Tag Archive for: supplements
By Maya Shetty, BS and Felicia Song, BS
Midlife marks a significant life transition, bringing hormonal shifts that can reshape a woman’s body and well-being. As women navigate this period, their bodies undergo physiological changes that can impact muscle mass, bone density, metabolism, and overall well-being. Lifestyle factors play a fundamental role in healthy aging, but strategic supplementation can further support women in optimizing their health through midlife and beyond.
Nutrition and exercise researcher at Stanford Lifestyle Medicine Rachele Pojednic, PhD shares evidence-based strategies to help women maintain strength, vitality, and resilience as they age.
Different Supplements for Different Stages of Life
As women age, there are distinct shifts in body composition, and as a result, our nutritional needs change. For example, in our thirties, the focus should be on building and maintaining muscle mass, as bone formation peaks in the late teens and 20s. This foundation is critical because it helps offset the decline in estrogen during perimenopause, which reduces the body’s ability to preserve muscle and bone.
“Research shows that women begin losing skeletal muscle around age 30, with declines ranging from three to five percent per decade, and in some cases, up to 10 percent during the first postmenopausal decade,” states Dr. Pojednic.
After menopause, estrogen and other hormones stabilize at lower levels, making it more difficult for the body to build bone and muscle. Therefore, strength training, a nutrient-dense diet, and intentional supplementation become essential tools not just to mitigate loss of bone density and muscle mass, but to support long-term health.
Also, estrogen has anti-inflammatory properties throughout the body. When estrogen levels begin to decrease during perimenopause, systemic inflammation increases, contributing to a range of health concerns including changes in cognitive function, mood, and sleep. To help counter these effects, strategic supplementation can play a key role in supporting overall health, reducing inflammation, and maintaining balance.
Top 6 Supplements for Perimenopause and Menopause
1) Creatine
Creatine is a tripeptide that is naturally produced by the body and found in animal products. It plays a critical role in energy production and is crucial for maintaining muscle, bone, and brain health. In the body, creatine is stored in the muscles as phosphocreatine, which acts as a fast-acting energy reserve by donating a phosphate group to regenerate ATP, the primary energy currency of cells. This makes muscles more efficient, allowing for improved muscle function and greater overall strength.
“Creatine is one of the most extensively studied supplements in the world, and for good reason,” states Dr. Pojednic. “Recent research has shown considerable benefits in muscle, bone, and brain health.”
Why Creatine Matters for Women 40+
As women age, creatine levels naturally decline. In fact, women tend to have 70 to 80 percent lower creatine stores than men, and this difference becomes even more pronounced with age. This decline can contribute to age-related muscle loss, bone density reduction, and changes in cognitive and emotional health.
Benefits of Creatine Supplementation
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Muscle and Bone Health
Research suggests that creatine supplementation can help improve muscle function, increase muscle size, and enhance bone density in peri- and postmenopausal women, particularly when combined with resistance training.
“By enhancing ATP regeneration, creatine allows women to push their muscles a little harder during exercise, promoting more robust muscle mass and bone strength,” states Dr. Pojednic.
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Cognitive Health
The brain relies heavily on phosphocreatine for energy, and low levels can contribute to brain fog and mood changes. Studies have shown that creatine may enhance short-term memory and overall cognitive performance in adults aged 45 to 64.
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Mood Stability
Emerging research suggests that creatine supplementation may help offset mood changes associated with perimenopause, including anxiety, depression, and sympathetic overdrive. A recent study found that adding creatine to therapy for depression led to greater symptom improvement compared to therapy alone, highlighting its potential role in brain health as women age.
“Topping off creatine stores may help reduce brain fog, moodiness, and other cognitive side effects often experienced during perimenopause,” states Dr. Pojednic.
How to Supplement with Creatine
Dr. Pojednic recommends that women supplement with three-to-five grams of creatine per day. Timing doesn’t matter, so it can be taken at any time of the day that’s convenient. When choosing a supplement, look for one that uses a water-based wash rather than an acid-based wash, as the latter may cause gastrointestinal side effects.
2) Protein
Protein is a vital macronutrient made up of 20 amino acids, nine of which are essential, meaning they must come from food since the body cannot produce them. These essential amino acids—histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine—are crucial for muscle growth, maintenance, recovery, and overall health.
Why Protein Matters for Women 40+
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Increased Protein Needs
As women age, their ability to absorb and utilize protein efficiently declines, making adequate protein intake even more critical. Aging leads to anabolic resistance, meaning the body requires more protein and a greater resistance training stimulus to maintain and build muscle. Without sufficient protein, women may struggle to preserve lean mass, recover from exercise, and maintain metabolic health.
“Most women at all stages of life are not consuming enough protein, and this becomes more of a problem with age. While many women consume only 40 to 60 grams per day, research suggests that a more optimal range is 80 to 100 grams per day for muscle maintenance and growth,” states Dr. Pojednic.
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Muscle and Metabolic Health
Protein is necessary for preserving lean mass, which helps maintain strength, independence, and metabolic function. It also supports post-exercise recovery and reduces the risk of sarcopenia (age-related muscle loss).
How to Get Enough Protein
High-quality animal proteins like meat, dairy, and eggs naturally provide all nine essential amino acids needed for muscle maintenance. Plant-based options such as soy and pea protein can also be effective, but it’s important to ensure they offer a complete amino acid profile. Consuming protein after workouts is particularly beneficial for muscle recovery and growth. Dr. Pojednic recommends women aim for 1.2 to 1.6 grams of protein per kilogram of body weight per day, which translates to a more practical target of 80 to 100 grams.
While a food-first approach is ideal, strategic use of protein powders can help women meet their daily protein needs to support strength, metabolism, and longevity. When choosing a protein powder, look for one that contains all nine essential amino acids and has minimal additives, which can cause bloating or gut irritation. “I opt for unsweetened protein powders to limit additives and sweeten them with ingredients I prefer,” states Dr. Pojednic.
What About Collagen Protein?
While collagen supplements are often marketed for skin, hair, and nail health, collagen is an incomplete protein and does not contain all essential amino acids. It should not be relied upon as a primary protein source over complete protein supplements or whole foods.
3) Vitamin D3
Vitamin D3, in conjunction with calcium (next section), plays a critical role in maintaining bone density, muscle function, and overall health. While commonly associated with osteoporosis and osteopenia prevention, vitamin D is essential for many tissues beyond bone, including the muscles, immune system, cardiovascular health, and cognitive function.
“As women age, they experience a decline in skeletal muscle starting around age 30 and bone mass loss after 40, with both reducing at an accelerated rate during and after menopause,” states Dr. Pojednic. “Supplementation with Vitamin D3 can offer support with both muscle and bone health.”
Why Vitamin D3 Matters for Women 40+
Vitamin D3 is vital for calcium and phosphate regulation, ensuring that bones stay strong and muscles function properly. Additionally, estrogen and vitamin D interact to affect bone health, as estrogen regulates vitamin D metabolism. During perimenopause, declining estrogen levels reduce vitamin D’s effectiveness, making adequate intake even more important.
Key Benefits of Vitamin D3
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Bone and Muscle Health
Vitamin D plays a critical role in skeletal muscle function and bone maintenance. Deficiency in vitamin D (<50 nmol/L) is strongly associated with age-related muscle weakness and muscle mass loss. Inadequate vitamin D levels (<29 ng/ml) have been linked to poor lower body function, particularly in women, increasing the risk of falls and fractures. Studies have shown that supplementation with vitamin D3 improves muscle strength and function, particularly in postmenopausal women with insufficient levels.
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Iron Absorption and Recovery
Vitamin D plays a key role in iron regulation by reducing hepcidin levels, which helps improve iron absorption—particularly important for post-exercise recovery. Since training increases hepcidin, which inhibits iron absorption, taking vitamin D after exercise may counteract this effect, reducing the risk of low iron and anemia in active women.
How to Supplement with Vitamin D3
Vitamin D is difficult to obtain from diet alone, as it is naturally found in few foods, including fatty fish, liver, beef, and fortified foods like cereals, dairy, and juice. The body’s main source of vitamin D comes from sun exposure, but in many regions, the sun’s UVB rays are not strong enough to support vitamin D synthesis between October and April.
To ensure adequate levels, supplementation is often necessary. The recommended dose ranges from 800 to 4,000 IU per day, though higher doses can be detrimental to bone health.
“Finding the ‘sweet spot’ is key, as excessive intake of vitamin D offers diminishing returns. Blood testing can help determine individual needs, ensuring levels are sufficient without exceeding optimal ranges,” states Dr. Pojednic.
For best absorption, look for Vitamin D3 (cholecalciferol), the most bioavailable form. Additionally, taking a Vitamin D3 supplement with fat, such as an omega-3 supplement (keep reading for more on this) will enhance its absorption.
4) Calcium
Calcium is a key mineral required for bone rigidity, stability, and muscle contraction, yet many people—especially women—fail to consume enough from their diets. While green leafy vegetables and dairy are excellent sources, many people don’t eat enough of them, and dairy alternatives are often not fortified with calcium. Without sufficient intake, the body pulls calcium from bones, increasing the risk of osteopenia and osteoporosis with age.
“While calcium is crucial for bones, it also plays a role in nerve function, blood clotting, and muscle contractions—making it essential for heart health and overall mobility,” says Dr. Pojednic.
How Much Calcium Do You Need?
The recommended daily intake for women in their 40s is 1,000 mg of calcium per day. “However, balance is key—too little calcium weakens bones, but excessive calcium without proper nutrient pairing may lead to arterial calcification instead of proper bone mineralization,” warns Dr. Pojednic.
5) Omega-3 Fatty Acids (Fish Oil)
Omega-3 fatty acids are essential nutrients because the body cannot produce them, meaning they must come from food or supplements. These powerful antioxidants help scavenge free radicals, reducing tissue damage and supporting cell membrane integrity in every organ. Omega-3s are particularly important for vascular health, keeping blood vessels flexible and reducing the risk of cardiovascular disease and dementia. They also play a key role in brain function, supporting neurons, maintaining myelin, and helping to keep chronic inflammation low.
Why Omega-3s Matter for Women 40+
Estrogen has natural anti-inflammatory properties, offering protection against chronic inflammation throughout life. However, perimenopausal women lose some of this protective effect, increasing the need for anti-inflammatory support through other mechanisms.
Key Benefits of Omega-3s
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Cognitive Health
Omega-3s may help reduce the risk of Alzheimer’s disease by lowering brain inflammation and supporting nitric oxide production, which promotes blood flow to the brain.
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Muscle Health
Research shows that omega-3s enhance muscle protein synthesis and mitochondrial function, helping to counteract sarcopenia. Their anti-inflammatory properties may also aid recovery and improve performance in athletes.
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Inflammation Reduction
Omega-3s help regulate inflammatory cytokines like IL-1 and IL-6, which may support joint health and post-exercise recovery.
How to Supplement with Omega-3s
For optimal benefits, choose high-quality, purified fish oil supplements to avoid contaminants. If possible, prioritize whole food sources such as fatty fish (salmon, sardines, mackerel), which provide a naturally balanced omega-3 profile. While omega-3s have well-documented benefits, most research has been conducted in men, so more studies are needed to fully understand their effects in female athletes and aging women.
6) Fiber
Rather than a supplement, fiber should primarily be consumed in our diet. The current dietary guideline for fiber is 25 grams daily through fruits, vegetables, whole grains, legumes, beans, nuts, and seeds. Fiber is crucial for our gut health, helps to maintain our blood glucose levels and improve insulin sensitivity, and helps to lower LDL (the bad) cholesterol.
“If fiber is not sufficient through diet, I recommend a fiber supplement, such as psyllium husk, inulin, or methylcellulose daily to help you meet the fiber requirements,” says Gray Shimko, RD, leading dietician at the Stanford Menopause and Healthy Aging program.
The Importance of Exercise When Taking Supplements
While supplements like creatine, protein, vitamin D3, calcium, omega-3s, and fiber provide the body with essential nutrients for muscle, bone, and brain health, they cannot replace the need for exercise. Strength training serves as the necessary trigger for muscle growth and adaptation. While protein and creatine supply the raw materials for muscle repair, it is the physical act of contracting muscles through exercise that signals the body to build and strengthen them.
“To effectively build and maintain muscle as we age, women must actively engage in resistance training, as muscle follows a ‘use it or lose it’ principle,” states Dr. Pojednic. “Engaging in resistance training at least two-to-three times per week—whether through weightlifting, resistance bands, or bodyweight exercises—helps maintain muscle mass, improve bone density, and support metabolic health.”
Exercise also improves how the body absorbs and utilizes nutrients, making supplementation more effective. For example, creatine supplementation enhances strength and performance, but its full benefits are only realized when paired with resistance training. Similarly, omega-3s can reduce inflammation and support muscle recovery, but their impact is greatest when muscles are actively engaged in movement.
By combining strategic supplementation with regular strength training, women 40 plus can maximize muscle retention, protect bone health, and maintain cognitive function, ensuring long-term strength, mobility, and independence as they age.
Foundational Nutrition Before Supplementation
Lastly, when choosing supplements, quality and transparency are key. Look for third-party tested products to ensure two critical factors: first, that the ingredients listed on the bottle are actually present and in the correct doses. Second, third-party testing verifies that there are no undisclosed or harmful substances, such as heavy metals or adulterants. While supplements should complement–not replace–a nutrient-rich diet, the 40s decade is a pivotal transition, making it especially important to identify and address any dietary gaps.
“Think of supplementation as the icing on the cake—helpful for optimizing health, but most effective when approached with prudence and balance,” says Dr. Pojednic. “Supplements should be viewed as tools for marginal gains, not miracle solutions. Foundational nutrition—getting enough protein, fiber, and healthy fats from our food—remains crucial.”
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Key Takeaways:
- The supplement industry operates with minimal external oversight. Thus, it is critical for consumers to rigorously assess the actual need and proven efficacy of a supplement prior to its use.
- Most supplement claims lack scientific evidence. Consumers should only consider supplements with solid scientific backing.
- Opt for brands verified for purity and bioavailability by third-party organizations.
- Supplements should supplement—not replace—a healthy diet and lifestyle. Emphasize whole foods, physical activity, and balanced health practices over seeking quick fixes.
In an era where every shelf in the wellness aisle promises a solution to your health concerns, supplements stand out as both suspects and saviors. The market is flooded with options: B12 promises to energize you, omega-3 asserts it will curb inflammation, vitamin C and zinc vow to enhance your immunity, and greens powders claim to do everything in between. With so many claims, it’s important to learn how to navigate the supplement world with a critical eye and an informed mind. Stanford Lifestyle Medicine Registered Dietician Marily Oppezzo, PhD, MS, RDN, DipACLM explains how to approach the supplement market and make informed choices for your health.
What is a Dietary Supplement?
Dietary supplements are ingestible products that contain “dietary ingredients” intended to supplement the diet, including vitamins, minerals, herbs, amino acids, fatty acids, live microbials, and protein powders, among many others. Navigating this expansive world requires an understanding of their nature and regulation—or lack thereof. Though many claim to be from natural sources, supplements are essentially laboratory-created entities designed to alter our physiology, underscoring the importance of approaching them with the same level of scrutiny as any medication.
“Just because a supplement is labeled as ‘natural’ or derived from natural sources doesn’t make it healthy, or even safe,” states Dr. Oppezzo. “This is particularly relevant when considering the unnaturally high concentrations [of the nutrient] often found in supplements.”
Despite their widespread use for health-related purposes, dietary supplements are in a regulatory gray area. When it comes to most supplements, the Federal Drug Administration (FDA) is not responsible for ensuring safety, efficacy, purity, or potency. These aspects are managed by the supplement manufacturers themselves (per the Dietary Supplement Health and Education Act of 1994). This means that supplements are exempt from the rigorous testing and validation process mandated for pharmaceuticals, with the FDA stepping in only if enough post-market reports indicate adverse effects. This regulatory gap makes it challenging for consumers to navigate the supplement aisle, emphasizing the importance of thorough evaluation when considering the necessity of a supplement.
Evaluating the Need for a Supplement
While many individuals view supplements as a way to meet their basic nutritional requirements or as a convenient method to optimize health, the reality is that there are relatively few situations where supplements have proven beneficial.
Before taking any supplement, Dr. Oppezzo recommends pausing to consider several key questions:
- What is my reason for believing I have a nutritional deficiency or need to take this supplement? Have I spoken to my doctor or taken a blood test to confirm this deficiency? Is there even a test to confirm this?
- Has a credible source such as a Registered Dietitian or Doctor recommended this to me, or am I influenced by persuasive advertising?
- What benefits do I expect to gain from taking this supplement? Is there any scientific evidence that this supplement will help me?
Of course, there are circumstances where supplementation can be beneficial. Age, certain medical conditions, and specific lifestyle choices can impact our body’s ability to absorb or synthesize vital nutrients. For instance, older adults might struggle to produce enough vitamin D or B-12 naturally. Athletes engaging in intense training may require additional iron or protein or calories to support their performance levels, while those following vegan or vegetarian diets might need nutrients less common in plant-based foods, such as B-12, omega-3 fatty acids, calcium, and vitamin D.
The most reliable way to determine your nutritional needs is through a professional consultation with a dietitian. This approach allows for a tailored assessment for needs, evaluation of evidence behind supplements you are interested in, and ongoing monitoring to adjust as necessary.
Assessing Supplement Claims
A significant portion of supplement usage is driven by misconceptions and marketing rather than genuine need. “The wellness industry often races ahead of scientific validation, promoting products with claims that outpace the available evidence,” states Dr. Oppezzo. “They aren’t cutting edge, they are flying out way past the cliff of evidence.”
Addressing this challenge, Dr. Oppezzo encourages consumers to first look for any peer-reviewed studies backing the “need” or the claim of a supplement. Ideally, ask an expert to do this for you.
While certain supplements, such as vitamin B12, are actually essential nutrients, supported by extensive research, others, like various greens powders and phytochemical blends, lack robust evidence demonstrating their effectiveness throughout the body. The absence of any regulation allows many products to make exaggerated claims without solid proof. As such, many supplement labels contain a hodgepodge of wellness buzzwords, such as “immune booster,” “supports gut health,” and “promotes health aging,” without any science to back up the claims.
Secondly, Dr. Oppezzo urges us to think about its bioavailability—the extent to which it can be absorbed and utilized by the body. Imagine being in the shoes of a supplement itself, considering all the gauntlets it has to pass to do the thing you think it will do and deliver the marketed effects.
Like any ingested substance, supplements are first broken down by the stomach, absorbed in the gut, processed in the liver, incorporated into the bloodstream, and then transported to organs and cells throughout the body. The critical question is whether the supplement can survive this journey in a form that retains its intended benefit and reaches the organ or cell where you think it will do its purported job.
“Let’s put essential vitamins and minerals aside for a moment. Even if there is evidence some supplement or chemical will do something if you dropped it on your cells in a test tube, you don’t know that this translates to your real live body. Further, you don’t even know if the supplement will even succeed at getting inside your body in the first place, let alone maintaining its original ‘active’ structure after it gets inside,” states Dr. Oppezzo.
It’s important to approach supplements with a healthy dose of skepticism and informed judgment. Not all supplements are inherently harmful; some can offer significant benefits when used appropriately. Yet, the decision to incorporate them into your health regimen should be made with careful consideration, guided by credible evidence and, when possible, professional advice. Once identifying the need for a supplement, Dr. Oppezzo recommends the following framework to decide the appropriate brand, dosage, and context for its consumption.
Framework for Choosing a Supplement
1. Assess the Safety and Efficacy
When it comes to supplements, third-party testing is a gold standard for ensuring product safety and efficacy. Organizations like ConsumerLab, US Pharmacopeia, and NSF International offer unbiased supplement evaluations, checking for purity, potency, and safety. Consumers can either check these websites to find a trustworthy supplement brand or look for products that bear their certifications. While some manufacturers conduct their own testing, third-party validation is preferable for an impartial review. Also, the supplement landscape is ever-changing, so checking for updates regularly is wise.
However, it’s important to understand that these organizations do not directly test the efficacy and safety of supplements. This information can only be provided through clinical trials. According to Dr. Oppezzo, these organizations primarily verify the product has the amount that it claims on the bottle, has the supplement in at least a bioavailable form that can get absorbed into your body, and that it is free from high levels of known contaminants.
2. Dosage Matters
The saying “more is better” is not necessarily true for supplements – or even essential nutrients. Both inadequate and excessive consumption of nutrients can have detrimental effects on health. Although the body is capable of excreting surplus nutrients, fat-soluble vitamins can accumulate in the body to toxic levels if consistently consumed in large amounts. On the other hand, overconsumption of water-soluble vitamins usually leads them to be excreted through urine, which is inefficient, costly, and known as “expensive urine.”
Therefore, it is crucial to adhere to recommended dietary allowances (RDAs) as a starting point and tailor intake based on individual responses. Importantly, consistently exceeding 100 percent of the RDA can result in nutrient imbalances. One example is selenium, a nutrient where both insufficient and excessive intake have been associated with hair loss. Ironically, many products marketed as “hair vitamins” contain selenium levels surpassing the RDA, potentially worsening the very issue they aim to remedy.
3. Consider the Chemistry
The effectiveness of a supplement can also depend on its chemical form. For example, vitamins that are fat-soluble achieve maximum absorption when consumed simultaneously with a source of fat, such as a small portion of nuts. Additionally, the interaction between nutrients is important; for instance, copper and zinc compete for absorption, and an excess of one can lead to a deficiency in the other. Supplements can also have harmful interactions with certain pharmaceutical medications, so it is important to consult with healthcare providers before starting a new supplement.
Another important consideration is the degradation of these compounds. For example, there is an oxidation potential of omega-3 and other fatty acid supplements. This means they have the potential to go “rancid” and lose their efficacy, especially when exposed to heat or open air. This vulnerability stems from the unsaturated nature of these fats, which contains double bonds in their molecular structure that are more reactive with oxygen.
Indications of rancidity include a strong, fishy odor or an unpleasant taste in fatty acid supplements. Additionally, you can look for information on the peroxide value (PV), a common measure of its oxidation potential. This can be found on some supplement labels, as well third-party testing reports, such as NutraSource. Dr. Oppezzo recommends supplements with PV levels less than 8 mEq/kg.
Supplements Are Not Substitutes for a Healthy Diet
Regardless of whether supplements are part of your daily routine, it is important to remember supplements should be seen as supplemental and not taken at the cost of eating whole foods. While they can sometimes fill nutritional gaps, supplements should be distinct from other health behaviors, such as eating well and moving often.
Moreover, focusing on single ingredients or specific nutrients without considering the holistic picture can lead to misconceptions about what supplements can achieve. Just taking vitamin D, for instance, won’t fully address bone health if it’s not combined with strength training and a calcium-rich diet. Good health is about the synergy between multiple health practices and how they complement each other.
“The allure of a quick fix or ‘magic pill’ is an enticing narrative in our fast-paced world, yet it’s important to remember that there is no replacement for a good diet and regular exercise,” states Dr. Oppezzo. “The foundation of healthy aging always has and always will be a direct result of the choices we make on a daily basis, which is what lifestyle medicine is all about.”
This blog is part of our Supplements newsletter. If you like this content, sign up to receive our monthly newsletter!
Key Takeaways:
- Vitamin D affects the health of bones and also plays a role in our muscles, immunity, and prevention of some diseases.
- The most common form of vitamin D is synthesized in the skin after exposure to sunshine. Vitamin D can also be found in some foods naturally as well as supplements and fortified foods.
- Vitamin D insufficiency is defined as less than 30 ng per mL of blood. Strive to maintain sufficient vitamin D levels through a balanced diet, sensible sun exposure, and supplementation as needed.
- When choosing a vitamin D supplement, D3 is recommended over D2, and should be combined with a fat (such as a handful of almonds or an Omega-3 supplement). You should not take more than 4,000 IU (100 mcg) per day due to the potential for toxicity unless recommended by a medical professional.
In a nation saturated with supplements, vitamin D commands the spotlight as one of the most widely taken across all age groups, second only to multivitamins.
“Ever since vitamin D deficiency was found to be the root cause of rickets, we have long recognized its role in bone health. Now research is looking at this vitamin as a panacea for numerous ailments, from the common cold, to even cancer,” states Robert Oh, MD, MPH, Chief Wellness Officer of the VA Palo Alto Healthcare System.
As ongoing research peels back the layers of complexity surrounding this vitamin, the scientific landscape becomes dynamic and subject to rigorous debate.
Where Does Vitamin D Come From?
Vitamin D distinguishes itself from other vitamins due to its unique ability to exist as both a dietary nutrient and as a hormone. Sourced from sunlight exposure, food, and supplements, this fat-soluble vitamin accumulates in the body’s fatty tissues and liver, available to be released as needed.
Sunlight
The primary source of vitamin D is the production that occurs in our skin from cholesterol precursors when exposed to the sun’s ultraviolet-B (UVB) rays, earning its nickname “the sunshine vitamin.” Considering the pivotal role sunlight plays in vitamin D production, daily exposure is beneficial.
Some plants and animals also possess the ability to synthesize vitamin D, contributing to the vitamin’s content in various foods and supplements. In plants, vitamin D is in the form D2 (ergocalciferol), while in animals, including humans, it is in the form D3 (cholecalciferol). Both forms are absorbable by humans; however, there is evidence suggesting that D3 has a more substantial and prolonged impact.
Food
High amounts of vitamin D3 are found in oily fishes such as salmon, mackerel, and sardines, whereas small amounts are found in eggs, red meat, and liver.
Vitamin D2 is found in specific mushrooms, but its concentrations vary significantly based on exposure to light. Mushrooms, much like our skin, require sunlight for vitamin D production. “Since commercially available mushrooms are typically grown in dark conditions, they contain minimal amounts of vitamin D and organic mushrooms will contain almost none. Exposure to UV light through irradiation, which is not allowed in organic food production, will substantially increase conventional mushroom vitamin D content,” said Rachele Pojednic, PhD, Stanford University nutrition and exercise scientist.
Due to the limited natural food sources of vitamin D, many products, including breakfast cereals, dairy items, and plant-based milks, are fortified with vitamin D2 and D3. For a comprehensive list of vitamin D content in specific foods, refer to the U.S. Department of Agriculture (USDA) list categorized by nutrient content and food name.
Supplements
Vitamin D2 and D3 can be found in supplement form. Due to the potentially higher bioavailability, D3 supplements are typically recommended over D2.
Dr. Pojednic emphasizes the importance of considering the fat-soluble nature of vitamin D when taking a supplement. “Vitamin D absorption, especially when consumed in concentrated doses, will be significantly enhanced when taken in conjunction with dietary fat, such as a handful of almonds or an omega-3 supplement,” she says.
When determining the appropriate vitamin D supplementation dosage, keep in mind that higher is not better. Toxic levels of vitamin D can arise from excessive supplement intake, a risk not associated with sunlight exposure due to the skin’s ability to self-regulate production. Therefore, Dr. Oh advises consulting with a physician or dietitian before taking high-dosage supplements. “Too much vitamin D can cause health issues, such as too high calcium levels or even kidney damage, so work with your care team if you are taking high doses of vitamin D,” he says.
Health Benefits of Vitamin D
Vitamin D is crucial for human health. While primarily recognized for its role in building strong bones, new findings suggest that this fat-soluble vitamin may exert a broader influence throughout the body.
“We now know that the majority of organs and tissues in the body possess vitamin D receptors,” states Dr. Pojednic. “This finding suggests vitamin D has effects beyond the skeletal system, sparking considerable research in the potential benefits of vitamin D for multiple health conditions.”
A substantial portion of this research focuses on the effects of vitamin D supplements, rather than dietary and sunlight sources. However, this by no way means the benefits of vitamin D are found solely through supplementation. Additionally, it should be noted that many studies have not compared outcomes in individuals with sufficient versus deficient vitamin D blood levels, which make conclusions from many supplementation studies difficult to interpret.
Bone Health
Vitamin D stands as a key player in sustaining the structural integrity of our skeletal system by facilitating the absorption of calcium and phosphorus—the building blocks of our bones. Through the process of mineralization, these minerals are incorporated into our bones to maintain normal bone density. Inadequate vitamin D levels can result in insufficient mineralization, which can lead to weakened bones and conditions such as osteoporosis, as well as more severe disorders like rickets and osteomalacia.
While the adverse effects of inadequate vitamin D on bone health are well-established, the evidence concerning the impacts of supplemental vitamin D over-and-above sufficient levels remains inconsistent.
In 2007, the US Agency for Healthcare Research and Quality synthesized the research on vitamin D and determined daily supplementation of vitamin D (≤ 800 IU) with calcium (≥ 500 mg) resulted in small increases in bone mineral density in older adults.
There is additional evidence that suggests that vitamin D supplementation lowers the risk of fractures in institutionalized older adults (700-800 IU vitamin D) and female navy recruits (800 IU vitamin D and 2000 mg calcium). However, both groups were initially at a high risk of vitamin D deficiency, and their levels were likely insufficient to begin with.
On the contrary, the largest vitamin D study to date, Vitamin D and Omega-3 Trial (VITAL), showed that daily supplementation of 2000 IU vitamin D did not reduce fracture risk in more than twenty-five thousand midlife and older adults who had sufficient vitamin D levels on average.
The current body of evidence indicates that vitamin D supplementation offers the most significant benefits for individuals with deficiencies. However, for those already meeting their vitamin D requirements, the benefits of additional supplementation are less clear. This suggests the need to approach vitamin D supplementation for bone health as a targeted strategy—aimed at maintaining sufficient levels rather than striving for excessively high, or supramaximal, levels. Such a focused approach ensures supplementation benefits those who need it, without unnecessary excess in those already meeting their vitamin D requirements.
Dr. Pojednic underscores the importance of a proactive approach, stating, “Ensuring sufficient intake of vitamin D and calcium serves as a foundational preventive measure to mitigate bone mineral loss and reduce the risk of osteoporosis later in life.” This strategy is particularly crucial early in life, as the foundation for peak bone mass, particularly for women, is established in our twenties. By achieving and maintaining optimal levels of vitamin D and calcium from a young age, individuals can maximize their bone strength and preserve it as they age.
Muscle Health
Our muscles need vitamin D to function and develop properly. Studies have established a correlation between deficient vitamin D levels and muscle weakness, pain, and atrophy. While the precise molecular mechanisms of vitamin D’s influence on skeletal muscle necessitate further investigation, cell culture studies indicate that vitamin D administration can alter cell pathways related to muscle contraction, cell proliferation, differentiation, growth, and inflammation.
An increasing body of research suggests a positive impact of high and low vitamin D supplementation on physical performance and injury prevention, particularly in vitamin D deficient adults and athletes. Research has identified a negative correlation between blood levels of vitamin D and biomarkers of muscle damage and inflammation, as well as number of injuries.
“These findings indicate the potential of vitamin D as a supplement for aiding recovery in injured or overtrained athletes,” states Dr. Pojednic. “However, further research is required to determine the optimal dosages and interventions for effective recovery.”
It has also been hypothesized that vitamin D may reduce the risk of falls in older adults by enhancing muscle strength and coordination, thus improving balance and postural sway. An analysis of multiple studies indicates that daily vitamin D supplementation may decrease the risk of falls in older adults with low vitamin D levels. However, this protective effect was not observed in individuals with sufficient vitamin D levels, a conclusion supported by the VITAL trial, which administered 2,000 IU of vitamin D daily.
The current evidence regarding vitamin D and muscle health suggests that the benefits of supplemental vitamin D are, again, primarily observed in individuals deficient in the vitamin, mirroring patterns observed in bone health. However, it may also have some benefit for athletes and others struggling with muscle damage and recovery. Overall, more research is needed to understand the optimal level of vitamin D for muscle health and determine whether these levels exceed what is required for bone health.
Immune Function
Vitamin D plays a crucial role in immune health, demonstrating various effects on inflammation, autoimmune diseases, and infection rates. The VITAL study revealed that healthy individuals taking vitamin D (2,000 IU per day) were less likely to develop autoimmune diseases such as rheumatoid arthritis and psoriasis, with a 22 percent reduction in incidence over the five-year supplementation period. However, these protective effects were no longer evident after participants discontinued the vitamin D supplement. This implies that vitamin D needs to be consistently taken for long-term prevention.
In the context of respiratory health, a comprehensive meta-analysis demonstrated that daily or weekly vitamin D supplementation lowers the risk of upper respiratory tract infections, especially in very deficient individuals. During the COVID-19 pandemic, studies revealed that low serum levels are associated with a higher risk of COVID-19 infection.
These findings underscore the importance of maintaining optimal vitamin D levels for immune health and the long-term prevention of autoimmune and respiratory diseases. “Similar to muscle and bone health, supplemental vitamin D has the most consistent benefits among those with deficient levels at baseline,” states Dr. Oh. “However, the new findings suggest supplemental vitamin D may reduce autoimmune disease risk even in individuals with already sufficient vitamin D levels.” Therefore, further research is warranted to identify the optimal vitamin D level for sustaining long-term immune health.
Diabetes
Research has consistently found an inverse relationship between vitamin D blood levels and diabetes risk. Vitamin D deficiency may influence key biochemical pathways involved in the development of prediabetes and diabetes, impacting beta cell function in the pancreas and contributing to inflammation.
In a noteworthy observation from the Nurses Health study, women who regularly consumed higher daily doses of vitamin D (>800 IU) and calcium supplements (>1,200 mg) experienced a remarkable 33 percent lower risk of Type 2 Diabetes compared to those with lower doses (400 IU vitamin D, <600 mg Calcium).
Further evidence comes from randomized control trials, which have shown that the benefits of vitamin D supplementation are most pronounced in individuals with low levels of this nutrient. In a randomized clinical trial involving 2,000 adults with prediabetes, participants received daily high doses of vitamin D (4,000 IU) over two years. The study discovered a significant risk reduction for diabetes among those with severely low vitamin D levels. However, this beneficial effect was not observed in participants who already had sufficient levels of vitamin D.
Cancer and All-Cause Mortality
Epidemiological studies have revealed a connection between insufficient vitamin D levels and an increased risk of cancer and all-cause mortality, prompting significant research into the potential role of vitamin D in cancer prevention and overall longevity.
Laboratory studies showcase vitamin D’s ability to inhibit cancer cell growth, while epidemiologic investigations suggest that inadequate vitamin D levels correlate with a 30 to 50 percent increased risk of incident colon, prostate, and breast cancer, along with elevated mortality from these cancers. Despite these findings, clinical evidence remains mixed. The large-scale VITAL study reported a reduction in cancer-related deaths over five years of daily vitamin D supplementation (2,000 IU), but not a decrease in the risk of developing cancer. However, a recently published secondary analysis of the trial data revealed that participants taking the vitamin D supplement had a 20 percent lower likelihood of developing advanced cancer, defined as metastatic or fatal.
A review of several clinical trials further substantiated the link between low vitamin D levels and risk of mortality, more broadly showing a seven percent reduction in all-cause mortality with daily vitamin D supplementation (median dose 800 IU).
Many unknowns continue to surround vitamin D and its relation to cancer risk and overall mortality. “Significantly more research is needed to determine if low vitamin D levels are a risk factor for cancer and whether supplementation can impact overall longevity,” states Dr. Oh. “Nevertheless, the present data does suggest that individuals at risk for cancer may consider supplementing with vitamin D.”
How Much Vitamin D Do I Need?
There is controversy over the levels of vitamin D considered to be sufficient; however, it is widely acknowledged that 25-OH vitamin D levels below 30 ng per mL of blood (50 nmol/L) are insufficient to maintain bone health.
Optimal levels of vitamin D vary among individuals based on factors such as age, race, metabolic differences, and physiological condition. Adding complexity to this understanding, Dr. Pojednic emphasizes that most vitamin D recommendations are based solely on bone health, and levels required to support other tissues may vary. As such, there is no universally accepted optimal vitamin D level for overall health.
Dr. Oh recommends optimizing natural sources of vitamin D first, such as averaging about 30 minutes in the sun most days, and including a few servings of vitamin D-rich foods in their diet.
Dr. Pojednic adds that achieving these levels does not need to be a daily practice. “Since vitamin D is a fat-soluble vitamin, our fat cells can store excess for weeks. Therefore, it is more important to consider average sunlight exposure and vitamin D consumption rather than focusing on daily intakes,” she says.
Because vitamin D is stored in fat cells, excessive doses can build up to toxic levels, therefore taking high doses of vitamin D (i.e. more than 4,000 IU per day) can be dangerous and should be avoided. Symptoms of vitamin D toxicity include weight loss, irregular heart beat, hardening of blood vessels and tissues due to increased blood levels of calcium, potentially leading to damage of the heart and kidneys.
Common Risk Factors for Vitamin D Deficiency
Although it seems easy to absorb 30 minutes of sunlight per day , vitamin D deficiency is common in the US. There are many factors to explain this, including limited geographical location, time outdoors, age-related changes, skin color, restrictive diets, and certain medical conditions. Those affected by these factors may need supplementation to ensure they meet their body’s vitamin D requirements.
1. Sun exposure
During the winter months, people who live in areas above 37 degrees north latitude, which includes cities such as San Francisco, Seattle, Denver, St. Louis, Philadelphia, New York, Boston, and Chicago, do not receive sufficient UVB exposure to produce the necessary amount of vitamin D.
“Vitamin D synthesis in our bodies occurs only at specific wavelengths,” explains Dr. Pojednic. “Thus, geographical location is an essential factor in determining the best way to maintain your vitamin D levels.”
Even people living in sunny areas can experience deficiency related to sun exposure. By spending significant time indoors or consistently wearing clothing that covers most of the body, our skin will not receive necessary exposure for optimal vitamin D synthesis. Moreover, while many believe they get sufficient sunlight through car or office windows, most windows filter out the UVB rays necessary for synthesis.
Of course, there are many concerns surrounding direct sun exposure, most notably skin cancer. Using sunscreen and limiting sun exposure are still very important measures to protect the skin. While the role of sunscreen in contributing to low vitamin D levels is subject to debate, evidence indicates that the typical use of sunscreen does not significantly impact the body’s ability to produce vitamin D. This means that for most individuals, wearing sunscreen during exposure to sunlight still allows for the synthesis of vitamin D.
2. Age
The skin’s ability to produce vitamin D diminishes significantly with age, declining at an estimated rate of 13 percent per decade of life. Additionally, as we age, our body becomes less efficient in absorbing and utilizing vitamin D.
3. Skin color
Individuals with darker skin often exhibit lower blood levels of vitamin D likely due to the pigment melanin acting as a natural shade, reducing the production of vitamin D. Consequently, low vitamin D levels are particularly prevalent among Americans with darker skin tones.
4. Diet
Individuals who cannot tolerate or choose not to consume milk, eggs, and fish, such as those with lactose intolerance or those adhering to a vegan diet, face an elevated risk of vitamin D deficiency. “The exclusion of these food sources, which are rich in vitamin D, makes it challenging for individuals in these groups to obtain sufficient levels of this nutrient from food alone,” states Dr. Pojednic.
5. Certain medical conditions
Individuals with inflammatory bowel diseases, such as ulcerative colitis, Crohn’s disease, celiac disease, and chronic pancreatitis may encounter difficulties in maintaining optimal vitamin D levels. This is because the absorption of vitamin D, a fat-soluble vitamin, is contingent on the digestive tract’s ability to absorb dietary fat, and inflammatory conditions within the tract can impede this process. Additionally, certain liver and kidney conditions may impair the metabolism and utilization of vitamin D within the body.
“Signs that your body may need more vitamin D than it is currently getting include bone pain, especially of your chest, shins and even overall chronic pain. For athletes, any bone stress injury like shin splints and poor healing stress fractures may indicate a vitamin D deficiency,” states Dr. Oh. “Finally if you have muscular weakness or pain, especially of your upper legs it would be reasonable to check your vitamin D levels with a blood test.”
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Key Takeaways:
Here are a few supplements that our health professionals recommend for healthy aging for individuals in midlife and beyond:
- Creatine – To maintain and build muscle mass and potentially improve cognitive performance.
- Vitamin D – To promote muscle and bone strength.
- Magnesium – To promote restful sleep and brain health.
- B12 and B9 (folate) – To promote brain health. (B12 is particularly recommended for vegans since it is primarily found in animal products).
- Multivitamin that is FDA-regulated or third-party tested. Unregulated supplements may not contain the active ingredients to live up to their advertised claims and may contain harmful ingredients.
As we age, taking too many supplements may be taxing to our liver and kidneys, so it’s best to screen to assess where we are deficient and supplement as needed.
Lifestyle choices are most important for maintaining good health as we age, and supplements do not replace a healthy diet and daily exercise.
As a Physical Medicine and Rehabilitation resident, my patients often ask me, “What supplements should I take as I get older?” While it is a complicated question without a clear answer, it’s important to consider.
Rather than investigating how a supplement affects the entire body as we age, researchers study how supplements impact specific aspects of health, such as sleep, muscle mass, and brain health. However, we all know that we don’t age in only one domain–the aging process affects many parts of the body. Therefore, there are multiple supplements to consider, and which supplement you take depends on your individual goals.
So, whenever I am posed with this question, I always respond with these two questions:
1) What are your goals regarding aging? Is it just a longer lifespan, or do you also want to feel good in your 70s and 80s and maintain high-quality interactions with people and places?
2) What aging concerns do you want to address or avoid? Some examples include optimizing your bones and muscles for sustained athletic ability, brain health and cognition performance, and your ability to have restful sleep on a consistent basis.
Which Supplements Should I Take for Healthy Aging?
Supplements to Maintain Muscle Mass and Bone Strength
As we age, the most important things we can do to maintain muscle and bone strength are resistance training at least twice weekly and consume adequate protein, especially from food (both plant and animal sources). Without these two things in place, supplements alone have not been shown to be helpful.
Regarding protein, I recommend consuming 1.2 – 1.6 grams per kg of body weight per day. This translates to approximately 0.65 grams of protein multiplied by your body weight in pounds, to be consumed evenly over three to four meals per day.
To maintain and build muscle mass as we age, I also recommend creatine. Consuming between 5 – 25 grams of creatine per day (either as a supplement or in food) has been shown to increase strength and muscle protein synthesis, and maintain lean body mass.
Vitamin D supplementation also has substantial evidence showing improvements in muscle and bone strength in older adults.
Supplements for Brain Health and Cognitive Performance
Some studies show that vitamin D may improve brain health and cognitive performance. Also, magnesium and higher doses of creatine have emerging evidence suggesting they could also be helpful. B vitamins like B6, B12, and B9 (folate) have also been shown to help with cognition prior to diagnosis of mild cognitive impairment and Alzheimer’s Disease.
Many people take omega-3 supplements intending to improve cognition; however, the data is not as strong as many people suspect. Some studies suggest that these supplements are effective, and some don’t. Most experts believe that getting omega-3s from food (such as fatty fish, walnuts, and chia seeds) is preferable to getting them from a supplement in that they are better absorbed in the body. For my patients, I recommend consuming omega-3s by eating more salmon and enjoying a low-inflammatory diet, such as the Mediterranean diet.
Supplements for Sleep
There is not currently a supplement that the American Academy of Sleep would recommend, however, melatonin is the most popular sleep supplement. If you find melatonin helpful, it’s important to use it at the minimum effective dose to prevent circadian rhythm shifts. There is also recent evidence that magnesium is helpful for sleep.
Lifespan vs. Healthspan
Lifespan is the number of years we are alive, whereas healthspan is how many of those years we feel good (physically and mentally) and are healthy enough to live independently and free from debilitating diseases.
Although there is no magic pill for a longer life, these supplements may improve your healthspan by increasing your levels of functioning and slowing the progression of chronic conditions. Healthy aging is not only about preventing illness or falls; it also encompasses the ability to engage in activities we enjoy, spend quality time with people we love, and maintain a sense of purpose and excitement as an older adult.
When choosing a supplement, it is crucial to remember that the FDA does not regulate most supplements. Therefore, there is minimal oversight regarding the ingredients in these supplements and whether they live up to their advertised claims. Without regulation, some supplements don’t contain the active ingredient, and they may even contain ingredients that are harmful, such as heavy metals, not listed on the bottle. Therefore, it is essential to go with supplements that are third-party tested or recommended by health professionals you trust and not just rely on advertising.
Lastly, it is most important to recognize that supplements cannot replace a poor diet or lack of exercise. We must take supplements in the context of other healthy lifestyle choices, such as adequate nutrition, sleep, exercise, and working with a medical professional to treat any medical conditions.
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Stanford Lifestyle Medicine’s nutrition experts, dietitians, and supplement researchers recommend getting nutrition from your food rather than a supplement as much as possible. For example, rather than drinking water with greens powder for lunch, eating a salad with a variety of vegetables is recommended to ensure that you’re getting the nutrition you need in a form that’s bioavailable (still useful) in the body.
“You can’t supplement your way out of a poor diet,” says Rachele Podjenic, PhD, Stanford nutrition and supplement researcher. “Even though fruits and vegetables are technically in many greens powders, since these whole foods are no longer in their original structure, we don’t really know if the nutrients are bioavailable once they are absorbed. There are a lot of claims being made, but almost no data to support them. In my opinion, greens powders are just a waste of money.”
If you’re eating healthy but want to be sure you’re covering all your nutritional bases, our experts recommend taking a multivitamin, and perhaps a couple other supplements (like vitamin D and B12) for healthy aging. Dr. Podjenic says that it’s important that every supplement you take be third-party tested by organizations such as ConsumerLab, US Pharmacopeia, and NSF International.
“We need to see supplements as a supplement in our already healthy diet, not as a substitute for eating well,” says Dr. Podjenic. “If you’re already eating healthy and a blood test shows you’re still deficient in a particular nutrient, that is where supplements come in.”
How do we get nutrition from our food?
Below is a graphic listing common supplements with their food equivalents. We aren’t suggesting you stop your supplements altogether (especially if your doctor or dietician recommends them), but to recognize that when we eat whole foods, we consume these nutrients in a more bioavailable form.
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A recent analysis done by members of the Stanford Lifestyle Medicine team on how different supplements impact sports performance, highlighted creatine since it has been vastly researched and shown to improve muscle strength.
“What many do not realize is that supplements, like creatine, can be beneficial for more than just professional athletes and bodybuilders,” says Matthew Kaufman, MD, member of the Stanford Lifestyle Medicine Exercise and Movement research team and lead author of “The Impact of Supplements on Sports Performance for the Trained Athlete: A Critical Analysis.”
What is Creatine?
So, what is creatine? Creatine is a natural amino acid that people can gain in their diet with foods high in protein or through supplementation. Mechanistically, creatine supports powerful muscle contractions, which is why it is popular among bodybuilders. After digestion, creatine-phosphate is stored in skeletal muscle until the onset of quick, intense physical activity. Once activity is initiated, it is used to rapidly phosphorylate ADP into ATP, which drives fast-twitch muscle contractions, the primary drivers of quick, forceful exercise movements like weight lifting and sprinting.
According to the analysis, athletes that also depend on fast, powerful movements and mobility, like soccer and basketball players, may also benefit from increasing their creatine intake. Its ability to heighten muscle performance is continuing to be tested and is being used by many to increase the size and strength of their muscles.
“What’s nice about creatine, especially compared to other supplements, is how much it has been studied. It has robust, promising data that shows it can really improve athletic performance and muscle composition,” says Dr. Kaufman. “Plus, it can help muscle growth and performance for all different types of people.”
Creatine Is Not Just for Bodybuilders!
Creatine may also be a good supplement for plant-based athletes. The analysis found evidence that vegetarian athletes improved more than omnivorous athletes with creatine supplementation in terms of muscle power output and lean muscle mass, therefore plant-based athletes could consider supplementation to support their athletic performance.
Creatine is also recommended for older individuals to support muscle sarcopenia. With age, many people experience a loss of muscle vitality, which heightens risk of falling and injury. Research published in the Journal of Clinical Medicine indicates that creatine supplementation may help older adults maintain muscle vitality. It suggests that there could be significant benefits from supplementing their diets with creatine for an “anti-aging” effect for the body.
How Much Creatine Do I Need?
Whether taking creatine supplements for athletic performance or daily functioning, it is important to know what the International Society of Sports Nutrition’s (ISSN) recommended dosing strategy is. Their recommendation begins with all individuals taking 5 grams of creatine, four times per day (20 g total per day) for about a week. This first week is called the loading stage, which helps many people adjust to the supplement before experiencing any physical changes. Next, ISSN recommends maintaining a dose between 3-5 grams daily. Males and larger athletes may need 5-10 grams daily to maintain their body’s creatine stores.
People considering taking creatine should be aware of some potential side effects. Studies report the possible side effects of increased water retention and airway sensitivity in elite athletes, the latter suggesting the need for further research on how creatine affects those with asthma. We recommend consulting with your physician ahead of time so they can tailor the ISSN’s dosing recommendations for your specific needs.
Overall, creatine supplementation may be promising for many individuals, bodybuilders or not, looking to improve the power of their muscles.