By Dr. Jackie Piasta, DNP, WHNP-BC, MSCP — Monarch Health

If you’ve stood in the supplement aisle lately, you know: it’s a jungle.

Let’s cut through the noise with an evidence-first guide to the few supplements that reliably help in midlife, the many that don’t, and how to use them safely alongside a food-forward lifestyle.

First, a quick reality check

Supplements are not pre-approved by the FDA for safety or effectiveness. Under the Dietary Supplement Health and Education Act (DSHEA), manufacturers can sell products without proving efficacy or safety to the FDA. This means marketing claims often outpace the evidence, and quality can vary widely.
Big business, big profits. The U.S. dietary supplement market alone is valued at nearly $70 billion annually, with the global market exceeding $220 billion, driven as much by marketing as by science.
Food comes first. Supplements are just that: supplementary. You cannot out-supplement a poor diet. A nutrient-dense eating pattern built on whole foods, lean protein, fiber, and healthy fats forms the foundation of midlife wellness.

“Supplements can help fill targeted gaps but should never replace nutrition.”

The “often worth it” short list (for the right person)

1) Creatine monohydrate (3–5 g daily)

One of the most rigorously studied and consistently effective supplements. In middle-aged and older adults, creatine paired with resistance training improves muscle strength, lean mass, and functional performance. It may also have emerging benefits for bone and cognition. Safe for healthy adults; avoid only if you have kidney disease. Expect a benign rise in serum creatinine (a lab artifact, not actual kidney damage).

Monarch take: 3-5 g daily with a meal. Look for “creatine monohydrate” and third-party seals like USP or NSF Certified for Sport.

2) Vitamin D — if you’re deficient or high-risk

Large trials (like the VITAL study) show no reduction in cancer or cardiovascular disease with routine vitamin D. But if your blood level is low or you have risks (low sun exposure, darker skin at high latitudes, osteoporosis, malabsorption), supplementing to correct deficiency is appropriate.

Key point: Vitamin D is useful for treating deficiency, not as a general prevention strategy. Vitamin D blood levels should be checked routinely if on a supplement regimen.

3) Magnesium (glycinate or l-threonate, 200–400 mg daily)

Supports sleep quality, migraine prevention, bowel regularity, and muscle function. Most adults don’t meet the RDA from food alone. GI upset is the main dose-limiting factor; glycinate is gentler, citrate works well if constipation is also a concern.

See the blog post on magnesium for more detailed info on the different forms and uses for magnesium.

4) Iron — only if labs say you need it

For menstruating or perimenopausal women, iron deficiency often precedes anemia. Low ferritin can also be found in those with GI conditions such as celiac. Ferritin is the best early test of iron stores. Low iron can drive fatigue, brain fog, and hair shedding, but supplementing when not deficient has potential health risks.

Key Takeaway: Take only when deficiency is documented. Every other day dosing has been shown to be more effective for absorption.

5) Targeted B-vitamins (situational)

B12: Needed if you’re vegan/vegetarian, on metformin or acid-suppressing meds, or if levels are low.
Folate: Essential in pregnancy planning.
Beyond that? High-dose B-vitamin therapy doesn’t prevent heart disease or dementia despite lowering homocysteine in trials. They can however boost mood and energy and are relatively harmless. B vitamin are not fat-soluble which means they do not accumulate in your body over time and can be typically taken without monitoring levels routinely.

The “maybe” category (manage expectations)

Probiotics

Evidence is strain-specific. Some may help IBS symptoms, but the overall certainty of benefit is low. For “general gut health,” evidence is inconsistent. Food sources like yogurt, kefir, and fermented vegetables remain the best place to start.

Collagen

Small improvements in skin hydration and elasticity are seen in some studies, but the effects are modest and fade when only non–industry-funded trials are considered. Collagen is low in essential amino acids, so it doesn’t replace protein from food.

Calcium

Aim for 1,000–1,200 mg daily, ideally from food. Supplement only to fill a true gap. Calcium ± vitamin D supplementation has inconsistent fracture-prevention benefits, and excess calcium may increase kidney stone risk.

My favorite calcium are made from real food sources. Check them out here.

Omega-3 fatty acids (fish oil, flax, chia, walnuts)

Omega-3s are essential fats that play a role in heart and brain health, support the immune and endocrine systems, and help regulate the body’s inflammatory response.

Omega-3s may help by reducing triglyceride levels, supporting vascular health, and possibly easing symptoms like depression, psychological stress, and even hot flashes in some studies.

How much? The NIH recommends women consume about 1,100 mg daily (men: 1,600 mg). This can be achieved by eating fatty fish (like salmon, sardines, trout) twice per week, or by combining food sources with supplementation. Plant sources include flaxseed, chia seeds, walnuts, firm tofu, beans, canola oil, and avocado.

Caution: Omega-3s can thin the blood, so if you are on blood thinners, have clotting disorders, or are preparing for surgery, talk with your healthcare provider before adding supplements.

Bottom line: In many cases, aiming for dietary intake first and supplementing if needed is a smart approach.

What to leave off your list (in most cases)

Daily multivitamin for longevity or disease prevention

The USPSTF finds insufficient evidence that multivitamins prevent cancer or heart disease; large meta-analyses show no mortality benefit.

But here’s the nuance: If your diet is restrictive, such as being on a GLP-1 agonist medication, where appetite suppression often lowers intake, then a well-rounded multivitamin may help fill gaps. A recent study found adults on GLP-1s had inadequate intakes of fiber, calcium, iron, magnesium, potassium, choline, and vitamins A, C, D, E, among others. In these contexts, a multivitamin can be a smart insurance policy.

Important: USPSTF specifically recommends against beta-carotene and vitamin E supplementation for prevention (harms ≥ benefits).

High-dose biotin (“hair/skin/nails”)

Popular but problematic. High doses interfere with key blood tests, including thyroid, troponin (heart attack marker), and hCG. On top of this, data is mixed on benefits for H/S/N. Always tell your clinician if you’re taking it.

“Detox,” mega-dose antioxidants, or proprietary blends

No credible evidence for sweeping claims. Proprietary blends often hide doses and can interact with medications.

Quick takes on popular questions

Magnesium forms: Glycinate or L-threonate for sleep/anxiety, citrate for constipation, oxide is poorly absorbed and mostly laxative.
Creatine and kidneys: Raises serum creatinine but not actual kidney damage in healthy adults.

How we personalize at Monarch Health

Food first. Whole foods are the foundation of health.
Test, then target. We check labs when symptoms or risk factors suggest a deficiency.
Simplify the stack. Most people do best with 1–3 purposeful supplements, not a cabinet full.
Verify quality. We recommend brands that are USP Verified or NSF Certified for Sport.

A example pragmatic midlife starter kit

Creatine monohydrate (3–5 g/d with resistance training)
Magnesium (200–400 mg/d, glycinate or l-threonate at bedtime)
Vitamin D3 (only if deficient or high risk)
Iron (only with low ferritin or confirmed deficiency)
B12/folate (if dietary pattern, medication, or labs indicate)
Probiotic (strain-specific, if IBS symptoms persist)

Obviously, let’s have a chat before you implement anything new into your regimen. (JP)

Bottom line

For most individuals, the winning formula is food first, targeted testing, and a short, purposeful supplement list. Creatine, magnesium, and correcting true deficiencies (vitamin D, iron, B12) offer the most reliable upside. Routine multivitamins and catch-all wellness pills rarely move the needle, but can be valuable when diet is limited.

If you want a personalized supplement plan aligned with your labs, medications, and health goals, we can map it out together at your next visit.

References

U.S. Preventive Services Task Force. Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer. JAMA. 2022.
Manson JE, et al. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. N Engl J Med. 2019 (VITAL Trial).
American Gastroenterological Association Technical Review on Probiotics in IBS. Gastroenterology. 2021.
Lopez HL, et al. Creatine Supplementation and Resistance Training in Older Adults: Systematic Review. J Gerontol A Biol Sci Med Sci. 2022.
Frontiers in Nutrition. Investigating nutrient intake during use of GLP-1 receptor agonist. 2025.
Council for Responsible Nutrition. Economic Impact Study of the Dietary Supplement Industry. 2023.
Nutraceuticals World. U.S. Supplements Market Approaches $70 Billion. 2024.

Midlife Supplements: What’s Worth the Hype (and What to Skip)