TL;DR: When choosing supplements, choose Vitamin D3 over D2 and take it with K2, choose Folate over Folic acid for B9, use ascorbic acid for Vitamin C if your stomach can handle it, use either Methylcobalamin or Cyanocobalamin for B12 depending on your preference and stay away from Vitamin A, E and Calcium supplements.
Introduction
If you take a walk down the Health section of your local grocery store or pharmacy, you’ll probably see something eerily similar to this:
Lots of different brands, lots of different bottles, lots of different prices. To make matters worse, there’s not just one bottle of those Vitamin D supplements you were looking for, there’s 10. All of them are slightly different, but in ways that aren’t very clear. It really can be overwhelming.
In our article on Shitty Supps we went over red flags on supplements to watch out for. This article will go over a few specific things you should be looking for in order to help you get the right supplements, and to minimize the amount of time you have to spend staring at the wall of bottles in the Health aisle.
Vitamin D
Vitamin D supplements come in two main forms; Vitamin D3 and D2. D3 is known as cholecalciferol and comes from animal sources and is what your skin produces when exposed to sunlight. D2 is known as ergocalciferol and comes from plant sources. D2 is a cheaper form of the vitamin to produce, which is why it is usually used in fortified foods and often in supplements [1].
Taking an intuitive look suggests that D3 may be a superior form of the vitamin as this is the form that our human bodies naturally produce and use. The science confirms that this is true.
When Vitamin D is metabolized by the liver, it becomes a compound known as calcifediol. Your Vitamin D status can be determined by measuring the blood levels of calcifediol. D3 has been shown to be much more effective at raising blood calcifediol levels than D2. A 2008 study [2] performed on eldery subjects with vitamin D deficiencies found that a large dose of D3 was nearly twice as effective at raising blood calcifediol levels as a similar dose of D2.
Additionally, D2 has been found to be more sensitive to humidity and temperature changes than D3, meaning it is more likely to degrade over time [1].
It is also recommended to supplement Vitamin K2 with Vitamin D3 as they have a synergistic effect with one another. In short, Vitamin D is responsible for ensuring that your blood has adequate levels of calcium in it, while Vitamin K is responsible for determining where that calcium ends up, ideally in your bones and teeth, rather than on the walls of your arteries, potentially causing blood clots leading to heart disease [10].
K2 is recommended over K1 as its longer molecular chain allows it to circulate in the blood for a longer period of time which is believed to improve its effectiveness. K1 usually circulates for a couple hours whereas K2 can circulate for several days [11].
Because of their synergistic effect, many commercially available D3 supplements contain K2 as well.
Recommendation:
When choosing a Vitamin D supplement be sure to select one that contains D3, rather than D2, and preferably one that also contains K2 to take advantage of their synergistic effect.
Vitamin B9
The two forms of vitamin B9 supplements that you will find are folate and folic acid. Folate is a common form of B9 found in many foods such as eggs and leafy greens whereas Folic acid is a synthetic form of B9, found exclusively in fortified foods and supplements. The molecular structures of folate and folic acid are extremely similar, so much so that it is common to use them interchangeably. However, new evidence suggests that they aren’t quite as equal as originally thought.
An intuitive approach would suggest that folate is a superior form of B9 as it is a natural form of the vitamin. Once again, the science proves our intuition to be true.
In order for the body to utilize Folic acid it must first undergo several conversions. First into dihydrofolate (DHF) and then into tetrahydrofolate (THF) before it can finally be converted into L-methylfolate, the usable form of folate in the body. Unfortunately, an estimated 60% of Americans [3] have genetic variations which reduce their ability to effectively convert folic acid into L-methylfolate. This means that many of those supplementing with Folic acid could still experience B9 deficiencies.
Furthermore, it is possible to take dangerous amounts of folic acid. Taking too much folic acid can overwhelm your liver, sometimes allowing it to enter your bloodstream, unmetabolized. This unmetabolized folic acid in the bloodstream has been shown to increase the risks of cancer and lead to faster cognitive decline in older people. On the other hand, there have been no adverse symptoms associated with consuming too much folate.
Recommendation:
When supplementing Vitamin B9 choose a folate supplement, or more specifically an L-methylfolate supplement over Folic acid.
Vitamin C
You will see Vitamin C coming in many different forms, but they can pretty much all be lumped into two categories; Ascorbic acid and Mineral ascorbates. Ascorbic acid is vitamin C in its most pure form. Synthetic Ascorbic acid is chemically identical to the vitamin C found in food and has no known difference in biological activity [4]. Mineral ascorbates on the other hand are various minerals bounded with Vitamin C, such as calcium in Calcium Ascorbate and Sodium in Sodium Ascorbate.
The reasoning for mineral ascorbates existing is simply because many people find that pure ascorbic acid is too hard on their stomach and can even cause heartburns in some. For this reason, mineral ascorbates are sometimes called “buffered” Vitamin C.
It has been suggested that ascorbic acid may be more bioavailable than mineral ascorbates, but there is little scientific evidence to support this. For this reason, ascorbic acid really only wins out in the price compartment, granted your stomach can handle it. However, one thing to be aware of if choosing to take mineral ascorbates is that your body will be absorbing the mineral alongside the vitamin C. This means that if you are trying to reduce the amount of sodium in your diet, Sodium Ascorbate is likely not the best source of Vitamin C for you.
There are also several “luxury” Vitamin C supplements available which sell for a high price and usually contain a mixture of either Ascorbic acid or a Mineral ascorbate and several other compounds which claim to increase the amount of Vitamin C absorbed. However, clinical studies have found that there is no notable increase in Vitamin C status when comparing these luxury supplements to regular old ascorbic acid [5].
Recommendation:
Supplement Vitamin C with ascorbic acid, if your stomach can handle it. If it causes stomach pain or discomfort for you choose an appropriate Mineral Ascorbate, such as Calcium Ascorbate.
Vitamin B12
Vitamin B12, aka cobalamin, comes in two main forms: methylcobalamin and cyanocobalamin. Methylcobalamin is the form of B12 found naturally in food and it features a methyl group bonded to the B12. Cyanocobalamin is a synthetic form of B12 and is the type most commonly found in supplements. It features a cyanide molecule bonded to the B12. The mention of cyanide probably gives most readers somewhat of an uneasy feeling, but fear not. The amount of cyanide in cyanocobalamin is too low to be harmful to humans in any way.
There is plenty of debate surrounding which form of B12 is superior. Some studies suggest that Cyanocobalamin is better absorbed by the body, whereas others suggest that Methylcobalamin is better retained by the body [13]. At the end of the day, both have been found to be effective at improving B12 status [13]. Some may opt for Cyanocobalamin as it is usually much cheaper, whereas others might choose Methylcobalamin as it is the natural form of B12 which aligns with our “natural = better” theme from earlier in the article
Recommendation:
Both methylcobalamin and cyanocobalamin are effective supplement choices for B12. Choose methylcobalamin if you prefer more natural supplements or choose cyanocobalamin if you want to save money.
Next, we will talk about some supplements that you likely should stay away from:
Vitamin A
In developed countries, Vitamin A deficiency is quite rare [6]. Since here at UpRiver we believe that supplements are solely made to supplement, this is already enough reason to cross Vitamin A off your supplement list as you are likely already getting sufficient amounts from your food.
If, despite this, you are still interested in getting some vitamin A supplements, you may want to think again. A 2008 study [7] performed by the American Cancer society on over 100,000 people who regularly took multivitamins containing beta-carotene, a common form of Vitamin A, found that it significantly increased the chance of developing lung cancer in participants who were smokers.
Additionally, Vitamin A can be very toxic and harmful if taken in high doses. Supplementing 10000 mcg of Vitamin A a day has been shown to lead to the following long term health problems [6]:
- Bone thinning
- Liver damage
- Headache
- Diarrhea
- Nausea
- Skin irritation
- Pain in the joints and bone
- Birth defects
Recommendation:
Stay away from Vitamin A supplements and instead add a bit more Vitamin A rich foods to your diet such as organ meat, carrots and leafy greens.
Vitamin E
Much like with Vitamin A, Vitamin E deficiency is rather uncommon in the developed world [8]. Combined with the several health risks associated with Vitamin E supplementation, this gives us more than enough reason to recommend staying away from supplementing Vitamin E.
Vitamin E supplementation has been hypothesized to help reduce the risk of prostate cancer, however one study actually found the opposite to be true. A 2011 long term study [9] on over 35,000 men found that men who supplemented with Vitamin E were actually 17% more likely to develop prostate cancer than the placebo group.
Furthermore, while there are no known health risks involved with getting excessive levels of Vitamin E from food, taking high doses of Vitamin E supplements in the form of alpha-tocopherol has been shown to cause hemorrhaging and to interrupt blood coagulation, leading to excess bleeding and potentially increasing the risk of having a stroke [10]
Recommendation:
Stay away from Vitamin E supplements and instead consume more Vitamin E rich foods such as spinach, nuts, olive oil and meats.
Calcium
Calcium supplementation is often preached as essential for good bone health as you age, however, there are several known health concerns involved with taking calcium supplements.
Supplementing calcium has been shown to increase the prevalence of painful kidney stones. Additionally, calcium supplementation has been linked to calcification of arteries, which can cause blood clots leading to serious heart disease. Furthermore, some scientists have hypothesized that calcium supplementation may be linked to an increase in prostate cancer, yet there is currently not enough evidence to confirm this [12]. Pairing this with the other negative health effects mentioned earlier makes it not worth the risk, especially for men who are already at a lower risk for bone density problems later in life.
Recommendation:
Stay away from calcium supplements and instead consume more calcium rich foods such as milk, cheese, yoghurt, almonds and oranges.
Conclusion
The supplement section can be an overwhelming place, with so many options to choose from. If you know what you are looking for you can save yourself time, hassle and money.
For Vitamin D choose D3 over D2 and take it alongside Vitamin K2. For vitamin B9 make sure to get a folate supplement rather than folic acid. For Vitamin C choose Ascorbic acid if your stomach can handle it and for B12 choose either Methylcobalamin if you want to go the natural route or Cyanocobalamin if you want to save money.
Additionally, avoid Vitamin A, Vitamin E and calcium supplements as their potential health risks outweigh their benefits.
Are there other supplements that you think deserve to be discussed in this article? Please let us know in the comments below!
References:
[1] https://www.healthline.com/nutrition/vitamin-d2-vs-d3#section2
[2] https://pubmed.ncbi.nlm.nih.gov/18492750/
[3] https://takecareof.com/articles/benefits-folic-acid-vs-folate
[4] https://lpi.oregonstate.edu/mic/vitamins/vitamin-C/supplemental-forms
[5] https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
[6] https://www.mayoclinic.org/drugs-supplements-vitamin-a/art-20365945
[7] https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.23527
[8] https://www.health.harvard.edu/vitamins-and-supplements/should-i-take-a-vitamin-e-supplement
[9] https://jamanetwork.com/journals/jama/fullarticle/1104493
[10] https://www.healthline.com/nutrition/vitamin-d-and-vitamin-k#section3
[11] https://www.healthline.com/nutrition/vitamin-k1-vs-k2#section3
[12] https://www.healthline.com/nutrition/calcium-supplements#section4
[13] https://www.healthline.com/nutrition/methylcobalamin-vs-cyanocobalamin#bioavailability
