Category Archives: Supplements

Nutritional Concerns for Vegetarians and Vegans

Becoming a vegetarian or vegan, by forgoing consumption of some or all animal products, has been linked to many health benefits, including lower blood pressure, cholesterol, and body mass index.  While vegetarian and vegan diets tend to be lower in saturated fat and cholesterol – nutrients whose consumption should be limited anyway – they also tend to be lower in Vitamin B12, iron, protein, and calcium.  Deficiencies in each of these nutrients pose their own unique sets of concerns, so it’s important for vegetarians and vegans to take steps to eat a balanced diet that includes alternative sources of nutrients that might otherwise be lacking in a diet that excludes or limits animal products.

Vitamin B12, which helps the body convert food into energy and keeps the nervous system running efficiently, is found only in animal products.  While some plant-based foods like cereal are fortified with B12, it is recommended that vegetarians and, especially, vegans, talk to their doctors about receiving a B12 shot to ensure their levels are adequate.  A deficiency in Vitamin B12, unlike other nutrient deficiencies that can be resolved by taking mega-doses of supplements, is best corrected with a monthly shot.

Iron is an essential part of the body’s production of red blood cells; an iron deficiency can lead to anemia.  While iron is found in both animal (in the form of heme iron) and plant products (in the form of nonheme iron), the body absorbs heme iron much more efficiently.  Iron can still be absorbed from plant sources, and it is recommended that vegetarians and vegans include a variety of them in their diets.  Good plant-based sources of iron include nuts, seeds, beans, and green leafy vegetables.  Fortified foods are also a good option.

Protein helps the body build, repair, and maintain tissues (such as muscles) and organs.  As with iron, the body best absorbs animal-based sources of protein, as animal proteins contain all nine essential amino acids (the building blocks of protein) that the body can’t produce on its own.  Two plant proteins – soy and quinoa – also contain all nine of these amino acids, so they are excellent choices for vegetarians and vegans to consume.  Combining different sources of protein – e.g., grains (like rice) and legumes (like beans) – to ensure adequate amino acid intake is also a smart strategy.

Calcium, crucial to bone health, is abundant in dairy products.  It is also naturally found in green leafy veggies and beans and is commonly added into fortified soy products and other non-dairy products like orange juice.  Again, calcium is best-absorbed when it comes from animal sources, but a carefully-planned diet rich in plant-based sources of calcium can usually meet the body’s needs for this nutrient.

If you choose to forgo some or all animal products, a healthy, balanced diet should be able to meet most of your nutritional needs.  However, in some cases, supplementation – with B12 and other vitamins and minerals – may be necessary, so make sure to speak to your doctor to determine a plan of action.


Fish Oil and Omega-3 Fatty Acids

Chances are, if you have high cholesterol, are at high risk of developing heart disease, have inflammatory issues, or are concerned about brain health, you have probably talked with your doctor about taking fish oil pills, which have been shown to help with all of these conditions. The reason fish oil has such beneficial effects on a number of conditions is that it’s high in omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), two types of fat that are crucial for optimal health.  EPA and DHA are also known as essential fatty acids, meaning your body can’t produce them on its own, so the only way you can meet your needs for these nutrients is through food or supplementation.  Many people turn to fish oil supplements as a convenient way to meet their essential fatty acid needs, but there are actually other, tastier ways to do so.

Fish oil is made from, obviously, fish, which means that eating the “real thing” will provide you with the same nutrients as a pill.  The bonus of eating fish that contain omega-3s is that your body will absorb more of these fatty acids than if you were to take a pill, plus the fish will provide other beneficial nutrients like protein. The best sources of omega-3s are oily fish like salmon, tuna, sardines, and anchovies, although most types of fish contain EPA or DHA in varying amounts.  You can meet your body’s needs for omega-3s through food alone if you eat two servings of oily fish each week; a serving of fish is generally considered 3.5 ounces.

Some people, myself included, are not fans of oily fish, but there’s hope for us yet, as other healthy foods, like flaxseeds and walnuts, also contain omega-3 fatty acids.  The type of omega-3 found in foods other than fish is of a slightly different variety, however, which is not as well-absorbed as the omega-3s found in fish.  The omega-3 fatty acid found in flaxseeds and walnuts is called alpha-linolenic acid, or ALA.  Although ALA on its own doesn’t confer the same nutritional benefits as EPA and DHA, your body is able to partially convert it to its more beneficial omega-3 counterparts.  What this means is that, when you eat a food that contains ALA, an extra step has to occur in order for your body to use it in the same way it uses EPA and DHA.  Therefore, ALA is not used as efficiently or absorbed as well as EPA and DHA, although it’s a still a great way to increase omega-3 intake without eating oily fish or taking fish oil supplements.

If you prefer to take a supplement to ensure adequate omega-3 intake, know that fish oil has been proven to be more effective (and safer) than up-and-coming “designer” counterparts like krill oil.  Flaxseed oil is a good vegetarian alternative to fish oil, but like flaxseeds themselves, the omega-3s it contains will not be as well-absorbed.  Although fish oil supplementation is generally safe, research shows that consuming greater than 3,000 mg (or 3 grams) of fish oil a day increases the risk of serious side effects like stroke.  As always, make sure to talk to your doctor before starting any supplementation routine, and aim to get your intake of omega-3 fatty acids, and most other nutrients, the natural way – through food!

Are You Getting Enough Vitamin D?

Vitamin D has a very important job – it helps keep our bones strong by enhancing absorption of the minerals calcium and phosphorus. While it’s essential that we consume enough Vitamin D through food and supplements (the Institute of Medicine currently recommends 600 International Units (IU) a day for everyone under age 70, and 800 IU for adults over 70) to reduce our risk of bone pain and fractures, the sad truth is that most adults fall far short of these recommendations.

The bad news, if you want to call it that, is that a few of the reasons for low Vitamin D intake are beyond your control. First off, Vitamin D is not found naturally in very many foods. Even if you eat a healthy, balanced diet, there’s a good chance that it does not include high levels of naturally-occurring Vitamin D, since most people don’t consume the main food sources of the vitamin – yeast, fatty fish, and mushrooms – in large quantities or on a daily basis. Second, due strictly to the fact that you live in New England, you’re exposed to less-than-optimal levels of the best source of Vitamin D there is – the sun. Living in a northern latitude means less sun exposure throughout the year, especially in the winter. In addition, the sun’s rays are not as strong as they are in states down South, closer to the Equator. Since your body produces Vitamin D when it’s exposed to sunlight, the fact that you live in a place without a lot of high-quality sun, comparatively speaking, means that you’re at a disadvantage when it comes to naturally producing the vitamin. Studies have shown that for this reason, many New Englanders suffer from Vitamin D deficiency, especially during the winter months.

The news here isn’t all bad, however. There are ways you can beat the odds and increase your intake and absorption of Vitamin D. The first place to start is with your diet: Include as many naturally-occurring food sources of Vitamin D as you can, and supplement those with foods that have been fortified with the vitamin, like low-fat milk and orange juice. Next, aim to get as much sun exposure as is safe and possible (this shouldn’t be too hard with the nice weather we’ve been having lately). Experts recommend between 5-30 minutes of sun exposure to your face and arms at least twice a week for optimal Vitamin D production. Although I wouldn’t normally recommend you skip the sunscreen when playing outside, sunscreen actually blocks production of Vitamin D, so you want to try and avoid wearing it for a least a few minutes of sun-exposure time. Finally, if you’ve tried the above strategies and you believe your Vitamin D levels are still low, consider taking a Vitamin D supplement. Vitamin D supplements can be effective in preventing deficiency, but can be harmful if taken in very high doses, so make sure you talk to your doctor before starting any supplementation regimen.

Calcium 101

At almost every nutrition-related Lunch ‘n Learn I conduct, I get at least one question about supplements. The supplement that most often comes up in conversation is calcium, a mineral that’s best known for its involvement in bone health (but also has a role in blood clotting, muscle and nerve action, and basic metabolic functions). Since calcium is involved in so many different aspects of our health, it’s important to make sure we’re getting enough of it. Calcium intake is often too low in the following groups of people: women, the elderly, and those who do not consume dairy. For these populations, and others for whom adequate calcium intake is a concern, doctors may prescribe a calcium supplement.

Calcium supplements have a lot of what I call “special considerations,” meaning that there isn’t a one-size-fits-all pill, and there are many factors that can help or hinder how well the calcium from a supplement is absorbed. Here are some key points to note about calcium supplements:

  • Supplemental calcium normally takes one of two forms: calcium citrate and calcium carbonate. Calcium citrate is easily absorbed and digested, so it’s a good choice for many people. Calcium carbonate, which also happens to be the active ingredient in Tums, is best absorbed when taken with food. Calcium citrate supplements are probably better for people with digestive issues, and calcium carbonate supplements may be less expensive, but at the end of the day, it really doesn’t matter which form of calcium you choose.
  • Calcium is best absorbed when it’s taken alongside Vitamin D. This is why many supplements contain both. Vitamin D is best absorbed when taken with food, especially food that contains fat, since fat helps transport Vitamin D throughout the body. If you’re taking a combined calcium and Vitamin D supplement, make sure you take it with a meal or snack.
  • Our bodies can only absorb 500 mg of calcium at a time. Anything greater than that amount just gets excreted and isn’t used. It’s especially important to be aware of this fact if you take more than 500 mg of supplemental calcium a day, or if you take a calcium supplement alongside your multivitamin. It’s very easy to consume more than 500 mg of calcium at a time if you take a calcium supplement at the same time as a multivitamin. Make sure to take calcium-containing supplements or vitamins 4-6 hours apart so that your body has time to properly metabolize each supplement and none of the calcium in those supplements is going to waste.

It’s best to consume calcium, like most other nutrients, in its natural form – food. Dairy products like low-fat or non-fat milk and yogurt are some of the best sources of calcium, as the calcium they contain is present in high-quantities and is well-absorbed. If you are unable to or choose not to consume dairy, other good sources of calcium include fortified soymilk, orange juice, and cereal; okra; and green leafy veggies like kale, collard greens, and bok choy.

Cholesterol-Lowering Supplements – Which One Should You Choose?

High cholesterol is becoming more and more common, due to higher rates of both screening and obesity, a major driver for developing the condition. As mentioned in a previous post, one of the best and safest ways to lower cholesterol is by following the TLC (or Therapeutic Lifestyle Changes) Diet, developed by the National Institutes of Health to help Americans lower their cholesterol levels by eating a heart-healthy diet and exercising regularly.

For some people, diet and exercise alone are not enough to get their cholesterol levels to where they need to be. These people are usually prescribed cholesterol-lowering medications, like statin drugs, which they often need to take for the rest of their lives. If the prospect of taking a prescription medication for the next 40 or 50 years seems daunting, there is what I consider to be an “in-between” option for when diet and exercise don’t work and taking a prescription drug isn’t the first choice on your list: over-the-counter supplements.

Supplements can be seen as a more “natural” way to lower cholesterol, since their active ingredients are naturally-occurring, rather than man-made. A “dietary supplement,” as defined by the Dietary Supplement Health and Education Act (DSHEA) of 1994, is a product “taken by mouth that contains a ‘dietary ingredient’ intended to supplement the diet.” These dietary ingredients include vitamins, minerals, herbs, and enzymes. While cholesterol-lowering medications, particularly statins, are some of the drugs most commonly-prescribed by doctors, cholesterol-lowering supplements are just as popular among consumers.

Perhaps the most well-known (and well-studied) cholesterol-lowering supplement is fish oil. Fish oil supplements contain the omega-3 fatty acids that are naturally found in oily fish like salmon, tuna, and sardines. These concentrated sources of heart-healthy omega-3s are commonly sold in capsule form and have few side effects, the most common being belching and a fishy aftertaste (although “belch-free” formulations are becoming more and more prevalent). Fish oil is generally safe to consume, although adverse effects such as an increased risk of stroke have been reported in people who consume greater than 3,000 mg, or 3 g, of fish oil a day. However, fish oil taken in lower amounts has been shown to be effective in lowering total cholesterol and triglyceride levels, reducing inflammation, and preventing heart disease and heart attacks.

Two other cholesterol-lowering supplements that have been in the news lately are krill oil and flaxseed oil. Krill oil is an up-and-coming “designer” alternative to fish oil. While krill oil may seem trendy, it also comes with a much higher price tag than fish oil, and its safety and effectiveness haven’t been adequately studied. What studies have shown, however, is that krill oil comes with a higher risk of side effects than fish oil, so it might not be a worthwhile investment, since it may not be safe and it hasn’t yet been proved to be effective. Flaxseed oil, a vegetarian source of omega-3 fatty acids, is generally thought to be safe to use, but it isn’t as effective as fish oil. Our bodies don’t absorb plant-based omega-3 fats as well as those that come from animal sources, so flaxseed oil doesn’t offer as much “bang for the buck” as fish oil does, since its cholesterol-lowering effects aren’t as potent. It remains, however, a good alternative for vegetarians or those concerned about the mercury content of fish oil supplements.

Before starting any supplementation regimen, talk with your doctor, as certain supplements can interact with medications or other supplements you may be taking. Also be aware that supplements are not regulated by the FDA, so you can’t be 100% sure if the supplements you purchase are going to be as safe and effective as their labels tout them to be. But if you must choose a supplement to lower your cholesterol levels, go with fish oil, as there is the most evidence out there on its safety and effectiveness.

Enhance Your Digestive Health with Probiotics

Dietary supplements seem to be a hot topic these days, and I often get asked whether or not it’s necessary to take a daily multivitamin or any other supplement.  I have already expressed my opinion on multivitamins, but I believe that they are not the only supplement that is safe to take on a daily basis.  One of the only other supplements I recommend for daily use is a probiotic, which helps improve digestive health and may increase immunity and decrease inflammation.   Probiotics contain live and active cultures of “good” bacteria that can help outweigh the effects of “bad” bacteria in our bodies, especially our digestive tract.

A lot of us are familiar with probiotics’ role in digestive health thanks to clever marketing from yogurt companies.  Yogurt is a natural source of probiotics, although some brands lead consumers to believe that the ingredients in their yogurt have magical powers to transform the way a person’s digestive tract functions.  The truth is, the only difference between these specially-marketed yogurts and “regular” yogurt is the strain of bacteria present.   There is no need to pay more money for yogurt that’s advertised as being good for digestive health – any yogurt whose label states that it  “contains live and active cultures,” (and almost all yogurts do) is good for digestive health!

The strain of bacteria found in most yogurts, Lactobacillus acidophilus, is also a strain commonly found in supplement form (and the one I recommend, due to its effectiveness, low risk of side effects, and budget-friendly price tag) .  Since yogurt would need to be consumed at least once a day, every day, to reap its maximum probiotic benefits, supplementation is often a good idea for anyone looking to improve their digestive health.  Acidophilus can help regulate the digestive tract, has minimal side effects (gas and bloating may occur during the first few days of use, but they almost always subside once your body gets used to the supplement), and 100 capsules of the CVS brand only cost around $6.  As with most other supplements, price and quality vary by brand (since supplements are not regulated by the FDA), so stick to brands you know and trust, and don’t fall into the trap of believing that a higher price automatically equals higher quality.

With regular use, probiotics can help achieve intestinal regularity and reduce digestive disturbances by counteracting the effects of harmful bacteria in the digestive tract.  As an added bonus, regulation of the digestive tract may lead to weight loss and a smaller midsection, as these problems are sometimes caused by an inefficient digestive system.  If any of the above issues apply to you, I would recommend talking to your doctor about taking a probiotic supplement – it’s a safe, cost-effective step toward a healthier digestive tract.