Q&A: which supplements to take; age-related weight gain; perimenopause and alcohol; & heart palpitations

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ICYMI 👉

• How's Your Relationship with Alcohol?

• Psychiatric Pills Are Not the Problem—The System Is

• The Pitfalls of the Wellness Industry

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📣This is a free event. Paid subscribers can submit questions by commenting below or via the paid subscriber group chat here!

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In this week’s reader-submitted Q&A, we’re tackling these questions:

• Which supplements, if any, should I be taking?

• Is weight gain a natural part of aging?

• Is drinking making my perimenopause symptoms worse?

• When should I worry about heart palpitations?

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Photo by jack atkinson on Unsplash

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: WHAT SUPPLEMENTS TO TAKE

I take a multivitamin, omega-3s, magnesium, probiotics, and a few other things—but I don’t even know if they’re doing anything. What supplements are actually worth taking?

-Todd

Hi Todd,

I get this question a lot. Thanks for asking it here. Many people take supplements thinking that they will improve their health. The truth is that some supplements can be beneficial, however, there is no standard supplement list to suits every body (despite what the supplement industry might try to sell you!) The key is knowing which ones are truly necessary for YOU based on your diet, lifestyle, and individual health needs.

Approximately one-third of all Americans pop a multivitamin, largely because they think it will fill gaps in their diets or improve longevity in some way or another. Sure, a multivitamin can act as a safety net, but if you eat a well-balanced diet, you may not need it. Some people benefit from a daily multivitamin if they have certain dietary restrictions, nutrient deficiencies, or increased needs due to age or certain health conditions.

One of the largest and highest-quality studies (i.e., a randomized, double-blind, placebo-controlled trial) tested a multivitamin supplement (the equivalent of Centrum Silver) in the maintenance of cardiovascular health and cancer risk in more than 21,000 older adults over 3.5 years. The study, called COSMOS, found that multivitamins showed no improvement for men or women in cancer risk, mortality or cardiovascular disease.

However, an ancillary study did find that certain aspects of cognition significantly improved for men and women over age 60: “More specifically, participants assigned to the multivitamin group did significantly better on the COSMOS-Web memory tests at the pre-specified primary time point of 1 year.”

Here is what I tell my patients about multivitamins:

• Don’t rely on multivitamins as a substitute for other things that are proven to protect cognition (such as healthy eating, regular exercise, adequate sleep, stress management, and brain-stimulating activities).

• A multivitamin may help cognitive function, and it probably cannot hurt.

What about other common vitamins? I recommend vitamin D supplements to my patients who are at risk for (or already have) osteoporosis if their serum vitamin D levels are low. I recommend iron supplements to menstruating young women who have iron deficiency anemia.

Omega-3s can be useful if you don’t eat fatty fish regularly. They support heart, brain, and joint health, and some research suggests they may help with inflammation. But if you already consume salmon, sardines, or flaxseeds consistently, supplementation may not be necessary.

Magnesium is involved in muscle function, sleep, and stress regulation. Many people don’t get enough through diet, particularly those who consume a lot of processed foods. If you experience muscle cramps, poor sleep, or high stress, magnesium may be worth keeping in your routine.

Probiotics can support gut health, but their effectiveness depends on the strain and your individual needs. If you eat fermented foods like yogurt, kimchi, or sauerkraut, you may already be getting beneficial bacteria. For digestive issues or after taking antibiotics, probiotics can be helpful, but not everyone needs them long-term. Other supplements depend on personal factors. B vitamins can support energy and metabolism, especially for those with vegetarian or vegan diets.

It would be inappropriate to recommend any vitamin or supplement without a specific reason. Believe it or not, they can do serious harm! I’ve seen kidney and liver problems as a result of everything from green tea extract to excessive vitamin C consumption. It’s a jungle out there, folks! I wrote more about vitamins and supplements here.

The upshot: the best approach is to tailor supplements to your needs rather than taking a broad mix just in case. If you're unsure, getting bloodwork and discussing it with your doctor can help determine what’s best for you.

Does that help?

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QUESTION #2: AGE RELATED WEIGHT GAIN

I eat well and exercise (at least I think I do), but in my 40s, I’ve gained weight around my middle that won’t go away. Is this just part of aging, or is there something I can do?

-Mark

Hi Mark,

Ah, the joys of middle age. 😆 Weight gain around the midsection in your 40s is common and often tied to shifts in metabolism, body composition, and lifestyle factors. While aging does play a role, there are ways to manage and even reverse some of these changes.

As we get older, metabolism naturally slows, meaning the body burns fewer calories at rest. Muscle mass also tends to decline, which further impacts how efficiently calories are used. If exercise and diet stay the same as in your 20s or 30s, it may no longer be enough to maintain weight. Stress and poor sleep can also contribute, as elevated cortisol levels are linked to increased fat storage, particularly around the abdomen.

If your usual approach to diet and exercise isn’t working as well as it once did, small adjustments may help. Strength training is particularly important because muscle mass helps keep metabolism active. Increasing protein intake can support muscle retention and promote satiety. Prioritizing fiber-rich foods, healthy fats, and reducing processed carbohydrates and alcohol is crucial to regulate blood sugar and prevent excess fat storage.

Beyond diet and exercise, sleep quality and stress management are key. Chronic stress and poor sleep can lead to hormonal imbalances (e.g., surges in cortisol levels) that make it harder to maintain a healthy weight. Developing a consistent sleep routine, managing stress through relaxation techniques or movement, and staying hydrated can all contribute to overall metabolic health.

If weight gain persists despite these efforts, it may be helpful to check in with a doctor to rule out factors like insulin resistance, thyroid imbalances, or other metabolic issues. While midlife weight shifts are common, they don’t have to be inevitable—adjusting your approach to exercise, nutrition, and lifestyle can make a meaningful difference. I hope that helps!

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QUESTION #3: PERIMENOPAUSE AND ALCOHOL

I’m in perimenopause and have been dealing with hot flashes, mood swings, and poor sleep. Could my occasional drinking be making things worse?

-Betsy

Hi Betsy,

Yes indeed—alcohol can contribute to some of the symptoms you're experiencing during perimenopause. While an occasional drink may not seem like a big deal, alcohol can affect hormone balance, body temperature regulation, and sleep quality, all of which can make hot flashes, mood swings, and sleep disturbances worse.

Alcohol is a known trigger for hot flashes because it can cause blood vessels to dilate, leading to sudden warmth and sweating. Some women find that even small amounts of alcohol, particularly wine, can bring on or intensify these symptoms.

When it comes to mood swings, alcohol can interfere with neurotransmitter function and hormone fluctuations, sometimes leading to heightened emotional ups and downs. If you already feel more sensitive or reactive during perimenopause, alcohol can amplify these feelings.

Sleep quality is another key factor. Even though alcohol can initially make you feel relaxed or drowsy, it disrupts the sleep cycle, particularly the deeper restorative stages of sleep. This can lead to more nighttime awakenings, lighter sleep, and overall poorer rest, which in turn can make other perimenopausal symptoms feel more intense.

If you suspect alcohol is playing a role, you might try cutting back for a few weeks to see if it makes a difference. Some women notice significant improvements in sleep and fewer hot flashes by reducing or eliminating alcohol. Staying well-hydrated, eating balanced meals, and finding other ways to unwind—like herbal tea, stretching, or mindfulness practices—may also help you manage symptoms more effectively. If your symptoms continue to interfere with daily life, it might be worth discussing additional options with your doctor.

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QUESTION #4: WHEN TO WORRY ABOUT HEART PALPITATIONS

Every so often, I feel my heart skip a beat or flutter. My doctor says my heart is fine, but it still freaks me out. How do I know when to worry?

-Gerald

Hi Gerald,

Feeling your heart skip a beat or flutter can be unsettling, but in many cases, it’s completely benign. These sensations, often referred to as palpitations, can be caused by things like stress, caffeine, dehydration, lack of sleep, or even hormonal fluctuations. If your doctor has evaluated your heart and found no underlying condition, it’s likely that these occasional flutters are harmless.

That said, it’s understandable to wonder when to take it more seriously. If palpitations are brief, infrequent, and not accompanied by other symptoms, they are usually nothing to worry about. However, if you start experiencing dizziness, fainting, chest pain, shortness of breath, or a rapid, prolonged heart rate, it’s important to seek medical attention. These could be signs of an underlying issue that needs further evaluation.

If palpitations are happening frequently and affecting your quality of life, it may be helpful to track when they occur. Paying attention to triggers—like certain foods, alcohol, stress, or exercise—can provide clues. Staying hydrated, managing stress, cutting back on stimulants like caffeine, and getting enough sleep can also help reduce them.

Even though your doctor has reassured you, if the palpitations continue to cause anxiety, consider asking for additional testing, such as a Holter monitor or an ECG, to provide more reassurance. Trusting your instincts is important—while most palpitations are harmless, advocating for further evaluation when something feels off is always reasonable.

Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.