What Supplements Should I Recommend?

Many healthcare professionals were interested in the post I wrote on Omega-3 fatty acids and CVD.  This was based on a large meta-analysis done in JAMA.

Supplements are Not Recommended for the General Population

On February 5th, there was a viewpoint article written in JAMA on the different vitamins we can consider recommending.  The article:  Vitamin and Mineral Supplements – What Clinicians Need to Know is available for free from JAMA.  I may not agree with everything in the article, but I think it is a good starting point for clinicians making supplement recommendations.

Some key thoughts from the article are:

  • Most RCTs of vitamin and mineral supplements have not demonstrated clear benefits for primary or secondary prevention of chronic diseases not related to nutritional deficiency
  • Some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance (high doses of beta carotene, folic acid, vitamin E, or selenium) may have harmful effects, including increased mortality, cancer, and hemorrhagic stroke
  • We should be promoting for people to obtain their vitamins and minerals from foods instead of supplements
  • Consider recommending targeted supplementation for high-risk groups

Here are some of the recommendations you can consider in your practice.

When to Consider Recommending Supplements
Healthy people at different life stages ·         Pregnancy: folic acid, prenatal vitamins

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

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

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/months 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, magnesium

The magnesium evidence is inconsistent

Age-related macular degeneration ·         Specific formulation of antioxidant vitamins, zinc, copper
Medications (long-term use) ·         Proton pump inhibitors: vitamin B12, calcium, magnesium

·         Metformin: vitamin B12

Inconsistent evidence for these recommendations

Restricted or suboptimal eating patterns ·         Multivitamins/multiminerals, vitamin B12, calcium, vitamin D, magnesium

What do you think?

  • I am interested to hear if you would recommend anything different.

Reference

Manson JE, Bassuk SS. Vitamin and Mineral Supplements: What Clinicians Need to Know. JAMA. February 2018. doi:10.1001/jama.2017.21012

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