Daily vitamins and other stuff - what is needed, and what's the best source?

[Aardvark]

I'm 30 years old, my wife is 27.
Neither of us take any supplements of any kind, and we are wildly healthy.
Are daily supplements like vitamins and minerals actually necessary? Or are they just a waste of money. If they are necessary, what's the most mustachian way of acquiring them? Does higher price = more value or is a basic cheapo option good enough?

Not just asking about a general "What do you do" - hoping to get facts and references. Happy to read up on journal articles. Would appreciate insights from medical professionals that have looked into this - or from people that have seriously geeked out on the internet.

[ixtap]

If you have a varied diet, supplements are only necessary if you have a condition that causes deficiency.

No source at my finger tips, but I did once read that cancer rates were higher among supplementers. The study suggested it might be because people were substituting supplements for good habits, rather than the supplements causing the damage.

[remizidae]

If you're trying to get pregnant, or are pregnant, then folic acid is actually necessary. Iron too if you become anemic (or know you have a tendency to get anemic.)

Not pregnant? And do you eat reasonably healthy, with vegetables, fruit, and fiber? You probably don't need anything. I take Vitamin D because my levels of that vitamin were borderline low. But it's an expensive to test for Vitamin D levels, and if you're "wildly healthy" already, why bother?

Edit: Emily Oster (an economist who writes about health) recently covered this.

[NotBadForADad]

I'm 35 and have started taking Psyllium Husk and Collagen.

[dcheesi]

As others said, you shouldn't need a lot if you're healthy and eat well. Most of what I take is to counter specific ailments and/or medication side-effects.

[Sibley]

I don't eat all that wonderfully, so I eat the daily gummy multivitamins. If my diet was better, I probably wouldn't do that (they taste yummy).

[Kris]

I have asked multiple doctors and a nutritionist friend about this. Echoing that if you eat a healthy, varied diet you should be getting all your necessary stuff from that and you don’t need supplements or vitamins.

[JupiterGreen]

Partner and I have been vegetarian/vegan for several decades. We supplement liquid sublingual methylcobalamin Bs and they are fairly pricey but after researching the methyl versus the synthetic Bs, methyl seems worth it (also go with liquid sublingual for Bs). We also live in a polluted area so even though the sun shines and we take daily walks, Ds don't seem to get through the air pollution as well here so our doctors sometime put us on Ds. It doesn't seem to matter what Ds we take, I opt for a liquid over the counter my partner usually gets a prescription caplet and they both bring our Ds to within normal range when they are down. For probiotics, last time I researched there was only 1 brand that showed effectiveness in clinical studies (at the time I researched this) it was Garden of Life and you can only find it in refrigerated section. You don't need a daily probiotic, but there are times and for those times I recommend that brand. Not sure about the research, but we occasionally drink EmergenC during cold season (it seems to help). I had a free app (sorry I can't remember the name of it, but I'm sure there are a few) that tracked my food intake and also nutrients within that food, that was really helpful because it will show you what nutrients your diet is lacking (if any) then you can take action on that deficit.

Other than that, we don't do much and we are very healthy (good weight, no health issues/concerns, no meds etc). Maybe a multi works for others, IDK but that's been our experience. So my advice is get your blood checks at your yearly, maybe try an app that will track your nutrients and adjust accordingly, eat the rainbow, and stay active. Also love helps, stay in love :)

[dreaming]

You don’t hear much about Vitamin K2.  If you take D3, you should be taking K2.  It’s good for telling calcium to go to your bones, not your arteries. 

‘Taking Vitamin D3 with Vitamin K2 helps to ensure the calcium transported by the Vitamin D is absorbed by your bones where it's needed, rather than accumulating in deposits in your arteries.’

[Kris]

You don’t hear much about Vitamin K2.  If you take D3, you should be taking K2.  It’s good for telling calcium to go to your bones, not your arteries. 

‘Taking Vitamin D3 with Vitamin K2 helps to ensure the calcium transported by the Vitamin D is absorbed by your bones where it's needed, rather than accumulating in deposits in your arteries.’

Can you post the source for that quote, please? I’d like to read it, and potentially send it to DH.

[dreaming]

You don’t hear much about Vitamin K2.  If you take D3, you should be taking K2.  It’s good for telling calcium to go to your bones, not your arteries. 

‘Taking Vitamin D3 with Vitamin K2 helps to ensure the calcium transported by the Vitamin D is absorbed by your bones where it's needed, rather than accumulating in deposits in your arteries.’

Can you post the source for that quote, please? I’d like to read it, and potentially send it to DH.

I did a google search and that paragraph showed up. Not very technical but the source is here:

https://drlaraweightloss.com/2020/11/why-should-i-take-vitamin-d3-with-vitamin-k2/

I am a fan of Chris Kresser and he goes deeper on K2.

https://chriskresser.com/vitamin-k2-the-missing-nutrient/

A more technical read:

https://www.nutraceuticalbusinessreview.com/news/article_page/The_perfect_pair_how_vitamins_K2_and_D3_combine_to_support_health_and_well-being/202233

[Kris]

You don’t hear much about Vitamin K2.  If you take D3, you should be taking K2.  It’s good for telling calcium to go to your bones, not your arteries. 

‘Taking Vitamin D3 with Vitamin K2 helps to ensure the calcium transported by the Vitamin D is absorbed by your bones where it's needed, rather than accumulating in deposits in your arteries.’

Can you post the source for that quote, please? I’d like to read it, and potentially send it to DH.

I did a google search and that paragraph showed up. Not very technical but the source is here:

https://drlaraweightloss.com/2020/11/why-should-i-take-vitamin-d3-with-vitamin-k2/

I am a fan of Chris Kresser and he goes deeper on K2.

https://chriskresser.com/vitamin-k2-the-missing-nutrient/

A more technical read:

https://www.nutraceuticalbusinessreview.com/news/article_page/The_perfect_pair_how_vitamins_K2_and_D3_combine_to_support_health_and_well-being/202233

Hmmm.

Thanks.

[Ecky]

I'm healthy and eat a varied diet. I was curious and had some blood testing, and found my vitamin D levels were "borderline deficient" during the months where there is less sunshine and I have more clothing on. As a result, I take a combined chewable D + K2 supplement. Tastes great.

[Metalcat]

I take only supplements prescribed by my MD for a specific condition.

The supply chains for supplements are horrific in general, and the oversight is virtually non-existent. So the risks of not getting what you are spying for and getting contamination are very high, so I consider every supplement to be a risk.

If you are going to take a supplement, then research common issues within the supply chains, try to find companies that have higher standards, although this is hard because they can just claim that they do.

Source: a family member owns a very respected supplement company in the US, she's frequently on TV talking openly about the supply chain problems in her industry and why her products are superior...except they aren't. I also consult for a health supplement company, helping them navigate the legalities of what they can and can't say.

Some companies do this in blatantly egregious ways. I saw someone ask in a forum about collagen supplements, and I made a comment about how the collagen supply chain is filthy because the grades of meat don't stay separated in the connective tissue market. So the connective tissue of grade A beef gets mixed with the dog food grade, and that's what the collagen companies source.

A poster replied with '"that's why I only buy my collagen from X source" citing how their collagen sources are higher quality and ethically sourced. I look up the company and yep, their main marketing tactic is that their collagen comes from cleaner sources.

Their source: beef from the grasslands of Brazil.

Brazil...whose beef at the time was so unbelievably filthy that it was banned from almost everywhere in the world, even China! When China bans your beef, it's gotta be disgusting. But processed connective tissue wasn't banned, so that's what this company was marketing as their superior quality product.

People tend to think of supplements as benign and safe, but that should not be the default thinking.

[fraylock]

MD here.  I've published in the past on the utility or lack of utility of multivitamin and vitamin d supplementation in the past, though even so wouldn't consider myself an expert on this.  To answer the OP's question, "Are daily supplements like vitamins and minerals actually necessary?", the short answer is no.  In non-pregnant, healthy adults, there is no compelling evidence of benefit for multivitamin supplementation (EDIT - As another poster commented, women planning pregnancy should take folic acid daily in the year prior to conception).  There is a lot of data out there and I am happy to link sources, but what outcome measure are you looking for?

1) Here is a systematic review from the Journal of the American College of Cardiology examining the effects of multivitamin supplements and antioxidants on all cause mortality and found no benefit: https://pubmed.ncbi.nlm.nih.gov/29852980/

2) Here is a Cochrane Review (generally considered to be the premier meta-analysis group) examining the effects of antioxidants on mortality, finding no benefit: https://pubmed.ncbi.nlm.nih.gov/22419320/

3) If you're looking for cardiovascular disease rather than mortality, here's a systematic review from JAMA (probably the most respected medical journal in the US) which found no benefit for multivitamins or anti-oxidants: https://pubmed.ncbi.nlm.nih.gov/35727272/

Part of the challenge here is that supplement manufacturers are not bound by the same standards as drug manufacturers in backing up their claims, so you tend to get a lot of "miracle cure" marketing.  Supplement manufacturing is also not strictly regulated to the extent that you often are not getting what you think you are (wide variability in dose, etc).  Furthermore, there are LOTS of little, poor quality trials, especially retrospective cohorts or case control studies, which have drawn associations between specific vitamin supplements and some outcome or another.  However, the study design is not able to draw causal relationships and is vulnerable to substantial bias.  Frequently these do not live up to greater scrutiny when better randomized controlled trials are performed.  I am healthy and vegetarian and do not personally take any vitamins or supplements.  Eat well, exercise and be mindful.

[Fru-Gal]

Fish oil, when I remember to buy it. Other than that nothing.

[SquarePeg]

The consensus in this thread about supplements, i.e., that they're not necessary except in special circumstances as long as one's diet is good, matches with my take as well. I'd consider Dr. fraylock's post above to be "case closed" on the question.

So, not to hijack the thread, but how about a follow-on question?

What's a good way to get one's SO to believe the above, and cut down/cut out their supplement intake?

My SO has a literal cabinet full (the small cabinet above the sink, but still a cabinet) of various types of supplements, and takes a handful (again literally) at breakfast, lunch, and dinner.

My approach to date has been to leave it alone, but from a MMM perspective, it would be better to eliminate this unnecessary expense, right? Our diet, thanks to SO's cooking, is great, with lots of attention to macro- and micro-nutrient content.

And it also seems like a waste of time and energy keeping all these different things in stock, buying them from different stores, parceling out each day's doses, etc.

My SO is naturally reasonably frugal and has expressed some receptiveness to MMM ideas (a recent example is looking at the cable bill and suggesting some alternatives, including cord-cutting and moving to an internet-only plan). But I think the supplements thing is at least partly due to teachings from her mom when she grew up, which makes me worried that if I venture into this territory I could find myself in too deep, you know?

Anyway, any ideas?

[Metalcat]

The consensus in this thread about supplements, i.e., that they're not necessary except in special circumstances as long as one's diet is good, matches with my take as well. I'd consider Dr. fraylock's post above to be "case closed" on the question.

So, not to hijack the thread, but how about a follow-on question?

What's a good way to get one's SO to believe the above, and cut down/cut out their supplement intake?

My SO has a literal cabinet full (the small cabinet above the sink, but still a cabinet) of various types of supplements, and takes a handful (again literally) at breakfast, lunch, and dinner.

My approach to date has been to leave it alone, but from a MMM perspective, it would be better to eliminate this unnecessary expense, right? Our diet, thanks to SO's cooking, is great, with lots of attention to macro- and micro-nutrient content.

And it also seems like a waste of time and energy keeping all these different things in stock, buying them from different stores, parceling out each day's doses, etc.

My SO is naturally reasonably frugal and has expressed some receptiveness to MMM ideas (a recent example is looking at the cable bill and suggesting some alternatives, including cord-cutting and moving to an internet-only plan). But I think the supplements thing is at least partly due to teachings from her mom when she grew up, which makes me worried that if I venture into this territory I could find myself in too deep, you know?

Anyway, any ideas?

What is your actual concern with your spouse taking supplements.

It's not your place to decide for her what she does with her body. Don't try to convince her of anything. Even thinking that way is not particularly healthy.

However, sharing a concern is totally legitimate. You can say that you are concerned about the supply chain safety of supplements if that's your main concern. You can say that the waste of money is a concern.

What is your actual concern? Just be honest about that and allow her to decide if she wants to factor your concerns into her decisions. But at the end of the day, it's her decision.

That is, unless your main concern is financial and you have completely pooled finances. That is the only scenario in which you have real say over what she buys.

My DH and I have 100% pooled finances. We have no private money at all, so we have to both be okay with literally anything the other spends on. So if he decided he wanted to pick up a $200/mo collagen powder habit, then yeah, I would take major issue with that.

He has full bodily autonomy, but he doesn't have financial autonomy. That said, it doesn't mean I have magical veto and get to tell him what to do, it just means we have to find a way to agree.

So figure out what exactly your concern is, figure out if you have any real say in the decision, and then discuss with her accordingly.

But do not approach the situation from a place of trying to get her to behave in a way that you think is "correct." In fact, if it were me, I would start with trying to really understand why she thinks this "health" habit is important. Until you can get to a point where you respect why she feels this way, you won't be able to get her to respect your position.

[getsorted]

It's extremely difficult to obtain quality data on supplements and when they are helpful. The German government has done some of the best research on supplements and herbal medicines and even that is pretty small in scale. But in general, there isn't enough money in selling them to fund full clinical trials. But there IS enough money in them for vast amounts of spin and pseudoscience!

There are some supplements with some evidence that they treat one condition or another, but that's really all you're going to get, and you will have to sort through mountains of bullshit.

I have had multiple vitamin deficiencies diagnosed by an ordinary doctor; apparently I just don't absorb my food well (and some chronic conditions play a role). Clinical vitamin D deficiency is horrible-- your bones hurt. Iron deficiency and B-vitamin deficiencies are similarly pretty obvious. I take all of those, plus calcium/magnesium/zinc because I generally feel better when I do. But if you are wildly healthy, why bother?

[Loretta]

I had major gastro surgery and need to take a lot of supplements due to malabsorption.  I mostly do subscribe and save with AMZ. 

[dblaace]

You don’t hear much about Vitamin K2.  If you take D3, you should be taking K2.  It’s good for telling calcium to go to your bones, not your arteries. 

‘Taking Vitamin D3 with Vitamin K2 helps to ensure the calcium transported by the Vitamin D is absorbed by your bones where it's needed, rather than accumulating in deposits in your arteries.’

Can you post the source for that quote, please? I’d like to read it, and potentially send it to DH.

I did a google search and that paragraph showed up. Not very technical but the source is here:

https://drlaraweightloss.com/2020/11/why-should-i-take-vitamin-d3-with-vitamin-k2/

I am a fan of Chris Kresser and he goes deeper on K2.

https://chriskresser.com/vitamin-k2-the-missing-nutrient/

A more technical read:

https://www.nutraceuticalbusinessreview.com/news/article_page/The_perfect_pair_how_vitamins_K2_and_D3_combine_to_support_health_and_well-being/202233

I get my K2 from eating natto every other day.

[fraylock]

The consensus in this thread about supplements, i.e., that they're not necessary except in special circumstances as long as one's diet is good, matches with my take as well. I'd consider Dr. fraylock's post above to be "case closed" on the question.

So, not to hijack the thread, but how about a follow-on question?

What's a good way to get one's SO to believe the above, and cut down/cut out their supplement intake?

My SO has a literal cabinet full (the small cabinet above the sink, but still a cabinet) of various types of supplements, and takes a handful (again literally) at breakfast, lunch, and dinner.

My approach to date has been to leave it alone, but from a MMM perspective, it would be better to eliminate this unnecessary expense, right? Our diet, thanks to SO's cooking, is great, with lots of attention to macro- and micro-nutrient content.

And it also seems like a waste of time and energy keeping all these different things in stock, buying them from different stores, parceling out each day's doses, etc.

My SO is naturally reasonably frugal and has expressed some receptiveness to MMM ideas (a recent example is looking at the cable bill and suggesting some alternatives, including cord-cutting and moving to an internet-only plan). But I think the supplements thing is at least partly due to teachings from her mom when she grew up, which makes me worried that if I venture into this territory I could find myself in too deep, you know?

Anyway, any ideas?

What is your actual concern with your spouse taking supplements.

It's not your place to decide for her what she does with her body. Don't try to convince her of anything. Even thinking that way is not particularly healthy.

However, sharing a concern is totally legitimate. You can say that you are concerned about the supply chain safety of supplements if that's your main concern. You can say that the waste of money is a concern.

What is your actual concern? Just be honest about that and allow her to decide if she wants to factor your concerns into her decisions. But at the end of the day, it's her decision.

That is, unless your main concern is financial and you have completely pooled finances. That is the only scenario in which you have real say over what she buys.

My DH and I have 100% pooled finances. We have no private money at all, so we have to both be okay with literally anything the other spends on. So if he decided he wanted to pick up a $200/mo collagen powder habit, then yeah, I would take major issue with that.

He has full bodily autonomy, but he doesn't have financial autonomy. That said, it doesn't mean I have magical veto and get to tell him what to do, it just means we have to find a way to agree.

So figure out what exactly your concern is, figure out if you have any real say in the decision, and then discuss with her accordingly.

But do not approach the situation from a place of trying to get her to behave in a way that you think is "correct." In fact, if it were me, I would start with trying to really understand why she thinks this "health" habit is important. Until you can get to a point where you respect why she feels this way, you won't be able to get her to respect your position.

I agree with Malcat.  Best not to give advice unless asked.  For the most part, there is not much risk for harm by taking multivitamins/most supplements, except for expense.  Who am I/who are we to argue if someone takes a harmless supplement and feels better.  I'm sure they are perfectly capable of making decisions for themselves and I would suggest leaving it at that.  I would never chastise someone for taking multivitamins, even in cases I feel they are not necessary, and there are exceptions to every rule.  If, however, someone asks for my advice, I'm happy to share what I know, though I'm quick to admit that there's a lot out there that I don't know.

[Paul der Krake]

In the spirit of let's try everything, nothing to lose, I bought this a few years ago when I was having unexplained chronic pain:
https://www.costco.com/kirkland-signature-daily-multi%2C-500-tablets.product.11491625.html

I still take them. Not every day as I often forget, but the container is slowly but surely getting drained. In 3-6 months it will be empty and I will likely buy it again.

I have absolutely zero evidence that doing so has made me healthier, or prevented any other problem. But the cost is beyond negligible, we're talking $5-10/year. If there is any chance this could help cover any unknown deficiencies or improve overall athletic performance, even at the slimmest of margins, that seems like a net positive. If nothing else, I see it as a not-quite-daily ritualistic reminder that I only have one body, it's not getting any younger, and I must strive to take care of it as best I can.

[Metalcat]

I agree with Malcat.  Best not to give advice unless asked.  For the most part, there is not much risk for harm by taking multivitamins/most supplements, except for expense.  Who am I/who are we to argue if someone takes a harmless supplement and feels better.  I'm sure they are perfectly capable of making decisions for themselves and I would suggest leaving it at that.  I would never chastise someone for taking multivitamins, even in cases I feel they are not necessary, and there are exceptions to every rule.  If, however, someone asks for my advice, I'm happy to share what I know, though I'm quick to admit that there's a lot out there that I don't know.

Just to be absolutely clear, since you say you are agreeing with me, I DO NOT consider supplements to be benign and "generally safe." I wrote a long post about it earlier in the thread.

Supplements are highly unregulated and untested. When they are tested, which is rare, often horrible things are found in them, and when that happens, there are few regulatory levers to even get the products off of the shelves.

The vast majority of these products are made in China and India, and with no regulation on how they are manufactured, they can contain literally anything.

It's often a lot easier and cheaper to just throw basement-lab grade pharmaceuticals into a pill than to produce a high quality supplement, plus then the supplement actually "works."

Many men's herbal supplements have been shown to contain basement-lab grade Viagra/Cialis, or Propecia. Not too long ago two popular lines of pre-workout were show to contain meth.

And that's not even getting into the contamination issues.

Supplements should not be considered to be benign by default. They should actually be considered to be dirty by default.

[Moonwaves]

I agree with Malcat.  Best not to give advice unless asked.  For the most part, there is not much risk for harm by taking multivitamins/most supplements, except for expense.  Who am I/who are we to argue if someone takes a harmless supplement and feels better.  I'm sure they are perfectly capable of making decisions for themselves and I would suggest leaving it at that.  I would never chastise someone for taking multivitamins, even in cases I feel they are not necessary, and there are exceptions to every rule.  If, however, someone asks for my advice, I'm happy to share what I know, though I'm quick to admit that there's a lot out there that I don't know.

Just to be absolutely clear, since you say you are agreeing with me, I DO NOT consider supplements to be benign and "generally safe." I wrote a long post about it earlier in the thread.

Supplements are highly unregulated and untested. When they are tested, which is rare, often horrible things are found in them, and when that happens, there are few regulatory levers to even get the products off of the shelves.

The vast majority of these products are made in China and India, and with no regulation on how they are manufactured, they can contain literally anything.

It's often a lot easier and cheaper to just throw basement-lab grade pharmaceuticals into a pill than to produce a high quality supplement, plus then the supplement actually "works."

Many men's herbal supplements have been shown to contain basement-lab grade Viagra/Cialis, or Propecia. Not too long ago two popular lines of pre-workout were show to contain meth.

And that's not even getting into the contamination issues.

Supplements should not be considered to be benign by default. They should actually be considered to be dirty by default.

And there are some vitamins that can be detrimental to your health if you take too much, aren't there? I seem to remember by boss was taking some combination of supplements a couple of years ago that ended up with him having way too much of something (vitamin A? vitamin D? I can't really remember, sorry). So mixing and matching lots of different supplements can be tricky.

In Ireland (and maybe some other more northern countries?) it is increasingly recommended that all adults supplement with vitamin D. I don't live there anymore but am from there and have been tested and had to take prescription supplements before. The look on the German doctor's face when he saw how little I had (may 5 or 10, when 20 is the minimum you're supposed to have or something like that) in the first test was kind of amusing actually. These days, I do still take it every day but not the high-dose prescription stuff, just what you can get in the supermarket.

I also currently take magnesium, as advised by a doctor last year. I've been doing a lot more exercises and was getting muscle twitches and cramps and it helped deal with that.

I have to admit, the only reason I take these supplements regularly is because I now also have several other medications that I have to take every day. Since I now have a pillbox for mornings and another for evenings, I'm much better about actually taking them regularly.

[Metalcat]

I agree with Malcat.  Best not to give advice unless asked.  For the most part, there is not much risk for harm by taking multivitamins/most supplements, except for expense.  Who am I/who are we to argue if someone takes a harmless supplement and feels better.  I'm sure they are perfectly capable of making decisions for themselves and I would suggest leaving it at that.  I would never chastise someone for taking multivitamins, even in cases I feel they are not necessary, and there are exceptions to every rule.  If, however, someone asks for my advice, I'm happy to share what I know, though I'm quick to admit that there's a lot out there that I don't know.

Just to be absolutely clear, since you say you are agreeing with me, I DO NOT consider supplements to be benign and "generally safe." I wrote a long post about it earlier in the thread.

Supplements are highly unregulated and untested. When they are tested, which is rare, often horrible things are found in them, and when that happens, there are few regulatory levers to even get the products off of the shelves.

The vast majority of these products are made in China and India, and with no regulation on how they are manufactured, they can contain literally anything.

It's often a lot easier and cheaper to just throw basement-lab grade pharmaceuticals into a pill than to produce a high quality supplement, plus then the supplement actually "works."

Many men's herbal supplements have been shown to contain basement-lab grade Viagra/Cialis, or Propecia. Not too long ago two popular lines of pre-workout were show to contain meth.

And that's not even getting into the contamination issues.

Supplements should not be considered to be benign by default. They should actually be considered to be dirty by default.

And there are some vitamins that can be detrimental to your health if you take too much, aren't there? I seem to remember by boss was taking some combination of supplements a couple of years ago that ended up with him having way too much of something (vitamin A? vitamin D? I can't really remember, sorry). So mixing and matching lots of different supplements can be tricky.

In Ireland (and maybe some other more northern countries?) it is increasingly recommended that all adults supplement with vitamin D. I don't live there anymore but am from there and have been tested and had to take prescription supplements before. The look on the German doctor's face when he saw how little I had (may 5 or 10, when 20 is the minimum you're supposed to have or something like that) in the first test was kind of amusing actually. These days, I do still take it every day but not the high-dose prescription stuff, just what you can get in the supermarket.

I also currently take magnesium, as advised by a doctor last year. I've been doing a lot more exercises and was getting muscle twitches and cramps and it helped deal with that.

I have to admit, the only reason I take these supplements regularly is because I now also have several other medications that I have to take every day. Since I now have a pillbox for mornings and another for evenings, I'm much better about actually taking them regularly.

Yep, I take magnesium daily as well, as prescribed by one of my MDs. But I am particular about sourcing it.

Again, I'm not against taking supplements, I'm against people perceiving them as harmless and safe by default.

They are not.

[Raenia]

@Malcat, do you have any advice on how to find a safe and reliable source?  I'm currently on a prenatal vitamin (trying to get pregnant), and my doctor told me anything on the shelf at CVS is fine so I just bought the store brand.  Is it enough to find one made in the USA/Canada/Europe, or should I be going deeper than that, and if so how do I find that information?

ETA: I checked the bottle and it says made in USA with imported ingredients.

[Metalcat]

@Malcat, do you have any advice on how to find a safe and reliable source?  I'm currently on a prenatal vitamin (trying to get pregnant), and my doctor told me anything on the shelf at CVS is fine so I just bought the store brand.  Is it enough to find one made in the USA/Canada/Europe, or should I be going deeper than that, and if so how do I find that information?

ETA: I checked the bottle and it says made in USA with imported ingredients.

lol, then your MD knows very little about vitamin and supplement supply chains. That's normal, I wouldn't expect them to know, they're not taught anything about it, I wasn't. I only know from working in the industry.

Many commonly used prenatal vitamins have been tested and shown unacceptable heavy metal contamination (20/51 common brands sampled in a Canadian study from 2018).

Thorne Research is generally accepted as one of the gold standard brands for supply chain and product safety. NSF certification is a common indicator that products are made to a higher standard. But each product has to be certified, some brands only get some products certified. Also, having every product tested is insanely expensive, so the brands that do will be very expensive.

It is tricky to navigate.

That's why I emphasize so much that they shouldn't be considered default safe. You kind of have to jump through hoops to even figure out how to evaluate if a product is likely safe and actually contains what it says it does.

I used to think people who said these things were fear mongering and exaggerating, but then I go exposure to the industry and was like fuuuuuuuuuck.

Supplements aren't food and they aren't drugs, so they're not regulated like either. One of the products I consult on is a cannabis product, and the regulatory hoops the company has to jump through are enormous. The non cannabis products? Nothing. Nothing at all. No one has any mandate to review or test our product safety or claims. No one. We can just make it and sell it, with no regulation whatsoever. As long as we don't poison anyone too bad to the point that they can prove that we knowingly did so/did so through criminal negligence, then we can produce and sell whatever we want. If we bake it into a food? Oof, massive oversight and regulations, because that's food. But an ingestible supplement??? No problem, not food, not a drug, no rules.

And that's here in Canada where the laws are stricter than the US.

[Raenia]

@Malcat, do you have any advice on how to find a safe and reliable source?  I'm currently on a prenatal vitamin (trying to get pregnant), and my doctor told me anything on the shelf at CVS is fine so I just bought the store brand.  Is it enough to find one made in the USA/Canada/Europe, or should I be going deeper than that, and if so how do I find that information?

ETA: I checked the bottle and it says made in USA with imported ingredients.

lol, then your MD knows very little about vitamin and supplement supply chains. That's normal, I wouldn't expect them to know, they're not taught anything about it, I wasn't. I only know from working in the industry.

Many commonly used prenatal vitamins have been tested and shown unacceptable heavy metal contamination (20/51 common brands sampled in a Canadian study from 2018).

Thorne Research is generally accepted as one of the gold standard brands for supply chain and product safety. NSF certification is a common indicator that products are made to a higher standard. But each product has to be certified, some brands only get some products certified. Also, having every product tested is insanely expensive, so the brands that do will be very expensive.

It is tricky to navigate.

That's why I emphasize so much that they shouldn't be considered default safe. You kind of have to jump through hoops to even figure out how to evaluate if a product is likely safe and actually contains what it says it does.

I used to think people who said these things were fear mongering and exaggerating, but then I go exposure to the industry and was like fuuuuuuuuuck.

Supplements aren't food and they aren't drugs, so they're not regulated like either. One of the products I consult on is a cannabis product, and the regulatory hoops the company has to jump through are enormous. The non cannabis products? Nothing. Nothing at all. No one has any mandate to review or test our product safety or claims. No one. We can just make it and sell it, with no regulation whatsoever. As long as we don't poison anyone too bad to the point that they can prove that we knowingly did so/did so through criminal negligence, then we can produce and sell whatever we want. If we bake it into a food? Oof, massive oversight and regulations, because that's food. But an ingestible supplement??? No problem, not food, not a drug, no rules.

And that's here in Canada where the laws are stricter than the US.

Thanks for the recommendations on Thorne and NSF, I'll check for those next time I'm at the pharmacy or order online if needed - I suspect it will be needed.  I'm definitely willing to spend more to avoid heavy metals and all the other serious issues.

I work in an FDA regulated field, so I'm familiar with the regulation gap on supplements and "naturals" - a few years ago my company purchased a "naturals" brand and has been trying to drag them up to snuff, kicking and screaming all the way that "it's not legally required!"  I haven't been closely involved in those projects, though, so I hadn't seen firsthand how bad it is, but I've heard enough stories second and third-hand to convince me to advise everyone I know not to buy any supplements, not just this brand.  And I bet this brand is better than most, which is not a compliment!  They mostly objected to the amount of work required, rather than being concerned the products would fail more rigorous requirements.

Also not surprised my doctor didn't know to give any better advice, there's so much they need to know that if they tried to keep up with everything, there'd be no time to see patients!  They've been taught that a prenatal supplement is needed to get folic acid and iron, so that's the advice they repeat back, no further investigation needed.

[E.T.]

@Malcat , do you have an opinion on USP certification? I'm assuming not since you're in Canada but that version of third party testing is usually easier to find on vitamins here in the U.S.

I like the free app Cronometer for tracking nutritional info. I use the app and a kitchen scale to make sure I get the recommended daily amounts of key vitamins though my food. It's a very good source if you're someone that cooks regularly. Most ingredients are available with detailed nutritional info from the NCCDB (Nutrition Coordinating Center Food & Nutrient Database) which is lab analyzed data curated by the University of Minnesota. They have other data sets they pull from too and I think it's far preferable to the other food diary apps which have user inputted data.

I agree with previous posters that unless you've been prescribed a supplement for a specific condition, it's best to avoid taking them. I can't point you to all the scientific articles I read but I spent hours diving into the topic last year and came to the same conclusion that the risks of "dirty" or incorrect supplements far outweighed the largely unproven benefits.

[ChickenStash]

I do occasionally go for a multivitamin to cover over when I may not be eating the best, but I suspect it is more a placebo than anything else. The only thing I do take regularly is a vitamin D supplement on the advice of my PCP. She ran a blood test and found I was a fair bit below the low end of the normal range so she wanted me to add 2000IU to keep things in check.

[Fru-Gal]

The thing @Malcat said about cheap drugs being included is really eye-opening. It reminds me of the time my husband bought into that nutritional supplement scam, I can’t member what it’s called. But basically it was all these different shakes and pills you had to take and one of them was phentermine. And he started shedding weight like a maniac and acting jittery. So I looked up the ingredients & realized that he was taking phentermine, which soon became illegal.

[getsorted]

The thing @Malcat said about cheap drugs being included is really eye-opening. It reminds me of the time my husband bought into that nutritional supplement scam, I can’t member what it’s called. But basically it was all these different shakes and pills you had to take and one of them was phentermine. And he started shedding weight like a maniac and acting jittery. So I looked up the ingredients & realized that he was taking phentermine, which soon became illegal.

I have a friend who hawks a multilevel marketed weight-loss drink/cure-all elixir that contains several stimulants, including a caffeine analogue. It also includes grapefruit seed extract, which can interfere with birth control and a large number of other medicines. I'm pretty sure that's how they ended up with a surprise pregnancy.

[Metalcat]

The thing @Malcat said about cheap drugs being included is really eye-opening. It reminds me of the time my husband bought into that nutritional supplement scam, I can’t member what it’s called. But basically it was all these different shakes and pills you had to take and one of them was phentermine. And he started shedding weight like a maniac and acting jittery. So I looked up the ingredients & realized that he was taking phentermine, which soon became illegal.

Yeah, and that's when the supplement actually contains what it says.

[Metalcat]

@Malcat , do you have an opinion on USP certification?

USP is nowhere near as rigorous, but it's better than the huge amount of totally fake labels that supplement companies use to look like they undergo testing or certification, labels that say "verified," etc.

Then there are the products that just go ahead and print UPS on their labels without submitting for testing. A lot of supplement companies are set up so that they can be quickly collapsed if they get caught doing anything sketchy. Then the manufacturer just launches a new brand and sells the same shitty product.

In my work with the health supplement company, I've ended up reporting several competitors for printing their labels with the "certified organic" symbol despite them not having submitted for certification as organic.

But it's like whackamole, they're Chinese companies, so when they get reported, they just disappear, and another one pops up in their place.

[wenchsenior]

I agree with Malcat.  Best not to give advice unless asked.  For the most part, there is not much risk for harm by taking multivitamins/most supplements, except for expense.  Who am I/who are we to argue if someone takes a harmless supplement and feels better.  I'm sure they are perfectly capable of making decisions for themselves and I would suggest leaving it at that.  I would never chastise someone for taking multivitamins, even in cases I feel they are not necessary, and there are exceptions to every rule.  If, however, someone asks for my advice, I'm happy to share what I know, though I'm quick to admit that there's a lot out there that I don't know.

Just to be absolutely clear, since you say you are agreeing with me, I DO NOT consider supplements to be benign and "generally safe." I wrote a long post about it earlier in the thread.

Supplements are highly unregulated and untested. When they are tested, which is rare, often horrible things are found in them, and when that happens, there are few regulatory levers to even get the products off of the shelves.

The vast majority of these products are made in China and India, and with no regulation on how they are manufactured, they can contain literally anything.

It's often a lot easier and cheaper to just throw basement-lab grade pharmaceuticals into a pill than to produce a high quality supplement, plus then the supplement actually "works."

Many men's herbal supplements have been shown to contain basement-lab grade Viagra/Cialis, or Propecia. Not too long ago two popular lines of pre-workout were show to contain meth.

And that's not even getting into the contamination issues.

Supplements should not be considered to be benign by default. They should actually be considered to be dirty by default.

And there are some vitamins that can be detrimental to your health if you take too much, aren't there? I seem to remember by boss was taking some combination of supplements a couple of years ago that ended up with him having way too much of something (vitamin A? vitamin D? I can't really remember, sorry). So mixing and matching lots of different supplements can be tricky.

In Ireland (and maybe some other more northern countries?) it is increasingly recommended that all adults supplement with vitamin D. I don't live there anymore but am from there and have been tested and had to take prescription supplements before. The look on the German doctor's face when he saw how little I had (may 5 or 10, when 20 is the minimum you're supposed to have or something like that) in the first test was kind of amusing actually. These days, I do still take it every day but not the high-dose prescription stuff, just what you can get in the supermarket.

I also currently take magnesium, as advised by a doctor last year. I've been doing a lot more exercises and was getting muscle twitches and cramps and it helped deal with that.

I have to admit, the only reason I take these supplements regularly is because I now also have several other medications that I have to take every day. Since I now have a pillbox for mornings and another for evenings, I'm much better about actually taking them regularly.

For sure.  I got neurotoxicity from excess B6 (by taking a standard B-complex 2x per week for a year or so); luckily, my endo figured it out and tested me, and I stopped before permanent damage occurred. Also, if you have a tendency or family tendency to kidney stones, taking a lot of otc calcium and/or vit D can increase the likelihood of developing them. That's just off the top of my head, but there's absolutely risks to taking too much of these.

[getsorted]

Also, if you have a tendency or family tendency to kidney stones, taking a lot of otc calcium and/or vit D can increase the likelihood of developing them. That's just off the top of my head, but there's absolutely risks to taking too much of these.

Are you sure? I only ask because I knew a urologist who did research into this. He found that for kidney stone patients with vitamin D deficiency (which was nearly all of them), normalizing their serum vitamin D made kidney stones less likely to recur. He used to come into my work and interrogate us all to make sure we were taking lots of vitamin D.

[SquarePeg]

Seems like the convo has mostly moved on from my question, but to be clear, I'm not interested in making any demands of or belittling my SO about the supplements. I just think it's a waste -- of money, time, and energy. But I think if I just baldly throw that on the table I'm going to get some pushback. And yes, that's their right, so don't worry, I'm not going to force anything.

Anyway, perhaps relevant for this thread, especially since there are some posts about Vitamin D:

Is it time to stop taking vitamin D?
https://www.seattletimes.com/life/wellness/is-it-time-to-stop-taking-vitamin-d/

Paywall circumventing link:
https://archive.ph/dky6i

Some quotes:

As potential links between vitamin D and one health condition after another broke, the link between vitamin D and bone health still seemed certain. Now, data from the vitamin D and Omega-3 Trial published July 28 in The New England Journal of Medicine knocks down even that last bit of nutritional “certainty” — participants randomly assigned to take 2,000 IU (international units) of vitamin D3 per day were no less likely to suffer a bone fracture than those taking a placebo pill.

VITAL researchers previously found that vitamin D did not reduce the risk of developing cancer, having a heart attack or stroke, dying from cardiovascular disease, suffering a fall or experiencing depression. It also did not affect body fat. The vitamin D and Type 2 Diabetes randomized controlled trial found that after 2.5 years, taking 4,000 IU of vitamin D3 daily was no better than a placebo at preventing diabetes in high-risk adults.

Ott agrees there’s no reason for most people to be tested. However, she does think that in Seattle we may still need some supplemental vitamin D, but only in the 400-1,000 IU range. Our skin makes vitamin D when it’s exposed to sunlight, which those of us in northern climates get less of. “If you happen to have a bunch of 2,000 IU supplements, take them every few days,” she said.

Ott cautions that some of the big U.S. labs that process vitamin D tests say that “normal” levels are between 30-100 nanograms per deciliter, whereas the rest of the world says normal levels are between 20-50 ng/dL. There’s been a lot of controversy about that, including accusations of financial conflicts of interest. “It’s an expensive test and the labs are making a lot of money,” she said. “When vitamin D is low, everything they say about it is true. It’s just that the level of what’s low isn’t 20, it’s more like 10. If your levels are around 20-30, you’re probably going to be pretty safe.”

[Metalcat]

Seems like the convo has mostly moved on from my question, but to be clear, I'm not interested in making any demands of or belittling my SO about the supplements. I just think it's a waste -- of money, time, and energy. But I think if I just baldly throw that on the table I'm going to get some pushback. And yes, that's their right, so don't worry, I'm not going to force anything.

To be clear, I wasn't suspecting that you were going to force anything, make demands, or be belittling of her.

I was recommending that you not approach it from a position of trying to modify her behavior and instead approach it from a place of trying your best to communicate your own concerns in a way that's honest, but respectful.

I get A LOT of people asking me "how do I get my spouse to..." and I always push them to see that that question in and of itself isn't very healthy compared to 'how do I effectively communicate my concerns to my spouse?"

You *can* actually badly come out and express to your wife your concerns about the cost, effectiveness, and safety of supplements. The key is finding a way to be honest and genuinely respectful and caring in your delivery.

So yeah, you're not going to get very far with 'oy! Dumbfuck! Stop throwing useless supplements down your stupid gob because of dumb shit your mother says! She's a stupid cow! It's a waste of money and makes you seem gullible and dumb"

Obviously a joke, but you get the point.

But you can broach it by taking a keen interest. You could say "I've been reading about how unregulated the supplement industry is and I wanted to talk to you about all of the supplements you take. It made me feel a bit concerned, but first I want to really understand why they're important to you, because I'm not sure I fully get it, and you invest a lot in them so they must be quite important to you. I would like to understand better why."

Or something along those lines.

First try to respect her needs, which means fully understanding the needs she's trying to meet with the behaviour you have concerns about. Then try to be a collaborator with her to best meet those needs.

[SquarePeg]

To be clear, I wasn't suspecting that you were going to force anything, make demands, or be belittling of her.

Okay, fair enough, but you did say this:

It's not your place to decide for her what she does with her body. Don't try to convince her of anything. Even thinking that way is not particularly healthy.

And later used the phrase "bodily autonomy" which feels to me to be a pretty heavily loaded concept in this context. Also, another poster referred to "chastising someone," so I wanted to clear the record: my SO will make the decision about what supplements they purchase and consume.

Anyway, I agree with your overall thesis: honesty and respect are the best policy. I think I need to find a way to broach the topic without being phony or seeming manipulative. She's way too smart for that.

[Metalcat]

To be clear, I wasn't suspecting that you were going to force anything, make demands, or be belittling of her.

Okay, fair enough, but you did say this:

It's not your place to decide for her what she does with her body. Don't try to convince her of anything. Even thinking that way is not particularly healthy.

And later used the phrase "bodily autonomy" which feels to me to be a pretty heavily loaded concept in this context. Also, another poster referred to "chastising someone," so I wanted to clear the record: my SO will make the decision about what supplements they purchase and consume.

Anyway, I agree with your overall thesis: honesty and respect are the best policy. I think I need to find a way to broach the topic without being phony or seeming manipulative. She's way too smart for that.

I'm a health professional. Talking about bodily autonomy is my normal. It's meant to be accurate language, not loaded language.

It's a huge part of my job to advise people what to do without trying to make decisions for them. It's an important distinction that I see many couples struggle with.

I stand by what I said. I don't think it's healthy for one partner to operate from a position of trying to convince the other what to do with their own body. Instead, I think it's healthiest to approach it from the stance of sharing your concern, opinion, perspective, knowledge, etc, etc.

But the goal should be to support that person in making the best decisions for themselves, not trying to "get them" to behave your way, aka the "superior" way.

Now that said, it's her obligation, as a good partner, to care about what you have to say.

[wenchsenior]

Also, if you have a tendency or family tendency to kidney stones, taking a lot of otc calcium and/or vit D can increase the likelihood of developing them. That's just off the top of my head, but there's absolutely risks to taking too much of these.

Are you sure? I only ask because I knew a urologist who did research into this. He found that for kidney stone patients with vitamin D deficiency (which was nearly all of them), normalizing their serum vitamin D made kidney stones less likely to recur. He used to come into my work and interrogate us all to make sure we were taking lots of vitamin D.

Could be newer research...I was being advised about 10 years ago, but to be clear, it was otc supplements at high doses that were of concern, not lower dose or occasional supplementation. At that time, no risk from calcium or D from natural sources was id'd...it was specifically high dose supplements.

ETA: Apparently, newest research is inconclusive but still of concern.  https://pubmed.ncbi.nlm.nih.gov/34959915/

[Raenia]

To be clear, I wasn't suspecting that you were going to force anything, make demands, or be belittling of her.

Okay, fair enough, but you did say this:

It's not your place to decide for her what she does with her body. Don't try to convince her of anything. Even thinking that way is not particularly healthy.

And later used the phrase "bodily autonomy" which feels to me to be a pretty heavily loaded concept in this context. Also, another poster referred to "chastising someone," so I wanted to clear the record: my SO will make the decision about what supplements they purchase and consume.

Anyway, I agree with your overall thesis: honesty and respect are the best policy. I think I need to find a way to broach the topic without being phony or seeming manipulative. She's way too smart for that.

I'm a health professional. Talking about bodily autonomy is my normal. It's meant to be accurate language, not loaded language.

It's a huge part of my job to advise people what to do without trying to make decisions for them. It's an important distinction that I see many couples struggle with.

I stand by what I said. I don't think it's healthy for one partner to operate from a position of trying to convince the other what to do with their own body. Instead, I think it's healthiest to approach it from the stance of sharing your concern, opinion, perspective, knowledge, etc, etc.

But the goal should be to support that person in making the best decisions for themselves, not trying to "get them" to behave your way, aka the "superior" way.

Now that said, it's her obligation, as a good partner, to care about what you have to say.

And just to address the bolded, I'll add something Malcat has made clear in many other threads on these forums - the trick is to be genuinely concerned and genuinely curious about what drives her behavior.  You won't come off as phony and manipulative if you actually aren't secretly being manipulative.  If you can't approach her with genuine interest in why this is important to her, not to persuade but to understand, then you shouldn't try to approach the issue at all.

[Metalcat]

To be clear, I wasn't suspecting that you were going to force anything, make demands, or be belittling of her.

Okay, fair enough, but you did say this:

It's not your place to decide for her what she does with her body. Don't try to convince her of anything. Even thinking that way is not particularly healthy.

And later used the phrase "bodily autonomy" which feels to me to be a pretty heavily loaded concept in this context. Also, another poster referred to "chastising someone," so I wanted to clear the record: my SO will make the decision about what supplements they purchase and consume.

Anyway, I agree with your overall thesis: honesty and respect are the best policy. I think I need to find a way to broach the topic without being phony or seeming manipulative. She's way too smart for that.

I'm a health professional. Talking about bodily autonomy is my normal. It's meant to be accurate language, not loaded language.

It's a huge part of my job to advise people what to do without trying to make decisions for them. It's an important distinction that I see many couples struggle with.

I stand by what I said. I don't think it's healthy for one partner to operate from a position of trying to convince the other what to do with their own body. Instead, I think it's healthiest to approach it from the stance of sharing your concern, opinion, perspective, knowledge, etc, etc.

But the goal should be to support that person in making the best decisions for themselves, not trying to "get them" to behave your way, aka the "superior" way.

Now that said, it's her obligation, as a good partner, to care about what you have to say.

And just to address the bolded, I'll add something Malcat has made clear in many other threads on these forums - the trick is to be genuinely concerned and genuinely curious about what drives her behavior.  You won't come off as phony and manipulative if you actually aren't secretly being manipulative.  If you can't approach her with genuine interest in why this is important to her, not to persuade but to understand, then you shouldn't try to approach the issue at all.

DING! DING! DING! We have a winner.

It's not about not "coming off" as manipulative. It's definitely not about outsmarting a smart person either. It's about just not being manipulative.

IMO, you're better off saying "y'know what, I've always believed that supplements are a huge, useless, waste of money, and I don't get why you feel the need to take them, but I really want to try and understand, since it's obviously important to you and I care about what's important to you."

Always seek to understand before seeking to be heard.