What vitamins should I take?

Dr Paul Clayton

Most people consider a vitamin supplement for two reasons. First, to make sure they are not deficient in any important vitamin or mineral. The second reason is to help reduce the risk of long term health problems.

Important research shows that achieving the first (preventing deficiency) does not necessarily achieve the second (reducing the risk of declining health as you get older).

Preventing Deficiency
We still often hear that you can get all the nutrition you need from a well-balanced diet. That might well have been true 50 or 60 years ago, when we were far more physically active, ate more food and consumed fewer empty calories; and if by ‘all the nutrition you need’ you only mean the rather limited range of vitamins and minerals for which there is an RDA (Recommended Daily Amount).

The RDA concept is very much in doubt today. There is good evidence that some of the recommended levels are far too low to sustain good health – vitamin D is a case in point. And to make matters worse, we now know that the A-Z vitamins and minerals are by no means the only nutrients that are critical for health, for example they ignore the critically important omega 3s and a wide range of phytonutrients – nutrients from plants.

Insufficiency is today’s problem
Why the difference between 60 years ago and now? Because today, our low-energy, sedentary, and largely indoor lifestyles mean that most people have had to cut their average daily food intake to about 2,000 – 2,500 calories a day if they are not to put on weight.

Thanks to the food industry, many of us eat far more processed foods, and far more empty calories. And in any case, even if you choose and mix your foods scrupulously, you cannot get a full range of nutrients at today’s calorie intakes.

The data confirm this. The Journal of Nutrition (August 2011) reported on a three-year study surveying the dietary habits of over 16,000 Americans. It found that a significant portion of the population consistently fails to meet even the minimal intakes recommended in the Dietary Reference Intake (DRI) for many key nutrients. UK data shows the same trend.

In the USA, the National Health and Nutrition Examination Survey (NHANES) 2003-2006 reviewed the average intake of 19 micronutrients in 16,110 people. They found that:

  • 25% do not get enough Vitamin C
  • 34% do not get enough Vitamin A
  • 38% do not get enough Calcium
  • 45% do not get enough Magnesium
  • 60% do not get enough Vitamin E and
  • 70% do not get enough Vitamin D

RDA is not the amount needed for optimum health
The minimum daily requirement for a nutrient is normally defined as the lowest amount that can be taken in order to not develop a “deficiency” and its associated disease or health condition.

Vitamin C
For example, the RDA for Vitamin C is 60mg in the UK and 90 mg in USA. Less than this amount over an extended period and you will develop scurvy. But although taking 60/90 mg will prevent scurvy (which is not exactly a major health problem!), it is not the amount needed for optimal health.

Indeed the US National Institutes of Health confirmed that “scientific evidence indicates that an increased intake of vitamin C is associated with a reduced risk of chronic diseases such as cancer, cardiovascular disease, and cataract, probably through antioxidant mechanisms. It is likely that the amount of vitamin C required to prevent scurvy is not sufficient to optimally protect against these diseases.”

Vitamin D
Another example: Up to 70% of people in northern countries are deficient in vitamin D. Yet every cell in your body needs vitamin D to function at its best, and deficiencies are responsible for high blood pressure, increased risk of heart attacks and strokes, and impaired immune function.

As a result, low vitamin D is also associated with loss of bone density, increased risk of cancer, autoimmune disorders, Alzheimer’s disease and diabetes.

What of nutrients with no RDAs?
But these are just nutrients for which there ARE RDAs. We now know that some of the most important nutrients for long term health have not yet had RDAs established for them; such as the omega 3 fatty acids and the polyphenols, two classes of nutrient that have critically important anti-inflammatory properties.

Omega 3
There is overwhelming evidence that Omega 3 fish oil is heart-protective, helps to protect brain function and has a role to play in reducing the risk of cancer. But few people have sufficient Omega 3 in their normal diet. You would need to eat 3-4 portions of oily fish such as herring, mackerel, sardines or wild salmon (not farmed) a week.

There is equally good evidence to support the importance of polyphenols (a group of phytonutrients found in fruits and vegetables) to our long-term health, so much so that the American Cancer Society and many other authorities now recommend 9 portions of fruit and vegetables a day!

Anti-inflammatory nutrients are key
Why do we need these anti-inflammatory nutrients? Because they protect us against so-called ‘chronic sub-clinical inflammation’, an insidious and invisible process that develops in our tissues and which is now known to drive all the degenerative diseases, from cancer to Alzheimer’s to heart disease, diabetes, arthritis and osteoporosis; not to mention sexual dysfunction, ageing of the skin, and indeed the bulk of the ageing process.

Preventing deficiency is not enough
It now becomes much clearer why you should consider a supplement – and why that supplement needs to go beyond a simple vitamin and mineral pill.

Up to the age of about 50, the aim of a well-designed supplement should be to ensure you have a full spectrum of vitamins and minerals, plus adequate Omega 3 fish oil, plus polyphenols including flavonoids.

To recap, Omega 3’s and polyphenols are important because they are anti-inflammatory nutrients which protect us from the silent danger of chronic sub-clinical inflammation; the trigger for the health problems we formerly assumed would inevitably increase with age. As Scientific American confirmed in a major review:

“Inflammation is an underlying contributor to virtually every chronic disease … rheumatoid arthritis, Crohn’s disease, diabetes and depression, along with major killers such as heart disease and stroke. The connection between inflammation and cancer has now moved to center stage in the research arena.”

Reduce pro-inflammatory factors and increase anti-inflammatory vitamins
These dangers can be lessened by taking two simple steps. Firstly, we must reduce pro-inflammatory factors in our lifestyle, like high temperature cooking and fast foods; and secondly, we should increase the level of anti-inflammatory nutrients in our diet. That’s why increasing the amount of fruits, vegetables and oily fish in your diet – which provide the key anti-inflammatory nutrients – is so important.

And that’s why I also recommend Omega 3 and polyphenol supplements – such as from curcumin, green tea and grapeseed extract. They are powerful anti-inflammatory ingredients.

You need these elements even in your 30s and 40s because over time, inflammation causes slowly progressive damage in the tissues. The symptoms of heart disease or osteoporosis, for example, may only become overt in your 60s or 70s – but the damage leading up to the emergence of clinical symptoms had been gradually accumulating for decades.

Over 50s need even more vitamins and nutrients
Over the age of 50, when the powers of healing and regeneration are no longer as effective as they were in youth, there are further protective supplement steps you can take. For example, the evidence for the carotenoid supplements such as beta carotene, lutein and lycopene is persuasive. Lutein appears to have a protective effect for eyes and the laboratory research for the anti-cancer effect of lycopene is increasingly convincing.

I would also add Co-enzyme Q10 and Betaine. CoQ10 helps the transfer of energy from food, and the little-known quasi B vitamin Betaine in combination with certain B vitamins helps lower homocysteine levels, which are linked to lower heart disease risk.

Soy isoflavones are one of the dietary elements that contribute to the generally better health and life expectancy of the Japanese. If you don’t eat much soy, then supplementation is worthwhile.

Reproducing the world’s healthiest diets
All these nutrients occur in high levels in the diets of those societies that have a long life expectancy and HEALTH expectancy. It’s a combination designed to reproduce the elements in an ideal diet.

It’s also a combination that I recommend if you have already been diagnosed with a health issue like diabetes or angina. Because although food and supplements cannot treat or cure age-related disease, they can create a climate in the body where disease is less likely to develop or worsen, and where the body’s own ability to heal itself is supported.

So which vitamins to take?
Don’t bother with vitamin and mineral supplements labelled as being especially for women or men. These are marketing gimmicks. We’re all human and we all need almost the same vitamins and minerals.

The only exception is iron. Iron in men and post-menopausal women can potentially accumulate to the point where it becomes pro-inflammatory and pro-oxidative, so I would not include it in an all-purpose supplement. But pre-menopausal women should include it. Some women may also benefit from extra calcium, although if you have regular dairy products and leafy green vegetables, you should have adequate calcium.

Don’t bother with specialist supplements either – for eyes or heart or for the brain. Why try to protect one vital organ and leave others undefended? Especially when the secret of long-term brain, eye, heart and indeed sexual health, lies in reducing the tissue damage inflicted by chronic inflammation.

You should also take your chosen supplement with a meal. This will help absorption.

My final point. You’ll have read attacks in the press on vitamin supplements. However, a careful reading of the reports behind the headlines reveals that the criticisms are largely based on the conclusion that one-a-day vitamin and mineral supplements have little effect on reducing age-related diseases. You can now see why this is true, as most of these rather threadbare supplements are only designed to avoid deficiency diseases. They have little or no anti-inflammatory effect and cannot combat the key driver of age-related health decline, namely chronic inflammation. Only a comprehensive nutrient support programme can do that.

1. Clayton P, Rowbotham J. How the mid-Victorians worked, ate and died. Int J Environ Res Public Health. 2009 Mar;6(3):1235-53
2. Ames BN. Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage. Proc Natl Acad Sci U S A. 2006 Nov 21;103(47):17589-94
3. Ames BN. Optimal micronutrients delay mitochondrial decay and age-associated diseases. Mech Ageing Dev. 2010 Apr 24. [Epub ahead of print]
4. Schick B. A tea prepared from needles of pine trees against scurvy. Science. 1943 Sep 10;98(2541):241-2
5. Bolland MJ, Avenell A, Baron JA, Grey A, Maclennan GS, Gamble GD, Reid IR. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010 Jul 29;341:c3691. doi: 10.1136/bmj.c3691.
6. IoM Worksop Summary. The Development of DRIs 1994–2004: Lessons Learned and New Challenges. November 30, 2007
7. Jiang Q, Moreland M, Ames BN, Yin X. A combination of aspirin and gamma-tocopherol is superior to that of aspirin and alpha-tocopherol in anti-inflammatory action and attenuation of aspirin-induced adverse effects. J Nutr Biochem. 2009 Nov;20(11):894-900
8. Royer MC, Lemaire-Ewing S, Desrumaux C, Monier S, Pais de Barros JP, Athias A, Néel D, Lagrost L. 7-ketocholesterol incorporation into sphingolipid/cholesterol-enriched (lipid raft) domains is impaired by vitamin E: a specific role for alpha-tocopherol with consequences on cell death. J Biol Chem. 2009 Jun 5;284(23):15826-34
9. Sacha B, Zierler S, Lehnardt S, Weber JR, Kerschbaum HH. Heterogeneous effects of distinct tocopherol analogues on NO release, cell volume, and cell death in microglial cells. J Neurosci Res. 2008 Dec;86(16):3526-35
10. Ren Z, Pae M, Dao MC, Smith D, Meydani SN, Wu D. Dietary supplementation with tocotrienols enhances immune function in C57BL/6 mice. J Nutr. 2010 Jul;140(7):1335-41
11. Sen CK, Khanna S, Roy S. Tocotrienols in health and disease: the other half of the natural vitamin E family. Mol Aspects Med. 2007 Oct-Dec;28(5-6):692-728. Epub 2007 Mar 27. Review.
12. Comitato R, Leoni G, Canali R, Ambra R, Nesaretnam K, Virgili F. Tocotrienols activity in MCF-7 breast cancer cells: involvement of ERbeta signal transduction. Mol Nutr Food Res. 2010 May;54(5):669-7
13. Pierpaoli E, Viola V, Pilolli F, Piroddi M, Galli F, Provinciali M. Gamma- and delta-tocotrienols exert a more potent anticancer effect than alpha-tocopheryl succinate on breast cancer cell lines irrespective of HER-2/neu expression. Life Sci. 2010 Apr 24;86(17-18):668-75
14. Grant WB, Schwalfenberg GK, Genuis SJ, Whiting SJ. An estimate of the economic burden and premature deaths due to vitamin D deficiency in Canada. Molecular Nutrition & Food Research 2010 March 29th.Published online ahead of print, doi: 10.1002/mnfr.200900420
15. Hanley DA, Cranney A, Jones G, Whiting SJ, Leslie WD, Cole DE, Atkinson SA, Josse RG, Feldman S, Kline GA, Rosen C. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada. CMAJ. 2010 Jul 19
16. “Dietary Supplement Fact Sheet: Vitamin D” Retrieved 2010-03-25
17. Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999; 69(5):842-56.
18. Vieth R, Chan P-C, MacFarlane GD: Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr 2001;73:288–94.
19. Adams JS, Clemens TL, Parrish JA, Holick MF Vitamin-D synthesis and metabolism after ultraviolet irradiation of normal and vitamin-D-deficient subjects. N Engl J Med.1982 Mar 25;306(12):722-5
20. Munro I, Derivation of tolerable upper intake levels of nutrients, Letter, Am J Clin Nutr 2001; 74:865
21. Woodhead JS, Ghose RR, Gupta SK. Severe hypophosphataemic osteomalacia with primary hyperparathyroidism. Br Med J 1980; 281:647-648.
22. Eguchi M, Kaibara N. Treatment of hypophosphataemic vitamin D-resistant rickets and adult presenting hypophosphataemic vitamin D-resistant osteomalacia. Int Orthop 1980; 3:257-264.
23. Schurgers LJ, Vermeer C. Differential lipoprotein transport pathways of K-vitamins in healthy subjects. Biochim Biophys Acta. Feb 15 2002;1570(1):27-32.
24. Schurgers LJ, Cranenburg EC, Vermeer C. Matrix Gla-protein: the calcification inhibitor in need of vitamin K. Thromb Haemost. 2008 Oct;100(4):593-603. Review.
25. Knapen MH, Schurgers LJ, Vermeer C. Vitamin K2 supplementation improves hip bone geometry and bone strength indices in postmenopausal women. Osteoporos Int. 2007 Jul;18(7):963-72
26. Kim KH, Choi WS, Lee JH, Lee H, Yang DH, Chae SC. Relationship between dietary vitamin K intake and the stability of anticoagulation effect in patients taking long-term warfarin. Thromb Haemost. 2010 Jul 20;104(4)
27. Kaneki M, Hodges SJ, Hosoi T, Fujiwara S, Lyons A, Crean SJ, Ishida N, Nakagawa M, Takechi M, Sano Y, Mizuno Y, Hoshino S, Miyao M, Inoue S, Horiki K, Shiraki M, Ouchi Y, Orimo H. Japanese fermented soybean food as the major determinant of the large geographic difference in circulating levels of vitamin K2: possible implications for hip-fracture risk. Nutrition. 2001 Apr;17(4):315-21
28. Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ 2011 Apr 19;342:d2040.
29. Krebs-Smith SM, Guenther PM, Subar AF, Kirkpatrick SI, Dodd KW. Americans do not meet federal dietary recommendations. J Nutr. 2010 Oct;140(10):1832-8.
30. Troesch B, Hoeft B, McBurney M, Eggersdorfer M, Weber P. Dietary surveys indicate vitamin intakes below recommendations are common in representative Western countries. Br J Nutr. 2012 Aug;108(4):692-8.
31. Fulgoni VL 3rd, Keast DR, Bailey RL, Dwyer J. Foods, fortificants, and supplements: Where do Americans get their nutrients? J Nutr. 2011 Oct;141(10):1847-54