A Vitamin and Mineral Supplementation Crib Sheet for Clinicians

Americans love their vitamin and mineral supplements, and this often creates confusion or concern for health care providers. Often, clinicians have difficulty finding randomized clinical trials that support or refute vitamin and mineral use. It's no wonder that this is the case; the vitamin and mineral supplementation market hosts more than 90,000 individual products. Approximately 10% of Americans report using at least 4 of these products and studies indicate that 1 of every 2 patients takes at least 1 supplement.

A recent issue of the Journal of the American Medical Association has published a crib sheet for clinicians that covers the basics of vitamin and mineral supplementation.

The authors provide information that anticipates clinicians' (and patients') frequently asked questions. According to the authors, clinicians should advise patients to consume sufficient vitamins and minerals from a healthy diet. Online interaction checkers can help clinicians to ensure that patients’ supplements will not interact with their prescribed medications. Long-term medications that may interact with supplementation include proton pump inhibitors and metformin.

According to the authors, general guidance for supplementation in healthy individuals include:

• Pregnancy: folic acid, prenatal vitamins
• Infants and children: for breastfed infants, vitamin D until weaning and iron from age 4 to 6 months old
• Midlife and older adults: some may benefit from supplemental vitamin B12, vitamin D, and/or calcium

The authors noted that some high risk groups may have difficulty consuming a sufficient quantity of vitamins and minerals. These groups include pregnant women, individuals who've undergone bariatric surgery, people at ages when deficiencies may be more likely, and other high risk subgroups. Medical conditions that interfere with nutrient absorption or metabolism include bariatric surgery, pernicious anemia, Crohn disease, other inflammatory bowel disease, and celiac disease.

For individuals with osteoporosis or other bone health issues, vitamin D, calcium, or magnesium supplementation is recommended. But, the authors remind clinicians that the FDA does not review dietary supplements for safety and efficacy before the products are marketed.

Overall, they concluded that clinicians should steer patients toward supplements certified by independent testing companies including consumerlab.com, US Pharmacopeia, and SF International or UL. Clinicians and patients can also use the Office of Dietary Supplements, National Institutes of Health for reliable information.

Reference

Manson JE, Bassuk SS. Vitamin and mineral supplements: what clinicians need to know. JAMA. 2018 Feb 5. doi: 10.1001/jama.2017.21012. [Epub ahead of print]