Dietary supplements come in many forms including pills and capsules, liquids, and injectables. Generally the best source for vitamins and minerals is the healthy food we eat. In some cases taking supplements may be appropriate if we cannot get what we need in our diet. I have divided this section into antioxidants, calcium and other vitamins and minerals. There is some overlap in the topics. Also, information changes rapidly, and there may be newer information that is available. Always discuss any supplements with your physician before taking.

Antioxidants – Are They Safe and Effective?

Antioxidants are substances that convert free radicals to harmless waste products that can be eliminated before they cause damage. The major antioxidant vitamins include beta-carotene (forms vitamin A), vitamin C, and vitamin E. The mineral, selenium, is also a major antioxidant. There are many other antioxidants not listed here.
What are free radicals? Free radicals are oxygen and nitrogen by-products resulting from the body’s normal operation and from environmental factors such as cigarette smoke, burns, and ultraviolet light. Free radicals can react so easily with other molecules that they frequently interfere with normal metabolism and can cause cell injury. This is called oxidative stress. Oxidative stress can lead to illness including cancer, cardiovascular disease, cataracts, and arthritis.
A report was released April 2000 by the Institute of Medicine on Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (Norman I. Krinsky, PhD., Chair, Panel on Dietary Antioxidants and Related Compounds). Dr. Krinsky stated “the question of whether dietary antioxidants can prevent chronic disease still remains unanswerable.” Scientific studies have shown that populations eating a diet rich in foods containing antioxidants have a lower incidence of certain chronic diseases. But it is not known whether the antioxidants or other factors are the reason for the lower incidence. On the other hand, it is known that taking large quantities of these nutrients can be dangerous. The following are the revised recommendations for adult daily consumption by The Panel.

Vitamin C

  • Recommend Daily Allowance:
  • Women: 75 milligrams
  • Men: 90 milligrams
  • Smokers: add 35 milligrams
  • Food Sources: broccoli, citrus fruits, leafy green vegetables, peppers, potatoes, strawberries
  • Maximum Daily Intake: 2000 milligrams
  • Effects of Excess Intake: diarrhea in some – excess likely excreted in urine unused

Vitamin E (alpha-tocopherol)

  • Recommended Daily Allowance: Adults: 15 milligrams (22 International Units natural-source vitamin E or 33 I.U.s of the synthetic form)
  • Food Sources: nuts, seeds, leafy green vegetables, some vegetable oils
  • Maximum Daily Intake:  1000 milligrams (1500 IU d-alpha tocopherol or 1100 IU dl-alpha tocopherol)
  • Effects of Excess Intake:  increases risk of bleeding especially when taken with prescription blood thinners, aspirin, gingko baloba, and other products that affect blood clotting


  • Recommended Daily Allowance:  Adults: 55 micrograms
  • Food Sources: seafood, meat, and grains
  • Maximum Daily Intake: 400 micrograms
  • Effects of Excess Intake: hair loss and nail damage

Beta-carotene (and other carotenoids) – The antioxidant activity in humans is uncertain. Carotenoids are precursors of vitamin A. The data on the effects of excess intake of carotenoids is contradictory. Carotenoids and vitamin A will be addressed in a future report by The Panel. Excess intake of vitamin A can cause birth defects.
More detail on antioxidants and other nutritional issues can be found at The National Academies of Science at current recommendation is that most nutrients be consumed through a healthy balanced diet. Excess consumption of supplements may not only be ineffective but also harmful.


Calcium and Other Vitamins and Minerals

The best source for vitamins and minerals is not from a pill but from a well-balanced diet. However, it does make sense to supplement what you get in your diet in certain cases.

Weight-bearing exercise, adequate estrogen, and calcium (1200 mgs per day) are all needed by women to build and maintain strong bones and reduce osteoporosis. Along with dairy products, foods high in calcium include broccoli and leafy greens such as kale, turnip greens, and collard and mustard greens. Calcium-fortified orange juice is another good source of non-pill calcium. If you do not get enough calcium from dairy products and foods, supplements are available in many forms. Recent medical data suggests an increased risk of heart attack when getting calcium from a pill rather than from dietary sources. If you do not get enough calcium in your diet, taking a Slow Release calcium rather than the regular calcium pills is probably safer.  My wife takes Citracal with D Slow Release, two pills in the morning. Absorption of the calcium is improved when the tablet also contains 5 mgs (200 IU) of vitamin D. To increase your calcium intake without pills, mix two-thirds of a cup of non-fat dry milk into one cup of skim milk – this contains 900 mgs of calcium.


Supplement vitamins and minerals when necessary. The right vitamins and minerals may reduce the chance of heart attack, cancer, birth defects, and even fragile bones (as discussed above). It is difficult for most women to get enough of these vital substances in their diets. Supplements are appropriate for most women. Taking a multivitamin made by a well-known brand can be helpful. Some of the most important vitamins and minerals (in addition to calcium) include: vitamin C, vitamin E, and folic acid.
Vitamin C (500-2,000 milligrams per day) is an antioxidant that may help deter the damaging effects of free-radical molecules, which damage cells in our body and can result in cancer and heart disease. A medical study (Circulation 95:1107-1113, 1996) showed 2,000 mg of vitamin C improves dilation of arteries and may reduce the chance of heart attack. Moderate doses of vitamin C seem to boost our immune system to lessen the symptoms of colds and other viral illnesses.

Another antioxidant, Vitamin E (400 international units of the natural form, alpha-tocopherol, per day), also seems to help prevent heart disease and certain cancers. Some researchers advise caution since one study showed large amounts of vitamin E may slightly increase the risk of stroke when taken in conjunction with blood thinning medications.

Folic acid (400 micrograms per day) is a B vitamin that helps prevent certain birth defects and may also help fight heart disease by clearing the blood of homocysteine, a substance that can damage arteries.


The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.

 Advanced Healthcare for Women
5354 Reynolds Street, Suite 518
Candler Professional Building
Savannah, Georgia 31405
Telephone 912-355-7717
Fax 912-355-0979