growth failure, and anemia. Dietary vitamin B12 deficiency is a severe problem in the Indian subcontinent, Mexico, Central and South America, and selected areas in Africa [3].

Surely the above information is sad but how does this affect me as an American or a person who lives in what is considered the first world. The countries and examples stated above are endemic for malnutrition and poor access to healthy diets. On the contrary in the western world we are constantly dieting due to excess food and nutrition!

Do You Need Supplements?

One thing the pandemic has taught us all is that we are not so different from the rest of humanity. This unfortunately is also true for our nutritional status in the United States. Let’s take a simple look at the three common nutrients stated above and which should be abundant in the normal western diet: Iron, Vitamin D3 and B12.

Many women try to supplement their diet with lean red meat, dark leafy greens, nuts, seeds, and shellfish; however, many women remain severely deficient in this important supplement and Iron deficiency anemia remains a major reason for doctor visits in the United States [4].

Also in the United States especially among young children, women of reproductive age, and pregnant women  iron deficiency is associated with other nutrient deficiencies. The scary news for those who are counting calories is that in a typical western diet of 1000 calories only 1mg of iron is absorbed [6]. Hence to obtain 22mg of daily iron requirement a healthy female must intake 22000 calories a day, not so healthy after all. Are you still sure you don’t need supplementation?

National Institute of Health (NIH) states that Vitamin D3 is considered “a fat-soluble prohormone” which is involved in many aspects of our wellbeing and regulatory functions just like a hormone. Everyone is aware that calcium absorption and bone health are major part of vitamin D3 benefits. However, most people may not know that Vitamin D3 is also involved in control of inflammation, sugar control, proper cell death, proper cell growth, and many other cellular and system regulation. ‘Unfortunately, about 42% of the US population is vitamin D deficient with some populations having even higher levels of deficiency, including premenopausal women, those with poor nutrition habits, people over age 65, Caucasians who avoid even minimal sun exposure, and those who take prescription medication long term for heartburn, acid reflux, and constipation [5]. Studies show people with darker skin, such as African Americans and Latinos, are also at risk for lower vitamin D levels because high amounts of melanin in skin reduce the body’s ability to produce vitamin D from sunlight. In addition, certain chronic conditions—such as celiac disease, bariatric surgery, obesity, and chronic kidney or liver disease—can contribute to deficiency.’ Most people in the western hemisphere do not obtain their vitamin D3 from sun exposure or food sources and need to be supplemented to obtain optimal levels. 

Vitamin B12 deficiency in the United States has been approximated at 6 to 40% depending on the age of the population being studied [7,8]. This may have to do with a protein called Intrinsic Factor (IF) and its lowered production by the body in later life. However, the reality remains that such an essential vitamin is not absorbed directly from our western diet as we would expect. It seems that we now agree that we need supplements to remain healthy, active, and young. 

Should I Take A Multivitamin?

Here comes the industry lie, as you all know we expect to take a multivitamin a day and feel safe that we have obtained the needed daily requirements of all our vitamins. We have been fed this lie by not only our parents (due to their lack of understanding) but also by the nutraceutical industry from the outset. The body and nature fail to work that way and that is probably why nature never created a fruit that contains all the vitamins-a multivitamin fruit.

The best way to understand your daily needs is to obtain a simple available blood test by your physician that shows your vitamin deficiencies. For example, it is unlikely a black male will require D3 or will suffer from osteoporosis. It is also unlikely that a 65-year-old white female does not require vitamin D3. At the same time, she most likely does not require iron supplements. Hence if you want to make sure you are taking the right vitamins then just have a simple physical by your doctor and understand your true vitamin needs and deficiencies.

Another reason why multivitamins usually fail us is that they lack the high dosages required to resolve vitamin deficiencies that already exist in an individual.

What form of vitamins are best absorbed?

Today when you enter any pharmacy or nutrition shop the shelves are filled with multiple brands offering lozenges, gummies, tablets, pills, gel caps, vitamin drinks and chewables.  They all have the need to be swallowed and survive the stomach acids, pancreatic juices, and bile acids before they can be absorbed by your intestinal tract and cleared and delivered by the liver. Hence, many of the products don’t survive to be absorbed or have to be protected by additives, preservatives and excipients to protect the vitamin against your stomach and bile acids, but not necessarily to protect you the individual that takes them. If our intestinal absorption was doing its job in the first place, then our diet would be enough and swallowing more pills or capsules would not be necessary.

To swallow supplements and expect a different result than we already have failed to obtain from swallowing our foods is considered insanity. Hence the better alternative may be supplements that can be absorbed directly under the tongue with cleaner production methods and faster absorption independent of the need to be swallowed or absorbed through the intestinal tract.

 How to absorb vitamins more effectively?

Iron deficiency hinges on the fact that most oral iron supplements are full of additives, inactive substances and inactive ingredients. On top of it most of the iron swallowed ends up not being absorbed and causing severe nausea, vomiting and at best constipation. As stated, a typical western diet of 1000 calories about 1mg of iron is absorbed [6]. Hence to obtain 22mg of daily iron requirement a healthy female must intake 22000 calories a day, not so healthy after all. Oral iron supplements have notoriously poor absorption and for almost every day multiple large dosing, 325mg iron tablet, one only absorbs around 16% of the elemental iron at best [9].

If you want a cheap product then might as well know that with oral iron supplements you are getting the side effects without many benefits. Intravenous Iron infusions are also not so easy to obtain since insurance companies refuse to pay for such costly alternatives. So, what is one to do, you need the iron, cannot get it from the supplements or the diet. Under the tongue iron supplementation appears to allow absorption without the intestinal side effects. Due to direct absorption of the elemental iron under the tongue one can obtain their required iron needs without the intestinal side effects associated with swallowed iron products. It is always good to brush your teeth after taking any iron supplement regardless of the route of intake since iron can cause staining of the teeth in a small minority of individuals.

Due to its inability to dissolve in water D3 is at times difficult to absorb without large fatty meal or a glass of whole milk. If you are taking your vitamin D3 in pill form, experts recommend taking the pill with a full meal – preferably a fatty meal – to maximize absorption. If you take vitamin D3 tablets under the tongue for better absorption, you do not need to worry about any of the above since it absorbs under your tongue and directly into your bloodstream. No need to plan a fatty meal or worry about an upset stomach because under the tongue D3 absorbs directly into the blood stream from the tongue blood plexus and avoids the passage through the gastrointestinal tract.

The problem with any oral vitamin B12 is that it must be swallowed. Now, whether you chew, drink, or swallow your B12 the biggest issue is that after surviving the harsh environment of acidic stomach B12 requires to be bound to a protein called Intrinsic Factor (IF) to be absorbed into our body. As we age our body makes less and less IF and hence, we absorb less B12. Many complain of chronic fatigue or tiredness as they reach their 30’s, 40’s and 50’s. What is your best option if you do not want to get a B12 shot in the butt?  Under the tongue absorption or “sublingual” dosing equals bypassing the need to be swallowed, or the need to survive the harsh environment of the gut or in the case of B12 even the need for binding to IF to be absorbed. Hence under the tongue absorption allows a quick and easy way again to absorb the vitamin directly into the blood stream and avoid the need to swallow a large tablet or capsule and require absorption to be a random and not an assured process.

 

This information is only for educational purposes and is not medical advice or intended as a recommendation of any specific products. Consult your health care provider for more information. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

 References:

  1. World Health Organization. Worldwide Prevalence of Anemia 1993–2005: WHO Global Database on Anemia. World Health Organization, 2008.
  2. Natasha Van Schoor, Paul Lips, et al. Global Overview of Vitamin D Status, Endocrinol Metab Clin North Am. 2017 Dec; 46(4): 845-870. [PubMed abstract]
  3. Sally P Stabler, Robert H Allen, et al. Vitamin B12 deficiency as a worldwide problem, Annu Rev Nutr. 2004; 24:299-326. [PubMed abstract]
  4. National Ambulatory Medical Care Survey: 2016 National Summary Tables; 2016, 1-43.
  5. Cleveland Clinic Mercy Hospital Internet Publication. 42% Percent of Americans Are Vitamin D Deficient. Are You Among Them?. 2018 July.
  6. Lisa Wartenberg, MFA, RD, LD— Medically reviewed by Katherine Marengo LDN, R.D. How Much Iron Do You Need per Day? 2019 Dec. [Healthline]
  7. Hazra et al. Common Variants of FUT2 are Associated with Plasma Vitamin B12 Levels. Nature Genetics Advance Online publication, Sept. 7, 2008, DOI: 10.1038/ng.210
  8. B12 Deficiency in 40% of US Population Proves Concern is Not Just for Vegans
  9. Nicole U Stoffel, MSc, Colin I Cercamondi, PhD, Gary Brittenham, MD, Christophe Zeder, MSc, Anneke J Geurts-Moespot, BSc, Dorine W Swinkels, PhD, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. 2017, Nov. Volume 4, Issue 11, E524-E533 [The Lancet]

 

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