I used to proudly eschew health supplements. Doctors always told me that if you eat a healthy diet, you’d only be flushing money down the loo. Studies showed that people who popped multivitamins didn’t live any longer, with some even dying a little younger – a 4% higher mortality risk according to one just last year. But now I’m unequivocally post youth, my supplement intake has crept up to four a day: vitamin D (by NHS decree), magnesium (for sleep, muscle relaxing, brain and stress; pretty sure it’s helping), lion’s mane mushroom (cognition; no idea if it’s working), biotin (hair health; ditto) and I’m considering crowbarring more in if I can afford them. Am I a total sucker, though? Do women really need to start taking supplements when they hit middle age?
“There are plenty of reasons why we might need supplements as we age,” says Claire Pettitt, a specialist women’s health dietitian, who works in the UK and Singapore. “It’s not drastic, as if all of a sudden we need a drip,” she says. “But as we age, our body doesn’t work as well, and there are some nutrients, such as vitamin B12 and calcium, that we start to absorb much less efficiently as we get older.”
Hormonal changes are another valid reason to take supplements, she says, because waning oestrogen “impacts so many parts of the body, whether that’s our bone health, our metabolism, cardiovascular disease risk or muscle mass, and there are various nutrients that will help reduce all of those disease risks.” That said: “There’s no blanket. You’re entering perimenopause; you’re going to be deficient in all these things.”
Before considering any supplements, it’s best to take a cold, hard look at eating habits. “We might have poor dietary patterns, especially in middle age, where we’re that sandwich generation and our time is not our own and we don’t always put ourselves first,” says Pettitt. Social ideals around body size and diet often encourage drastic measures, such as ditching meals for a buzzy green smoothie, or cutting out dairy. “Sometimes fad diets end up meaning you don’t have a balanced diet.”
Another basic consideration to master, says Nichola Ludlam-Raine, a specialist dietitian and author of How Not to Eat Ultra-Processed, is consuming an adequate amount of protein: “About 1.6g per kilogram of ideal body weight a day, spaced throughout the day.” (Ideal body weight meaning what a person would weigh with a BMI between 18 and 25.) If you’re really active, up to 2g per kg is good, she says, “alongside resistance training, two to three times a week, for bone health and muscle mass preservation”.
Getting enough fibre is fundamental too, she says, “because if you look after your gut, it will support almost every single bodily function, from immunity to mood”. It will also help your friendly gut microbes digest and produce more nutrients – an in-house supplement factory, if you will.
How to spot deficiencies
Our bodies will usually tell us if they’re not getting what they need. “I think we lose the skill of paying attention to our body. We’re too busy,” says Pettitt. “It’s noticing when things change, like if you’ve got fatigue, muscle weakness or hair loss, which could all reflect any number of micronutrient deficiencies.”
Looking at your lifestyle, medications and dietary patterns can also provide clues. “If you’re vegan, you might need a supplement with B12,” says Ludlam-Raine. “Or if you’re on a proton pump inhibitor [to reduce stomach acid] or metformin [for type 2 diabetes], they can reduce absorption.” It’s easy to inadvertently lower calcium intake by switching to organic plant-based milks. “These are not fortified with calcium and iodine,” says Ludlam-Raine. “Calcium is essential for bone health. Iodine is essential for thyroid function. So I would say to menopausal women: go for dairy, or maybe a fermented dairy like kefir, or go for a fortified milk alternative.”
Women can bleed more heavily during perimenopause, which could cause iron deficiency. Another question Pettitt would ask is whether you have digestive health issues, “like coeliac disease or anything that impacts absorption of nutrients”.
Serious deficiencies can usually be verified with a blood test. “See a dietitian, a doctor, get some blood tests done to look for black-and-white evidence,” says Pettitt.
Which supplements work?
“The most common supplement a woman would need is vitamin D, which is crucial to bone health, immunity, muscles and even your hormones,” says Pettitt. General advice is to take it during autumn and winter, but if you have darker skin, wear high SPF or are covered up when you go out, consider taking it all year, says Ludlam-Raine. “A lot of my patients, especially if the BMI is above 30, are deficient. Look to take a minimum of 10mcg (400IU) of vitamin D (vitamin D3 is more effective than D2) – a supermarket own-brand will do!”
Pettitt has had a flurry of questions about magnesium from clients lately. “It has been used a lot in the past for muscle relaxation, if you get cramps. Muscle health is important in our nerve stimulation, so it’s part of our nervous system. It’s important for that, brain health, and helps with sleep and stress.”
Ludlam-Raine bought some for herself – a mix of three types commonly sold together. Sounds like a no-brainer, although Pettitt says you might not need it if you eat a wholegrain diet along with nuts, avocado and black beans. “I often say: what’s your baseline?” says Pettitt. “Where are we at with our lifestyle? And can you make these changes and see if they make any difference? If you want to try it, try it, but are you going to monitor your symptoms?”
“The problem I often see is people start all these supplements at the same time,” says Pettitt. She recommends starting each one in isolation for four to six weeks, ideally three months, “depending on what you’re trying to change. You can’t necessarily expect a change in your mental health overnight with a supplement.”
If you don’t eat oily fish at least once a week, your omega-3 might need supplementing. “Omega-3 is a powerful anti-inflammatory,” says Pettitt. “It’s going to help minimise your risk of cardiovascular disease. It’s also important for brain health, joint health, and all of these are changing as we age and go through menopause.” She says it doesn’t matter what kind of supplement you take, “because obviously there are all these different ones, saying all the other ones are rubbish. You want to get enough EPA and DHA [two of the three types of fatty acid that are known as omega-3s], but choose a brand that’s third-party tested.” This means the product’s ingredients have been independently verified.
Other claims you’ll see on expensive supplements include “food grown” and “micronised”, both promising superior absorption, but Pettitt cautions that these terms are ambiguous, with no standardised definition, and can be misleading. “‘Food grown’ refers to supplements that claim to be derived from whole foods or fermented ingredients, as opposed to synthetic or isolated nutrients, and therefore might be better absorbed or more bioavailable to the body because they contain other naturally occurring cofactors, like enzymes, phytonutrients, or other beneficial compounds,” she says. “However, this is not always true, and some supplements that are labelled ‘food grown’ are actually highly processed, or may not be more easily absorbed.” Similarly, micronised is often more of a marketing term “than a scientifically validated claim. The goal is to make nutrients more bioavailable, but whether this process improves absorption or effectiveness is often unclear or lacks robust evidence.”
Ludlam-Raine agrees: “For most people, the key is taking the right nutrient in the right dose for their needs. My advice is always to focus first on getting nutrients from food where possible, and use supplements when needed as a top-up or safety net. Paying more for ‘micronised’ or ‘food-grown’ versions isn’t usually necessary.”
Fibre powders and probiotics (live microbes) have become popular, as health advice increasingly focuses on the gut, but Pettitt believes we should prioritise packing these into our diets. “Foods that have fibre bring so much more. If you eat lots of fruits and vegetables, you’re getting all the micronutrients, antioxidants, anti-inflammatories, the phytochemicals (plant chemicals) that bring benefit to our bodies. Most people should be eating more fruits and vegetables.”
Ludlam-Raine does try to take a probiotic when she remembers, but this is in addition to eating naturally probiotic fermented foods. She believes that “in the future, the UK will have recommended servings a day, like ‘five-a-day’ for ferments”. Kimchi, sauerkraut, miso, natural yoghurts all count. “I think kefir is almost the most acceptable and versatile. You can have it for breakfast; as a snack.”
Collagen is, says Pettitt, “a really trendy one. Most of its evidence is around joint and bone health, which is important in perimenopause, and as we age.” It’s increasingly touted as a brain-health boost too, but she says there’s not as much evidence for that yet. “You could probably try it and see if it makes any difference.” Ludlam-Raine is turning 40 next birthday and has started taking it for her skin health. It certainly won’t do her any harm. “It is such a safe supplement and a bit of a protein boost.”
Ludlam-Raine often works with people who have had bariatric surgery for obesity, of which hair thinning can be a side-effect – but hair loss can also be caused by dropping oestrogen levels in perimenopause. “Biotin is a really popular supplement for this,” she says. She only recommends it in cases where a biotin deficiency has been identified through a blood test, “which is what the evidence supports for hair health, but I would suggest people focus on a food-first approach: eggs, salmon, nuts, seeds, sweet potatoes, legumes, mushrooms and avocados, etc”. But as it’s water soluble and we don’t store it in the body, she is not against people trying the supplement, “just in case it may help”, as long as they remember to stop taking it three days before blood tests, as it can skew some results.
As for my lion’s mane mushroom capsules, Ludlam-Raine says that, while the fungus has been shown to improve cognition and nerve regeneration in some animal trials: “We don’t have large-scale human studies.” But as long as you’re getting a good diet, a supplement won’t cause any harm. “If it makes you feel good, then do it. But don’t do them as a first line. You can’t compare mushrooms to HRT, if that’s been recommended, which we know can help with brain fog.”
“Creatine is having a moment outside of the gym,” says Ludlam-Raine, where it’s known for providing a fuel boost for hard-working muscles. It’s one of the most-studied supplements – and benefits to brain health and cognitive processing are a growing field of interest. Unless you have a kidney condition (in which case, talk to your doctor first), she says: “Taking three to five grams a day is safe, so I almost think, why not give it a go for four weeks and see how it goes?” It’s still worth trying even if you’re not technically deficient, she believes, “because we do use up creatine stores, especially if you’re working out. The research is now quite substantial that shows when you supplement, even if you’ve got a healthy, balanced diet, you may reap these other benefits.”
All manner of vitamins and micronutrients now come in highly palatable gummy form, which on the one hand might mean you’re more likely to take them regularly. But, says Ludlam-Raine, “the sugars in chewables can add up. Check the ingredients and how many you are taking, because it might be like eating half a packet of fruit pastilles.”
Warnings and cautions
It’s easy to think “the more the merrier” with all these wonder-nutrients, but despite the unregulated mega-doses being sold, you can have too much of various supplements, including iron, vitamin A, vitamin D and magnesium. Make sure you don’t take more than you need.
“Pharmacists are such an underutilised resource,” says Ludlam-Raine. “If you have pre-existing medical conditions or you’re taking other prescribed medications or supplements, always double-check with a pharmacist, because there might be some sort of interaction.”
Pettitt cautions against thinking of a supplement as an easy short cut. “It’s often seen as something that we can take control of now, whereas changing your lifestyle, changing your job because it’s too stressful, getting a divorce because you’re not happy in your marriage, those are really big things that take time to change. And actually, it’s much easier to say: right, I’m going to buy this supplement, and it’s going to help me sleep and I’m going to be less stressed.”
Ludlam-Raine thinks people who are feeling chronically under par are vulnerable to “marketing over evidence. I think it’s a case of remembering the pillars of health: your diet, your physical activity, your stress, sleep and also social connection, and just remembering that you need to get the basics right before even considering a supplement.”
