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10 dietitian-approved supplements for midlife women
My all-time favorite supplements (that I take, too)
It’s baffling to me that just 10 years ago I took only two supplements. Now, I have a much longer list, but it is not without reason. Supplementing my diet has turned out to be hugely beneficial to my health.
It just felt time to bring together my midlife supplement recommendations in one place. I know women get inundated with supplement advice, but I personally don’t take something just because someone says, “I took this, and I feel great.”
I want to understand the mechanism behind it. Because I really don’t want to take more than I need. Each of the supplements listed below pack a big punch. Even though we need more research. (By the way, we’ll always need more research).
But first, my general criteria for deciding on supplements.
What makes a good supplement?
I have rough criteria in which I judge supplements. First and foremost is that they need to be safe. That means they have been around a while and show little in the way of side effects in studies. Of course, you can never know for sure. But overall, I prefer supplements (including dosage amounts) that are not brand spanking new.
Second, they have a clear mechanism as to why they show benefit. Meaning that they help do something that is needed in women as they age and go through menopause.
Third, they have evidence to show efficacy. Now, this doesn’t mean they have significant scientific agreement. Most supplements don’t. But they have evidence to support the mechanism behind them.
When it comes to the supplement itself, I look for ones that have third party testing. Supplements are not regulated by the FDA, and we need to be careful to choose companies with credible practices.
So with that in mind, let’s go deeper into the 10 supplements.
1. Fish oil
I have been taking fish oil since my second pregnancy 14 years ago. Because I ate fatty fish twice a week, I took any old supplement. When I started reading about the benefits of omega-3 fatty acids at midlife, I got a little more serious.
In this post I detail why midlife women need more DHA as they transition through menopause. Our brains and hearts need it! I strongly believe our needs increase as our body doesn’t make as much from dietary sources as it did when we were younger.
I finally decided to get omega-3 levels checked (Omega-3 index) a few years ago. Omega-3 index is the percentage of omega-3 in red blood cells. Experts recommend >8% and mine was 6.1, and that’s with eating fish twice a week. By choosing a stronger fish oil and eating fatty fish two-three times a week, my levels increased to 8.98%!
Now to keep my levels up I take Nordic Naturals Ultimate Omega and continue to eat fish. Of course, this is individual, so getting your levels checked can go a long way. For testing I recommend Omega Quant.
2. Vitamin D (with K2)
Vitamin D is the supplement I’ve taken the longest and for good reason: it’s virtually impossible to get enough through diet. I’ve written about vitamin D’s role in immune health, breast cancer, heart health, diabetes risk, mortality, and hypertension. Because every cell in the body has a vitamin D receptor, it’s quite important.
I used to work to keep my blood levels >30ng/dl. But with more recent research, especially with covid-19, I now aim for over 50. A September 2023 systematic review by Sunil Wimalawansa details the importance for 50ng/ml for immune – and levels for other health indicators -- as shown below.
The last few years I’ve had my physical in the summer or early September. This is when I get a little more sun than usual, a key source of vitamin D. I find that 2000IU of vitamin D during the summer and early fall is enough. But after having my vitamin D tested in the winter, I see I do better on 3000IU. My numbers have been pretty consistent the last two years:
More recently, I added vitamin K2 along with my vitamin D. Vitamin K2 ensures that vitamin D is working to deposit calcium in bones and not the arterial wall. Vitamin K2 plays a key role in bone and heart health, and it’s not found in many common foods. I take this vitamin K2 supplement with vitamin D unless I take my multi, which has K2.
So, there is no one amount of vitamin D for anyone. Test your levels to determine what you need. And you’ll my free biomarker guide to help you understand your numbers when subscribing subscribing.
Magnesium is a major shortfall nutrient in women's diets. The RDA is 320mg for midlife women, yet 64% do not reach 265mg/day with an average intake about 246mg.
Falling short on magnesium over the long-term is called “chronic latent magnesium deficiency” and it can increase free radicals, elevating the risk of various chronic disease states. Complicating matters is evidence showing that estrogen plays a role in magnesium metabolism and that many commonly prescribed medications decrease the absorption of magnesium.
What really bothers me, though, is that we don’t have a reliable biomarker for magnesium. Once blood levels decline, we've had depleted intracellular levels for who knows how long. That is why it’s so important for women to assess their diet for magnesium. That’s what I did.
I get over 400mg of magnesium on a typical day of eating, so I don’t really need to take it. But I do take it on days–mostly weekends—when my eating is different. When I consume a handful of nuts and seeds, around 3 servings of whole grains, two or more servings of milk or yogurt and ½ cup of beans/legumes — I’m fine.
There are so many magnesium supplements to choose from, but overall magnesium oxide and hydroxide have poor absorption and more laxative side effects. Good choices include magnesium citrate and lactate, according to Examine.com.
4. Multi with higher than the RDA for B vitamins
I wrote a whole post on why I think most midlife women benefit from a multivitamin here but will recap and add context.
B vitamin needs increase with age and play a role in keeping homocysteine, a sulfur-containing amino acid, under control. High homocysteine is common post menopause, and linked to dementia and heart disease risk. In fact, it deactivates nitric oxide, the magic midlife molecule.
Yes, you can take a B complex, but it may not have all the B vitamins and it’s missing the added benefit of a multi. First is iodine, which is another nutrient to watch out for at midlife. Second is selenium, a mineral that goes hand in hand with iodine for thyroid health. And there’s vitamin K2 which not all supplements contain.
I looked around and found this multivitamin from Igennus Pure and Essential that I really like. It’s got the perk of more vitamin C (see below) and it contains active methyl forms of folate and B12. Yet any formulation for women over 50 fits the bill.
I take this multivitamin every other day. On the days I don’t take the multi, I take Mary’s iodine drops to ensure I’m meeting my iodine needs.
5. Vitamin C
Vitamin C is a water-soluble vitamin needed to make collagen, a coenzyme in numerous reactions, and it’s a potent antioxidant. Higher vitamin C intake has been associated with decreased risk of heart disease, hypertension, and stroke.
Of particular importance is the effect of vitamin C on endothelial health, increasing the bioavailability of nitric oxide. A 2014 review of 44 clinical trials showed a significant positive effect of vitamin C supplementation on endothelial function. Those with established disease require a higher intake of vitamin C due to the likely higher oxidative stress, which leads to a stronger positive effect on endothelial function..
Aging and menopause increase the risk of oxidative stress and endothelial dysfunction (read more about that here) thus the need for antioxidants like vitamin C increase as well.
It takes 200-400mg to bring blood levels to near saturation, which plateaus around 2000mg, the safe upper limit. Linus Pauling recommends 400mg for people over 50. This is more than the RDA of 75.
If you get 5 servings of fruits and vegetables, you most likely get about 150-200mg vitamin C. I take 250mg vitamin C on an as needed basis. It’s also in my multivitamin (240mg).
As women age and transition through menopause, the gut and vaginal microbiome can become less diverse. And it’s possible that taking probiotics can help, according to small studies.
For instance, a 2023 review in Current Nutrition Reports summarizes the research to date on the use of probiotics in postmenopausal women:
Although evidence from human intervention studies is limited so far, probiotic supplementation in postmenopausal women could represent a feasible and safe strategy to manage the menopause-related disease. In particular, oral probiotic formulations—especially those including Lactobacillus ssp. casei, helveticus, rhamnosus, and reuteri—might have pleiotropic beneficial effects on health
Some of those benefits include promoting calcium absorption/improving bone density, improving symptoms of genitourinary (vaginal) symptoms, reducing the PH of the vagina, and improving insulin resistance, dyslipidemia, and inflammation.
Lactobacillus rhamnosus is what’s found in Culturelle, a supplement I started taking years ago which put me in remission for ulcerative colitis. And there are more strains of lactobacillus found in their Women’s Healthy Balance (now called Women’s 4 in 1) which I have switched to help my vaginal microbiome.
There are products like MenoFit from MenoLabs but it has a slew of other ingredients (28!) and I’m not a fan of combining a bunch of vitamins and herbs together.
I hope the research expands in this area because it’s very promising.
Choline is hot right now. Animal studies suggest that choline supplementation can reduce the risk of Alzheimer’s. A deficiency in choline increases the risk of fatty liver and researchers have found higher rates of this condition in midlife women.
As I’ve written about before, as women lose estrogen, they lose their ability to make choline through the PEMT enzyme.
The biggest issue with supplementation is the risk of choline converting to trimethylamine N-oxide (TMAO), which is linked to increased risk of heart disease (Synoradzki, 2019). Yet the evidence for this is limited.
Citicoline is a supplement that is a source of both choline and cytidine. Emerging data shows that this combination helps with memory and is less likely to convert to TMAO, although I can’t find any studies with postmenopausal women.
Of course, we need more research. But if you find that the amount of choline you are getting is not enough, and want to supplement, Citicoline might be the supplement to try. Doses used in studies range from 250-500mg/day. And the brand name is Cognizin.
It’s important to remember that 18% of that 250-500mg is choline. So, if you’re looking to get more choline, another type of supplement may be better. I take 250mg most days.
8. Nitric Oxide boosters
Products with Beetroot–whether it be beetroot powder, tablet, or beetroot juice–contain nitrates and/or nitrites in high concentrations. Through a process called the nitrate-nitrite-nitric oxide (NO) pathway, nitric oxide is produced and used in the body, which you can read more about here.
According to a 2019 review on inorganic nitrates and cardiovascular disease:
consuming between 4 and 12 mg/kg of nitrate (~300–800 mg/day) in supplement form—such as sodium nitrate, beetroot juice, or beetroot concentrates and powders—should provide a significant cardioprotective effect or improve conditions for those with CVD
The research to date shows that nitrate-rich foods and supplements help lower blood pressure, arterial stiffness, and platelet aggregation and improve endothelial function. They also help improve athletic performance by increasing oxygen utilization during exercise.
A few years back, I tried Superbeets from HumanN and immediately felt an increase in energy and improved sleep. Eventually I backed off and used super beets before exercise 2-3 times a week, which is what I continue to do.
Aerobic exercise increases nitric oxide production. But when estrogen levels decline, exercise doesn’t provide the same vascular response as it does to age-matched men.
Adding a nitrate supplement can help women boost vascular health during exercise. This is actually being studied in the "Beetroot supplementation in women enjoying exercise (Bee Sweet)" right now, and I can’t wait to see the results.
If you're super tired, have decreased exercise tolerance, and have tried everything, you might want to give one of these products a try.
Taurine is a sulfur-containing semi-essential amino acids found in high concentration in plasma and cells. It plays a role in regulating cellular function, has anti-inflammatory effects, decreases reactive oxygen species, and enhances glucose control. It’s considered a "cell protector," which is needed with aging.
Levels of taurine likely decline with aging, which was demonstrated in a study with mice and monkeys. The taurine fed mice lived 18-25% longer. Not only that, but they had better functioning of bone, muscle, pancreas, brain, gut and immune system.
Taurine supplementation has a positive effect on endothelial health, cholesterol levels, and blood glucose control, including insulin resistance. And it decreases blood pressure in animals and humans. Researchers showed in one study with midlife women that taurine decreased markers of oxidative stress. According to a 2018 review:
“Because taurine is a naturally occurring substance that exhibits few adverse side effects and plays a fundamental role in the function of most mammalian cells, the future of taurine as an effective therapeutic agent and a nutritional supplement is seemingly bright.”
So, if you are experiencing higher-than normal blood pressure, suspect insulin resistance (see Biomarker Guide for calculation using triglycerides and HDL), or have high cholesterol, you might want to consider taurine supplementation. Most studies use 1-3g/day which is considered safe.
I have been taking 1g taurine for about 6 months now.
Creatine is found naturally in muscle (95%) and some in the brain (5%). It helps muscles produce more energy (ATP) and can enhance muscle growth and strength. When you supplement you increase your stores of phosphocreatine.
On average, women contain 70-80% less creatine stores than men. And during menopause, which can increase inflammation, creatine may help to counteract those effects.
In a study focusing on the benefits to women, researchers state: “When combined with resistance training, creatine further augments body composition and bone mineral density, particularly in post-menopausal females. “
There are two ways to take it. First is a loading phase of 5g about 4 times a day for 5 days and then take a 5g/day maintenance phase.
Or you can just take 5g/day–or every other day— without the loading phase. The second way takes longer for stores to increase, but it still works. Vegetarians may benefit from 10g a day.
It’s recommended adults get 3g of creatine a day but most get less than one gram. I take 5g every other day but often forget to take this one.
The most studied form is creatine monohydrate, and it comes in a tasteless powder. I just add it to water or smoothie.
There’s one more
I wanted to briefly touch on iron. I no longer take it but if you are menstruating and you have a ferritin <50, you might want to consider it. Women should always get their ferritin checked as I outline here.
All of these supplements are based on midlife woman's changing needs with both aging and menopause. Even if you’re years away from menopause, getting this straight now, WILL help you later.
Is there a supplement you're taking that's not on the list?
This post is meant for education and not meant to replace medical advice. If you have a health condition, always check with a healthcare provider before starting a supplement.
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