Sarah Remmer: The Non-Diet Dietitian


Supplements for Your Family: What to Get, What to Forget

Is a balanced diet enough?

You may be wondering if you should take nutritional supplements. After all, there seems to be more conflicting messages flying around about supplements than there are supplements themselves. Although it's definitely possible to get all your essential nutrients through food, it's not always realistic. And at certain times in our lives, our nutrient needs exceed what we receive through food, just as in the case of women of child-bearing age (especially when pregnant or breastfeeding), or if we become deficient in a certain nutrient (which can only be determined through proper blood testing), or if we decide to experiment with a vegan lifestyle. It's important to speak with your medical doctor or a Registered Dietitian prior to taking supplements though. In some cases, taking too much of one (or several) nutrients can actually cause more harm than good.  

First things first -real food

I would be remiss not to mention the importance of a balanced diet. Ideally, you should aim to get all of your nutrition through real food. Yoni Freedhoff points out in a recent Weighty Matters blog post (referring to a new supplements study out of the Journal of Medicine), that "our bodies are incredibly well adapted to handle different levels of nutrient intakes and that we have mechanisms that help us to deal with shortfalls and surpluses of most supplements and that as a consequence, for true deficiency states to occur, usually a great deal of time (and dietary deficiency) needs to pass."

You should ideally be consuming a well balanced diet containing high quality protein-rich foods (meats, fish, beans, lentils, dairy), a nice variety of vegetables and fruits (I suggest at least 3-5 different colours a day), whole grain foods and healthy fats. If you're eating every 3 to 4 hours on most days and focusing on balance at each meal (I suggest including protein, veggies/fruits and a smaller portion of whole grains at each meal) and snacks (protein-rich food as well vegetable and/or fruit), then you are likely meeting your nutrient requirements. 

Women of child-bearing age and pregnant/breastfeeding women

All women of child-bearing age should be (ideally) taking a regulated pre-natal multivitamin daily, containing folic acid (0.4mg-1.0 mg) to prevent neural tube defects (these can occur in the first trimester--that's why it's so important to take a prenatal before you become pregnant). If you have a high chance of delivering a baby with neural tube defects (something to talk to your doctor about), you may be prescribed a higher dose of folic acid. Folate, the natural form of folic acid can be found in certain foods such as dried beans, peas and lentils, dark leafy green vegetables, and oranges. During pregnancy, your Iron needs increase (Iron is naturally found in meats, poultry, fish, beans, lentils, and some vegetables), therefore, your prenatal multivitamin should contain at least 16-20mg of Iron (your doctor, midwife or Dietitian may suggest more depending on whether you are deficient or not). Calcium and Vitamin D are also important nutrients during pregancy, so it's important that your prenatal contains these nutrients as well. 

How to choose the best pre-natal multivitamin

Prenatal multivitamins typically do not include omega 3 fatty acids, but it's important to make sure that you're getting enough prior to and during pregnancy, as your requirements are higher. During pregnancy, omega-3 fatty acids travel through the placenta to your baby to help grow his or her brain and tissues. The best way to ensure you're getting enough, is to consume at least two standard servings (2.5-3 ounces cooked is a serving) of fatty, low-mercury fish per week such as salmon, canned light flaked tuna, or trout. If you don't like fish, you should consider taking an omega-3 supplement (see Omega-3 section below). 

The 6 Most Important Nutrients For A Healthy Pregnancy

Vitamin D--you might need a supplement

Vitamin D has long been touted for its role in building and maintaining healthy bones as it helps with the absorption of calcium. There is also a growing body of research suggesting Vitamin D plays a significant role in many diverse disease processes. Studies have shown that people with Vitamin D deficiency have a higher risk of certain cancers and heart disease (specifically hypertension and heart attacks). Vitamin D may also play a role in preventing depression, autoimmune disease, Diabetes, Alzheimer’s, Multiple Sclerosis, and obesity.  The Dietary Recommended Intake (DRI’s) for Vitamin D is as follows:

Infants 12 months or younger: 400 IU (international units) per day (if breastfeeding, must be given a Vitamin D supplement)
Toddlers ages 1-3: 600 IU's per day 
Children ages 4-9: 600 IU's per day
Adults ages 9-70: 600 IU’s per day and
Adults over 70 years old: 800 IU's per day. 
Although most toddlers children consume cow's milk or non-dairy Vitamin D-fortified milk, I still recommend that a 400 IU supplement be given daily to ensure that their Vitamin D needs are met. If you are deficient in Vitamin D (as determined through a blood test), your doctor may recommend a higher dose. Because there are few food sources of Vitamin D, most family doctors and Dietitians are recommending that all adults (and babies and children) take a Vitamin D supplement ranging from 400-2000 IU’s per day. If you are taking a multivitamin, it may contain some Vitamin D as well. If you are unsure about how much Vitamin D to take in supplement form, ask your doctor or a Registered Dietitian. 

Does your toddler need a nutritional supplement? 


You have no doubt heard the buzz around the beneficial qualities of Omega-3 fatty acids over the past decade or so.  Omega-3 fatty acids is an umbrella term to describe three various forms of Omega-3 fats (ALA-Alpha-linolenic acid, DHA- Docosahexaenoic acid and EPA-Eicosapentaenoic acid ). ALA is a precursor to DHA and EPA and can be found in plant sources such as canola oil, flaxseed oil and soybean oil. DHA and EPA are the two most important and beneficial forms of Omega-3 are found in fatty fish such as salmon, tuna, halibut and mackerel as well as certain Omega-3 fortified foods like yogurts, milk and cereals. DHA and EPA have been studied for their beneficial effects on heart disease, cancer, arthritis, depression and asthma. DHA is also important for development of the brain and retina, and for neurological functioning and cognitive development. 

Health Canada recommends that healthy adults consume about 300-450 mg of EPA and DHA combined per day.  To achieve this, it is recommended to eat at least two 75 gram (2.5 oz) servings of fatty fish per week (75 gram= size of deck of cards when cooked). For those with Coronary Artery Disease and/or high triglycerides their needs are higher (and must be discussed with a doctor or Registered Dietitian). For those with increased needs and those who do not eat fish, an Omega-3 supplement may be necessary. Omega-3 supplements can be made from ALA or DHA+EPA-rich oils in varying quantities, so it is important to carefully read labels. 

High Potency Doesn’t Mean Better

Some nutrients can be harmful if taken in the large amounts. While this is rarely a problem when it comes to nutrients in foods, vitamin and mineral supplements (including multivitamins) may contain excessive amounts. For example, while the Recommended Dietary Allowance (RDA) for Vitamin C for adults is 75 mg/day, several vitamin C supplements provide 500 mg or more in just one tablet. Taking excessive amounts of Iron can cause severe stomach upset and even liver damage. Vitamin A in large doses can lead to liver failure. 

Some dietary supplements can also interact with certain medications that you may be taking. If you’re unsure ask your family doctor, Registered Dietitian or a Pharmacist. Make sure that your supplement is government regulated as well. It should have a NPN (Natural Product Number) or NHP (Natural Health Product Number) written somewhere on the label to prove that it is regulated and safe. 

Special Dietary Considerations

Some people need supplements because their diet doesn't provide all essential nutrients. Vegans and vegetarians who do not eat any animal products most often need to eat Vitamin B12 fortified foods or take a supplement. They may also find it difficult to meet their needs for Iron, Zinc, Calcium, and Vitamin D with foods, and they may need to take a supplement that provides these nutrients as well (perhaps a multivitamin). 

Adults and children who do not consume milk or calcium-fortified milk alternatives (and those who are at an increased risk of getting, or have, Osteoporosis) may need a calcium supplement and it is important to note that multivitamin/mineral supplements do not contain enough Calcium to meet daily needs.

People with poor appetites, or those with many food allergies or intolerances, may need a multivitamin and mineral supplement and/or other supplements to meet their needs. It is important for anyone with special dietary concerns to speak with their family doctor or a Registered Dietitian for guidance in terms of supplementation. 

If it sounds too good to be true, it probably is

If you've read or heard that you should be taking a nutritional supplement (whether it be a vitamin/mineral supplement, sports/protein supplement or a special herb supplement) from a friend, personal trainer, the internet, a family member or someone other than your family doctor or Registered Dietitian, to cure or improve your health in a significant way, it's probably too good to be true and could even be dangerous. Make sure you double check with your doctor or dietitian to make sure that what you're taking is necessary and safe. 

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