This month, Dr. Amy Whittington, Trilogy’s naturopathic physician, answers your top five supplementation questions.

Should I take a multiple vitamin?
The goal of a multiple vitamin is to “top off the tank” for any of the main nutrients that you might be missing. Most nutrients in the body cannot be measured accurately (some popular testing shows serum levels, but not the more important tissue levels). Multiples are formulated by assuming what our collective deficiencies might be. For this reason, most people don’t see a therapeutic benefit, but might be getting a preventive advantage. The only exception is for those who are suffering from a lack of energy, for which the B vitamins in the multiple can give a boost. I think of a multiple vitamin like an umbrella policy. If you have room in your budget and your pillbox, then it is worth consideration. If not, I often deem a multiple as less important than other supplementation for my patients.

What is physician/pharmaceutical grade supplementation?
Supplements are considered physician or pharmaceutical grade only when they meet the highest standards. These supplements are typically found only at your doctor’s office or compounding pharmacy. These nutrients, herbs, and homeopathic remedies are third-party tested for bioavailability, efficacy, hypo-allergenicity, and to ensure that bottle claims for dosages are correct and that no other components are present. Perhaps the most relevant discrepancy between physician grade and over-the-counter (OTC) is the amount of therapeutic ingredients. Often times OTC or multi-level-marketed supplements have such a low amount of active ingredients that they are therapeutically ineffective. This is to reduce liability for the company who makes the supplement. Physicians assume the prescribing liability for physician-grade supplements, allowing higher dosages. Most of the time, you will find that physician grade are actually more cost-effective because they are formulated to therapeutic values (you don’t need to take as many to get to the proper dosage). There certainly are some good OTC options, but it can be difficult to tell the good from the bad. In general, be suspicious of “proprietary blends” and other non-specific claims. Particularly when choosing a supplement to address a specific concern, try to stick to physician-grade so that you are prescribed, and using, the proper dosage.

Should I take calcium, and if so, how much?
The goals of calcium supplementation have changed a few times over the last few years based on new research. Results show that a decreased calcium intake compared to recommendations in the past, along with increased amounts of bone-building co-factors, can lead to better bone-strength outcomes. Calcium supplementation should be considered for those with osteoporosis, osteopenia, or with risk factors for bone loss, such as family history, small frame, or use of certain medications. Calcium in the form of citrate, malate, or aspartate has better absorption than calcium carbonate. It is now most commonly prescribed in dosages from 400-900mg daily, divided into no more than 500mg at any one time. Calcium should also typically be prescribed with Vitamin D (at a dosage depending on your levels), and magnesium (usually 100-200mg). Other co-factors such as boron, strontium, and Vitamin K2 (especially as MK4) should also be strongly considered to decrease bone loss and improve bone building. Having an integrative physician guide you in proper supplementation can lead to better results and even an improvement in DEXA (bone health) scans.

What should my fish oil dosage be?
Perhaps the most well-studied supplement, fish oil is a very effective anti-inflammatory that is beneficial for heart, brain, skin, joint health and more. Nearly everyone should consider fish oil for its omega-3 content, although it does have some blood-thinning interactions, so you must be monitored if you have a coagulation disorder or if you are taking blood thinners. Fish oils are not all the same, with the biggest differences being where they are sourced and their strength. It is important that you take fish oil that is responsibly sourced from clean waters, so that the mercury content is less than 10ppm (parts per million). For maintenance and prevention, the daily dosage should be 1200-1500mg of the most active omega-3s, EPA and DHA. The ingredient list will show total omegas, DHA, and EPA. You simply add the DHA and EPA numbers together to see how many capsules you will need to reach 1200mg. Don’t be fooled by the claim on the front of the bottle, or the “total,” as other less effective omega-3s are included in this number. Many that claim 1000mg on the front only include about 200mg of EPA and DHA. Therapeutic dosages of fish oil can go much higher, in the range of a few thousand milligrams of EPA/DHA, and if you have particular concerns, such as memory or vision problems, you might benefit from a combination higher in DHA as opposed to the more common version with higher EPA. This is yet another great place to have someone prescribe based on your individual needs. If you choose Krill oil, you can cut the dosage to about 1/4 to 1/3, as Krill naturally contains phospholipids, which improve omega absorption (it is typically more expensive, however).

What other general preventive supplementation should I discuss with my doctor?
There are a handful of other supplements in addition to a multiple vitamin, calcium, and fish oil that many should consider. All make frequent appearances in my articles because of their benefits to the body.

Coenzyme Q10 (as the more active ubiquinol) helps to shuttle oxygen for energy production. More energy availability is advantageous for the heart, brain, kidneys, metabolism, and your perceived energy level. This should be a consideration for every person with a heart malady, memory or other neurological concern, decreased kidney function, or decreased energy (or it can be used preventively). Dosages range from 100mg to higher amounts as needed.

Probiotics, or good bacteria, should be considered for anyone showing signs of disruption in their own normal flora, such as issues with digestion, sinuses, or skin. Those who have been exposed to high amounts of antibiotics are especially in need of re-inoculation with beneficial strains. Choose a refrigerated version with a mix of species.

Vitamin D has shown benefit at a maintenance dosage of 1000-2000IU daily, or at higher dosages if a blood test shows a deficiency (Vitamin D is one of the few vitamins whose levels we can accurately test). Vitamin D is important in bone and immune health, has an influence on improving mood and decreasing anxiety, and it may even have anti-carcinogenic effects.

Although there are many supplement questions with general answers, I hope that you have gleaned from this article that there are many decisions about what nutrients you should supplement that should be made based on your individual health and needs. Nutrients, herbs, and homeopathy should be overseen by your treating physicians. Supplements can be a great place to begin or continue your journey for health, but they can be even more effective if you have the proper guidance.