What functional medicine supplements are recommended for a general adult population seeking to improve overall health and wellness?

Functional Medicine Supplements for General Adult Health

For the general adult population seeking to improve overall health and wellness, the evidence does not support routine supplementation with vitamins, minerals, or multivitamins for disease prevention, and most commonly promoted "functional medicine" supplements lack sufficient evidence to recommend their use. 1

Evidence-Based Recommendations Against Routine Supplementation

What NOT to Take

The U.S. Preventive Services Task Force explicitly recommends AGAINST β-carotene and vitamin E supplementation for cardiovascular disease or cancer prevention (Grade D recommendation). 1 β-carotene specifically increases lung cancer risk in high-risk populations and is associated with increased cardiovascular mortality. 1

Insufficient Evidence for Most Supplements

The USPSTF concludes there is insufficient evidence to assess benefits versus harms for the following in healthy adults without nutritional deficiencies: 1

• Multivitamins - No demonstrated effect on all-cause mortality, cardiovascular disease, or cancer in most populations 1
• Vitamin C - No significant effect on cardiovascular disease, cancer, or mortality 1
• Vitamin A - May increase hip fracture risk in postmenopausal women 1
• Vitamin D (alone or with calcium) - No consistent benefit for cardiovascular disease or cancer prevention in general populations 1

Diabetes-Specific Guidance

For individuals with diabetes, routine supplementation is similarly not recommended: 1

• Antioxidants (vitamins E and C) - Not recommended due to lack of efficacy and long-term safety concerns 1
• Herbal supplements (cinnamon, curcumin, aloe vera, chromium) - Insufficient evidence to improve glycemia 1
• Vitamin D - The D2d and DPVD trials showed no significant benefit for diabetes prevention, though post-hoc analyses suggest potential benefit in specific subpopulations requiring further research 1

Limited Evidence for Specific Supplements

Cancer Treatment Context Only

The ASCO/SIO guidelines identify numerous supplements with insufficient evidence even in the specific context of breast cancer treatment, including: 1

• CoQ10 (for fatigue, depression, quality of life)
• Omega-3 fatty acids (for neuropathy)
• Vitamin E (for neuropathy, lymphedema, vasomotor symptoms)
• Ginkgo biloba (for cognition)
• Multivitamins (for fatigue, quality of life)

These supplements lack evidence even in symptomatic cancer patients, making their use in healthy adults even less justified. 1

Exceptions: Targeted Supplementation for Specific Deficiencies

Supplementation is appropriate ONLY when addressing documented deficiencies or specific high-risk conditions: 2

Post-Oophorectomy/High-Risk Populations

For specific populations with increased needs (e.g., post-surgical, elderly), targeted supplementation includes: 2

• Vitamin B12: 1000-2000 mcg daily (hydroxocobalamin or methylcobalamin preferred over cyanocobalamin) 2
• Calcium: 1200-1500 mg daily (calcium citrate preferred, divided doses of ≤600 mg) 2
• Vitamin D3: 2000-4000 IU daily to maintain serum 25-hydroxyvitamin D >30 ng/mL 2
• Protein: 1.0-1.2 g/kg body weight daily for sarcopenia prevention 2

Osteoporosis Prevention (Men >50 on ADT)

The National Osteoporosis Foundation recommends for men over 50 years receiving androgen deprivation therapy: 1

• Calcium: 1200 mg/day 1
• Vitamin D3: 800-1000 IU/day 1
• Additional bone-protective therapy (denosumab, zoledronic acid, or alendronate) when FRAX indicates 10-year hip fracture risk ≥3% or major osteoporotic fracture risk ≥20% 1

Common Pitfalls to Avoid

The "Wellness" Marketing Trap

Most supplements marketed for "general wellness" lack evidence of benefit and may cause harm. 1 The dietary supplement industry broadly defines products to include vitamins, minerals, herbs, botanicals, amino acids, and organ extracts, but federal regulation does not require proof of efficacy. 1, 3

Baseline Nutritional Status Matters

Supplementation benefits are modified by baseline nutrition status - those with adequate dietary intake gain no additional benefit and may experience harm. 4 The evidence supporting supplementation comes primarily from populations with documented deficiencies, not well-nourished individuals seeking optimization. 4

Potential for Harm

Beyond β-carotene and vitamin E, other supplements carry risks: 5

• High-dose vitamin A: Hip fractures in postmenopausal women 1
• Selenium: Mixed evidence with potential toxicity at high doses 5
• Caffeine: Adverse events reported with large intakes 6

The Bottom Line Algorithm

For a healthy adult without documented deficiencies:

1. Do NOT routinely supplement with multivitamins, antioxidants, or individual vitamins/minerals 1
2. Specifically AVOID β-carotene and vitamin E 1
3. Focus on adequate dietary intake rather than supplementation 1
4. Consider targeted supplementation ONLY if:
   • Documented deficiency exists (requires laboratory confirmation) 2
   • Specific high-risk condition present (pregnancy, post-surgical state, malabsorption) 2
   • Age >65 years with osteoporosis risk factors (calcium 1200 mg + vitamin D 800-1000 IU) 1

The evidence consistently shows that for disease prevention and health optimization in well-nourished adults, dietary improvement trumps supplementation, and most "functional medicine" supplements lack the evidence to justify their cost or potential risks. 1, 4