If you eat a reasonably varied diet, with dal, rice or roti, vegetables, some fruit and some dairy, eggs or meat, you get most of what you need from food. A supplement is useful when there is a specific gap. Taking everything "just in case" mostly costs money, and with a few vitamins it can do harm.

That said, there are gaps that are common in Nepal. This is a guide to the usual ones. A blood test, done when your doctor thinks it is needed, is the only way to know for sure.

Iron

The 2016 Nepal National Micronutrient Status Survey found anaemia in about one in five non-pregnant women aged 15 to 49, and in a similar share of young children. Iron deficiency is one of the main causes.

Women with heavy periods, pregnant women, people who eat little meat, and young children are the groups most likely to be low. Tiredness, breathlessness on stairs and looking pale are typical signs, but they have other causes too, which is why a test matters. Iron tablets can cause stomach upset and constipation, and too much iron is harmful, so take them when there is a reason to.

Vitamin D

It seems strange in a sunny country, but vitamin D deficiency is common in Nepal. A study of mothers and their infants in Nepal found that around 60% of the mothers had insufficient vitamin D levels. Covering up, working indoors, darker skin, winter fog in the Terai and air pollution in the Kathmandu Valley all reduce how much vitamin D the skin makes.

Office workers, older adults, people who rarely go outside and women who cover most of their skin are the most likely to be low. Vitamin D is fat-soluble, which means your body stores it, so very high doses taken for a long time can build up. Stick to the dose your doctor or the label recommends.

Calcium

Calcium matters most for children, teenagers, pregnant and breastfeeding women, and older adults, particularly women after menopause. If you drink milk, eat curd or paneer, or eat a lot of green leafy vegetables, you may get enough from food. If not, a calcium supplement, often combined with vitamin D, is one of the more commonly recommended ones. Calcium can block absorption of some medicines, so see our post on supplements and prescription medicine if you take any.

Vitamin B12

B12 comes almost entirely from animal foods: meat, fish, eggs and dairy. Strict vegetarians who eat little dairy, and older adults (who absorb it less well), are more likely to be low. Long-term use of metformin, a common diabetes medicine, and of some acid-reducing medicines can also lower B12. Low levels can cause tiredness, tingling in the hands and feet, and memory problems.

Zinc and iodine

The same national survey found zinc deficiency in about one in five women and children. Zinc comes from meat, pulses, nuts and whole grains. Iodine deficiency used to be widespread in Nepal before iodised salt became standard. Today, using iodised salt at home covers most people. Avoid loose, non-iodised salt for everyday cooking.

Folic acid before and during pregnancy

This is one of the clearest recommendations in all of nutrition. Women planning a pregnancy are advised to take folic acid before conceiving and in the early weeks of pregnancy, because it lowers the risk of certain birth defects of the spine and brain. Pregnancy care in Nepal normally includes iron and folic acid. Ask your health worker or doctor about the right dose.

What most people do not need

  • High-dose vitamin C every day. Your body passes out what it cannot use. Fruit and vegetables cover normal needs.
  • Several multivitamins at once. It is easy to double up on vitamin A, D or iron by combining products. Check labels for overlap.
  • "Energy" vitamins when the real problem is sleep, stress or an untreated condition. If you are tired for weeks, see a doctor before buying a tonic.

Buying supplements for the family

Children need children's doses, not a broken adult tablet. Pregnant women should check every supplement with their doctor, especially anything containing vitamin A or herbal extracts. Older adults are more likely to be on several medicines, so interactions matter more.

When you do buy, buy a registered product from a licensed pharmacy, and read the label for what is in it and at what amount. Price does not tell you much on its own, as we explain in our post on generic and branded medicines.

This article is general information, not medical advice. Talk to your doctor or pharmacist about your own medicines and health.