Do You Need a Supplement When Eating a Balanced Diet? An Expert’s Take

Everyone is obsessed with vitamin D, but it is only one of the essential vitamins your body
needs in a day to function optimally and boost immunity. Even if you eat a perfect diet full of
healthy plant-based protein, complex carbs from fruits and vegetables, legumes, and whole
grains, and heart-healthy fats from nuts, seeds, and a small amount of oil, you may have
a hard time getting all essential daily vitamins and nutrients your body needs to
function at its optimally healthy level, says Mastaneh Sharafi Ph.D., a nutrition scientist and
Registered Dietician.

Follow the "Food First" approach to nutrients, she says, but then be realistic since some key nutrients may be under-consumed, and consider supplementing, especially with two hero vitamins that she says are more important than others, especially when eating mostly plant-based.

You may get your daily C in that half a grapefruit or an orange in the morning, or in the red bell
pepper that you added to your salad for lunch. But there are other nutrients that are not as easily available in the diet that your body needs to function and that your cells use to operate.

"Sometimes it simply is not possible to eat enough nutrients in your healthy, mostly plant-based diet to reach the recommended amount of vitamins and minerals your body needs in a day," explains Dr. Sharafi, a Ph.D. in Nutritional Sciences, who has helped to develop multivitamins such as those for Ritual, to help healthy eaters make up the gap.

You may get your daily C in that half a grapefruit or an orange in the morning, or in the red bell pepper that you added to your salad for lunch. But there are other more challenging vitamins and minerals your body needs to function, your cells to operate all their tasks without failing, and your brain needs to focus.

The essential vitamins that the NIH wants us to get on a daily basis are: Vitamin A, vitamin C, vitamin D, vitamin E, vitamin K, and the B vitamins, which are: thiamine, riboflavin, niacin, pantothenic acid, biotin, B₆, B₁₂, and folate. Vitamin C and Calcium are readily available in our diets, but some of these other nutrients are harder to get on a daily basis, even if you eat a balanced diet, according to experts.

To get a sense of what you would have to eat to get all your necessary vitamins, Dr. Sharafi explains that you'd be taking in 2,000 or more calories of healthy foods, and still have trouble. "Not everyone achieves that level of perfect eating, of course," she says.

"For the times when you can't get enough vegetables, fruit, nuts, seeds, whole grains, and legumes, there is always a multivitamin or supplement option."

Instead of holding yourself to a somewhat unrealistic standard of trying to eat a plethora of plant-based foods every day, all day, for the rest of your life (which would be nice, of course) there is a way of ensuring you get the vitamins you need, advises Dr. Sharafi, who received her degrees from Penn State University and University of Connecticut, has researched dietary patterns, chemosensory perception, and community nutrition. Her work is focused on promoting healthy eating habits by translating the science of nutrition into practical information for the public.

Food first is the way to go, but when you need a little help there is nothing wrong with supplementation, as long as they are clean plant-based sources of vitamins that contain only the necessary elements and nothing else.

"The two supplements you need most are vitamin D3 and omega-3, especially for individuals eating a mostly plant-based diet," says Dr. Sharafi. The reason for this, she explains, is that there are simply not many natural rich sources of these nutrients in plant-based foods.

More than 97 percent of women age 19-50 are not getting enough Vitamin D from their diet, says Dr. Sharafi. "Look for a multivitamin with 50 mcg of vegan-certified Vitamin D3 to help support normal immune function. One university-led clinical study showed that 50 mcg of vegan-certified Vitamin D3 is enough to help support normal immune function, according to Dr. Sharafi. "The results showed vitamin D levels raised 43 percent over 12 weeks, as compared to no change in a placebo group."

Vitamin D is a vital element that allows your body to absorb other important nutrients such as calcium, which helps your bones stay strong. But D has also been linked to your immune system's ability to fight viruses and your body's ability to combat or prevent chronic conditions that, according to the Mayo Clinic, include "rheumatoid arthritis, chronic pain, diabetes, high blood pressure, cardiovascular disease, and some cancers." Because few foods contain vitamin D naturally, taking a supplement may be your best bet. Mayo recommends that adults get at least the RDA of 600 IU, "however, 1,000 to 2,000 IU per day of vitamin D from a supplement is generally safe." Taking multiples of that can be detrimental to your health.

Omega-3 is a key nutrient to help support heart, brain, and vision health, says Dr. Sharafi. Studies show that omega-3 may help prevent or improve chronic conditions, including heart disease, and certain cancers, depression, and inflammatory conditions, even Alzheimer's. You can get this essential fatty acid in flaxseeds or soybeans or even in smaller amounts in leafy green vegetables, or by taking an algae supplement, but before you choose your source, look at the type of omega-3 since some are DHA and others are EPA and they are effective in different ways.

"When it comes to omega-3, the beauty of plant-based diets is that you get a lot of essential omega-3 fatty acids. ALA is a short-chain omega-3 fatty acid. There’s another group called long-chain omega 3 fatty acid, which includes EPA and DHA. So, when you look at healthy patterns, if you follow a healthy vegetarian diet, you get around 100 mg of DHA plus EPA. The experts say that you need more than most healthy diets can provide. That’s another reason that supplementation comes in handy. If you follow a typical healthy vegetarian diet then you need to get supplementation for long-chain omega-3 fatty acids.

When you choose supplements, Sharafi suggests you consider replacing a long-chain omega-3 daily, at a dose of 250–500 mg combined EPA and DHA each day.

Work on a "Food First Philosophy" when it comes to getting nutrients, she adds. "In my work, I look at how much nutrients people are getting, how much is the gap, then we identify those people who have gaps and figure out how to help fill them."

Another thing she wants consumers to understand is that one reason to take supplementation is nutrient adequacy. "Nutrient adequacy is not just dependent on what you eat. It is also dependent on how your body processes the nutrients,

"We all have a different genetic makeup. It can influence how our body processes certain nutrients. I think looking at studies on nutrient and gene interactions becomes really important. We looked at nutrigenetic studies, which is the research to see if there are any nutrients that get processed differently if you have different genetic makeup. One of the best examples is folate. About one-third of us have a certain genetic variation that makes it hard for us to process synthetic folic acid."

Vitamin E helps you fight against oxidated stress. "You may think, 'I am getting enough vitamin E from my diet.' But if we look at the food sources, it’s in many foods, but not that much. and even less gets absorbed," she says.

"When you add up all this food that you are getting on a daily basis, it usually does not add up the RDA for the vitamin E. Let me give you an interesting example. I follow a plant-based diet myself. Talking about the plant-based diet. It is very broad. it could be vegan, vegetarian, diets that are more focused on plant-based, or some that have some meat, like the Mediterranean diet.

"What do dietary guidelines usually do? They offer healthy food patterns. Every time they arrive, they provide recommendations of different food groups within each category so you can consume those food groups and have a healthy dieting pattern. For example, if my diet is 2,000 calories per day, and I can look at the bracket and see how much of each food group I should eat, to meet the definition of a healthy eating pattern. For a female who follows a healthy vegetarian diet, it should provide all the nutrients she needs because this is the best way you can eat. But there are still some nutrients that you still will not get 100 percent, like vitamin D and E. It just does not add up in a day."

"Folic acid isn’t something that you find in nature. It is the synthetic form of folate that is used in many supplements and in fortified grains. For people with a certain genetic variation, it is hard for them to process the folic acid efficiently," Dr. Sharafi explains. "So, when we are thinking about the form of nutrients we need to come up with, it's a form for those people who have the genetic variation. We say we are getting 100 percent of our needs for the day with all these fortifications, but it doesn’t mean your body is actually getting enough. A plant-based diet, which we always need to plan for, provides the nutrients but you need to know, are they bioavailable or not? That also impacts the decision about what we need to supplement and what we should not."

"When it comes to iron, you have to look at bioavailability, says Dr. Sharafi." So, my diet is plant-based and I mostly get my iron from plants but I try my best to take it with vitamin C which helps it get absorbed. When I have a plant source food like spinach, I try to have some citrus with that. Also, I try to avoid things that are high in calcium, because it can reduce that absorption."

Yes we do need magnesium, explains Dr.Sharafi. "You can get some good levels from your diet. When you look at the standard American diet, however, there is a large percentage of people who do not get enough magnesium. But for people who follow a plant-based diet, magnesium is typically not a nutrient of concern." However, if your diet does not include a good amount of seeds and green leafy vegetables, you may want to supplement, she adds.

Of course, the first choice is to eat your nutrients, whenever possible, explains Sharafi. "But sometimes that is not possible." She adds that each person has to understand their individual needs, which change over time. For instance, adults over 50 have trouble absorbing nutrients like B12 from food sources. "Because of this, the National Academy of Medicine (formerly the Institute of Medicine) recommends that adults over the age of 50 obtain most of their vitamin B12 from vitamin supplements or fortified foods."

As we age, bone health is more of a concern, she explains, so taking a multivitamin with magnesium can help support bone health, and since magnesium is found in pumpkin seeds, spinach, chia seeds, avocados, black beans, and other plant-based foods.

"Some key nutrients are hard to get enough of, especially considering how few people get from their diets, or due to lifestyle and genetic factors,"  Dr.Sharafi is the Vice
President of Scientific and Clinical Affairs at Ritual and has helped to formulate multivitamins for women, men, and with different ages and life stages in mind, but adds: Of course, first, eat your vegetables.