Episode Transcript

Welcome to Health Matters – your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

This week, we tackle the burning question: Do supplements and multivitamins help or hurt your health?

Joining me is Dr. Chiti Parikh, an Integrative Medicine Practitioner and the Executive Director of Integrative Health and Wellbeing at NewYork-Presbyterian and Weill Cornell Medicine.

We discuss when vitamins and supplements are recommended, how to check their quality, and what to look for on the label.

Faith Salie: Hi, Dr. Parikh. Thanks so much for joining us.

Dr. Parikh: My pleasure.

Faith Salie: Can you define what the difference is among vitamins, minerals, and herbs?

Dr. Parikh: So when it comes to vitamins, we generally think about the letters like vitamin A, B, C, D, E, K.

When you talk about minerals, they tend to be two letters, right? So like magnesium, zinc, calcium, potassium, those are your minerals.

Then you have your herbs.

So herbs can be single variety, just one herb, something like ashwagandha, some people might have heard of, or it could be a combination. But the issue nowadays is that many supplements are not clear what they actually contain. They’ll often have a combination of vitamins, minerals, and herbs, and they will often label it as their proprietary blend. So sometimes it’s hard to tell exactly what the ingredients are in any given supplement.

So as a name implies, supplement is meant to add to whatever you’re not getting enough of just through your diet. And that can hold true for some people, but not necessary for everybody as it is marketed.

And it’s not that supplements alone can replace diet, contrary to what all the marketing and all the health food stores might have you believe, most of us actually do not need to supplement. Our diets are adequate.

To a certain degree, we’re all victims of what I call the SAD diet. The standard American diet.

Faith Salie: Oh my gosh. Wait, did you coin that?

Dr. Parikh: No, it’s a common term. I mean, again, the acronym is SAD.

I cannot ignore the fact that it does make me sad that most of us are, unfortunately, eating a diet that is not what our ancestors were eating, right? We’re eating highly processed foods that is devoid of nutrition, you know, from vitamins to fiber to even micronutrients that we’re completely missing out on. Hence the idea that we might need to supplement.

Faith Salie:  So, would you say that most Americans are getting what they need through their diets?

Dr. Parikh: So the answer to that question is why don’t we take each person as an individual and look at what they need and what they don’t need.

So the common misconception is that you walk into a store and you are exposed to hundreds of bottles of supplements, each of them claiming to do something amazing for you, right?

One is promising amazing brain health, one is for your gut…

Faith Salie: Yeah, like “choose your superpower!”

Dr. Parikh: Yeah, I want all of it! Who doesn’t? Right? We want to optimize our well-being and we want to optimize all our organs. So where do you start?

So I always tell people that there’s a customized approach to this, that you don’t have to take everything because too many supplements can also be dangerous. So I treat supplements the same as any medication.

Faith Salie:. Do you prescribe supplements?

Dr. Parikh: I do.

So for instance, if I’m prescribing someone a medication for diabetes, I have to first check their blood test to make sure they have diabetes, how bad the diabetes is, what is the right dose of the medication that they’ll benefit from. Repeat the blood test to make sure the medication is working, not working. Adjust the dose.

And I do the same for supplements.

Often when I see my patients for the first time, I will get a baseline set of blood tests to check their vitamin levels, to check their mineral levels, to see if they’re deficient in any of these. And based on that, I’ll pick the right dose and repeat the blood test to make sure that dose is working for them, making sure it’s not too much or too little.

Faith Salie: I think most of us don’t think about checking in with our doctor for every supplement we might take, or even knowing all the supplements out there that we should be taking.

So should we be figuring this out on our own? Or should we be bugging our doctor every time we read something about ashwagandha or, you know, do I need this much vitamin D? Like everyone’s telling me, should we be checking?

Dr. Parikh: At least the basic vitamins and minerals, I do believe they should be checked and they can all be part of your standard blood work that you get done during your annual physical. So these are not necessarily very specialized tests. These are easily available, often insurance covered. So I do encourage my patients to request these blood tests, at least to establish a baseline.

Once we know they’re within the normal range, we don’t often need to worry about it as long as your diet is staying consistent.

Faith Salie: And if we decide on our own that we’ve heard something, we may want to try it. I want to, I want to take omega-3 pills. Should we ask our general practitioner?

Dr. Parikh: There’s really no downside to asking and making sure. I often educate my patients, but I also educate other doctors because this world of supplements has really taken off in the last five, 10 years.

One of the sources I often point out to my patients and to other doctors is something like consumerlab.com. So ConsumerLab is a third party testing organization that often does very thorough research and third party testing for many, many supplements, and they come out with their report to say whether the supplement actually contains what it claims to in what amount, and also if it has any adulterants or any other things that you don’t necessarily want that’s not on the label. For instance, many supplements that are often manufactured overseas can contain things like lead and mercury. So they do check for that as well.

So that is a great resource for my patients and also for other practitioners to go to and make sure that they are recommending brands and dosage of supplements that are actually properly verified by a third party.

Faith Salie: I want to ask you about this magical item called the multivitamin. I want to think that there is a multivitamin that my doctor will tell me to take that will cover all my bases.

Dr. Parikh: I wish the answer was yes, but it is no.

So the majority of the people do not need a multivitamin. And often I use a multivitamin when someone is low in more than two or three different vitamins. So instead of taking three or four different pills, a multivitamin could be sort of less burdensome.

But I’ll tell you one thing, out of hundreds of bottles of multivitamins that are out there, if you actually look at the ingredient list, there’s significant variation in what they actually contain, so, we often tend to think that I want to get my money’s worth, so we tend to gravitate towards multivitamins that will have a really long ingredient list, right? Because if I’m spending the money I want as much as possible, crammed into this one pill, but there’s only so much that can be crammed into one pill.

So often what ends up happening is you are getting minuscule doses of a lot of the vitamins, so is it really going to help you in any way?

That’s questionable.

If you’re going to take something, you want to make sure that the dose you’re getting will actually have the health benefits that you’re looking for instead of more of a placebo sugar pill.

Faith Salie: And the FDA doesn’t require that all of the ingredients be put on a label.

Dr. Parikh: Exactly. So I often joke with my patients and I tell them, you know, I can buy empty capsules and then put some sugar in it and market it as Dr. Parikh’s Magic Weight Loss Supplement, and there’s nothing stopping me from doing that. So just to give you an idea how little oversight there is when it comes to the supplement market.

The biggest difference is the FDA regulation, right? In order to go through FDA regulation, you have to provide lots and lots of data and research behind the safety and efficacy of any product that you’re marketing. Whereas supplements, they don’t necessarily have to go through the stringent process of establishing their safety and efficacy.

So that’s why you’re sort of on your own when you’re picking up a supplement bottle and when it comes to making sure it’s actually safe and effective.

Faith Salie: What should we be looking for on the label as far as certifications or qualifiers?

Dr. Parikh: When you look at the back panel, you want to make sure that the ingredient list is listing all the vitamins and telling you how much of the percent daily value it actually contains.

So for instance, if it says “vitamin C, 200%” that basically tells you that you are getting about 200% of your daily recommended value of that specific vitamin.

You want to be somewhere between 50% to 200%. More is not always better. And also less than 50%. I’m not sure that’s really going to give you any additional benefit.

And the other thing for brands, I always tell people to go with the bigger brands of multivitamins or supplements in general. They have a little bit better of a process when it comes to making sure that the safety of the ingredients, how it’s actually manufactured and processed, versus some of the smaller no-name brands, they’re really hard to track and trace where they’re actually manufactured. Whether it’s expiration date, production dates, it’s hard to say that those are actually accurate.

Faith Salie: Are there certain populations or age groups in which supplements or multivitamins are highly recommended? Because I remember happily taking a prenatal vitamin when I was pregnant.

Dr. Parikh: Absolutely. So that is a great question. So pregnant women, because their dietary needs and nutritional needs are very different during those nine months, especially before nine months, during nine months, and even after. So that is a special group that does require supplementation because diet might not be enough.

And that is also the group that needs to make sure that they get their blood test done as part of their routine checkup with their OB GYN to make sure what they’re taking is enough in case they need even higher doses.

Another population could be someone who has issues with absorbing nutrients. So if someone has issues with IBS or autoimmune diseases of the gut, but it actually impairs their ability to absorb vitamins and nutrition from the food they’re eating, they would benefit from supplementation.

Another population is our elderly population, where their dietary needs might not be complete in the sense that they might not be eating a diet that is really varied, so they might need to supplement because they might not be getting the right amount of calcium or potassium or magnesium or vitamin D that their body really needs just from the food that they’re eating.

Faith Salie: What about little kids? I mean, I think at least people of my generation have fond memories of having a Flintstones vitamin, and they tasted good!

Dr. Parikh: We should take this opportunity to really train our kids in eating a healthy, well-balanced diet.

Faith Salie: And not a “SAD” diet.

Dr. Parikh: Not a “SAD” diet, especially. Exactly. So it’s not about eating Skittles and then eating a multivitamin gummy, right?

Faith Salie: But they’re all such great colors!

Dr. Parikh: It is! And there are great colors for a reason, right? So I always tell people: ask yourself the question, am I doing something because it’s being marketed to me, it’s being sold to me, or is this something I really need? Right? This is where your doctor can help you make the distinction

Faith Salie: That is a great critical thinking lesson for kids. In a lot of ways, for all of us.

Dr. Parikh: Exactly.

Faith Salie: So, a study that caught my attention recently showed better performance on memory tests among the participants who were taking a multivitamin than those who were assigned a placebo. With 3,500 participants ages 60 and older a daily vitamin led to 3.1 years less cognitive aging, than for those who had the placebo. That’s kind of a lot!

What is your take on this study?

Dr. Parikh: Yeah, so folate and B12 are very much involved with brain health, our cognition, so many people are often deficient in that.

And studies have also shown that folate levels correlate with mood. So many people with depression often have low levels of folate in their blood and also low levels of folate in the fluid around their brain. So one of the cutting edge new treatments for depression is actually high levels of folate, which is folic acid, one of the B vitamins.

So we are just scratching the surface of this, but this is something I personally see in my practice. So these are the tests that I often check for my patients because especially if someone is eating a little bit more processed foods, they are more likely to be low in things like folate. So folate is found in fresh vegetables, fruits, whole grains. So if you’re eating mostly processed foods, even though they tend to be supplemented with a little bit of folic acid, it’s often not enough.

So that is my theory that in this study, people probably perform better, perhaps because they were likely deficient in things like folate, b12, and even iron.

Faith Salie: Are there any other studies you’re excited about or any other aspects of supplements and multivitamins that you think have a rosy future?

Dr. Parikh: Absolutely. There are some supplements that I’m excited about. Especially in the gut health area, there’s a lot of research that has gone into understanding our gut microbiome, the trillions of bacteria and microorganisms that live in the gut. We’re learning more and more about how they actually impact basically everything in the body, from our mood to our personalities, to our immune system.

Basically every disease that we’re treating, we’re understanding that there is a link with the gut microbiome.

So that’s what excites me, that in the next few years we’ll have a lot more resources supporting the use of whether it’s customized probiotics to customize dietary interventions to even certain supplements.

Faith Salie: Dr. Parikh, thank you for clarifying so much of this for us.

Dr. Parikh: My pleasure.

Our many thanks to Dr. Chiti Parikh

I’m Faith Salie.

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