Making Sense of Multivitamins

By Vicky Uhland

When we were kids, multivitamin choices seemed so simple: Do I want the yellow Pebbles or the purple Bamm-Bamm? But now that we’ve outgrown Stone Age chewables, our options have expanded. We can get our vitamins and minerals in tablets, liquids, or gummies. We can take one, two, or even five per day. We can opt for natural, food-based formulations or synthetic versions. Or, if we believe some of the latest research, we can toss out our multivitamins altogether and trust that our diets will deliver all of our nutrient needs. So how do you make the best multivitamin decision? Here’s what the experts say.

Do I even need a multivitamin?
Multivitamins have taken a pummeling in recent research, with some medical professionals saying these all-in-one supplements don’t provide enough nutrients to be worth the money. “The argument is that 500 years ago, they didn’t have multivitamins, so why do we need them now?” says Jacob Teitelbaum, MD, medical director of the national Fibromyalgia and Fatigue Centers. But our ancestors did not get one-third of their total daily calories from white flour and sugar like many Americans do today, Teitelbaum says. And their fruits and vegetables were not stripped of vitamins and minerals because mass farming had depleted the soil of its vital nutrients. In addition, our ancestors’ environment was not permeated with more than 80,000 different toxic chemicals that can affect the body’s ability to produce antioxidants.

The result? Many of us are not getting the daily nutrients our ancient forbearers enjoyed. US Department of Agriculture (USDA) statistics and various studies show that a whopping 75 percent of Americans do not get enough folic acid, calcium, and vitamin D each day; 86 percent lack optimum levels of vitamin E; and 55 percent are short on vitamin A.

But even if you eat the recommended nine servings of fruits and vegetables every day and processed foods never touch your lips, our 21st-century lifestyle can still deprive you of key vitamins and minerals. “Stress can alter the secretion of gastric juices and enzymes that help your body absorb nutrients,” says Jack Challem, a nutrition coach in Tucson, Arizona, and author of The Inflammation Syndrome (Wiley, 2010).

The bottom line is that no matter how healthy your diet, it’s a good idea to supplement with multivitamins at least a couple of times per week, says Madelyn Fernstrom, PhD, CNS, a professor of psychiatry, epidemiology, and surgery at the University of Pittsburgh Medical Center. With so many factors affecting the way the  body process vitamins and minerals, it is one way to ensure you are getting the essential nutrients your body needs. “Think of [multivitamins] like car insurance—you hope you never use the insurance, but you’re glad you have it,” Fernstrom says.

Which type of multivitamin should I choose?
“There are no studies that compare head-to-head the bioavailability of, say, a multivitamin liquid versus a tablet,” says Andrew Shao, PhD, and senior vice president of scientific and regulatory affairs at the Council for Responsible Nutrition. As a result, medical professionals often debate which type of multivitamin has the best delivery system—although they do tend to agree on the pros and cons of various formulations.

Powders and liquids
Pros: It’s simple physics—a scoopful of powder or a shot of liquid has more volume than one pill or capsule. Teitelbaum says you can get the equivalent of 35 multivitamin tablets in one serving of powder mixed in water. Liquids offer similar multi-dose benefits. This is especially important for bulky minerals like calcium and magnesium that can be difficult to fit into a tablet or capsule. Liquids and powders can also be beneficial for those that have difficulty swallowing tablets or gelcaps.

Cons: Powders and liquids usually contain sugar or artificial sweeteners to mask the acrid taste of B vitamins, so look for products with natural sugar alcohols like xylitol or sorbitol instead. Also, the fat-soluble vitamins A, D, E, and K are difficult to get in liquid form, and may require additional supplementation. Some liquids also contain chemical preservatives to prolong shelf life and prevent bacteria from growing. These liquids can oxidize rapidly causing the nutrients to loose potency quicker than a tablet or gelcap.

Tablets
Pros: Tablets are the most stable formulation, meaning the nutrients are much less prone to oxidation and maintain potency for much longer periods of time, compared to liquid multivitamins. They are also the most widely accessible delivery system.
Cons: Tablets may contain a fewer amount of nutrients than liquids or powders because binders (ingredients that give a tablet its shape) take up much of the available space. That means you may have to take multiple pills to achieve the recommended daily dosage. Also, because tablets are compressed so tightly together, it makes it harder for stomach acids to completely dissolve the tablets, thereby preventing absorption of some nutrients. For those with severe allergies, check ingredients for lactose as it is sometimes used as a binder. Look instead for binders made from cellulose, a natural plant fiber.

Gel capsules
Pros: Capsules’ outer layer of gelatin is easily digestible, making the vitamins’ essential ingredients more bioavailable. The gel also serves as a safe, natural binder.
Cons: Like tablets, gel capsules contain fewer nutrients than liquids or powders, meaning you may have to take multiple pills to reach the recommended daily dosage. Also, some gelatins are not vegetarian.

Gummies
Pros: These chewable, candy-like supplements are fun to take and easy to digest.
Cons: There are few adult formulations, and many contain sugar or artificial sweeteners. Look for gummies made with xylitol sweeteners or natural berry flavorings.

What’s the best way to take a multivitamin?
Experts disagree on this issue as well. You can pack more vitamins and minerals into a three-a-day pill than a one-a-day, but remembering to pop a multivitamin every eight hours can be an elephantine task. Studies show that people who take only one multivitamin tablet each morning are the least likely to forget a dose, says Sasson E. Moulavi, MD, medical director of Smart for Life Weight Management Centers. In short, if you are the kind of person who often misses a daily pill, stick to the one-a-days, but if you are confident about your supplement regimen, spacing out your multi intake to two or three times daily will improve absorption.  

But how should you ingest your morning multivitamin? With a hearty breakfast? After you brush your teeth? Washed down with a grande skinny latte as you bolt for the bus? Medical professionals make a case for each scenario. “If you take a vitamin on a full stomach, your digestive enzymes are already working, so that helps with absorption. Also, some vitamins and minerals are acidic—vitamin C, calcium, magnesium, zinc—which can make some people nauseous if taken on an empty stomach,” says John P. Salerno, DO, medical director of the Salerno Center, a holistic wellness center in New York City. But Teitelbaum argues that because a multivitamin is essentially a mishmash of nutrients that are ingested best in different ways—some on a full stomach, some on an empty stomach—“just take it in the way that’s easiest for you and let your body sort out how it’s absorbed.”

Should I buy a food-based or synthetic multivitamin?
There’s passionate debate among nutritionists about whether vitamins should be extracted directly from food or created in a lab. “Head-to-head studies haven’t been done to compare the stability, bioavailability, and health benefits of food-based versus synthetic multivitamins,” Shao says. However, there is a lot of anecdotal evidence. Many scientists argue that extracting a complex nutrient, such as vitamin E—which is made up of eight different compounds—from its natural source is the best way to ensure that all of its health-boosting components are included. Yet some nutrients, such as folic acid, are only available in synthetic form, and others, like vitamin C, are so difficult to get in a complete form from food that multivitamins would have to be the size of horse pills to fit in the recommended dosage. So what is the consensus? Most natural-health experts favor a multivitamin that contains mainly food-based nutrients.

Is an $80 bottle of multivitamins really 10 times better than an $8 one?
Fortunately, all of our experts can agree on this issue: When it comes to multivitamins, pricier is not always better. That said, “all dietary supplements are certainly not created equal,” Fernstrom says. One way to determine quality is to check dosages of individual nutrients. Challem says a rule of thumb is if a multivitamin contains at least 20 mg each of vitamins B1, B2, and B3, chances are it is of good quality. Also look for what Moulavi calls “padding” ingredients. “You don’t need things like potassium phosphate and salt, so when I see these I get suspicious that I’m just going to end up with expensive urine.
Another way to determine if a multivitamin is worth the money is to check its bottle for a label from an independent testing organization such as the US Pharmacopeia (USP), NSF International, or the Natural Products Association’s Good Manufacturing Practices (NPA GMP). These groups establish elaborate standards to analyze nutrient claims and manufacturing practices. The USP Verified label, for instance, relies on input from pharmacy volunteers and chemistry, biology, and toxicology industries, along with public forums, and is then approved by the FDA.   

Should my multivitamin contain ingredients like herbs and amino acids?
Multivitamins need to pack in so many essential vitamins and minerals, it is almost impossible to get efficacious doses of other nutrients without taking four or five pills a day, Teitelbaum says. “Asking for a one-a-day with herbs, antioxidants, and amino acids is like going car shopping with an $8,000 budget and asking for a car full of turbo doozies.” Even so, many experts believe the antioxidant coenzyme Q10 can be a valuable addition to a multivitamin because it’s a powerful antioxidant. Check labels for dosages containing between 25 and 100 mg, Moulavi says.

What to Look For in a Good Multivitamin
Some multivitamins are so jammed full of ingredients that they don’t have enough of the essential nutrients. Here’s what to look for in a good adult multivitamin, as recommend by nutritionist Jack Challem, Jacob Teitelbaum, MD, and Sasson E. Moulavi, MD; along with the US Institute of Medicine’s Dietary Reference Intake (DRI) daily standard for adults and the Council for Responsible Nutrition’s safe upper limit (or max dosage).

 

Vitamin/mineral DRI Daily Standard Optimal Intake Safe Upper Limit Tips
A 3,000 IU 2,000 to 6,000 IU 10,000 IU Standards don’t include beta-carotene, which the body converts to vitamin A.
 
B1 {thiamin} 1.2 mg 20 to 50 mg N/A N/A
B2 {riboflavin} 1.3 mg 20 to 50 mg N/A N/A
B3 {niacin} 16 mg 20 to 35 mg 35 mg N/A
B5 {pantothenic acid} 5 mg 20 to 50 mg N/A N/A
B6 {pyridoxine} 1.7 mg 20 to 50 mg 100 mg N/A
B12 2.4 mcg 70 to 500 mg N/A N/A
Folic Acid 200 to 600 mcg 400 to 800 mcg 1,000 mcg N/A
C 90 mg 500 to 1,000 mg 2,000 mg Ester-C is gentler on the stomach.
 
D 600 IU 600 to 2,000 IU 2,000 IU D3, or cholecalciferol, is the preferred form.
 
E 22 to 33 IU 100 to 400 IU 1,490 IU N/A
H {biotin} 30 mcg 70 to 300 mcg N/A N/A
K 120 mcg 100 to 500 mcg N/A N/A
Calcium 1,300 mg 100 to 600 mg 2,500 mg Upper levels only necessary for osteoporosis sufferers.
Chromium 35 mcg 200 to 400 mcg N/A N/A
Copper 0.9 mg 0.5 to 1mg 10 mg N/A
Iodine 150 mcg 150 mcg 1,100 mcg N/A
Iron 18 mg 0 mg 45 mg Teitelbaum says take only if blood ferritin test is below 100, even though some docs recommend iron for all children and women of childbearing age.
Magnesium 420 mg 150 to 350 mg 350 mg Too much can cause diarrhea.
Manganese 2.3 mg 2 to 10 mg 11 mg N/A
Selenium 55 mcg 200 mcg 400 mcg N/A
Zinc 11 mg 15 to 30 mg 40 mg