I used to proudly eschew health supplements. Doctors always told me that if you eat a healthy diet, you’d only be flushing money down the loo. Studies showed that people who popped multivitamins didn’t live any longer, with some even dying a little younger – a 4% higher mortality risk according to one just last year. But now I’m unequivocally post youth, my supplement intake has crept up to four a day: vitamin D (by NHS decree), magnesium (for sleep, muscle relaxing, brain and stress; pretty sure it’s helping), lion’s mane mushroom (cognition; no idea if it’s working), biotin (hair health; ditto) and I’m considering crowbarring more in if I can afford them. Am I a total sucker, though? Do women really need to start taking supplements when they hit middle age?
曾经我自豪地拒绝使用健康补充剂。医生总是告诉我，如果你吃健康的饮食，你只是在浪费钱。研究表明，服用多种维生素的人寿命并没有延长，有些人甚至比预期早死——根据去年的一项研究，死亡率风险甚至提高了 4%。但现在我毫无疑问地步入了中年，我的补充剂摄入量已经增加到每天四粒：维生素 D（根据 NHS 的规定）、镁（有助于睡眠、肌肉放松、大脑和压力；我确信它在起作用）、鹿角菌（认知；不知道是否有效）、生物素（头发健康；同样不知道是否有效），而且如果我能负担得起，我还在考虑再添加一些。不过，我真的是个傻瓜吗？当女性步入中年时，她们真的需要开始服用补充剂吗？
“There are plenty of reasons why we might need supplements as we age,” says Claire Pettitt, a specialist women’s health dietitian, who works in the UK and Singapore. “It’s not drastic, as if all of a sudden we need a drip,” she says. “But as we age, our body doesn’t work as well, and there are some nutrients, such as vitamin B12 and calcium, that we start to absorb much less efficiently as we get older.”
随着年龄的增长，我们可能需要补充剂的原因有很多，”英国和新加坡工作的女性健康营养师克莱尔·佩蒂特说。“这并不是突然需要点滴那么剧烈，”她说。“但随着年龄的增长，我们的身体机能会下降，有些营养素，如维生素 B12 和钙，随着年龄的增长，我们的吸收效率会大大降低。”
Hormonal changes are another valid reason to take supplements, she says, because waning oestrogen “impacts so many parts of the body, whether that’s our bone health, our metabolism, cardiovascular disease risk or muscle mass, and there are various nutrients that will help reduce all of those disease risks.” That said: “There’s no blanket. You’re entering perimenopause; you’re going to be deficient in all these things.”
激素变化是补充剂另一个合理的理由，她说，因为雌激素的下降“影响身体许多部位，无论是我们的骨骼健康、新陈代谢、心血管疾病风险还是肌肉量，都有各种营养素可以帮助降低所有这些疾病风险。”但她说：“没有一劳永逸的方法。你正在进入围绝经期；你将缺乏所有这些。”
Before considering any supplements, it’s best to take a cold, hard look at eating habits. “We might have poor dietary patterns, especially in middle age, where we’re that sandwich generation and our time is not our own and we don’t always put ourselves first,” says Pettitt. Social ideals around body size and diet often encourage drastic measures, such as ditching meals for a buzzy green smoothie, or cutting out dairy. “Sometimes fad diets end up meaning you don’t have a balanced diet.”
在考虑任何补充剂之前，最好先冷静地审视一下饮食习惯。“我们可能存在不良的饮食习惯，尤其是在中年时期，我们处于那个中间一代，我们没有自己的时间，而且我们并不总是把自己放在第一位，”佩蒂特说。关于身体大小和饮食的社会理想往往鼓励采取极端措施，比如用流行的绿色果蔬汁代替正餐，或者戒掉乳制品。“有时流行的饮食法最终意味着你无法获得均衡的饮食。”
Another basic consideration to master, says Nichola Ludlam-Raine, a specialist dietitian and author of How Not to Eat Ultra-Processed, is consuming an adequate amount of protein: “About 1.6g per kilogram of ideal body weight a day, spaced throughout the day.” (Ideal body weight meaning what a person would weigh with a BMI between 18 and 25.) If you’re really active, up to 2g per kg is good, she says, “alongside resistance training, two to three times a week, for bone health and muscle mass preservation”.
另一个需要掌握的基本考虑因素，Nichola Ludlam-Raine 说，一位专业营养师和《如何不吃超加工食品》一书的作者，是摄入足够的蛋白质：“每天每公斤理想体重约 1.6 克，分摊到一天中。”（理想体重是指一个人的 BMI 在 18 到 25 之间时的体重。）她说，如果你非常活跃，每公斤体重 2 克也是好的，并且“配合每周两次到三次的阻力训练，以保持骨骼健康和肌肉量”。
Getting enough fibre is fundamental too, she says, “because if you look after your gut, it will support almost every single bodily function, from immunity to mood”. It will also help your friendly gut microbes digest and produce more nutrients – an in-house supplement factory, if you will.
她说，摄入足够的纤维也很重要，因为“如果你照顾好你的肠道，它将支持几乎每一个身体功能，从免疫力到情绪”。它还将帮助你的有益肠道微生物消化并产生更多的营养——就像一个家庭补充工厂。
“女性最需要补充的是维生素 D，这对骨骼健康至关重要，”Claire Pettitt 说。照片：由模特儿摆姿势；Olga Pankova/Getty Images
How to spot deficiencies 如何发现缺乏
Our bodies will usually tell us if they’re not getting what they need. “I think we lose the skill of paying attention to our body. We’re too busy,” says Pettitt. “It’s noticing when things change, like if you’ve got fatigue, muscle weakness or hair loss, which could all reflect any number of micronutrient deficiencies.”
我们的身体通常会告诉我们它们是否没有得到所需的营养。“我认为我们失去了关注自己身体的技能。我们太忙了，”佩蒂特说。“这是注意到事情发生变化的时候，比如如果你感到疲劳、肌肉无力或脱发，这些都可能反映出多种微量元素的缺乏。”
Looking at your lifestyle, medications and dietary patterns can also provide clues. “If you’re vegan, you might need a supplement with B12,” says Ludlam-Raine. “Or if you’re on a proton pump inhibitor [to reduce stomach acid] or metformin [for type 2 diabetes], they can reduce absorption.” It’s easy to inadvertently lower calcium intake by switching to organic plant-based milks. “These are not fortified with calcium and iodine,” says Ludlam-Raine. “Calcium is essential for bone health. Iodine is essential for thyroid function. So I would say to menopausal women: go for dairy, or maybe a fermented dairy like kefir, or go for a fortified milk alternative.”
观察你的生活方式、药物和饮食习惯也可以提供线索。“如果你是素食主义者，你可能需要含有 B12 的补充剂，”Ludlam-Raine 说。“或者如果你正在服用质子泵抑制剂[以减少胃酸]或二甲双胍[用于 2 型糖尿病]，它们可以减少吸收。”通过改用有机植物奶，很容易无意中降低钙的摄入量。“这些奶没有添加钙和碘，”Ludlam-Raine 说。“钙对骨骼健康至关重要。碘对甲状腺功能至关重要。所以我会对更年期女性说：选择乳制品，或者可能是一种发酵乳制品如酸奶，或者选择强化奶替代品。”
Women can bleed more heavily during perimenopause, which could cause iron deficiency. Another question Pettitt would ask is whether you have digestive health issues, “like coeliac disease or anything that impacts absorption of nutrients”.
女性在更年期前期可能会经血量增多，这可能导致缺铁。佩蒂特还会问你是否存在消化健康问题，“比如乳糜泻或任何影响营养吸收的问题”。
Serious deficiencies can usually be verified with a blood test. “See a dietitian, a doctor, get some blood tests done to look for black-and-white evidence,” says Pettitt.
严重缺乏通常可以通过血液检查来验证。“去看营养师，医生，做一些血液检查来寻找黑白证据，”佩蒂特说。
Which supplements work? 哪些补充剂有效？
“The most common supplement a woman would need is vitamin D, which is crucial to bone health, immunity, muscles and even your hormones,” says Pettitt. General advice is to take it during autumn and winter, but if you have darker skin, wear high SPF or are covered up when you go out, consider taking it all year, says Ludlam-Raine. “A lot of my patients, especially if the BMI is above 30, are deficient. Look to take a minimum of 10mcg (400IU) of vitamin D (vitamin D3 is more effective than D2) – a supermarket own-brand will do!”
女性最需要补充的是维生素 D，这对骨骼健康、免疫力、肌肉甚至激素都至关重要，”佩蒂特说。一般建议在秋冬季节服用，但如果你的皮肤较黑，外出时涂抹高 SPF 防晒霜或穿着遮盖，可以考虑全年服用，鲁德兰-雷恩说。“我的许多病人，尤其是 BMI 超过 30 的人，都缺乏这种维生素。至少要服用 10mcg（400IU）的维生素 D（维生素 D3 比 D2 更有效）——超市自有品牌的维生素 D 就足够了！”
Pettitt has had a flurry of questions about magnesium from clients lately. “It has been used a lot in the past for muscle relaxation, if you get cramps. Muscle health is important in our nerve stimulation, so it’s part of our nervous system. It’s important for that, brain health, and helps with sleep and stress.”
佩蒂特最近收到了客户关于镁的大量问题。“过去经常用它来放松肌肉，如果你有抽筋。肌肉健康对我们的神经刺激很重要，所以它是我们神经系统的一部分。这对大脑健康很重要，还有助于睡眠和减轻压力。”
Ludlam-Raine bought some for herself – a mix of three types commonly sold together. Sounds like a no-brainer, although Pettitt says you might not need it if you eat a wholegrain diet along with nuts, avocado and black beans. “I often say: what’s your baseline?” says Pettitt. “Where are we at with our lifestyle? And can you make these changes and see if they make any difference? If you want to try it, try it, but are you going to monitor your symptoms?”
鲁德兰-雷恩为自己买了一些——三种常见组合的类型。听起来是个不费脑子的决定，尽管佩蒂特说如果你同时吃全谷物饮食、坚果、鳄梨和黑豆，你可能不需要它。“我经常说：你的基础是什么？”佩蒂特说。“我们的生活方式如何？你能做出这些改变并看看它们是否有所改变吗？如果你想尝试，那就试试，但你打算监测你的症状吗？”
如果你每周至少不吃一次油性鱼类，你可能需要补充 Omega-3。照片：Vicuschka/Getty Images
“The problem I often see is people start all these supplements at the same time,” says Pettitt. She recommends starting each one in isolation for four to six weeks, ideally three months, “depending on what you’re trying to change. You can’t necessarily expect a change in your mental health overnight with a supplement.”
《我经常看到的问题是，人们同时开始服用所有这些补充剂，》佩蒂特说。“我建议每次只单独开始服用一种，持续四周到六周，理想情况下是三个月，‘根据你想改变什么而定。你不能期望通过补充剂一夜之间就改变你的心理健康。’”
If you don’t eat oily fish at least once a week, your omega-3 might need supplementing. “Omega-3 is a powerful anti-inflammatory,” says Pettitt. “It’s going to help minimise your risk of cardiovascular disease. It’s also important for brain health, joint health, and all of these are changing as we age and go through menopause.” She says it doesn’t matter what kind of supplement you take, “because obviously there are all these different ones, saying all the other ones are rubbish. You want to get enough EPA and DHA [two of the three types of fatty acid that are known as omega-3s], but choose a brand that’s third-party tested.” This means the product’s ingredients have been independently verified.
如果您每周至少不吃一次油性鱼类，您的欧米茄-3 可能需要补充。“欧米茄-3 是一种强大的抗炎物质，”佩蒂特说。“它将有助于降低您患心血管疾病的风险。它对大脑健康、关节健康也很重要，所有这些都会随着我们变老和经历更年期而发生变化。”她说，你选择哪种补充剂都无关紧要，“因为显然有这么多不同的选择，都说其他的都是垃圾。你想要获得足够的 EPA 和 DHA[三种被称为欧米茄-3 的脂肪酸中的两种]，但选择一个经过第三方测试的品牌。”这意味着该产品的成分已经过独立验证。
Other claims you’ll see on expensive supplements include “food grown” and “micronised”, both promising superior absorption, but Pettitt cautions that these terms are ambiguous, with no standardised definition, and can be misleading. “‘Food grown’ refers to supplements that claim to be derived from whole foods or fermented ingredients, as opposed to synthetic or isolated nutrients, and therefore might be better absorbed or more bioavailable to the body because they contain other naturally occurring cofactors, like enzymes, phytonutrients, or other beneficial compounds,” she says. “However, this is not always true, and some supplements that are labelled ‘food grown’ are actually highly processed, or may not be more easily absorbed.” Similarly, micronised is often more of a marketing term “than a scientifically validated claim. The goal is to make nutrients more bioavailable, but whether this process improves absorption or effectiveness is often unclear or lacks robust evidence.”
其他昂贵的补充剂上可能还会看到“天然种植”和“微粉化”等说法，都承诺有更优越的吸收效果，但佩蒂特警告说，这些术语含糊不清，没有标准化定义，可能会误导消费者。“‘天然种植’指的是那些声称来源于全食物或发酵成分的补充剂，而不是合成或分离的营养素，因此可能因为含有其他天然存在的辅因子，如酶、植物营养素或其他有益化合物，而更容易被身体吸收或生物利用度更高，”她说。“然而，这并不总是正确的，有些标有‘天然种植’的补充剂实际上加工程度很高，或者可能并不更容易被吸收。”同样，“微粉化”通常更多是一个营销术语，而不是经过科学验证的主张。目标是使营养素更易于生物利用，但这个过程是否提高了吸收或效果往往不清楚，或者缺乏强有力的证据。
Ludlam-Raine agrees: “For most people, the key is taking the right nutrient in the right dose for their needs. My advice is always to focus first on getting nutrients from food where possible, and use supplements when needed as a top-up or safety net. Paying more for ‘micronised’ or ‘food-grown’ versions isn’t usually necessary.”
鲁德兰-雷恩表示同意：“对于大多数人来说，关键在于根据自身需求摄入正确的营养素和剂量。我的建议始终是首先尽可能从食物中获取营养，在需要时使用补充剂作为补充或安全网。通常没有必要为‘微粉化’或‘食品培养’版本支付更多费用。”
Fibre powders and probiotics (live microbes) have become popular, as health advice increasingly focuses on the gut, but Pettitt believes we should prioritise packing these into our diets. “Foods that have fibre bring so much more. If you eat lots of fruits and vegetables, you’re getting all the micronutrients, antioxidants, anti-inflammatories, the phytochemicals (plant chemicals) that bring benefit to our bodies. Most people should be eating more fruits and vegetables.”
纤维粉和益生菌（活微生物）越来越受欢迎，因为健康建议越来越多地关注肠道，但佩蒂特认为我们应该优先考虑将这些食物纳入我们的饮食中。“含有纤维的食物能带来更多的好处。如果你吃很多水果和蔬菜，你就能获得所有的微量元素、抗氧化剂、抗炎剂以及有益于我们身体的植物化学物质。大多数人应该多吃水果和蔬菜。”
Ludlam-Raine does try to take a probiotic when she remembers, but this is in addition to eating naturally probiotic fermented foods. She believes that “in the future, the UK will have recommended servings a day, like ‘five-a-day’ for ferments”. Kimchi, sauerkraut, miso, natural yoghurts all count. “I think kefir is almost the most acceptable and versatile. You can have it for breakfast; as a snack.”
鲁德兰-雷恩确实会在记得的时候尝试补充益生菌，但这是在食用天然发酵食品的基础上。她相信“未来，英国将推荐每天推荐的份量，就像‘每天五份’发酵食品一样”。泡菜、酸菜、味噌、天然酸奶都算数。“我认为酸奶几乎是接受度最高且最通用的。你可以用它作为早餐；作为小吃。”
Collagen is, says Pettitt, “a really trendy one. Most of its evidence is around joint and bone health, which is important in perimenopause, and as we age.” It’s increasingly touted as a brain-health boost too, but she says there’s not as much evidence for that yet. “You could probably try it and see if it makes any difference.” Ludlam-Raine is turning 40 next birthday and has started taking it for her skin health. It certainly won’t do her any harm. “It is such a safe supplement and a bit of a protein boost.”
胶原蛋白，佩蒂特说，“是一个非常流行的选择。大部分的证据都集中在关节和骨骼健康上，这在更年期前后很重要，而且随着年龄的增长也是如此。”它也越来越被吹捧为对大脑健康的提升，但她表示，关于这一点，证据还不足。“你可以尝试一下，看看是否有什么不同。”路德姆-雷恩将在下一个生日时满 40 岁，她已经开始服用它来改善皮肤健康。这肯定不会对她造成任何伤害。“这是一种非常安全的补充剂，也是蛋白质的补充。”
Ludlam-Raine often works with people who have had bariatric surgery for obesity, of which hair thinning can be a side-effect – but hair loss can also be caused by dropping oestrogen levels in perimenopause. “Biotin is a really popular supplement for this,” she says. She only recommends it in cases where a biotin deficiency has been identified through a blood test, “which is what the evidence supports for hair health, but I would suggest people focus on a food-first approach: eggs, salmon, nuts, seeds, sweet potatoes, legumes, mushrooms and avocados, etc”. But as it’s water soluble and we don’t store it in the body, she is not against people trying the supplement, “just in case it may help”, as long as they remember to stop taking it three days before blood tests, as it can skew some results.
鲁德兰-雷恩经常与因肥胖而接受过减重手术的人合作，其中脱发可能是副作用之一——但更年期前雌激素水平下降也可能导致脱发。“生物素是这种情况下非常受欢迎的补充剂，”她说。她只有在通过血液检查确认存在生物素缺乏的情况下才会推荐它，“这是证据支持头发健康的方式，但我建议人们首先关注食物疗法：鸡蛋、三文鱼、坚果、种子、红薯、豆类、蘑菇和鳄梨等”。但由于它是水溶性的，我们无法在体内储存它，她并不反对人们尝试这种补充剂，“以防万一它可能有所帮助”，只要他们记得在血液检查前三天停止服用，因为它可能会影响某些结果。
As for my lion’s mane mushroom capsules, Ludlam-Raine says that, while the fungus has been shown to improve cognition and nerve regeneration in some animal trials: “We don’t have large-scale human studies.” But as long as you’re getting a good diet, a supplement won’t cause any harm. “If it makes you feel good, then do it. But don’t do them as a first line. You can’t compare mushrooms to HRT, if that’s been recommended, which we know can help with brain fog.”
至于我的狮子鬃蘑菇胶囊，Ludlam-Raine 表示，尽管这种真菌在一些动物试验中已被证明可以提高认知和神经再生：“我们还没有大规模的人类研究。”但只要你的饮食良好，补充剂就不会造成任何伤害。“如果你感觉良好，那就去做。但不要将其作为首选。你不能把蘑菇与 HRT（激素替代疗法）相提并论，如果已经推荐了，我们知道这有助于脑雾。”
“Creatine is having a moment outside of the gym,” says Ludlam-Raine, where it’s known for providing a fuel boost for hard-working muscles. It’s one of the most-studied supplements – and benefits to brain health and cognitive processing are a growing field of interest. Unless you have a kidney condition (in which case, talk to your doctor first), she says: “Taking three to five grams a day is safe, so I almost think, why not give it a go for four weeks and see how it goes?” It’s still worth trying even if you’re not technically deficient, she believes, “because we do use up creatine stores, especially if you’re working out. The research is now quite substantial that shows when you supplement, even if you’ve got a healthy, balanced diet, you may reap these other benefits.”
肌酸在健身房之外也正迎来热潮，Ludlam-Raine 说，它因能为辛勤工作的肌肉提供能量补充而闻名。它是研究最广泛的补充剂之一——对大脑健康和认知处理的好处正成为一个越来越受关注的领域。除非你有肾脏疾病（在这种情况下，请先咨询医生），她说：“每天摄入三到五克是安全的，所以我几乎在想，为什么不尝试四周看看效果如何呢？”即使你技术上并不缺乏，她也认为值得一试，“因为我们确实会消耗肌酸储备，尤其是如果你在锻炼的话。现在的研究相当充分，表明即使你有健康均衡的饮食，补充肌酸也可能带来这些其他好处。”
All manner of vitamins and micronutrients now come in highly palatable gummy form, which on the one hand might mean you’re more likely to take them regularly. But, says Ludlam-Raine, “the sugars in chewables can add up. Check the ingredients and how many you are taking, because it might be like eating half a packet of fruit pastilles.”
各种维生素和微量元素现在都变成了非常可口的果冻形式，这在一方面可能意味着你更有可能定期服用它们。但是，Ludlam-Raine 说：“咀嚼片中的糖分可能会累积。检查成分和你的服用量，因为它可能就像吃了一半的果冻糖。”
Warnings and cautions 警告和注意事项
It’s easy to think “the more the merrier” with all these wonder-nutrients, but despite the unregulated mega-doses being sold, you can have too much of various supplements, including iron, vitamin A, vitamin D and magnesium. Make sure you don’t take more than you need.
对于这些神奇的营养素，人们很容易认为“越多越好”，但尽管市面上销售的这些未受监管的大剂量产品，但各种补充剂，包括铁、维生素 A、维生素 D 和镁，都可能摄入过多。确保您不要摄入超过所需的量。
“Pharmacists are such an underutilised resource,” says Ludlam-Raine. “If you have pre-existing medical conditions or you’re taking other prescribed medications or supplements, always double-check with a pharmacist, because there might be some sort of interaction.”
Ludlam-Raine 说：“药剂师是一种未被充分利用的资源。” “如果您有既往的疾病或正在服用其他处方药物或补充剂，请务必咨询药剂师，因为可能会有某种相互作用。”
Pettitt cautions against thinking of a supplement as an easy short cut. “It’s often seen as something that we can take control of now, whereas changing your lifestyle, changing your job because it’s too stressful, getting a divorce because you’re not happy in your marriage, those are really big things that take time to change. And actually, it’s much easier to say: right, I’m going to buy this supplement, and it’s going to help me sleep and I’m going to be less stressed.”
Pettitt 警告人们不要将补充剂视为一种简单的捷径。“它通常被视为我们现在可以掌控的东西，而改变生活方式、改变工作因为压力太大、离婚因为婚姻不幸福，这些都是真正需要时间来改变的大事。实际上，说‘好吧，我要买这种补充剂，它将帮助我入睡，我将减少压力’要容易得多。”
Ludlam-Raine thinks people who are feeling chronically under par are vulnerable to “marketing over evidence. I think it’s a case of remembering the pillars of health: your diet, your physical activity, your stress, sleep and also social connection, and just remembering that you need to get the basics right before even considering a supplement.”
鲁德姆-雷恩认为，那些长期感觉不佳的人容易受到“过度营销而非证据”的影响。我认为这是一个记住健康支柱的问题：你的饮食、你的身体活动、你的压力、睡眠，以及社会联系，并且记住在考虑补充剂之前，你需要确保这些基本要素正确无误。
