According to the CDC, over 50% of American adults continue to take vitamins and supplements – even though multiple studies suggest they are often “unnecessary or harmful”. A study in The Atlantic, published in 2013, showed that supplements “may shorten your life span”. Women tend to purchase and take supplements more than men. The studies keep changing, and some of the results are skewed due to size and study methods. At this point in time, it is still prudent to get most of your vitamins from food sources.

People with certain health conditions, including (but not limited to) kidney disease, may need supplementation. Those who are vegan, eat highly processed low fiber diets, often eat fast foods stripped of nutrients and fiber, and those who are on low calorie eating plans may also require extra vitamins and supplements. People who constantly eat the same things (which lack variety and multiple nutrients) may benefit as well. Extra vitamins and minerals may fill the holes in these eating plans. Always check with your own health care provider to see which direction you should take.

My patients frequently ask questions about vitamins and supplements and I thought it would be worthwhile to review. I am not suggesting or advocating that you use anything other than foods to obtain many of these nutrients. You and your professional provider should decide.

  1. Calcium: The need for calcium increases as we age – whether we have diabetes or not. As we age, our bone mass reduces, which leads to thinning of the bones. This condition mainly affects women, but men are at risk as well. Being small boned, thin, being a smoker, taking steroids, being inactive, short or having a family history increases your risk. Drinking too much alcohol and eating too much salt may increase your risk as well. A bone density test is usually suggested for women at the onset of menopause and for men at age 70. This non-invasive test can reveal a condition known as osteopenia (or osteoporosis). The test is usually repeated every 2-3 years after the initial screening. The recommendation for calcium is between 1000-1500mg a day, depending on your age. Try to regularly eat foods that contain calcium, such as low fat dairy products including milk, cheese and yogurt. Look for foods that are enriched or fortified with calcium. Dark leafy greens have good amounts of calcium and vitamin K which may help bone density. Calcium supplements may be recommended if you are vegan or do not eat or tolerate these foods (as in lactose intolerance). Remember not to take calcium when drinking coffee or diet cola, since this may interfere with calcium absorption. Divide your calcium doses into two times a day, since only 600mg is absorbed best at one time.
  2. Vitamin D: The research is not consistent. Some recommend vitamin D for every malady, while others think vitamin D is being over-prescribed. Aging makes it more difficult for us to convert sunlight into vitamin D. Due to winter seasons with lack of sunlight, as well as sunscreen use, we may not get enough vitamin D. Guidelines suggest combining calcium and vitamin D-3 supplements (which are abundant on the OTC market). Most recommend taking between 400-1000 IU a day. A simple blood test will tell you your specific value. An adequate vitamin D level is between 30-70. Always check with your physician, since vitamin D is fat soluble (stored in your fat) and may reach unsafe levels. Foods which are high in vitamin D are wild salmon, light tuna in oil, flounder, eggs, mushrooms, fortified milk and cereal, and ricotta cheese. Vitamin D may also prevent muscle mass decline in men as they age.
  3. Iron: This mainly concerns women prior to menopause, or anyone suffering from gastric bleeding or kidney disease where anemia is present. Always check with your health care provider, since too much iron can be dangerous. If supplements are needed, stick to a mild slow release supplement which will help protect your stomach and reduce constipation. Food sources that are high in iron are chicken, turkey, eggs, meat and tofu. Try to combine these iron rich foods with vitamin C, which will further increase absorption. Check with a dietitian when you have severe kidney disease, since you may need to be on a restricted protein diet.
  4. Vitamin B6/B12: The B vitamins are difficult to process as we age. You may consider a supplement if you do not eat foods high in vitamin B, since it is not fat soluble and does not stay in your tissues. Vitamin B12 helps with red blood cell and nerve cell formation. B6 is also needed for red blood cell formation. A highly absorbable route is in a sublingual tablet, spray, or liquid – since pills may not be adequately broken down. Foods that contain B vitamins are eggs, yogurt, white meat chicken, and milk and cereals fortified with vitamin B. Women as they age are especially low in vitamin B1 or thiamine. Many people receive vitamin B12 shots for added energy. Recent research suggests vitamin B may help with weight loss, but check with your physician for a final recommendation.
  5. Omega 3 Fatty Acids: This is still one of the most popular and often suggested supplements. They may decrease systemic inflammation, which is associated with many diseases including diabetes, heart disease, arthritis, and other auto immune disorders. If you take these supplements, they should be taken with food and kept cold in the refrigerator to decrease GI distress. Foods that contain Omega 3 fatty acids are salmon, mackerel, sardines, tuna and anchovies. Non-animal food sources are flax seeds, walnuts, tofu, and soybeans. Maintaining your Omega 3 and Omega 6 fatty acids in ratio are also important to lower inflammation.
  6. CoQ10: Although the research still shows mixed evidence, CoQ10 supplements may be especially worthwhile for those people taking a statin medication. CoQ10 is an antioxidant that may compensate for immune deficiencies and is needed for metabolism. It is made in smaller amounts as we age. The usual recommended dosage is 100mg and should be taken along with your statin medicine in the evening. Food sources of CoQ10 are meat and poultry, as well as soybean or canola oil, pistachio nuts, hazelnuts, and peanuts.
  7. Vitamin C: This vitamin is considered generally safe and is not fat soluble which means it can’t be stored in large amounts in the body. It boosts your immunity, promotes eye health, and helps reduce cardiovascular disease. If using a supplement, try a non-acidic buffered form to protect the stomach from GI irritation. Foods high in vitamin C are broccoli, red cabbage, red and green peppers, kiwi and raspberries, along with all citrus. It is generally recommended in dosages from 500-1000mg a day.

If you do decide with the help of your physician to take supplements/vitamins:

  1. Keep them in the original container in a cool, dry place (avoid bathrooms and kitchens)
  2. Check dates for expiration
  3. Purchase those with the USP seal on the packaging

You may be able to get your daily recommendations of vitamins and supplements from a varied healthy diet – without the need of extra expense. Each person is different with various health issues. This is just a short list of available products, so check into the ones that you find interesting and then decide what will work best for you!

NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

Roberta Kleinman

Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia.

She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.

She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.
Roberta Kleinman

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