I get asked “What supplements should I take?” surprisingly often.  For some reason, “graduate degree in nutrition” sticks to people’s brains more than “policy focus on the food system” does.  Hmmm…

Ideally, none.  Real food is your best answer, from both a clinical nutrition and policy approach (insufficient supplement quality and health claim regulation).  But, unfortunately, this is not the best of all possible worlds.  The best way to analyze your diet is to keep a three day diet record (write down everything you eat and drink, along with amounts and volumes on two weekdays and one weekend day).  Then take that information and enter into something like the mypyramid.com food diary system.  Look at the output, and you will be able to see what need to change. NOTE: be very careful of the volumes and measure of the foods you enter or your data will be badly skewed and not helpful.

No?  You don’t actually care that much?  Well, here’s a quick look at some common problems.

1) Dairy consumption below 3 servings ( 3 cups of milk/yogurt, or 2 cups milk/yogurt and 1.5 oz hard cheese like cheddar)?  You need a calcium supplement with vitamin D.  Calcium citrate is absorbed better than other forms, and does not need to be taken with food.

2) Woman of childbearing age who is vegetarian, a regular blood donor, or endurance athlete?  Consider taking a low dose daily iron supplement.  It is very important to consult your doctor about iron supplements.  Iron supplements can be poisonous at certain levels. They should not be taken with calcium supplements for best absorption.

3) Work indoors during mid-day, live north of North Carolina, or have a dark skin tone?  Vitamin D– 1000 IU/day or as needed based on blood work.  Vitamin D can also be toxic at very high doses or with certain health conditions, so occasional blood checks are helpful to monitor it.  Some medical conditions and medications also affect vitamin D.

4) Family history of heart trouble or strokes?  Two servings of fatty fish per week plus daily fish oil or daily ground flaxseeds.

5) Vegetarian or vegan?  Vitamin B12, calcium if you aren’t drinking dairy (fortified if plant-based).

6) Planning a baby?  Those prenatal vitamins are actually a good idea.  At the very least, get some folic acid.

7) Ear infections, tummy troubles, or history of cavities?  Try a pro-biotic.  It may not help.  But it might.  Anti-biotic induced digestive woes should definitely be treated with pro-biotics and yogurt.

8) Over 50?  Consider vitamin B12.  You can have your blood levels checked before treating, but many people start to lose the acid needed to digest the natural form as they age.  “Deficiency” cut-offs are set quite low, but if it’s under 500 (typical normal ranges are set around 150-1000), 10-20 mcg daily can’t hurt.

9) Meat & potatoes kinda guy?  Eat more beans, fruits, and vegetables.  We’re talking 4 to 6 cups of produce per day.  Really.  You can’t get it all from a vitamin.

Why not just take a multivitamin?  Well, most of the items above are not in the multivitamin in the amounts you would need.  In addition, absorption from multivitamins is worse than from individual supplements because the nutrients compete to get through the doors in your intestines.

And, honestly, try for real food.  Just do it.  Take a bite, chew, swallow, and repeat.