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Do Eggs Prevent Cognitive Decline?

March 3, 2026 by Dr. Steve Chaney

Are Eggs Brain Food?

Author: Dr. Stephen Chaney

For much of the past 10 or 20 years, eggs have villainized. We were told that their high cholesterol levels would clog our arteries and increase our risk of heart attack and stroke.

We were told to eat egg whites, egg substitutes (even though egg substitutes were a witch’s brew of chemicals), or avoid eggs altogether.

But in recent years, the ground has shifted.

Cholesterol is no longer viewed as the demon it once was. It is now thought of as more of a bit player in a cast of dozens of factors contributing to increased risk of heart disease and stroke.

And when it comes to increased risk of heart disease, the AHA (American Heart Association) position on egg consumption and heart disease risk has shifted dramatically. They now recommend:

“Healthy adults can eat up to one whole egg per day as part of a heart-healthy diet.”

Diet context is very important. The AHA recommends:

- “Eggs should not be paired with high-saturated fat foods like bacon, sausage, or butter. Instead, they should be poached, soft-boiled, or cooked in healthy fats like olive oil.”

- I would add that recent studies have shown that if you are consuming a whole-food, primarily plant-based diet, consuming one or two eggs per day actually decreases your risk of heart disease.

Your body’s ability to regulate cholesterol levels is also important. For that reason, the AHA recommends:

- “Individuals with diabetes, high blood cholesterol, or existing heart disease should be more cautious…limiting yolk consumption to 4 per week…[I would add obesity to this list].”

For more information on the studies behind these recommendations, go to https://www.chaneyhealth.com/healthtips/ and put eggs in the search box.

Are Eggs Brain Food?

There are lots of reasons to think of eggs as brain food. The authors of the study I am about to share observed:

“Eggs are a good source of protein (6.29 gram/medium egg), which has been linked to improved memory and reaction time in healthy young adults and reduced risk of cognitive impairment in older adults.”

“Egg protein is a good source of the essential amino acid tryptophan (77 mg per egg), which is converted to the neurotransmitter serotonin, involved in decision-making and memory.”

“Egg yolks are a good source of choline (150 mg per egg), which is a precursor to acetylcholine, a neurotransmitter involved in memory and learning. The authors went on to say, “Choline intake between 187 mg and 399 mg per day has consistently been associated with improved cognitive performance for both healthy younger and older adults.

“Egg yolks are also a good source of phospholipids (3.3 gm per egg), which are an important part of nerve membranes. Phospholipids modulate neurotransmitter receptors and have been linked to enhanced reaction time in healthy middle-aged men.”

“Egg yolks are a good source of DHA (between 25 to 50 mg DHA for commercially produced eggs and 100-150 mg of DHA for pasture-raised eggs) which has been associated with a lower risk of dementia.”

In short, there are lots of reasons to think that eggs might be good for the brain and might reduce the risk of age-related cognitive decline.

So, the authors of this study (N Sultan et al, Journal of Nutrition, Health, and Aging, 29, 100696, 2025) decided to conduct a systematic review of existing studies to evaluate the association between whole egg consumption and cognitive decline in healthy adults.

How Was The Study Done?

The authors set out to create a systematic review of studies looking at the effect of egg consumption on cognitive decline in older adults. This was not an easy undertaking because:

Most published studies in this area have looked at the effect of diets (e.g. MIND or Mediterranean diets) on cognitive decline rather than the effect of individual foods.

There are many ways to measure cognitive function, and no two studies used the same measures of cognitive function.

The authors utilized the top 5 databases of clinical studies and identified 10 studies with a total of >38,000 participants that investigated the effect of whole egg consumption on cognitive outcomes in healthy, older adults (average age = 68, 50% female).

Because the studies used different measures of cognitive function, the outcomes were divided into the following cognitive domains:

Global cognitive functioning.
Language functioning.
Verbal learning.
Memory.
Processing speed.
Decision-making.
Attention.
Executive function.
Risk-taking.
Reaction time.
Visuospacial ability.
Orientation.
Cognitive flexibility.
Interoception.

From these individual domains an overall cognitive function score was derived.

Do Eggs Prevent Cognitive Decline?

Memory loss due to Dementia and Alzheimer’s disease with the medical icon of a tree in the shape of a human head and brain losing leaves.

This is what the authors reported:

Two studies reported a reduced risk of dementia or cognitive impairment associated with moderate egg consumption (0.5-1 egg per day).

One study reported increased risk at high intake levels (> 1 egg per day).

Several studies showed improvements in memory, verbal fluency, and/or processing speed with moderate, but not high, egg intake.

The authors concluded, “This systematic review identified preliminary observational evidence that moderate habitual egg consumption may be associated with better cognitive performance, particularly in memory and verbal fluency domains, and reduced risk of cognitive impairment in adults without chronic disease…Further rigorous studies are required to determine whether egg consumption contributes to cognitive resilience and to clarify dose-response relationships. These efforts will help determine whether eggs can be recommended as part of evidence-based dietary strategies to support cognitive function in aging populations.”

As the authors said, this is not a definitive study. It is a preliminary study that lays the groundwork for future definitive studies. As someone who had dozens of publicly funded grants during my research career, I can tell you that publications like this are important, because they can be used to support requests for public funding of future research projects on that topic.

What kind of future research projects would be definitive? The authors said:

“Further rigorous studies are required to determine whether egg consumption contributes to cognitive resilience [as we age] and to clarify dose-response relationships.” Ideally these studies would:

- Be designed to test the dose-response relationship.

- Use similar measurement of cognitive function, so the study results would be easy to compare.

- Look at diet context. For example, do eggs have the same cognitive benefits in whole food, primarily plant-based diets and diets that are high in saturated fats and processed foods?

- Look at the effect of health status. Cholesterol build up can block arteries leading to the brain. Studies on heart health have shown eggs may not be beneficial for people who already have elevated cholesterol, diabetes, and arterial disease.

What Does This Study Mean For You?

Here are my thoughts:

As I outlined above, there are lots of reasons to think of eggs as brain food.

Moderate egg consumption may help protect against cognitive decline as we age. The current data are suggestive, but not definitive.

The American Heart Association now says that moderate egg consumption can be part of a heart-healthy diet. So, the major reason for avoiding eggs has been removed.

Egg consumption is likely to be most beneficial as part of a whole food, primarily plant-based diet. When I grew up Alabama a normal breakfast was eggs cooked in butter, sausage, grits and “red-eye gravy” (gravy made from ham fat). To say that it was probably not a brain-healthy way to eat eggs would be an understatement.

If you are already struggling with high cholesterol, diabetes and arterial disease, you should probably consult your doctor before increasing your egg consumption.

What Does A Brain-Healthy Diet Look Like?

According to the most recent US News & World Health ratings of the best diets in various categories, the top 4 diets for brain health are:

MIND diet (The MIND diet combines the best of the Mediterranean and DASH diets with an emphasis on brain healthy foods such as berries.)

Mediterranean diet.

Flexitarian diet (a flexible version of a semi-vegetarian diet).

DASH diet.

My Comments:

All four diets are whole food, primarily plant-based diets.

Although the MIND diet was specifically designed for brain health, it does not perform significantly better than the Mediterranean and DASH diets in slowing cognitive decline.

Of course, most people prefer to think in terms of foods rather than diets. In terms of brain-healthy foods, a recent Harvard Health Review suggests these are the foods we should emphasize for brain health:

Green Leafy Vegetables: Kale, spinach, broccoli, and collards are rich in brain-healthy nutrients like vitamin K, lutein, folate, and beta-carotene.
Fatty Fish: Salmon, trout, sardines, and mackerel provide omega-3 fatty acids, which are crucial for brain function and for reducing dementia risk.
Berries: Blueberries, strawberries, and blackberries contain antioxidants that have been shown to delay cognitive decline.
Nuts and Seeds: Walnuts are high in omega-3 fatty acids (ALA), while others provide vitamin E.
Healthy Fats: Olive oil is recommended as the primary cooking fat.
Whole Grains and Legumes: Oats, quinoa, beans, and lentils provide a steady, slow release of glucose for brain energy. Plus, their fiber supports the growth of friendly bacteria that produce brain-healthy nutrients (This is sometimes referred to as the gut-brain axis).
Other Foods: Avocados (monounsaturated fats), beets (nitrates for blood flow), and cocoa (flavonoids) are beneficial.

My Comment:

Based on their nutrient content and studies like this one, I would add eggs (consumed in moderation) to the list.

The Bottom Line

There are lots of reasons to think of eggs as brain food. A recent study suggests that moderate egg consumption may help slow cognitive decline as we age.

For more information on this study and what a brain-healthy diet looks like, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

_____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

___________________________________________________________________________

About The Author

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 54 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

What Nutrients Are Missing In Prenatal Supplements?

May 7, 2024 by Dr. Steve Chaney

Do These Deficiencies Matter?

Author: Dr. Stephen Chaney

If you are a pregnant mom, nothing is more important than the health of your baby. And if you are pregnant or thinking of becoming pregnant, your doctor has probably recommended a prenatal supplement. But does the prenatal supplement he or she recommended provide you with all the nutrients you need?

In a previous issue of “Health Tips From the Professor” I shared two studies that suggested the answer is, “No”. Those studies concluded that most prenatal supplements had little or no vitamin K, choline, DHA, and iodine – all of which are essential for the health of your newborn baby. And while most prenatal supplements contained calcium, the amount they provided was far below recommended levels.

The authors of the first study also made the point that most women going on a prenatal supplement will probably discontinue taking their multivitamin supplement, so a good prenatal supplement should provide all the essential nutrients.

But they don’t. Folic acid, iron, calcium, and vitamin D have long been recognized as essential for a healthy pregnancy. So, virtually every prenatal supplement contained these four nutrients, although calcium is often present in suboptimal amounts. Beyond those four nutrients, the design of prenatal supplements is haphazard. Some contain vitamin K, choline, iodine, or DHA (often in suboptimal amounts). But almost none contain all four nutrients.

And when you consider the other essential nutrients you find in most multivitamins, prenatal supplements often come up empty. Is that a problem? That’s what this study (KM Godfrey et al, PLOS Medicine, 1-27, December 5, 2023) was designed to find out.

How Was This Study Done?

This was a double-blind, placebo-controlled clinical trial, the gold standard for clinical studies. The investigators recruited 1,729 women who were planning to get pregnant from England, Singapore, and New Zealand between 2015 and 2017.

The women were randomly split into two groups:

The control group received a supplement containing nutrients that were most frequently included in prenatal supplements in those countries (folic acid, iron, calcium, iodine, and beta-carotene).

The intervention group received a supplement containing those nutrients plus riboflavin, vitamin B6, vitamin B12, vitamin D, zinc, inositol, and probiotics).

Riboflavin, vitamin B6, vitamin B12, vitamin D, and zinc were included because they are included in most multivitamins but are often missing in prenatal supplements.

Inositol was included because some studies have suggested that inositol may reduce the risk of maternal hyperglycemia and gestational diabetes.

Blood samples to assess nutritional status were obtained from all women in the study before the trial started (baseline) and after 1 month of supplementation with either the control or intervention formulation.

Of the women entering the study, 512 went on to have a singleton (one child) pregnancy. For these women supplementation was continued until childbirth. Additional blood samples were obtained in early and late pregnancy and at 6 months postdelivery. [Note: no supplementation was provided to either group postdelivery. And this is also a period of time when most women would be breastfeeding.]

The blood samples were tested for:

Blood levels of folic acid, riboflavin, vitamin B6, vitamin B12, and vitamin D.

Functional biomarkers of deficiencies of each of these vitamins.

What Nutrients Are Missing In Prenatal Supplements?

There was no difference in maternal hyperglycemia or gestational diabetes between the control group and the intervention group supplemented with inositol, so I will focus on the other nutrients present in the intervention group.

At baseline when subjects were first entered into the study.

29.2% of the subjects had low or marginal status for folic acid.

82.0% of the subjects had low or marginal status for riboflavin.

1.3% of the subjects had low or marginal status for vitamin B6.

9.1% of the subjects had low or marginal status for vitamin B12.

48.7% of the subjects had low or marginal status for vitamin D.

91.0% of the subjects had low or marginal status for one or more of these vitamins.

In the control group receiving folic acid but no riboflavin, vitaminB6, vitamin B12, and vitamin D:

Folic acid deficiency fell to 4.1% after 1 month of supplementation (the supplement used by the control group contained folic acid), 1% in early pregnancy, 6.1% in late pregnancy, and rose to 31.8% 6 months after supplementation was discontinued. The intervention group got the same amount of folic acid, and their results were similar.

Riboflavin deficiency ranged from 82-92% during pregnancy and returned to 82% 6 months postdelivery.

Vitamin B6 deficiency increased to 54% in late pregnancy and returned to 1.2% 6 months postdelivery.

Vitamin B12 deficiency increased to 55% in late pregnancy and returned to 12.4% 6 months postdelivery.

Vitamin D deficiency ranged from 35-43% during pregnancy and returned to 31% 6 months postdelivery.

Functional markers of vitamin B6 deficiency were evident by late pregnancy.

In short, data from the control group fell into 3 categories:

The data with folic acid confirm previous studies showing that folic acid in the amount present in most prenatal supplements is effective at preventing folic acid deficiency before and during pregnancy. It also strengthens the argument for continuing folic acid supplementation during breastfeeding.

Deficiencies of riboflavin and vitamin D are prevalent in women of childbearing age, but pregnancy does not appear to significantly impact the percentage of women who are deficient in these nutrients.

Deficiencies of vitamins B6 and B12 are rare in women of childbearing age, but pregnancy significantly depletes both nutrients.

- This was particularly evident for vitamin B6. Blood levels of vitamin B6 markers decreased to a level that could impact the functioning of vitamin B6-depended metabolic pathways.

For the intervention group receiving additional riboflavin, vitamin B6, vitamin B12, and vitamin D:

Deficiencies of these vitamins were eliminated by one month of supplementation.

Vitamin levels remained adequate during pregnancy.

Except for vitamin B12, deficiencies of these vitamins reappeared when supplementation was discontinued for 6 months. The maintenance of adequate B12 levels 6 months after supplementation stopped was expected because the body holds on to its B12 stores very tightly.

In short deficiencies of these nutrients before and during pregnancy could be eliminated by supplementation with levels of these nutrients found in many multivitamins.

The authors concluded, “Over 90% of the trial participants had low concentrations of one or more of folate, riboflavin, vitamin B12, or vitamin D during preconception, and many developed markers of vitamin B6 deficiency in late pregnancy. Preconception/pregnancy supplementation in amounts available in over-the-counter supplements substantially reduces the prevalence of vitamin deficiency and depletion markers before and during pregnancy, with higher maternal plasma vitamin B12 maintained during the recommended lactation period.”

Do These Deficiencies Matter?

It is well established that deficiencies of folic acid and vitamin D cause health risks for the mother and developmental risks for the fetus, so I won’t discuss these nutrients here.

However, the effect of riboflavin, vitamin B6, and vitamin B12 deficiencies on pregnancy is less well known, which is probably why these nutrients are often not added to prenatal supplements.

The authors of the study said small studies have suggested that:

Low or deficient riboflavin status may be associated with a higher risk of anemia during pregnancy.

Low vitamin B6 status may be associated with an increased risk of preterm birth and development of metabolic health risks in the child.

Low vitamin B12 status may be associated with increased risk of gestational diabetes and pre-eclampsia in the mother, and increased risk of neural tube defects, preterm birth, low birth weight, and neurocognitive delays in the baby – with the strongest evidence being an effect on neurocognitive development.

While none of these risks have been definitively proven, the authors point out that deficiencies of these nutrients can easily be eliminated with inexpensive, over-the-counter multivitamin supplements.

What Does This Study Mean For You?

Perhaps I should start this section by asking why these deficiencies are so common in women of child-bearing age.

The authors speculate that part of the reason is that many women are giving up meat (B12 and iron) and dairy (calcium and riboflavin) for health or environmental reasons.

However, they also point out that a more likely cause is that more than 60% of calories consumed in countries like England, New Zealand, and the United States comes from ultra-processed foods – otherwise known as “empty calories”.

Whatever the cause, the authors conclude, “…the findings suggest a need to reappraise dietary recommendations for preconception and pregnancy to consider further the role of multiple micronutrient supplements for women living in higher-income countries.” I agree.

In a previous “Health Tips From the Professor” article, I reported a recent study showing that most prenatal supplements have either no or inadequate amounts of vitamin K, choline, DHA, iodine, and calcium, nutrients that are absolutely essential for a healthy pregnancy. And I gave recommendations for choosing the best prenatal supplement for you and your child.

That study also noted that many women discontinue their multivitamin supplement when they start taking a prenatal supplement. The current study indicates that practice may be unwise. It shows that:

Many women of childbearing age are deficient in one or more of these essential nutrients, and…

Essential nutrients not found in most prenatal supplements may also be important for a healthy pregnancy.

So, if you are pregnant or thinking of becoming pregnant, follow this article’s recommendation to start with a well-designed prenatal supplement that provides adequate amounts of folate, iron, calcium, vitamin D, vitamin K, choline, DHA, and iodine and add a multivitamin supplement that provides the other essential nutrients. Alternatively, a simpler approach would be to choose a well-designed prenatal supplement that includes all the essential nutrients. That would be my recommendation.

I would also note this study showed that deficiencies of most of these nutrients reappeared as soon as supplementation was discontinued. Although the authors of this study did not mention it, this reinforces the importance of continuing supplementation during breastfeeding.

The Bottom Line

I have previously reported on a study that concluded many prenatal supplements lack one or more nutrients shown to be important for a healthy pregnancy. But let’s say you have found a prenatal supplement that provides all those nutrients. Is that enough?

Studies show that most women stop taking their multivitamin supplement when they start on a prenatal supplement. But is that a good idea? Are there essential nutrients found in multivitamins, but not in many prenatal supplements that are also important for a healthy pregnancy?

A recent study asked that question in women who were trying to become pregnant. The study found that:

Many women of childbearing age are deficient in one or more essential nutrients found in multivitamin supplements but often missing in prenatal supplements, and…

Essential nutrients not found in most prenatal supplements may also be important for a healthy pregnancy.

For more details about this study and what it means for you read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

______________________________________________________________________________

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

______________________________________________________________________

About The Author

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years. Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Prenatal Supplements Strike Out Again

May 9, 2023 by Dr. Steve Chaney

Is It Three Strikes And You Are Out?

Author: Dr. Stephen Chaney

If you are pregnant, you want the best for your unborn baby. Your doctor has recommended a prenatal supplement, but do the prenatal supplements on the market meet your needs? A few months ago, I shared two studies that concluded that most prenatal supplements on the market are woefully inadequate.

In fact, the authors said, “[Our] analysis found that prenatal supplements vary widely in content, often only contain a subset of essential vitamins, and the levels were often below…recommendations.”

In other words, their study found that most prenatal vitamins on the market may not be adequate to support your needs and the needs of your child through pregnancy and breastfeeding.

Now, a third study on the topic has been published (KA Saunders et al, American Journal of Clinical Nutrition, 117: 823-829, 2023. It differs from the previous studies in that:

1) The previous two studies took a comprehensive approach, while this study focused on 6 key nutrients.

The previous studies included all nutrients important for a healthy pregnancy including choline, iodine, and vitamin K, which have only recently been shown to be important for a healthy pregnancy.

This study focused on 6 nutrients, vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids, which have long been recognized as essential for a healthy pregnancy.

2) The previous two studies focused on prenatal supplements, while this study focused on all supplements that might be taken by pregnant women.

3) The previous two studies asked whether supplements provided recommended amounts of all nutrients needed for a healthy pregnancy. This study took a “Goldilocks approach” and asked whether levels of these 6 essential nutrients were appropriate (“just right”). The study:

Started by determining the intake of these 6 key nutrients by American women. The authors of the study then added the amount of each nutrient provided by the supplements in their study to the amount of that nutrient in the diet of American women and:

- Calculated the minimum amount of each nutrient that would be needed to assure that 90% of American women taking a particular supplement would meet the recommended intake for pregnant and lactating women.

- Calculated the maximum amount of each nutrient provided by supplements in their study to assure that that 90% of American women taking that supplement would not get potentially toxic amounts of that nutrient.

In other words, for each of the 6 nutrients they calculated a supplemental dose range that was neither too low nor too high. They called this the “appropriate dose range” for each nutrient. Goldilocks would have called it “just right”.

I’m sure you are anxiously waiting to learn what their study found. But before we go there, I will describe how the study was done.

How Was The Study Done?

For the dietary intake portion of the study, the authors used dietary intake data previously collected from the Environmental Influences on Child Health Outcomes (ECHO) study.

The ECHO study is a consortium of 69 medical centers across multiple states. It is an observational study of mothers and their offspring designed to understand the effects of early life exposures on child health and development.

The current study analyzed dietary intake data for 2450 participants from 6 medical centers across 5 states in the ECHO study. The women in this study were diverse with respect to ethnicity, education, and weight.

All pregnant women in the current study completed at least one 24-hour dietary recall between 6-week gestation until delivery (24% completed one dietary recall. 76% completed two or more dietary recalls). Dietary intake was generally assessed with an expert interviewer and included all foods and beverages consumed in the previous 24 hours.

For the supplement portion of the study, the authors used the NIH Dietary Supplement Label Database because it is the most complete listing of supplements in the US. The authors selected 20,547 supplements that contained at least one of the 6 essential nutrients from this database.

To determine which of the 20,547 supplements contained appropriate levels of the 6 nutrients (vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids) selected for this study, the authors used the process described in the introduction above. Briefly:

The authors added the amount of each nutrient provided by the supplements in their study to the amount of that nutrient in the diet of American women and:

Calculated the minimum amount of each nutrient that would be needed to assure that 90% of American women taking a particular supplement would meet the recommended intake for pregnant and lactating women.

Calculated the maximum amount of each nutrient provided by supplements in their study to assure that that 90% of American women taking that supplement would not get potentially toxic amounts of that nutrient.

In other words, for each of the 6 nutrients they calculated a supplemental dose range that was neither too low nor too high. They called this the “appropriate dose range” for each nutrient.

Why Are The 6 Nutrients Included In This Study Important?

Dietary Intake Is Often Inadequate

The diet analysis of pregnant American women in this study found:

42% were at risk of inadequate vitamin A intake.

96% were at risk of inadequate vitamin D intake.

45% were at risk of inadequate folic acid intake.

55% were at risk of inadequate calcium intake.

93% were at risk of inadequate iron intake.

67% were at risk of inadequate omega-3 intake.

The percentage of women at risk for inadequate intake of these nutrients varied with age, ethnicity, and income levels. But the overall message is clear. Most American women are not getting enough of these essential nutrients from their diet alone.

The Risk of Inadequate and Excessive Intake Of These Nutrients

These 6 nutrients were chosen in part because reviews by the Cochrane Collaboration have concluded that inadequate intake of these nutrients are associated with complications during pregnancy and delivery. They can also adversely affect the health and normal development of the baby.

This is important because the Cochrane Collaboration is considered the Gold Standard of clinical studies. You can find a more detailed description of Cochrane Collaboration studies and why they are the Gold standard here.

[Note: The Cochrane Collaboration has not yet evaluated choline, iodine, and vitamin K for pregnant women, but their inclusion in prenatal supplements is supported by multiple clinical studies.]

In addition, excess intake of all these nutrients except omega-3s can harm both the fetus and the mother. The is why the Food and Nutrition Board has set ULs (Upper Limits – the level above which toxicity can occur) for 5 of the 6 nutrients. This is important because previous studies have suggested that up to 25% of women may be getting toxic levels of one or more of these nutrients when you consider both their dietary intake and their prenatal supplement.

Summary

In other words, both too little and too much of these nutrients can harm the mom and her baby. It is critical that prenatal supplements get the dosing right.

It is for that reason that the authors of this study have set an “appropriate dose range” (high enough that 90% of women have enough of each nutrient to prevent deficiency and low enough that 90% of women do not exceed the UL for each nutrient) as the standard for evaluating the adequacy and safety of supplements for pregnant women.

Prenatal Supplements Strike Out Again

Of the 20,547 supplements (421 labeled as prenatal supplements) available on the US market as of December 31, 2022, the investigators reported that:

Only 69 (0.3%) supplements contained all 6 nutrients considered essential for a healthy pregnancy.

Only 1 supplement contained all 6 nutrients at the appropriate doses, and it wasn’t even labeled as a prenatal supplement.

In addition:

One supplement containing all 6 nutrients put 100% of the women in their study at risk for excessive intake of folic acid.

Another supplement containing all 6 nutrients put 46% of the women in their study at risk of inadequate calcium intake.

The authors concluded, “Almost no US dietary supplements provide key nutrients in the doses needed for pregnant women. Affordable and convenient products that fill the gap between food-based intake and estimated requirements of pregnancy without inducing excess intake are needed to support pregnant women and their offspring.”

In short, the conclusion of this study can be summed up as, “Prenatal Supplements Strike Out Again”.

[Note: It sometime takes a while for supplement labels to be posted in the NIH Dietary Supplement Label Database. The authors acknowledged that this study may not include supplements introduced or reformulated in the last quarter of 2022.]

Is It Three Strikes And You Are Out?

If you are pregnant or thinking of becoming pregnant, this should be a wake-up call.

70% of pregnant women in this country take prenatal supplements, usually based on recommendations by their health care provider. They assume the prenatal supplements meet their needs and the needs of their unborn baby.

Yet three studies evaluating the adequacy of prenatal supplements have been published in the past few months. They took very different approaches in evaluating the supplements. But all three studies concluded that the vast majority of prenatal supplements on the market are woefully inadequate.

You may be wondering, “Is it three strikes, and you are out?” Are there no decent prenatal supplements on the market? The answer to those questions is, “No. There are good prenatal supplements on the market.”

You may be wondering how I can say that in the face of such overwhelming negative data. That’s because while all 3 studies were very good studies, they each had “blind spots”:

1) Each of the studies used very stringent criteria for identifying adequate prenatal supplements. In some cases, their criteria were stricter than the RDA recommendations and the recommendations of the American College of Obstetrics and Gynecology for pregnant and lactating women. It could be argued that their criteria were too stringent.

2) In the case of the current study, it could also be argued that evaluating only 6 nutrients is not a good criterion for evaluating the adequacy of prenatal supplements. For example, I looked up the one supplement rated as adequate in this study. It does provide appropriate doses of the 6 nutrients this study focused on. It also provides appropriate doses of vitamin K and iodine. But it does not provide choline. It is a very good supplement for women, but it is not the perfect prenatal supplement.

So, what can you do? How can you find the best prenatal supplement for you? Unfortunately, you cannot rely on advice from your friends or your health professional. You cannot rely on advertisements. That is a good place to start, but you have to do your own sleuthing.

With that in mind, I have listed 7 simple rules for selecting the best possible prenatal supplement in my article about the first two studies. Use these rules for evaluating every prenatal supplement you come across. Happy sleuthing.

The Bottom Line

A recent study evaluated all 20,547 supplements on the US market to see if they met the needs of pregnant women in this country.

They focused on 6 nutrients (vitamin A, vitamin D, folic acid, calcium, iron, and omega-3s) known to be essential for a healthy pregnancy.

They determined the dietary intake for all 6 nutrients in a cross section of pregnant women in the US.

They added the amount of the 6 nutrients in each of the 20,547 supplements to the dietary intake of those nutrients by pregnant women.

They then asked which supplements provided the “appropriate dose” of all 6 nutrients. They defined “appropriate dose” as the dose range that was.

- High enough to prevent deficiency of that nutrient in 90% of pregnant women taking the supplement…and…

- Low enough to prevent toxicity from that nutrient in 90% of pregnant women taking the supplement.

In other words, for each of the 6 nutrients they calculated a supplemental dose range that was neither too low nor too high.

Of the 20,547 supplements (421 labeled as prenatal supplements) available on the US market:

Only 69 (0.3%) supplements contained all 6 nutrients they considered essential for a healthy pregnancy.

Only 1 supplement contained all 6 nutrients at the appropriate doses, and it wasn’t even labeled as a prenatal supplement.

If you are pregnant or thinking of becoming pregnant, this should be a wake-up call.

Yet three studies evaluating the adequacy of prenatal supplements have been published in the past few months. And all three studies concluded that the vast majority of prenatal supplements on the market are woefully inadequate.

You may be wondering how I can say that in the face of such overwhelming negative data. That’s because while all 3 studies were very good studies, they each had “blind spots”:

For more details on this study and 7 tips on finding the best prenatal supplement for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

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