Veggie Blog

The old version of this post said that fatigue is the biggest complaint doctors hear, that folic acid has been “proven” to raise energy, and that NADH, MSM and ginkgo biloba are vitamins that are great for energy. Several of those claims are not correct, so I have rewritten the post around what the research says.

Do vitamins give you energy?

Not directly. Vitamins do not provide energy the way food calories do. What they do is help your body work, so a shortage of some vitamins can make you feel tired. The NIH’s Office of Dietary Supplements says, for example, that vitamin B12 helps prevent megaloblastic anemia, a blood condition that makes people tired and weak, and that manufacturers often promote B12 for energy and endurance, but it does not provide these benefits in people who get enough B12 from their diet. The old post’s claim that folic acid has been “proven” to raise energy is also too strong. Folate deficiency can cause fatigue, but the ODS says it is rare in the United States.

Which shortages can make you tired?

Three are worth knowing about. Iron deficiency anemia can cause weakness, tiredness, lack of energy and trouble concentrating, and the ODS says it is not uncommon among young children, women under 50 and pregnant women. Vitamin B12 deficiency affects between 3 and 43 percent of older adults, and some people, such as those with pernicious anemia, cannot absorb it well. Folate deficiency is rare in the U.S. but can cause fatigue. A doctor can test for these. Do not start high-dose iron on your own, because the ODS warns that accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. Our posts on vitamin deficiency and why to test before you supplement and getting the right amount of vitamins explain more.

What about NADH, MSM and ginkgo?

The old post said NADH is very good for energy and is often used in chronic fatigue. Small studies in people with chronic fatigue syndrome have suggested benefits, but they were short, small and often used outdated diagnostic criteria, and systematic reviews have concluded that the evidence is insufficient to recommend supplements for this condition. I did not find solid evidence for MSM improving energy either, so I would not rely on it. Ginkgo is not a vitamin. According to the National Center for Complementary and Integrative Health, there is no conclusive evidence that ginkgo is helpful for any health condition, and it may increase the risk of bleeding in people taking anticoagulants such as warfarin. The old post warned about aspirin, which is wise: ask your doctor or pharmacist before combining ginkgo with any blood-thinning medicine.

What else causes tiredness?

Plenty. MedlinePlus says fatigue is a symptom, not a disease, and lists causes such as anemia, diabetes, thyroid disease, sleep apnea and other sleep disorders, depression and anxiety, certain medicines, too little sleep, too much alcohol or caffeine, and too little (or too much) exercise. If you have been tired for weeks, MedlinePlus advises contacting a health care provider. Meanwhile, get regular physical activity, improve your sleep habits, eat a healthy diet, manage stress and consider keeping a fatigue diary. See MedlinePlus on fatigue.

Should you take a vitamin for energy?

If you eat a varied diet and have no symptoms, a vitamin is unlikely to make a noticeable difference. If you suspect a deficiency, get a blood test first. The old post is right that you should ask your doctor before taking any supplement, especially if you have a medical condition or take medicine. For choosing products, see choosing vitamin supplements and vitamins and your health.

Getting the right amount of vitamins

If you eat healthy and balanced meals every day, you will get most of the vitamins and minerals your body needs to function. Even though we all have different dietary needs, we all need vitamins in order to live healthy lives and prevent disease. Vitamins were discovered in the early twentieth century, and since then we have learned a lot about how they keep us healthy.

There are many vitamins, and you need a certain amount of each one to keep your body healthy. They are classed by letter, including A, B, C, D, E and K. Each one serves a unique purpose for your body and your health; vitamin C, for example, is needed to make collagen and helps the body absorb iron.

The B vitamin family

When it comes to variety, the B vitamins are the most diverse. They were first thought to be a single vitamin, but scientists later found that ‘vitamin B’ is really a group of different compounds. Today the B vitamin family has eight members: B1, B2, B3 (niacin), B5, B6, B7, B9 (folate) and B12.

As with other vitamins, a lack of B vitamins can lead to different conditions, such as weight loss, weakness, tiredness, diarrhoea, anaemia and, with a long-term lack of B12, nerve damage and memory problems. If you think you may be low in a B vitamin, see your doctor, who can check with a blood test.

Together, the B vitamins help your body turn food into energy and keep your skin, nerves and blood cells healthy. Getting enough of them supports good health, but taking extra beyond what you need will not speed up your metabolism or lift your mood. All of these vitamins should be part of a balanced daily diet.

Even on a good diet, some people do not get enough of certain B vitamins. Vegans and many older people need a source of B12, such as fortified foods or a supplement, and women who may become pregnant are advised to take folic acid. If this applies to you, ask your doctor or pharmacist about vitamin supplements. For most people who eat a varied diet, supplements are not necessary, and very high doses of some B vitamins (such as B6) can cause harm.

Medicines and vitamins are often mentioned in the same breath when it comes to lowering cholesterol. They are very different. Prescription drugs have been tested in large trials, while many supplements have not. Here is what is known about each, so that you can ask better questions at your next appointment.

How do statins work?

Statins are the medicines most often used to treat high cholesterol. They reduce the amount of cholesterol made in the liver. The NHLBI says that studies have shown that statins lower the risk of heart attack and stroke in people with high LDL. The NHLBI adds that statins usually do not cause side effects, but they may raise the risk of diabetes, mainly in people who are already at high risk of it. Your doctor will weigh the benefits and risks for you. For more, see when lifestyle is enough and when medicine helps.

What are bile acid sequestrants?

These are another type of cholesterol medicine. They keep bile acids, which help digest fats and oils, from being absorbed into the body, and that lowers LDL cholesterol. They may be prescribed if you cannot take statins or if statins alone are not lowering your cholesterol enough. According to the NHLBI, they may cause diarrhea, make some other medicines less effective or raise triglyceride levels.

Does niacin lower cholesterol?

Niacin, also called vitamin B3, can do so, but only in very large doses. The NIH Office of Dietary Supplements says that doses more than 100 times the recommended daily amount, taken for months or years, can raise HDL by 10 to 30 percent and lower LDL by 10 to 25 percent. But in the largest trial to date, which included 25,673 adults with cardiovascular disease, adding extended-release niacin to statin treatment did not significantly reduce major vascular events, and the niacin group had more diabetes, digestive problems and skin rashes. Large doses can also cause flushing, itching, nausea, low blood pressure, raised blood sugar, blurred vision and, over months or years, liver damage. Experts do not agree on its value, and it is not something to start on your own. If a doctor prescribes it, the dose is supervised. For everyday amounts of vitamins, see getting the right amount of vitamins.

What about lecithin, vitamin C and vitamin E?

Lecithin is sold as a supplement that is said to help disperse fat and cholesterol in the body. The studies I could find on lecithin and cholesterol are small and mixed, and it is not a standard treatment, so it is not something to rely on. Vitamins C and E are antioxidants, and it was once hoped that they would protect LDL from damage and prevent heart disease. In practice, large trials have been disappointing. The Office of Dietary Supplements says that the HOPE and HOPE-TOO trials provide compelling evidence that moderately high doses of vitamin E do not reduce serious cardiovascular events, and that most trials have not found conclusive evidence that vitamin C supplements protect against heart disease. Fruits and vegetables, which contain these vitamins together with fiber and other nutrients, are associated with a lower risk of heart disease, and that is the reason to eat more of them.

What is the safest approach?

Start with food: more fiber, fewer saturated fats, regular activity and a healthy weight. Have your cholesterol measured and ask your doctor whether you need medicine, and if so, which type. Tell your doctor and pharmacist about every vitamin and supplement you take, because some can interact with medicines. Our guides to what you can do to lower your cholesterol and vitamin C are a good place to begin.

Vitamins and your health

Can you get all your vitamins from food?

Most of us know that vitamins are part of a healthy, disease-free way of life. Vitamin products have also become far more specialized than they used to be, and many are aimed at particular parts of your body or your health. That does not mean everyone needs them. For most healthy people who eat a varied diet with plenty of vegetables, fruit, whole grains, beans, nuts and dairy or fortified foods, food covers vitamin needs. Multivitamins cannot take the place of the variety of foods in a healthy diet, according to the US National Institutes of Health.

Supplements are meant to fill gaps, not to replace meals. The tricky part is knowing whether you have a gap.

Who may need a supplement?

Some people do find it hard to get what they need from food alone. This is more likely if you follow a vegetarian or vegan diet, have food allergies or other dietary restrictions, have a small appetite so that you feel full quickly, are an older adult, are pregnant, or have a medical condition that affects how your body absorbs nutrients. Vitamin B12 is the best example for readers of this blog. It is found naturally in animal foods such as fish, meat, eggs and dairy products, but not in plant foods, so vegans in particular need fortified foods, such as some breakfast cereals and nutritional yeast, or a supplement. Adults need 2.4 micrograms a day, according to the NIH Office of Dietary Supplements.

If you are not sure, ask your doctor. A simple blood test can show whether you are low in a vitamin, and our post on whether vegetarians need vitamin supplements covers more of the basics.

What do the main vitamins do?

B12 helps to keep your nerves and blood cells healthy. Many people think that it boosts energy, but the evidence shows that extra B12 only improves energy and performance if you were short of it to begin with. Vitamin A supports vision and the immune system. Vitamin C helps your body heal wounds and absorb iron, and you can read about it in our post on why you need vitamin C and where to find it. Vitamin D works with calcium to keep bones strong. Vitamin E is an antioxidant, and our post on vitamin E explains what it does and how much you need. Taking more than you need does not give you extra health, and some vitamins can do harm in large doses.

What about selenium and colostrum?

Selenium is a mineral, not a vitamin. Adults need 55 micrograms a day, and most people in the United States get enough from food. People on vegetarian or vegan diets may have lower intakes, and Brazil nuts are particularly rich in it, so a few are enough. The upper limit is 400 micrograms a day, and chronic high intakes can cause hair and nail loss and other problems, which is why megadoses are a bad idea.

Colostrum, the first milk produced after birth, is sold as a supplement. It is not a vitamin, and studies in healthy adults have given limited and mixed results for immune support, so it is not something you need. The kind sold in supplements usually comes from cows, which matters if you are a vegan. Ask your doctor before adding it.

How do you decide?

Start with your diet, then talk to a doctor or pharmacist about anything you might be missing. If you do take a supplement, choose one that fits your age and needs, keep to the recommended amounts, and see our post on getting the right amount of vitamins. For tips on picking and using supplements, read our companion post on how to choose and use supplements wisely.

Walk down the vitamin aisle and you will see tablets, capsules, gummies, chewables, powders and liquids. About 57.6 percent of U.S. adults aged 20 and older used a dietary supplement in the past 30 days, according to a 2017 to 2018 survey by the National Center for Health Statistics, so this is a question many people have. Some sellers claim that liquid vitamins are far better absorbed. Let us see what holds up.

Do liquids work better than pills?

You may have read that about 90 percent of the nutrients in pills are not absorbed, and that liquids are far more effective. I could not find a reliable source for this. The NIH Office of Dietary Supplements lists tablets, capsules, gummies, powders and drinks as supplement forms, and does not rank one as better than the others. How much of a nutrient you absorb depends on the nutrient itself, the dose, how well the product is made, what you eat with it and your own body. A good tablet that breaks down properly is absorbed well, and a poorly made liquid may not be.

What are the real differences?

Liquids are useful if you cannot swallow pills. They need accurate measuring, and it is worth checking the label for added sugar and sweeteners. Chewables and gummies are easy to take, but many contain added sugar, and nutrient amounts vary from brand to brand, so compare the Supplement Facts panel. Because they can taste like candy, keep them out of the reach of children. Tablets and capsules are the most common form and are easy to store and dose, although some people find them hard to swallow.

Which form should you choose?

Choose one that you will take every day. A supplement in a drawer does nothing, so a form that is easy for you to swallow, chew or measure is a better choice than the “best” one that you skip. If you take a vitamin with fat in it, such as vitamin D, take it with a meal. Calcium and iron are better kept apart, as the Office of Dietary Supplements advises; our guide to calcium supplements has more. Check the Supplement Facts label for the amounts of each nutrient, and compare them to what you need.

How do you know that a product is good?

Several independent organizations test supplements and let products that pass display a seal. According to the Office of Dietary Supplements, the seal indicates that the product was properly manufactured, contains the ingredients listed on the label and does not contain harmful levels of contaminants, although it does not guarantee that the product is safe or effective. Use is common and rises with age, reaching 74.3 percent among adults 60 and older, so it is worth reading labels carefully if you take several products.

Do you need a supplement at all?

Most healthy people can get what they need from food. A supplement can help if you have a medical need, a restricted diet, or a deficiency that a doctor has found. For example, vegans need a source of vitamin B12. Ask your doctor or a dietitian before you buy, and read vitamins and your health and getting the right amount of vitamins. If you take medicine, check with your pharmacist first, because some supplements interact with drugs.

In short, form is a matter of convenience, taste and price. The quality of the product, the dose and the habit of taking it matter far more.