Multiple Choice

What you need to know to find a multivitamin that's right for you.
By James Keogh

It’s finally time to get healthy, so off you go in search of a good multivitamin. It doesn’t take long, however, to get overwhelmed by your options. Given a choice between one-a-day or three-to-six-a-day; tablet, capsule, powder, fizzy, chewable, or liquid; synthetic, food-based, or whole-food varieties—not to mention multis designed for kids, women, men, seniors, and the athletes among them—it’s a wonder anyone can make a decision, let alone an informed one.

But worry not. Armed with some basic knowledge about which vitamins and minerals you need and in what quantities—and with the lowdown on how these various products are made—you can steer your way down any supplement aisle with confidence.

Why we need supplements
The National Institutes of Health has identified 13 vitamins—A, the B complex (B1, B2, B3, B5, B6, B12, and folate), C, D, E, H (biotin), and K—and 14 minerals—calcium, chromium, copper, fluorine, iodine, iron, magnesium, manganese, molybdenum, phosphorus, potassium, selenium, sodium, and zinc—they consider essential for human life. Theoretically, we get as much as we need from the food we eat. But in reality, some 92 percent of Americans are deficient in one or more essential vitamins and 70 percent lack sufficient zinc, says Mark Hyman, MD, author of The UltraMind Solution (Scribner, 2009). Why is that? Because in this age of industrial agriculture, depleted soils no longer supply enough raw materials for plants to create a full spectrum of nutrients and farm animals no longer eat their natural diets. Plus the way the food industry processes and prepares foods strips out or burns off what minerals and vitamins they do have. Simply refining wheat into white flour, according to John Neustadt, ND, coauthor of A Revolution in Health Through Nutritional Biochemistry (iUniverse, Inc., 2007), wipes out 50 to 80 percent of the various B vitamins, 86 percent of the vitamin E, 85 percent of the magnesium, and 60 percent of the calcium. No wonder flour needs to be “enriched.”

Many of us also contribute to our own vitamin deficiencies by eating what the big food conglomerates and fast-food outlets offer up, instead of building our diets out of the whole foods typically found along the edges of the supermarket—in produce, dairy, seafood, and meats. Choosing organic offers up even more nutritional benefit. A recent study by Washington State University researchers concludes that organically grown plant-based foods contain 25 percent more nutrients on average than those that are conventionally grown.

But even conscientious eaters need supplements. Taryn Forrelli, ND, a North Andover, Massachusetts, naturopath and director of medical education at supplement manufacturer New Chapter, explains why: “The ideal diet would require us to buy fresh produce every day, prepare the meals ourselves, and eat them in a relaxed state of mind so our digestive systems can do their job of breaking down foods and absorbing nutrients. I think many health-conscious people try to eat such a diet, but often end up short at the end of the day.” Just because it’s hard to get all of our nutrients from food doesn’t mean we shouldn’t try. “Food should always be your first line of nutritional defense,” says Marci Clow, RD, and director of product research at Rainbow Light Nutritional Systems in Santa Cruz, California. “Supplements shouldn’t be used to replace good eating habits, but they can help to replenish essential nutrients when our diets fall short, which they often do,” she says.

Getting the basics
Because we now get less of the vitamins and minerals we need from food and because other lifestyle factors—stress, lack of exercise, sleep deprivation—take a tremendous toll on our bodies, everyone needs a basic multivitamin and mineral supplement to get at least the recommended daily allowance (RDA) of these essential building blocks, says Hyman.

As important as those daily values are, it’s equally important to understand that RDAs are minimum levels established by the USDA to prevent deficiency diseases such as rickets (vitamin D) or scurvy (vitamin C). But, says Heather Pratt, CNT, a nutritional therapist and educator in Denver, the recommendations are outdated and don’t reflect current research. According to Hyman, the difference between just preventing a deficiency that quickly leads to acute disease and providing enough for optimal health can be crucial for arresting what he calls “long-latency deficiency disease”—a condition caused by less-than-optimal levels of a nutrient over decades. For instance, he says, a severe deficiency of folic acid can cause anemia within a few months; a less severe deficiency over 30 years may appear to do no harm, except that it doubles the risk of Alzheimer’s.

So look for a brand that delivers more than the RDA for each nutrient. Steer clear of megadoses, however. Taking many times the standard dose of one vitamin can create metabolic imbalances in the body, says Forrelli. Shoot instead for the recommended levels in the chart on page 59.

When to take more
Sometimes even the recommended dose of a specific nutrient won’t be enough. An individual who’s severely deficient in vitamin D may need 5,000 to 10,000 IU a day—up to five times the recommended level—for six to 10 months to recharge her tank, says Hyman. But severe deficiency may not be the only reason for ramping up a dose. John Cannell, MD, executive director of the Vitamin D Council, says he takes 5,000 IU of vitamin D3 a day during the darker winter months, and rarely gets sick.

Similarly, our ability to use vitamin C changes dramatically when we have a cold. Neustadt says that when we get sick, our bodies can absorb 10 times more C than when we’re healthy—and where does C concentrate in the body? In the white blood cells, the primary soldiers in our immune system.

While megadoses of vitamin C can help you get over a cold, taking large amounts of other individual vitamins can lead to sometimes dangerous consequences. If you’re worried about deficiencies, talk to a nutritionist.

Making a choice
When it comes to finding a daily multivitamin that will meet your nutritional needs, you have to account for the form it will take, the ingredients it contains, the way it’s produced, and what you can afford. There’s very little hard science on which to base your decision, unfortunately, so you’ll have to rely on your own judgment as you attempt to answer the following questions:

Tablet or capsule? Absorption is the big issue here. The US Pharmacopoeia manufacturing guidelines say that any tablet you take should break apart in 30 to 60 minutes to be effective. Not all of them do, however, either because they’re packed under too much pressure or they contain too much of a non-nutrient chemical—for example, magnesium stearate, a lubricant that allows tabletting machines to run faster but interferes with absorption. Proponents say capsules dissolve faster than tablets and therefore make their nutrients available more quickly and thoroughly. Tablets can contain up to twice the ingredients, however, and are generally less expensive to make. Avoid tablets or capsules that contain dicalcium phosphate, magnesium stearate, and such extra ingredients as artificial colors and sugars, and look for the safer compounds: cellulose, silicon dioxide, titanium dioxide, and magnesium citrate.

Synthetic or isolate? The vast majority of multis use USP ingredients that are either created in a lab or isolated from natural sources. A spirited debate rages, however, about whether the lab vitamins and minerals deliver the same benefits as those isolated from plants. The “a chemical is a chemical” crowd says both types are identical molecularly and point out that Nobel Laureate Linus Pauling’s groundbreaking experiments on vitamin C used synthetic ascorbic acid. Proponents of natural isolates counter that synthetic vitamins (some of which are created from coal tar or petrochemicals) lack the “cofactors” that accompany a vitamin in its natural state—such things as enzymes, bioflavonoids, amino acids, and phytonutrients. Without these, they say, the synthetics are less bioavailable, unless they pick cofactors up from food in the digestive system or from stores already in the body. “Isolated nutrients are preferable to synthetics, especially if the synthesized form has a different chemical conformation,” says Forrelli. This happens notably with vitamin E. The natural form, isolated from vegetable oils, is d-alpha tocopherol, whereas the synthetic version is a mixture of d- and l-alpha tocopherol, usually in a 1-to-1 ratio. The problem: L-alpha tocopherol conveys no known health benefit, which makes synthetic vitamin E half as effective as its natural counterpart. Similar differences between synthetic and natural versions occur in vitamins A and C, and chromium.

Food-based or food-grown? Both of these types place the vitamins and minerals in a food context—the first by combining them with a food base that will make them more bioavailable. “The addition of foods like fruit and vegetable concentrates or superfoods like spirulina, enhance the formula by supplying valuable antioxidants, phytonutrients, and other important cofactors that support digestion and absorption,” says Clow. Food-grown supplements (also known as food-cultured, whole food, or raw food) take this one step further by adding probiotics. Both processes seek to create supplements that more closely resemble the original natural context of the nutrients they contain, so the body will more readily recognize and assimilate them.

One-a-day or multiple pills? The issue here centers on the number of nutrients packed into each multi. More isn’t always better, but typically, one-a-days hold the bare minimum daily values of the vitamins and minerals they contain; brands with higher doses, a larger number of nutrients, or a food base require anywhere from three to six tablets a day. Forrelli says the one-a-days “work best for those already eating a healthy diet rich in organic fruits, vegetables, and whole grains.”

Cheap or expensive? Ultimately this depends on your budget, but you do get what you pay for. “Synthetic products are cheaper to make than those isolated from natural sources,” says Forelli, “and nutrients delivered in their truly natural whole-food form are the most expensive.” As for quality, cheaper multis are made from less expensive ingredients and use low-cost manufacturing processes. Under current laws, vitamin companies don’t have to say anything about either one of these, so unless you pry it out of them, you’ll have no way of knowing if, for instance, your multi was made in China—definitely a scary thought given the melamine debacle.

Along with your multi, Mark Hyman, MD, recommends you add extra supplements to stay healthy:
2,000 IU of vitamin D3 a day, in addition to what’s in your multi
1,000 mg of fish oil twice a day with an EPA-DHA ratio of 3-to-2
600 to 800 mg of calcium citrate total per day, in addition to what’s in your multi
400 to 600 mg of magnesium chelate total per day, in addition to what’s in your multi
10 billion to 20 billion live-organism probiotics twice a day to get the most out of all of the nutrients you put in your body