The Vitamin and Mineral Supplements You May Need in Midlife

You should rely on food first for the vitamins and minerals you need, but you may need supplements to fill nutrient gaps, especially after menopause.

Photo by pina messina on Unsplash

Critics of dietary supplements are quick to say that multivitamins and other supplements don’t reduce the risk for chronic disease, which is amplified by menopause and aging. They also maintain that it’s possible to get all the nutrients you need from food.

Wrong on both counts. Let’s get into it.

Who Needs Dietary Supplements

As a dietitian, I favor food first to satisfy nutrient needs. As a pragmatist, I know that vitamin and mineral (micronutrient) supplements are often necessary to meet suggested quotas in midlife and beyond. Dietary supplements are just what their name implies, and they should be considered as useful adjuncts to a balanced diet.

Most adults living in the US fail to eat the suggested fruits, vegetables, seafood, whole grains, and dairy foods. According to the Dietary Guidelines for Americans (DGA), that’s why women don’t consume enough fiber, calcium, vitamin D, and potassium, which guidelines call “nutrients of concern.”  In addition, research suggests that women come up short for magnesium, choline, and vitamins A, C, and E. What’s more, even the DGA acknowledges that dietary supplements are useful for providing one or more nutrients, such as vitamin D, missing in adequate amounts from their own thoughtfully-balanced eating plans!  

I get a lot of questions about what micronutrient supplements to take as a midlife woman.  The answer is: it’s personal. You may need supplements if any of the following apply, no matter where you are in the menopause transition:

• You skimp on food, especially nutrient-rich choices.

• You avoid foods from one or more food groups, such as dairy, seafood, or grains.        

• You limit or avoid all animal products.

• You follow a restricted diet, including a gluten-free eating plan, the Paleo diet, or the ketogenic diet. 

• You smoke cigarettes.

• You take certain medications, including protein pump inhibitors (PPI), such as omeprazole (Prilosec®) and lansoprazole (Prevacid®), used to treat gastroesophageal reflux disease and peptic ulcer disease. These medications, as well as digoxin, can deplete magnesium in the body.  PPIs and metformin can also interfere with the absorption of natural vitamin B12 found in foods. Long term use of prednisone and other corticosteroids can leach calcium from your bones and impair vitamin D metabolism. 

How Midlife Changes Vitamin and Mineral Requirements

The suggested intakes for certain micronutrients change for women after age 51. Some of those changes are related to menopause.  

Calcium: The recommended amount of calcium jumps from 1,000 to 1,200 milligrams (mg) per day. Calcium is crucial for bone health, and you need vitamin D to absorb calcium from the intestinal tract. Vitamin D requirements don’t change in midlife, but it’s difficult to consume adequate vitamin D from food. In addition, it’s unlikely that women consume enough calcium even before menopause increases the need for it. Dairy foods, such as milk, cheese, and yogurt and fortified soy milk and other plant milks are concentrated calcium sources, and you need at least three servings of these foods or their equivalents in calcium daily.  

Vitamin B6: The suggested daily intake for vitamin B6, which helps support energy metabolism and contributes to heart health, increases by 75% to 1.9 milligrams.  Vitamin B6 is a water-soluble nutrient, which means the body doesn’t store it and requires it every day. Vitamin B6 is found in animal and plant foods, including fish, chicken, and garbanzo beans, and it’s also added to fortified grain foods, such as breakfast cereal, bread, and pasta. 

Vitamin B12: Vitamin B12 needs don’t change after age 51, but the suggested form of the vitamin does.  After age 51 women (and men) should rely on synthetic B12, found in dietary supplements and foods with added vitamin B12, such as enriched grains and nutritional yeast, to meet most of their needs.  That’s because older people produce less stomach acid and may absorb less natural B12, found naturally only in animal foods such as seafood, meat, milk, and eggs. Synthetic vitamin B12 is processed without stomach acid, making it more available to the body.

Iron: If you’re still having periods, it’s OK to take supplemental iron, but you should stop after your last period (unless told by your MD or NP to continue), as iron needs drop dramatically from 18 mg to eight mg a day in menopause. Iron is found in animal and plant foods, including meat, seafood, and legumes, and it’s added to refined grains and dietary supplements.

Multivitamins, Brain Aging, and Cancer

Multivitamins are the most popular dietary supplement in the U.S. “Multivitamin” is actually a misnomer, because these supplements typically contain a mixture of vitamins and minerals. Multivitamins and single supplements help satisfy micronutrient needs that often rise to chronic illness, including osteoporosis, iron-deficiency anemia, goiter, and nerve damage. And there is evidence that multis help prevent other chronic conditions, in spite of what the critics say.

A 2023 study in The American Journal of Clinical Nutrition found that taking a daily multivitamin (Centrum Silver) slowed down brain aging in older adults and that the brains of people who took a daily multivitamin were about 3 years “younger” in terms of certain cognitive functions, including memory.  People with a history of cardiovascular disease who took multivitamins experienced the slowest brain aging. The study was a randomized controlled trial (RCT), the kind that’s able to prove that multivitamins caused the positive effects.

A 2012 landmark RCT of more than 14,500 middle-aged and older men found published in the Journal of the American Medical Association found that a daily multivitamin significantly reduced the risk for all types of cancer during an 11-year period. While the results may not be applicable to women of the same age, the results are still worth considering.

Why You May Need More Than a Multivitamin in Midlife

A daily multivitamin can cover a lot of bases but it can’t fill in all the micronutrient blanks. Here are some single nutrient supplements that you may need.

Calcium. Multivitamins provide little calcium. If you don’t get enough calcium from foods on a balanced diet – roughly the equivalent of three servings of dairy or fortified foods, such as soy milk daily - you may need a supplement.  Choose products made from calcium carbonate or calcium citrate. Calcium supplements are best absorbed in doses of 500 mg or less.

Vitamin D. Vitamin D helps the body to use calcium. With time, even slight shortfalls in vitamin D can put bones at risk for fracture and cause other health issues, as vitamin D also supports immunity, cell function, and the nervous system. In the US, multivitamins typically contain about 10 micrograms (400 International Units, or IU) of vitamin D. The recommended amount for women is 15 micrograms (600 IU) daily until age 70, and 20 micrograms (800 IU) per day after that. Very few foods naturally contain vitamin D, probably because the body can make it from exposure to strong sunshine. Fortified milk, salmon, and tuna are some of the best sources.

Omega-3 fats. Omega-3 fats (DHA and EPA) are not micronutrients but are still worth discussing. According to the American Heart Association, omega-3 fats help to keep the heart beating properly, decrease elevated blood triglycerides in the blood, and may lower blood pressure. Seafood is the best food source of DHA and EPA. Though there are no US Dietary Reference Intakes for EPA and DHA, the general consensus is to consume between 200 to 500 mg a day of EPA and DHA combined, which is about the amount you would get from eating the recommended eight ounces of fatty fish weekly. Women who avoid or limit fish may benefit from omega-3 supplements with DHA and EPA.

Choline.  Choline supports liver, muscle, and brain function and it’s part of every cell membrane, which protects the inner workings of cells. Menopause may increase the body’s need for choline, as estrogen is involved in choline production, but the current suggested daily intake – 425 mg – is the same for women over 51 right now. Protein-rich foods such as eggs, lean meat, poultry, and seafood are the richest choline sources and plant foods contain less. Multivitamins supply little, if any, choline. When purchasing choline supplements, choose choline bitartrate.

Photo by Ksenia Yakovleva on Unsplash

How to Use Dietary Supplements Safely

Food and dietary supplements can work together to meet nutrient needs and promote better health. Always rely on food first to satisfy nutrient needs and evaluate your diet and see what’s missing before you pile on the dietary supplements. Never substitute dietary supplements, such as those that promise to lower cholesterol levels, for medications that your doctor or nurse practitioner has prescribed.

The potential benefits of micronutrient supplements likely outweigh the risks in most cases, but there are some safety considerations.  Opt for reputable dietary supplements and only to fill in relatively small nutrient gaps. If a little is good, a lot is not necessarily better, so avoid going overboard on micronutrients. 

Keep a list of your dietary supplements and doses with you to share with healthcare professionals, including your dentist, as needed.  Alert your MD or NP if any of these apply:

• You take prescription or over the counter medication. For example, the FDA advises against combining warfarin (Coumadin) with omega-3 and vitamin E supplements (and with garlic, ginger, glucosamine, ginseng, ginkgo) because they enhance the effects of the drug and can increase the chance of bleeding. But vitamin K in dietary supplements (and foods) can lower the effectiveness of warfarin. If you take warfarin, talk to a registered dietitian/nutritionist (RDN) about how to eat a balanced diet that works with your medication, and not against it.

• You’re being treated for cancer, or you have a history of cancer. Do not take dietary supplements without consulting with a RDN who specializes in oncology.

• You’re having surgery, including dental surgery. Your surgeon or dentist may advise not avoiding certain supplements, such as vitamin E and omega-3s, which can thin your blood and prolong bleeding.

• You smoke or you did smoke cigarettes or were exposed to asbestos. Taking large amounts of beta carotene may increase the risk for lung cancer in people with a history of smoking or who were exposed to asbestos. Beta-carotene is the raw material for making vitamin A in the body. It’s sold as a single supplement and found in multivitamins. Avoid the single supplements and choose multivitamins with a low percentage of vitamin A as beta-carotene listed on the package label.

The Supplements I Take as a Registered Dietitian

I eat a balanced diet, but that doesn’t mean that I always satisfy my vitamin and mineral needs through food. Here’s what I take and why.

Multivitamin without iron. I am past menopause, so I don’t need supplemental iron. The multivitamin research I mentioned earlier is strong, and in my case there is little, if any, risk in taking a multi. I also need the vitamin D in the multi to fulfill my daily quota.  

Calcium: I don’t get enough calcium from food, so I take about half of what I require (600 mg) in pill form. I favor calcium carbonate, which is a well-absorbed form.

Magnesium: Magnesium needs don’t increase after age 51, but I probably don’t get enough daily and my multi provides very little. I take about half the daily requirement – 350 mg -  as magnesium glycinate.

I don’t bother with omega-3 supplements because I eat fish about five times a week, so that provides plenty of healthy fat. I also don’t take choline because I eat fish and other animal foods every day, so I consume enough choline from food.

What do you take for supplements and why? Let me know!