New dietary supplement labeling requirements will be in full effect by January 2021. These will change how ingredient amounts
of some dietary supplements are listed including folate, niacin, and vitamins A, D, and E. The change does not apply to
prescription products. See chart below for details
Dietary Supplement (old to new units)
Example
Folate or folic acid (mcg to mcg DFE) - 1 mcg dietary folate equivalent
= 1 mcg found in food = 0.6 mcg dietary supplements taken w food or
0.5mcg without food
A prenatal vitamin with 400 mcg of FA taken once daily, with
or without food, meets the RDA for FA during pregnancy (600
mcg DFE)
Niacin (mg to mg NE) – 1 mg Niacin equivalent = 1 mg inositol
hexanicotinate, niacin, niacinamide, nicotinic acid, nicotinamide,
vitamin B3
Niacin 500mg = 500 mg NE daily
Vitamin A (IU to mcg RAE) - 1 mcg Retinol Activity Equivalent =
A multivitamin with beta-carotene 1,000 IU taken once daily =
~150 mcg RAE
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3.33 IU retinol
6.7 IU beta-carotene (from dietary supplements)
20 IU beta-carotene (from food)
40 IU alpha-carotene or beta-cryptoxanthin
Vitamin D (IU to mcg) - 1mcg = 40IU from food and dietary
supplements
Vitamin D 1,000 IU taken once daily = 25 mcg vitamin D
Vitamin E (IU to mg alpha-tocopherol) - 1 mg alpha-tocopherol =
400 IU taken once daily = ~268 mg d-alpha tocopherol natural
or 180 dl-alpha-tocopherol synthetic
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1.49 IU d-alpha-tocopherol (natural)
2.22 IU dl-alpha-tocopherol (synthetic)
NIH. Dietary supplement ingredient database. Unit conversions. Updated August 2017.
https://dietarysupplementdatabase.usda.nih.gov/Conversions.php.
Product
Dosing
Opportunities
Vitamin D
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10-20 mcg/day (400-800 IU) daily for adult under 50
20 -25 mcg (800 to 1,000 IU) daily for older adults
North American Menopause Society recommends 8001000 IU daily for adults over 50
1.25mg (50,000) IU weekly for 8 weeks if level under
20ng/mL
Vitamin D levels are inversely related to body mass index in
obese patients, and anticonvulsants, glucocorticoids,
antifungals, and HIV antivirals increase vitamin D catabolism.
Therefore, obese patients or patients taking these medications
may need two or three times more vitamin D than is generally
recommended for their age group
Vitamin B
Niacinamide 500 mg once or twice daily
Oral Nicotinamide to Reduce Actinic Cancer (ONTRAC) study
Pre-natal
Vitamins
There are specific recommendations for certain ingredients in
prenatal vitamins (e.g., calcium, folic acid, iron, and iodine).
Calcium helps with healthy bones, folic acid with brain and
spinal cord development, and iron prevents anemia.
15mg/kg (9 mg/kg elemental Mag)/day
Magnesium
300-400mg daily
Vitamin C
1-3 g/day are the most common doses
(Cochrane Database Syst Rev)
Bone health (D3 cholecalciferol) is more potent than D2
(ergocalciferol)
Latest study did not prevent falls in elderly
Advanced age with history of fall or nontraumatic fracture,
malabsorption (e.g., inflammatory bowel disease, bariatric surgery),
and use of anticonvulsants, glucocorticoids, antifungals,
cholestyramine, or HIV antivirals. Pregnant or lactating women and
people with dark skin tone.
Dx of osteoporosis, osteomalacia, rickets, chronic kidney disease,
liver failure, hyperparathyroidism, obesity, granulomatous disease,
and lymphoma.
Some evidence supporting fibromyalgia, asthma or even depression
Niacinamide for Skin cancer
Recommend Vit B12 for pt taking metformin
Prevent leg cramp in pregnant women (fursultiamine 50 mg,
hydroxocobalamin 250 mcg, pyridoxal phosphate 30 mg, and
riboflavin 5 mg)
Key ingredients – 400-800 mcg folic acid, 27mg elemental iron,
150mcg of iodine per day for most. Add additional Calcium
1000mg/day depending on the risks
Pediatric migraine - Formulation may include riboflavin or
melatonin
Nighttime leg cramp (pregnant women) – Formulation may include
Vit E, B complex and calcium
Cold or flu
Formulation may include echinacea, elderberry, honey, zinc