Nutrition for Anxiety and Depression: Supplements for Deficiencies (Part 6)

In Part 4, we discussed how certain vitamin and mineral deficiencies can contribute to depression and anxiety. While obtaining nutrients from food is always the ideal approach, it’s not always realistic or practical for everyone to meet their needs through diet alone, especially when addressing or preventing a deficiency. In Part 5, I shared a sample meal plan to show what meeting your vitamin and mineral requirements through diet might look like. For those who may need additional support, self-diagnosing and self-prescribing supplements is not advisable. Always consult with a knowledgeable healthcare provider to ensure you’re making the right choice for your specific needs.

Key Considerations When Selecting Supplements

Many healthcare providers may suggest supplementing with a vitamin or mineral without specifying the best form to take. Not all forms of a nutrient are created equal, and supplement marketing can often mislead and confuse people. Below are key factors to consider when selecting supplements. I’ve also provided product recommendations for your convenience, though these are by no means the only good options.

A Good Multivitamin

I usually suggest people start with diet and a good multivitamin. Then consider other supplementation if you have labs showing deficiency or a diagnosis that might warrant additional supplementation.

• Products: Designs for Health Twice Daily Multi, Thorne Basic Nutrients, Pure Encapsulations O.N.E Multivitamin

Vitamin D

I recommend using a vitamin D supplement that includes vitamin K, particularly the MK-7 form of vitamin K2, for its enhanced synergy. Alternatively, a diet high in dark leafy greens, fermented foods, and animal products can provide the vitamin K you need. Combining that with cod liver oil will give you omega-3s, vitamin D, and vitamin A, all of which can have synergistic effects on the body.

• Products: Designs for Health ADK Evail (no MK-7), Pure Encapsulations Vitamin D3 & K2 (with MK-7)

Magnesium

The recommended daily allowance (RDA) for magnesium is 400 mg/day for adult men and 310 mg/day for adult women. An additional 10 mg/day is recommended for individuals over the age of 30, and 40 mg/day is added for pregnant women. Higher doses may be necessary for specific conditions, such as lowering blood pressure, treating migraines, or in some individuals with kidney disease. For brain health, magnesium glycinate and threonate are considered the best forms, with glycinate being especially effective for reducing stress, promoting relaxation, and alleviating anxiety.

• Products: Pure Encapsulations Magnesium (Glycinate), Integrative Therapeutics Magtein L-Threonate Plus

Iron

If you’re taking iron long-term, it’s important to test your levels regularly, as supplementation without a deficiency can lead to negative health effects. Certain factors, such as Vitamin C and foods with a lower pH (like vinegar and tomato sauce), can enhance iron absorption. Conversely, substances like coffee, tea, high-calcium foods, and antacids can interfere with absorption. To maximize iron intake, avoid taking your supplement with coffee, tea, or dairy, and space out calcium supplements from iron.
If you’re iron deficient and also dealing with acid reflux, it may be helpful to consult with a dietitian who can collaborate with your gastroenterologist to possibly reduce or wean you off antacid use.

The most affordable form of iron supplementation is ferrous sulfate, though it can often cause constipation. Ferrous bisglycinate is a gentler alternative, and iron supplements with Vitamin C, like Floradix, can improve absorption. However, my preferred choice is liver pills, as they provide a whole-food source of iron along with other essential nutrients that are needed to use iron properly in the body (i.e., copper, riboflavin, B12, folate). Since it’s a whole food, you need to take a higher dose, and for Ancestral Supplements, the recommended dose is 6 capsules a day.

• Products: Floradix Iron, Ancestral Supplements Grass Fed Beef Liver

Selenium

Brazil nuts are one of the easiest and most natural ways to boost selenium intake through food. If you’re unable to include them in your diet, selenomethionine is the most effective supplemental form of selenium. A typical dose is 200 mcg, but taking this amount daily may not always be necessary. Depending on your individual needs, you might consider reducing the frequency to two times a week. If you are supplementing with 200 mcg of selenium, it’s wise to periodically check your selenium levels to determine when you might need to adjust the dosage.

• Products: Pure Encapsulations Selenium

Zinc

Zinc comes in several forms, with the most effective and well-researched being zinc sulfate, gluconate, acetate, and citrate. Other highly absorbable forms include zinc methionine, glycinate, and orotate. Zinc carnosine is a favorite for its dual benefit of improving zinc status while supporting gut healing. Zinc oxide and picolinate are less ideal for general supplementation. For best absorption, take zinc with a snack that includes animal protein. The typical recommended dose is 7–15 mg, but if higher doses are necessary, consider splitting the dose into thirds at each meal. Be mindful that long-term high zinc intake can interfere with copper levels and potentially other nutrients.

• Products: Pure Encapsulations Zinc Liquid, Seeking Health Zinc Lozenge

Omega 3

There are several options for omega-3 supplementation. A high-quality cod liver oil, such as Rosita, is one of the least processed options available, offering both omega-3s and other beneficial nutrients like vitamins A and D. For those seeking a vegan alternative, algal oil, derived from algae, provides a plant-based source of omega-3s, particularly DHA and EPA, without the need for animal products. SPMs (Specialized Pro-Resolving Mediators) are bioactive molecules derived from omega-3 fatty acids that help resolve inflammation and support healing. While research has shown a link between inflammation and mental health, more studies are needed to determine if SPMs specifically improve mood or mental health outcomes compared to other omega-3 forms. However, it is promising since SPMs seem to be more powerful at fighting inflammation than standard omega-3 supplements.

• Product: Rosita Extra Virgin Cod Liver Oil (no Vitamin K, but is low enough in Vitamin D that in can be combined with another Vitamin D supplement, Vital Nutrients Ultra Pure Vegan Omega SPM+

B Vitamins

There are several different B vitamins, each with multiple forms, which can make things a bit confusing. On top of that, genetics can influence how well we absorb and utilize certain forms of these vitamins (more on this in Part 7). Plus, there’s ongoing research in this area, so recommendations may evolve over time. I’ll do my best to simplify everything and break it down for you.

Thiamin (B1)
If you’re on a budget, start with the more affordable option, thiamine hydrochloride. If you’re looking for potentially better results, try the other forms like benfotiamine, TPP, or TTFD. Some claim that benfotiamine is better since it is fat soluble and can easily penetrate inside the cell. However, there is currently no strong evidence from high-quality human studies to suggest that one form of thiamine is clearly superior to the others.

• Product: Life Extensions Benfotiamine

Riboflavin (B2)
Some suggest that free riboflavin is the preferred form over riboflavin 5′-phosphate, and it’s best taken with meals, ideally spread evenly throughout the day if possible. A typical dose of 2-5 mg per day is adequate for most people, though certain individuals may need higher doses, ranging from 200-400 mg per day, particularly those managing migraines or specific genetic conditions.

• Product: Integrative Therapeutics Riboflavin 400 mg, NOW brand B2 100 mg

Niacin (B3)

When choosing multivitamins or B complex supplements, opt for forms of nicotinamide, like niacinamide, NR, or NMN, as these are generally considered better than nicotinic acid or any nicotinate forms, such as inositol hexanicotinate.

• Product: Thorne Niacel 400 (fancy form that supports ATP and antiaging)

Pantothenic Acid (B5)

Vitamin B5 is naturally present in foods as part of complex compounds that aren’t typically found in supplements, and some argue that B5 from food may be more beneficial than the synthetic versions. However, pantothenic acid, pantothenate salts, and pantethine are effective supplements for most people. It’s important to note that taking higher doses of B5 for extended periods can deplete biotin and lipoic acid, which may require additional supplementation. If you choose to supplement with these nutrients, be sure to take them at least three hours apart from Vitamin B5 to avoid interference with absorption.

• Product: NOW brand Pantothenic Acid

Pyridoxine (B6)

The active form of B6 is P5P (pyridoxal-5-phosphate), and it’s typically the best form for supplementation. Vegans with a riboflavin deficiency, or those with certain genetic variations (which affect about 15% of people), may have difficulty converting the B6 found in plant foods into its active form. As a result, they may require P5P supplementation. However, this conversion issue doesn’t apply to people who consume animal foods rich in B6, as these foods contain the active form directly. That said, it’s still possible to be deficient in B6 even if you’re a meat eater.

• Product: Pure Encapsulations P5P 50 mg

Biotin (B7)

If you are dosing high (in the thousands) you may need to also supplement with B5 and lipoic acid, as discussed earlier.

• Product: Life Extensions Biotin 600 mcg

Folate (B9)

Folic acid is the inexpensive, synthetic form of folate and the most widely available. There’s ongoing debate about whether this synthetic form can contribute to negative health effects. However, folic acid has been shown to be an effective supplement for raising folate levels and is commonly added to foods like cereals, breads, pasta, juice, and other grain products. If your diet is very high in grain-based foods, you may be consuming more folic acid than you realize. In fact, it’s possible to exceed the upper safety limit (1,000 mcg) if a significant portion of your carbohydrates come from fortified flour products.
Additionally, some individuals with certain genetic variations may have trouble utilizing folic acid efficiently. Research has shown correlations between high folic acid intake and potential negative health effects (1–6). However, correlation does not imply causation, so these findings should be viewed cautiously. To be on the safe side, folinic acid may be a better option, as it is more easily absorbed and less likely to mask a B12 deficiency. Depending on your genetics and health status, you could be an over-methylator (experiencing too much methylation) or an under-methylator (experiencing too little). If you’ve had genetic testing and have been advised to use methylated folate, 5-MTHF (5-methyltetrahydrofolate) is usually the best choice. If you’re unsure, you can try either 5-MTHF or folinic acid. If 5-MTHF doesn’t work well for you, switching to folinic acid might be a better option.

• Products: Seeking Health folinic acid lozengers, Nutra BioGenesis Methyl Factors is a great option because it comes in liquid form, allowing you to easily adjust the dosage to mimic what you would get through food. For example, you can start with 3 drops three times a day and gradually increase to 5 drops three times a day if needed. It contains methyl B12, methyl folate, and the active form of B6 (P5P).

Cobalamin (B12)

Vitamin B12 comes in several forms, including methylcobalamin, cyanocobalamin, hydroxocobalamin, and adenosylcobalamin. Methylcobalamin can be especially helpful for individuals with certain MTHFR genetic SNPs. Cyanocobalamin is the most commonly used form of B12 and is effective, but it needs to be converted into active forms in the body, which may be less efficient for those with certain genetic variations and/or absorption issues. Hydroxocobalamin is a higher-quality, better-absorbing form of B12. If you see the hydroxo- or methyl- forms, you can usually expect a better-quality supplement. Adenosylcobalamin is more active in the mitochondria, supporting energy production. However, some argue that it might not be well absorbed through the digestive tract.

• Products: Seeking Health- Hydroxo B12 2,000 mcg Lozengers, NOW foods – Methyl B12 1000 mcg Lozengers

Choline

There are several forms of choline, each suited for different health needs. Trimethylglycine (TMG) is ideal for supporting methylation, while phosphatidylcholine is particularly helpful for fat digestion and liver health. For brain health, muscle strength, and relaxation, Alpha-GPC is the top choice. Citicoline is also highly effective for supporting brain health.
Product: NOW brand Alpha GPC 300 mg, Life Extensions TMG 500 mg, Biotics TMG Powder, Thone Phosphatidyl Choline

Final Thoughts

While whole foods should be your primary source of nutrients, supplements can play a helpful role when deficiencies are identified. It’s important to work with a healthcare provider before self-prescribing supplements to ensure you’re choosing the right ones. Start by improving your diet with nutrient-rich foods and consider supplements only when necessary, based on lab results. Remember, not all supplements are created equal, so it’s crucial to select high-quality options. Small, realistic steps, like adding a multivitamin or addressing specific deficiencies, can lead to improved mental health over time. Make a balanced diet your foundation to nourish both your body and mind for lasting health and well-being.