Supplements 101 — Part 3

Changes are a-coming!

Since creating this Substack in 2022, I have developed Insight into Health, where folks come to find my podcast, radio show notes, and live events. As Insight into Health has grown, juggling my various Substack publications has become confusing and in need of some simplification. Starting in September, here’s what you can expect:

• You will receive an email from insightintohealth.substack.com every Friday, which includes the writing or recipes you have gotten used to from me here.

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Thanks for being on this ride with me,

~Allison

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In Part 1 of my Supplement 101 series, I reviewed what supplements are and concerns about the supplement industry in general.

Part 2 explored the pros and cons of using supplements.

Today I’ll present the framework I use to evaluate the need for a supplement.

Are Supplements Right for You?

1. Test, Don’t Guess

I don’t use the “throw spaghetti at the wall” approach for supplements. Everyone has different needs, and taking something that you don’t need isn’t harmless.

Yes, Vitamin D, B12, and iron are important for all of us. But it doesn’t mean we all need to take them in pill form. Remember, supplements… supplement. We don’t need to fill a gap if there isn’t one.

Testing the status of vitamins and minerals in your body first to determine if a supplement is even needed is the place to start.

Now, it isn’t realistic to test the status of every vitamin and mineral. Nor would your doctor likely write that order. To figure out what nutrients to check, it is helpful to understand your risk:

• Dietary patterns at most risk of inadequate micronutrient intake:

  • Vegan: Vitamin B12, Vitamin D, Omega-3s, Iron, Zinc, Iodine, Calcium¹

  • Vegetarian (eats dairy/eggs): Vitamin B12, Iron, Vitamin D, Omega-3s

  • Bariatric surgery post-op (ex: gastric bypass, gastric sleeve): Vitamin B12, Iron, Calcium, Folate, Thiamine (B1), Vitamins A, D, E, K

• Life stages at most risk of inadequate micronutrient levels:

  • Older Adults:Vitamin B12, Vitamin D, Calcium

  • Pregnant/Breastfeeding: Folate, Iron, Iodine, Choline, Omega-3

  • Heavy Menstruation: Iron

• Medical & lifestyle factors at most risk of inadequate micronutrient levels:

  • Limited sun exposure, darker skin: Vitamin D

  • Digestive conditions (Crohn’s, Ulcerative colitis, celiac): Vitamin B12, Iron, Folate, Vitamins A, D, E, & K

  • Excessive Alcohol Intake: Thiamine (B1), Folate, Vitamin B6, Magnesium

  • Smokers: Vitamin C

  • Certain medications:

    • Metformin: Vitamin B12

    • Stomach acid reducers (ex: omeprazole/Prilosec, famotidine/Pepcid): Vitamin B12, Magnesium, Calcium

    • Diuretics: Potassium, Magnesium

2. The Limits of “Within Normal Limits”

Pet peeve time.

Just about everyone has access to their lab results and can quickly scan them for anything outside the “green” range, which indicates the “normal” reference range.

How handy. So what’s the problem?

1. Most reference ranges aren’t standardized.

2. Reference ranges are typically set by the lab or lab equipment company.

3. Reference group populations vary.

4. “Normal” shows what is common in a reference group, not necessarily what is ideal for you.

All of this means that simply looking for values that are either in or out of range can mislead you — a value outside the range can cause undue concern, and a value within a given range can create a false sense of security.

Interpreting lab results involves appreciating the context of age, medical history, symptoms, genetics, goals, and more.

A deficiency is defined as a nutrient level outside the reference range and likely to cause signs and symptoms in most individuals.

An insufficiency/inadequacy is suboptimal nutrient status typically at the low end of a reference range, which may cause signs and symptoms in some individuals.

Both can cause symptoms. But it takes more than being in or out of the reference range to appreciate that.

I recently experienced a perfect example of this. I was feeling more fatigued and just not feeling like me. So I asked my doctor to test for anemia and low iron stores (more about how they differ here).

The most sensitive marker of iron stores, ferritin, was just inside the green reference range:

But wait, do you see that reference range? It is almost too large to make it meaningful.

So I didn’t have iron-deficiency anemia.

I didn’t have iron-deficiency without anemia, either.

But with my symptoms and my unique history, my doctor agreed that I had insufficient iron levels and an agreed-upon supplementation regimen was started.

3. "More" ≠ better

If you do need to supplement, don’t reach for the biggest dose you can find. Not only can your body not always absorb larger doses, but it may also cause side effects and even toxicity.

Let’s go back to my iron example. We now know that iron supplements are most effective and have the least side effects when taken every other day.² More is not better.

Just because you can buy a 10,000IU Vitamin D3 supplement (typical doses are 2,000-4,000IU per day) or a 20mg melatonin supplement (I don’t typically recommend more than 5mg), doesn’t mean you should.

Please, please, please ask the questions to make sure you are supplementing only what you need and no more.

4. Happily Ever After?

The story does not end here. Periodically retesting nutrient status can let you know whether the amount you are taking is effective, the dose needs to be adjusted, or it can be stopped altogether.

While those following a vegan dietary pattern or who had bariatric surgery will likely need some level of supplement indefinitely, testing at least annually is recommended.

Many other supplements can be decreased or discontinued after a period of time, especially if the reason for the deficiency or insufficiency has been resolved.

In my case, my ferritin levels came back up nicely, but since I don’t eat red meat and I have other risk factors for iron insufficiency, I will continue to work with my doctor to create a plan to take my supplement less often and check my levels periodically.

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What was helpful in this series? What question do you still have?

Remember, you’ll hear from me next week from insightintohealth.substack.com!

Thanks for being here,

~Allison

Please remember that this information is meant to educate and inspire but is not medical advice - please consult your healthcare team to determine what is most appropriate for you.

1. Calcium is unique in that blood tests can't reliably assess intake adequacy. This is because the body may pull calcium from bones to keep blood levels stable, raising the risk of bone loss. Those at high risk of inadequate intake should work with a dietitian and ask their doctor about bone mineral density testing.

2. This is because iron receptors get saturated, meaning that even if taken daily, your body can’t really do anything with it, so it travels through your digestive system, which can potentially wreak havoc on your bowels.