To Supplement or Not? Navigating the World of Dietary Supplements

By Rebecca Jaspan, MPH, RD, CDN, CDCES

Dietary supplements include vitamins such as vitamin C or E, minerals such as calcium or magnesium, fish oil, and herbs. As registered dietitians, our clients ask us about supplements on a regular basis.  There is so much confusing information in the wellness space about taking supplements, it can be challenging to know if or what kind of supplement is right for you. While food is frequently the best source of vitamins and minerals, some individuals do not get enough nutrients through food and need an extra boost.

In a 2018 survey, the Council for Responsible Nutrition found that 75 percent of people in the United States take dietary supplements¹.  The survey also showed that vitamin D and calcium are the most popular supplements and the use of herbals and botanicals, especially turmeric, have increased in popularity in the past 5 years.  The first step is to speak with your doctor and dietitian to point you in the right direction of which supplements you may need to support your body.

Before starting a supplement, it is a good idea to get bloodwork taken to determine if you have any deficiencies. At Laura Cipullo Whole Nutrition, we provide our clients with a recommended list of labs to bring to their doctors’ visit to gather the information we need to help determine if a supplement is necessary.  Once we get your results, we use your medical and food history to create a meal structure together to help meet your nutrition needs.

There are a number of reasons why supplements are an important part of your diet, particularly if you have a condition or eating pattern that prevents you from absorbing or eating certain nutrients.  Some of these reasons include gastrointestinal disorders, eating disorders, vegetarianism and veganism.

Gastrointestinal Disorders

Gastrointestinal disorders such as irritable bowel syndrome, inflammatory bowel disease, and celiac disease frequently cause malabsorption of nutrients due to damage in the mucosal lining of the small intestine where the majority of our nutrients are absorbed.  While eating nutritious foods is important, you may not absorb all nutrients provided from the food.  Dietary supplements may provide the extra boost of nutrition your body needs.

It is common to see deficiencies in vitamin B12, calcium, iron, folate, vitamin D, and magnesium in individuals with gastrointestinal disorders. The degree of deficiency will depend on the severity of the disease².  Micronutrient deficiencies occur in more than half of people with inflammatory bowel disease, such as Crohn’s or ulcerative colitis.  Deficiencies are more common in Crohn’s than ulcerative colitis.  In addition to medication to decrease the inflammation in the gut, patients with inflammatory bowel disease need to be tested for common deficiencies of iron, B12, vitamin D, and vitamin K³.

In celiac disease, deficiencies most often seen are iron, B12, calcium, vitamin D, copper, and zinc.  In newly diagnosed and untreated celiac disease, inflammation and destruction of the small intestine leads to malabsorption.  Once the individual with celiac disease switches to a completely gluten-free diet, inflammation decreases and nutrients from food and supplements are better absorbed.

Additionally, GI disorders can cause fat malabsorption. Fat is necessary to increase the absorption of fat-soluble vitamins A, D, E, and K.  Dietary changes may need to be made to include lower fat foods that are more easily digested and absorbed.  Supplements may also be added to make up for nutrients that aren’t absorbed as well.

Eating Disorders

Individuals with anorexia, bulimia, or binge eating disorder may benefit from dietary supplements. They may deprive their bodies of essential macronutrients, such as carbohydrates, protein, and fat, and micronutrients, such as vitamins and minerals necessary for red and white blood cell production, and muscles, bone, and organs growth and development.  Prolonged eating disorder behaviors such as restriction, binging, purging, and laxative use can cause damage to bones, teeth, the digestive system, heart, and other organs.  Treatment focuses on refeeding with adequate food as well as the possible addition of supplements.

Common supplements include calcium and vitamin D to support bone health, iron to reverse anemia, and omega-3 fatty acids to aid in brain and nerve functioning.  Research on omega-3 fatty acid supplements show they can have a positive effect on the nervous system, by decreasing inflammation and protecting against oxidative stress, helping with mood and anxiety-depression symptoms.  Taking an omega-3 supplement in addition to supporting your body with adequate food intake can help your physical, mental, and emotional states to help in your recovery journey⁴.

Vegetarians and Vegans

A lacto-ovo vegetarian eats dairy and eggs, but avoids meat and fish.  Vegans avoid all animal products.  Vegetarian and vegan eating patterns can be nutritionally complete with some careful planning, however, there may be gaps that need to be filled with a supplement.  Common deficiencies in vegetarian and vegan diets are vitamin B12, vitamin D, omega-3 fatty acids, iron, calcium, and iodine.  Many of these essential vitamins and minerals are found in animal foods so will need to be supplemented in a vegetarian or vegan diet.

It is challenging to get enough protein in vegetarian and vegan diets and protein foods are where many of these nutrients are found.  Vitamin B12, calcium, and vitamin D are primarily found in dairy foods, which would be omitted in a vegan diet and many vegetarian diets.  While there are many plant-based sources of iron, the most efficiently absorbed form of iron is found in animal proteins, resulting in iron deficiencies in many vegans and vegetarians.  Additionally, omega-3 fatty acids are mainly found in fatty fish such as salmon and tuna.  This essential nutrient will need to be supplemented in a diet that does not contain fish.

If you are concerned you are not meeting your nutritional needs and may need a supplement, talk to your dietitian at Laura Cipullo Whole Nutrition.  We will collaborate with you to ensure you’re meeting your needs both through food and any additional supplements.

References:

1. 2018 crn consumer survey on dietary supplements | council for responsible nutrition.
2. Zuvarox T, Belletieri C. Malabsorption Syndromes. [Updated 2021 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553106/
3. Weisshof R, Chermesh I. Micronutrient deficiencies in inflammatory bowel disease. Curr Opin Clin Nutr Metab Care. 2015;18(6):576-581. doi:10.1097/MCO.0000000000000226
4. Díaz-Marsá M, Alberdi-Páramo I, Niell-Galmés L. Nutritional supplements in eating disorders. Actas Esp Psiquiatr. 2017;45(Supplement):26-36.