According to the Harvard School of Public Health, taking multivitamins may have little or no benefit if you are already having a healthy diet. A diet that contains plenty of fruits, vegetables, whole grains, good protein sources, and healthy fats should give you most of the nutrients you need for good health.
However, many Singaporeans still choose to take supplements. According to consumer research firm Euromonitor, Singaporeans spent S$490 million (US$374.4 million) on vitamins and other supplements in 2017, up by nearly S$40 million from 2012.
Some of the common vitamins and supplements that can be found in Singapore include:
- Gingko biloba for boosting memory
- Glucosamine for easing aching joints
- Omega-3 fatty acids to improve heart function
- Co-enzyme Q10 to improve blood pressure level
- Probiotics to aid digestion
- Folic acid to support pregnancy
- Vitamin C for an immunity boost
What are Supplements?
According to the Health Sciences Authority (HSA), a health supplement is a product that is used to supplement a diet with benefits beyond those of normal nutrients, and to support or maintain the healthy functions of the human body.
In essence, it is a capsule, softgel, tablet, liquid or syrup that contains one or more, or a combination of:
- Vitamins, minerals, or amino acids (both natural and synthetic).
- Substances derived from natural sources, including non-human, animal and botanical materials in the forms of extracts, isolates, concentrates.
Why Do We Need Supplements?
Not every one of us can say that we follow a healthy and balanced diet. This may be due to a variety of reasons including food preferences or restrictions, and the adoption of certain diets. For example, those who choose a plant-based diet are at risk of vitamin B12, which is almost exclusively found in animal-sourced foods.
Other times, supplements may be recommended when our bodies have an increased need for certain nutrients or do not absorb them as well. Interestingly, we do not only take in nutrients through our diet. Our bodies produce vitamin D when exposed to the sun. This is why vitamin D deficiency is commonly observed in areas further from the equator where levels of UV light are low throughout the year.
In these cases, supplements can help us to fill nutritional gaps and ensure our wellbeing. Do take note, however, that supplements are not meant to replace a healthy diet or exercise.
Who Could Be at Risk of a Nutrient Deficiency?
Some groups of people may be at a higher risk of nutrient deficiency than others. These include:
As we get older, our body’s ability to process and absorb certain vitamins may naturally decline. In particular, seniors tend to experience difficulty absorbing vitamin B12 from food. Hence, it is recommended that you take foods that are fortified with vitamin B12 or take vitamin B12 pills if you are over the age of 50,
Oral health may also be a cause of concern. Tooth loss can make certain food harder to chew and hence an increased tendency to avoid them. This can lead to deficiencies in certain nutrients.
A reduced appetite may also lead to nutrient deficiency. This could be due to taste alterations caused by multiple medications, or elderly depression which seniors are unfortunately prone to.
2. Pregnant Women
Getting adequate folate is important for pregnancy as it can lower the risk of having a baby with spina bifida – a condition that affects the spine at birth.
If you are a woman who is of childbearing age (aged between 15 to 45), the Centers for Disease Control and Prevention (CDC) recommend that you consume 600 micrograms of folic acid every day. Folate, together with other important nutrients for pregnancy – iron, calcium, vitamin D and DHA – are available in a prenatal multivitamin.
3. Individuals with Certain Medical Conditions
Certain medical conditions such as celiac or cystic fibrosis may also increase your risk of poor nutrient absorption. If you have had surgeries such as gastric bypass for weight loss in the past, you may also be at risk of poor absorption of nutrients as the procedure involves the removal of part of the digestive organs.
4. Individuals on Certain Medications
Some diuretics that are commonly prescribed to lower blood pressure can also reduce our body’s storage of magnesium, potassium and calcium. Those taking proton pump inhibitors for acid reflux and heartburn should take note of a reduced absorption of vitamin B12 and possibly calcium and magnesium. If your loved one has Parkinson’s disease, Levodopa and carbidopa prescribed may also reduce the absorption of B vitamins including folate, B6, and B12.
What Health Supplements Should I Take?
Due to a variety of reasons, we may not always be able to meet the Health Sciences Authority’s recommendation to consume two portions each of fresh fruits and vegetables every day.
In such cases, taking a daily multivitamin can help you to meet nutritional requirements. Multivitamins can come in various forms including tablets, capsules, liquids, powders. They are packaged as a specific combination of nutrients (B-complex, calcium with vitamin D) or as a comprehensive multivitamin. Look for multivitamins that contain the Recommended Daily Allowance amounts.
1. Vitamin B12 supplements
A key component for brain function, vitamins B, especially B12, help to keep our blood cells healthy and is responsible for making DNA. It can also boost our energy levels and strengthen our immune and nervous systems. The main source of vitamin B12 is derived from animal foods such as fish, meat, poultry, eggs, milk and milk products. If you follow a plant-based diet, you may need vitamin B12 supplements or food that are fortified with it.
2. Calcium Supplements
Calcium plays an important role in bone health and helps to reduce the risk of osteoporosis and other related fractures. It is commonly found in dairy products. Other non-dairy sources of calcium include green leafy vegetables, sardines, fortified cereals, almonds and soy products such as tofu and soy milk.
Women may need to take calcium supplements post-menopause, as the drop in estrogen levels during menopause increases the rate of bone loss and puts you at a higher risk of developing osteoporosis.
Apart from osteoporosis, you may also consider taking calcium supplements if you are lactose intolerant or do not eat a well balanced diet that contains calcium from natural food sources.
3. Omega-3 or Fish Oil
Omega 3 fatty acids have anti-inflammatory and antioxidant effects, which means they might promote healthier brain cells and less deterioration of the brain. If your diet is rich in vegetables, good quality meats or eggs and fatty fish, you probably do need to take omega-3-fatty acid supplements.
According to the National Centre for Complementary and Integrative Health, high doses of Omega-3 can reduce levels of triglycerides, which is important for heart health. Omega-3 supplements may also help to relieve symptoms of rheumatoid arthritis. If you prefer a plant-based option, non-fish related omega-3 supplements are also available.
4. Iron Supplements
Iron plays a key role in transporting oxygen around the body. It also helps to produce tissues such as keratin in hair and nails. Red meat and dark green leafy vegetables are the main sources of iron although your body may not absorb iron as well if you derive it from vegetables.
Iron deficiency can cause you to feel tired often. It is often caused by the monthly menstrual cycle in women, especially for those who experience heavy menstrual loss. Vegans and vegetarians may also find it hard to derive sufficient iron from diet alone.
If you are at greater risk of iron deficiency that may lead to anaemia, consider taking an iron supplement.
Found in yoghurt and other fermented foods such as kimchi and tempeh, probiotics are the good bacteria that help to promote our healthy digestive functions.
If you have poor gut health such as irritable bowel syndrome or if your diet lacks fruits, vegetables, whole grains, legumes and fermented foods, you can consider taking probiotics.
6. Vitamin C Supplement
As an antioxidant, Vitamin C helps to reduce the harmful effects of free radicals. It is also important for collagen formation, which plays a key role in the connective tissue found in our skin, bones, joints and gums.
If you eat enough fruits and vegetables, you can probably give this supplement a miss. But taking a Vitamin C supplement can be useful in situations where you may experience excessive stress as some research has shown that it can help the immune system fight off bacteria and viruses.
How Effective Are Supplements?
Apart from the above supplements, other common supplements such as Vitamin A and zinc could help to slow vision loss from age-related macular degeneration. However, most studies suggest that multivitamins do not help in increasing your lifespan, slow cognitive decline or lower your chances of heart disease, cancer or diabetes.
Side Effects of Vitamins and Supplements
If taken in large doses, some vitamins can have serious or life-threatening side effects. Many multivitamin products contain minerals such as calcium, iron, magnesium, potassium, and zinc. If taken in large doses, minerals can cause side effects such as tooth staining, increased urination, stomach bleeding, uneven heart rate, confusion, muscle weakness or a limp feeling. Hence, it is always important to follow the instructions on the label or consult a doctor before starting on a supplement.
As Vitamin C is a soluble vitamin, it can be excreted from the body even if you consume it in excess. It is unlikely to cause major harm except for some side effects such as abdominal cramp or diarrhoea.
If you take a high dosage of calcium that hits 2500mg/day, you will have a higher risk of developing kidney stones, cardiovascular disease and constipation.
A high dosage of omega-3 (3g/day) may increase your risk of bleeding, abnormal heart rhythm, or cardiovascular disease. As a rule of thumb, a 1 gram dose per day is sufficient to meet your daily requirement.
If you are taking both calcium and iron supplements, you should take them at least two hours apart so they will not compete for absorption in your body.
Taking iron supplements in excess can cause constipation. The excess iron can accumulate within the tissues in our body and cause damage through the generation of free radicals. You should take an iron supplement only if a blood test confirms an iron deficiency.
It is rare to experience side effects when taking probiotics but the most common side effect of bacteria-based probiotic supplements is a temporary increase in gas and bloating.
What to Look out for When Buying Vitamins and Supplements
The Health Sciences Authority (HSA) has provided a guideline to help you decide if the products you want to purchase are reputable.
- Do not be fooled by supplements that promise “quick cures” or “easy solutions”. Sometimes, health supplements have a quick effect because they contain undeclared, potent ingredients, which can cause health problems.
- Be careful of dubious marketing claims that cannot be easily verified. These may include personal testimonies, complex scientific terms and statements such as “used safely by millions” or “all-natural ingredients”.
Where to Get Vitamins and Supplements?
You should always buy your vitamins and supplements from a reputable store or pharmacy. The HSA does not approve or license health supplements before they are allowed to be sold on the market. Advertisements for these products also do not have to seek prior approval from the authority. HSA typically takes samples of products that are already on the market and rely on doctors’ reports of negative side effects from health supplements before it initiates product recalls.
It is advisable to speak to a doctor before taking any supplements as its effectiveness and safety may depend on your individual situation and health. If you find it a hassle to have to specially visit a clinic just to check if a supplement is good for you, consider teleconsultation services, where you can get medical advice anytime, anywhere, through a video call.
- Harvard T.H. Chan, School of Public Health. Retrieved 22 February 2021 from https://www.hsph.harvard.edu/nutritionsource/multivitamin/
- Harvard T.H. Chan, School of Public Health. Retrieved 1 March 2021 from https://www.hsph.harvard.edu/nutritionsource/vitamins/
- Balvinder Sandhu.The Singapore Women’s Weekly (10 July 2019). Which Health Supplements Should You Really Be Taking? Retrieved 22 February 2021 from https://www.womensweekly.com.sg/gallery/beauty-and-health/guide-to-health-supplements-vitamins/
- Linette Lai. The Straits Times (6 Feb 2018). That supplement may not always help you. Retrieved 22 February from https://www.straitstimes.com/singapore/health/that-supplement-may-not-always-help-you
- Money Smart (20 August 2018). Health Supplements in Singapore – Who Needs Them & How Do You Budget for Them? Retrieved 22 February from https://blog.moneysmart.sg/healthcare/health-supplements-singapore/
- Paulo, D. (2018). ‘Like a knife poking my heart’: Loss, loneliness and the killing pain of elderly depression. CNA. Retrieved 1 March 2021, from https://www.channelnewsasia.com/news/cnainsider/elderly-depression-lonely-dementia-chronic-illness-treatment-10159670
- Penn Medicine (4 February 2020). The truth about supplements: 5 things you should know. Retrieved 22 February from https://www.pennmedicine.org/updates/blogs/health-and-wellness/2020/february/the-truth-about-supplement
- Regulatory overview of health supplements. HSA. Retrieved 1 March 2021, from https://www.hsa.gov.sg/health-supplements/overview
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