Answering the Most Frequently Asked Question - Do I Need to Supplement?

In an ideal situation, the answer would be "no".

Supplements can never replace a healthy diet and should ideally only be used in a strictly ‘supplementary’ manner, to help us get all the nutrients we need to be healthy.

What is it to be truly ‘healthy’, though? We believe that it’s not just about the absence of disease, but is, in fact, a state of complete well-being. Diets that are balanced are the first, foundational step in helping us get there.

For some of us, though, it can get difficult to consistently maintain a balanced diet (for various reasons). That’s when it’s a good idea to supplement with the nutrients we may not frequently consume.

Supplements can even be used to optimise our health further. For example, antioxidants can not only help protect our skin from damage, but also make it visibly healthier [1, 2]. A collagen supplement can help strengthen our bones [3], and a protein supplement helps enhance the muscle-building effects of a workout [4]. 

Overall, good nutrition can go beyond keeping us operational - it can increase our energy levels, enhance our immunity, help us recover faster from stress and illness, reduce the risk of diseases and even make us look and feel better. 

Here are a few lifestyles and scenarios where you may need to take certain supplements in order to get the nutrition you need for optimum health:

If you follow a vegan or vegetarian diet

What happens here:

People following a vegan or vegetarian diet are more prone to a deficiency of zinc, iron, vitamin A, B12 and D, as these nutrients are more prevalent and/or in a more bioavailable form when they’re in animal-based food sources [5, 6, 7, 8].

An interesting paradox is that protein sources in vegetarian diets are also rich in carbohydrates [9]. Someone who is trying to increase their protein intake may also end up increasing their carbohydrate (and total calorie) intake significantly. Cutting down on other carbohydrate-rich foods in order to balance this may be tricky and inconvenient.

Would you need supplements?

In this instance, having a protein supplement can help increase your protein intake without significant addition to your calorie-intake. It’s also a good idea to support your diet with a multivitamin or mineral supplement to optimise your level of nutrients and prevent deficiencies of vitamin A, D, and B12, zinc and iron.

It’s even worth consuming foods that have been fortified with these nutrients. That said, if you have an existing deficiency, food sources will not provide a large enough dose to restore your required levels of these nutrients. In that case, we’d recommend consulting a doctor before taking them in larger doses, which are usually available in the form of single-ingredient supplements.

If you want to improve your skin and hair health 

What happens here:

Insufficient nutrition is one of the major reasons we face skin and hair issues (others being our genetic make-up, hormonal imbalances, etc.). When our body receives inadequate nutrition, it uses its available nutrients for the body parts and organs that are more essential to our survival (like our internal organs). In that case, our skin and hair don’t receive the supply of nutrients they need to stay healthy, and their quality gets compromised. For example, when our body doesn’t get enough protein through our diet, building keratin for our hair would be given less importance than building or repairing our muscles - and that’s exactly where the body’s protein is directed [10]. 

This issue then gets amplified when you consider the fact that our body needs a wide range of nutrients in order to build strong and healthy hair. In fact, poor hair quality is one of the first few signs of a diet that isn’t providing an adequate amount of the nutrition our body needs.

Would you need supplements?

First, identify the nutrients you generally need (here are some helpful tips for this) and adjust their intake accordingly. If fulfilling these nutritional requirements through your diet alone is difficult, that’s when a skin or hair supplement becomes particularly useful. Look for nutrients such as vitamins C, D, and E, B-vitamins, GLA (gamma linolenic acid), zinc, sulphur and collagen peptides while choosing a supplement [11, 12, 13, 14].

Once your nutrition has been optimised, any remaining skin or hair issues can indicate a deeper reason (like a hormonal imbalance, for example). The best way forward here would be to consult a dermatologist/relevant health professional.

If you perform intense exercises

What happens here:

Nutrients help our body repair itself and adapt to the effects of exercise. A nutritionally-inadequate diet may cause deficiencies that affect our physical performance. For example, a deficiency of iron and magnesium has been shown to impair exercise performance, and can cause cramps [15].

People whose lifestyle involves intense exercise require a higher amount of nutrients,  and may need supplements to help reach those quantities.

Would you need supplements?

Adding a protein supplement to your routine is a convenient way to help your muscles rebuild and recover from the intense activity [4] - especially when getting the required amount of protein through your diet isn’t feasible. It’s also a good idea to take a multivitamin, to optimise the body’s levels of its required nutrients and support your exercise performance [16].

Consuming omega-3 fats would also go a long way. These have anti-inflammatory properties, which may reduce muscle soreness. They also help reduce free radical damage, which improves muscular performance [17].

If you're on a restrictive or a weight-loss diet

What happens here:

1. Restrictive diets are the kind of diets that restrict the overall calories and amount of  macronutrients (mainly carbohydrates and fats) present in one’s meals. The consequences of these diets on a person’s micronutrient intake are often overlooked.

In fact, studies show that popular low-carbohydrate diets, when planned with just food (and no supplementation), are inadequate in micronutrients such as B-vitamins (like thiamine, folate and vitamin B12), magnesium, calcium, iron, and  iodine [18, 19].

The long-term implications of these potentially nutritionally-inadequate diets could result in clinically-relevant nutritional deficiencies [20]. Micronutrient deficiencies are even linked to a higher risk of diseases, including osteoporosis and heart disease [21].

Would you need supplements?

Yes, individuals on low-carbohydrate diets should consider consuming a daily multivitamin.

What also happens:

2. Most people don’t come close to getting the amount of fibre that’s recommended for us (about 40 grams per day) - and this is especially true for people who follow a typical restrictive diet [22, 23]. 

Whole grains are the most common sources of dietary fibre, but being carbohydrate-heavy, they’re prescribed in limited quantities for these diets.

Would you need supplements?

One way to consume more fibre is by making sure that the grains that are a part of this diet’s meal plan are whole grains. For example, use brown rice and whole wheat flour instead of white rice and refined flour, and whole-wheat bread instead of white bread. 

Taking a fibre supplement is also a good idea, to pack in a higher concentration of dietary fibre, which comes with far-reaching health benefits.

If you want to get enough vitamin D

What happens here:

85% of the population of India suffers from a vitamin D deficiency [24, 25]. 

Vitamin D is incredibly important for several health functions, which makes preventing a deficiency all the more important if you’re not only trying to stay healthy but even optimise your health.

Would you need supplements?

Exposing your arms and legs to the sun for just 15 to 30 minutes (twice a week) can be enough to prevent a vitamin D deficiency [26]. Apart from this, fatty fishes (such as sardines, trout, hilsa, salmon, mackerel, and tuna), egg yolk, and shiitake mushrooms are good sources to add to your daily meals [27, 28].

If getting it through these sources isn’t feasible, you could also try eating foods fortified with vitamin D.

Consuming a supplement is also a fairly common way to get your necessary levels of this important vitamin - however, it’s best to consult an expert to identify the dose and frequency of a vitamin D supplement before you begin.

If you want to improve your digestive comfort and health

What happens here:

1. Our body’s digestive system is sophisticated - and complex. It requires various functions (from digestion and absorption to excretion) to work in sync, with any disturbance potentially causing some form of digestive discomfort.

Constipation is one of the most common causes of this discomfort. When the excretory system is not able to get rid of its waste, the overall process of digestion gets disrupted. It’s common to experience abdominal pain and bloating when this happens, as well as fewer (and painful) bowel movements [29].

Would you need supplements?

Getting enough fiber by eating nine servings of fruits and vegetables daily, drinking 2-3 liters of water, and exercising regularly will help with constipation. 

If consuming this quantity of fruits and vegetables is difficult, it’s a good idea to add a fibre supplement - especially one that contains a good mix of insoluble fibre (like wheat bran) and soluble fibre (like methi seeds) [30, 31].

What also happens:

2. Our gut bacteria is intricately connected to our digestive health, and an imbalance in our gut flora (also known as dysbiosis) can also cause digestive discomfort (usually because of  a poor diet, antibiotics, or even stress) [32, 33]. 

Would you need supplements?

Try and make sure you have enough probiotics (good bacteria found in fermented foods) in your diet. Common probiotic food items are yogurt, kefir products, aged cheeses, kimchi, sauerkraut, miso, tempeh and cultured non-dairy yogurts.

If getting them through your diet is not possible then you can opt for probiotic supplements to help you maintain the balance of your gut bacteria. The number of colony-forming units, or CFUs, can tell you how many probiotics you’re getting per dose. There’s no official recommendation for how many CFUs you need, but most supplements contain between five and 10 billion per dose. In general look for supplements containing well-researched strains of bacteria such as Lactobacillus, Bifidobacterium, or Saccharomyces boulardii [34, 35, 36].

Having said that, health benefits are strain-specific, and not all strains are necessarily useful, so you may want to consult a practitioner familiar with probiotics to discuss your options.

Apart from probiotics, consuming enough soluble fibre helps as well. Soluble fibre acts as food for the gut bacteria, and helps them and your digestive health flourish  [34] .

If you don’t eat fatty fish 2-3 times per week

What happens here:

Fish and marine plants are our main dietary sources of omega-3 fatty acids, which are crucial for our overall health and wellbeing. 

There are three main omega-3 fats - ALA (alpha-linolenic acid), EPA (eicosapentaenoic acid), and DHA (docosahexaenoic acid). ALA is an essential fatty acid, meaning that our body cannot make it, and we must get it from our diet. It’s mainly found in plant-based foods such as flaxseed, chia seeds and walnuts. DHA and EPA, called ‘long-chain’ omega-3 fats, are found in fish and other seafood (marine algae) [37, 38]. 

Of these, ALA is the main omega-3 fat that people who don’t consume seafood end up getting from their diet. Our body can convert ALA into EPA and then DHA, but it happens in tiny proportions. Approximately 8-10% of dietary ALA is converted to EPA and 0-4% into DHA [37, 39]. This may not be enough for the healthy functioning of our body, given how important EPA and DHA are to our health.

Would you need supplements?

Indian fatty fish such as hilsa, black pomfret, tamb and rani are good dietary sources of EPA and DHA [40]. 

People who don’t consume fatty fish can supplement with a fish oil that contains omega-3 fatty acids (look for the EPA and DHA content in the total fish oil - it should come up to at least 500 mg per day).

Vegetarians or people who are allergic to fish can instead consume a DHA supplement that’s derived from marine algae (it converts back to EPA in the body) [41].

An interesting fact - A study has shown that individuals who live till they’re 100 years-old tend to have a lower amount of free radicals and a higher amount of omega-3 fatty acids in their blood, as compared to people decades younger. This, amongst other studies on ageing populations, indicates that optimal levels of omega-3 fats may promote longevity [42, 43, 44]. 

If you have a vitamin B12 deficiency

What happens here:

Vitamin B12 is absolutely necessary for a number of processes in our body, including the formation of red blood cells, important brain functions, the production of energy from food, etc. A deficiency of vitamin B12 may, over time, lead to fatigue, anaemia and nervous system issues, amongst other problems with skin, hair, bones and mental health [45]. 

At least 47% of the Indian population suffers from a vitamin B12 deficiency (and there’s limited data on the rest of the population being B12-sufficient). Being an essential nutrient, our body relies on the food we eat to get it. Since the main sources of B12 are animal products such as meat (mainly liver), dairy, and fish, people on a plant-based diet are more susceptible to developing its deficiency [46].

Vitamin B12 also has a complicated method of absorption in the body that puts people on certain therapies and medications particularly at the risk of its deficiency [47]. 

Would you need supplements?

Adding more vitamin B12 fortified foods like plant milks, soy products, breakfast cereals, and nutritional yeast (the packaging generally mentions whether these are fortified or not) can help.

Having said that, in India, it may be prudent to supplement with vitamin B12, especially for diabetics, vegans, vegetarians and non-vegetarians who consume non-veg occasionally [46]. You can speak to a medical practitioner to understand the dosage you need based on your current B12 levels.

Whenever you choose to supplement with a single nutrient, especially if it's dosage exceeds its recommended dietary allowance (RDA), it’s best to consult a healthcare professional.

As we mentioned - supplementation is a great way to conveniently consume the nutrients you need,  but a balanced diet is the first step to a healthy, functional body. Once that’s in place, all you have to do is optimise your levels of nutrients through supplements that add value to your health goals or needs. 

We’d love to know if you found this article helpful. Share any  comments and queries you may have in the comment box below :)