In the years that I’ve done health coaching, I’ve heard the full spectrum of nutrition qualifications – from the generic (and fairly useless) “I’m watching what I eat” to the hyper-specific, “I eat 120 grams of protein daily at 4 sittings, take 1000mg of calcium and 60 IU’s of Vitamin D, an omega-3 every other day, and I’m thinking about iron supplementation!” The quirkiest in recent memory was a woman who told me she was following a strict Paleo diet…in the form of branded protein shakes and supplements. Is there anything further from how our evolving ancestors ate than that?! But her quest for health through “optimum” nutrition focuses precisely on the point at hand: is it better to eat real food, or rely on supplements for our nutrient necessities?

Based on your gender, height, weight, age, health status, activity level, and genes, you need a certain amount of all of those things to have ideal health, regardless of what eating pattern you choose to follow (vegan, Paleo, vegetarian, etc.). Consistently missing out on even one will eventually lead to physical symptoms of some kind! Some nutrients have co-absorption mechanisms: calcium is facilitated by vitamin D, iron levels can be increased when consumed with vitamin C (but its absorption is inhibited by calcium), carbohydrates increase protein absorption by bumping up insulin, vitamins A, D, E, and K are better absorbed when consumed with fat…nearly all nutrients have a role in the absorption or use of others! It all seems very complicated – and it is. You’d have to have a degree in biochemistry to even begin to comprehend the mechanisms our bodies perform, which can make food choice intimidating. How do you know if you’re getting enough of the right stuff? This is why supplements are an enticing prospect: it feels like insurance if you can take a dense dose of vitamins and minerals, just in case you aren’t getting enough.

“Vitamins” – and when to take them

The two best determinants of a nutritious diet are variety (how many different things you eat) and balance (ensuring the things you eat are in the right ratio to one another). If you aren’t malnourished and you are following those rules, it’s likely that you’re getting enough nutrients to avoid deficiencies. When was the last time you heard of someone developing rickets, or scurvy? The cultivation of a secure food supply and fortifying staple foods made those simple deficiency diseases virtually obsolete in America.

Taking a multivitamin (a combination of the vitamins and minerals we need) has become commonplace in our country, but ironically the people who take them are not getting much benefit – because they’re people who are already conscious about their diet and health, and therefore getting more than the amounts a multivitamin provides! For this reason, I don’t usually recommend them. What I do recommend is targeted, clinically supported supplementation. There are some that are easy to guess based on population: young women are the most likely group to have low iron (most stores are found in blood, so a significant amount is lost during menstruation), older adults often require extra vitamin B12 (it’s activated by stomach acidity, which can worsen with age), and darker skinned people living in colder climates are likely vitamin D deficient (since we make that vitamin with UV sun exposure, and lighter-colored skin is more easily penetrated). You can determine what you need with this micronutrient calculator, in general, but should get blood work done to determine if you need to supplement anything in particular. It may be enough to eat foods that supply the ones you need, but adding some in pill form may appropriate!

What about herbal supplements?

There is a whole class of supplements that don’t contain the vitamins and minerals we need, but are instead based on plants that have phytochemicals that work within our metabolism to enhance physiologic function – and some are common herbs and spices that already have a place in our culinary world! Some examples: milk thistle has been shown to improve liver function, and for some people reduces hangover symptoms; St. John’s Wort can improve depression using some of the same mechanisms as drugs; garlic and turmeric have anti-cancer properties; ginger is known to reduce digestive discomfort and nausea. All of these should be treated like medicine: in concentrated forms, it is very possible to have too much of a good thing! They may interact with drugs you’re taking, each other, or be inappropriate for certain populations (young children and pregnant women need always be cautious!). If you want to take a deep dive into this subject, the book The Green Pharmacy is an amazingly complete and very easy to read guide; its author James Duke can also be found on his website.

It’s important to note that supplements are just that - the very word means “something that enhances or completes something else”…not a standalone entity! Even shakes and concoctions that purport to have “all the necessary nutrients” probably don’t, simply because that assumes that we know all of the intricacies of how our bodies interact with substances in food. You may very well get all the vitamins and minerals in the right amounts, but there are thousands of compounds in plants we have only begun to identify, let alone research. V+B meals are excellent because they do provide a variety of foods, in the right portions, and I’ve reviewed menus to ensure that they balance nutrients (and flavors, and textures) for a day of eating that will leave you feeling satisfied – and delighted by the deliciousness! If you do choose to supplement, make sure you’re informed (read the links I’ve posted throughout this article, and talk to your doctor!) to get the most benefit. Bon apetit!

Sarah Waybright MS, RD is the owner and founder of WhyFoodWorks and the team dietitian for Vegetable and Butcher. WhyFoodWorks does nutrition education through food in Washington, DC in corporate seminars. Vegetable and Butcher is a subscription-based service that delivers chef designed, dietitian approved, thoughtful prepared meals to health-conscious people in Washington, DC. You can find Sarah on Twitter,Facebook, Pinterestor Instagram to get food tips and nutrition - and of course, healthy recipes.