What to look for in a multivitamin

A lot of people take multivitamins, but in my clinical experience, many don’t really look at what’s in their multi and whether it is, in fact, the best option for them. Continue reading to find out what to look for in a multivitamin and why. 

In the first part of this article, we discovered that many people do not get all of the essential vitamins and minerals, in the recommended amounts from diet alone, and that there are compelling benefits from taking a multi, from improved overall health,1 protection from disease,2 reduced stress,3 improved sleep,4 and improved memory!5

On the other hand, some ingredients in multivitamin formulas may not be the best ones to achieve your health and performance goals, and more worryingly, some may even have detrimental effects on your health. So, it’s important to look for some key ingredient differences between the good… and the not-so-good multis on the market.

Here’s my go-to checklist for multivitamins:

    1. Contains all the major essential vitamins and minerals (with one exception…)
      The essential vitamins and minerals that should be included in a multivitamin are: Vitamins A, D, E and K (the ‘fat soluble’ vitamins), Vitamins B1, 2, 3, 5, 6, 7, 9, and 12, and Vitamin C, calcium, potassium, phosphorous, magnesium, selenium, and zinc. Also valuable in smaller amounts are manganese, copper, chromium, iodine, and molybdenum.The one exception is iron, as there can be some sub-clinical iron overload present in a significant proportion of the population. However, because iron is also the most common dietary deficiency, if you suspect a deficiency, see your health practitioner for proper diagnosis and prescription!
    2. Contains whole-food ingredients
      Whole-foods including herbs, berries, vegetables (and their concentrated extracts) help to provide secondary nutrients. These nutrients include antioxidants that help to support health in addition to the essential micronutrients. Conventionally farmed produce is often lacking in secondary nutrients. They are also not typically found in high amounts in highly processed and refined foods that are commonly part of our modern diet.
    3. Preformed vitamin A plus mixed carotenoids
      The most common carotenoid in supplements is beta-carotene, which can be converted into active Vitamin A. However, conversion rates of beta-carotene to usable Vitamin A can differ between people by a factor of nine-fold6 and beta-carotene is required in amounts at least four times higher than pre-formed Vitamin A.7, 8 So, having both preformed Vitamin A (for example from retinyl palmitate) along with sufficient beta-carotene (pro-vitamin A) and other naturally occurring carotenoids helps to ensure a full range of positive health effects.

      Note: Some care should be taken with pre-formed Vitamin A as it can be toxic in high doses. Multi-nutrient formulas, taken according to label directions, should not be any risk though.
    4. Safest forms of Vitamin B12
      Cyanocobalamin is the common form of Vitamin B12 used in supplements. It’s a synthetic form not found naturally in foods, and it leaves behind a cyanide residue that the body must excrete. Though this is unlikely to cause problems for most people (the amount of cyanide left is extremely small), those with pre-existing or undiagnosed kidney problems may have trouble excreting even these small amounts.9 Because of this, it has been recommended that cyanocobalamin should be replaced with a non-cyanide form of B12 for general safety.10

      Naturally occurring cobalamins are also absorbed more effectively than synthetic B12 (cyanocobalamin).11, 12 So, natural forms are both safer and more effective. Win-win.Now, you may have heard of the buzz-word ‘methylation’ in health circles. That’s because we require these methyl groups in order to convert various substances in the body for excretion or use by tissue. This important process is important for the function of our neurotransmitters, phospholipids and myelin (both important structural compounds in the body, especially the central nervous system).The non-methylated forms of B12 need to themselves be methylated to do this. This step may be limited in some people and even in healthy people could tax methylation pathways unnecessarily, whereas the natural, methylcobalamin form contains a methyl group and so helps, rather than hinders methylation.

    5. Best forms of Vitamin B9 (FOLATE)
      Many people cannot effectively convert synthetic forms (like pteroylmonoglutamate) of folic acid to active folate in the body (see methylation above.). This can lead to high levels of unmetabolized folic acid in the blood.13, 14 In turn, this interferes with the actions of folate,15, 16 which can, over the long-term, reduce immunity and increase cancer risk.17 Use a methylated form of folate such as L-5 methyl tetrahydrofolate (L5-MTHF).

    6. Broad spectrum vitamin E
      It was once thought that the only active form of Vitamin E in the body was a chemical called d-alpha-tocopherol. However, all four tocopherols and four tocotrienols demonstrate important health functions, including increased antioxidant activity and reductions in cancer formation. Overloading with alpha-tocopherol alone may reduce levels of the other health-promoting forms of Vitamin E in the body.18 To get the broadest range of benefits, choose a mixed tocopherol/tocotrienol blend that also has ample amounts of alpha-tocopherol.

    7. Includes Vitamin K
      Vitamin K is often left out of multinutrient formulas because it’s only relatively recently that we have begun to understand the full nature of its role in the body. Vitamin K plays an important role in promoting proper coagulation and wound healing, but it’s also involved in regulating immunity and inflammation and in aiding proper bone construction and development. Look for a multivitamin that contains Vitamin K, and for an extra boost, look for a form called Vitamin K2, menaquinone-7 (K2-MK7). This has demonstrated promise to help reduce arterial calcification and so may offer additional cardiovascular benefits.

    8. The best form of Vitamin D
      Vitamin D3 is the naturally occurring animal form of Vitamin D. D2, on the other hand, is produced by fungi. Typically D2 has been used because of cost, and because vegetarians couldn’t use D3 extracted from Sheep wool, however, there are now Vitamin D3 extracts from algae that are used in premium, vegan-friendly multis.19 In the largest comparison of D2 vs. D3 it was found that Vitamin D3 was associated with improved mortality and better health outcomes, but Vitamin D2 was not.19


Consider using this list when shopping for your next multivitamin, so you can make sure you are maximizing the efficiency of that multi for your health and wellbeing.

References

  1. Huang H-Y, Caballero B, Chang S, Alberg AJ, Semba RD, Schneyer CR, et al. The Efficacy and Safety of Multivitamin and Mineral Supplement Use To Prevent Cancer and Chronic Disease in Adults: A Systematic Review for a National Institutes of Health State-of-the-Science Conference. Annals of Internal Medicine. 2006;145(5):372-85.
  2. Alexander DD, Weed DL, Chang ET, Miller PE, Mohamed MA, Elkayam L. A Systematic Review of Multivitamin–Multimineral Use and Cardiovascular Disease and Cancer Incidence and Total Mortality. Journal of the American College of Nutrition. 2013;32(5):339-54.
  3. Macpherson H, Rowsell R, Cox KHM, Scholey A, Pipingas A. Acute mood but not cognitive improvements following administration of a single multivitamin and mineral supplement in healthy women aged 50 and above: a randomised controlled trial. AGE. 2015;37(3):1-10.
  4. Sarris J, Cox KHM, Camfield DA, Scholey A, Stough C, Fogg E, et al. Participant experiences from chronic administration of a multivitamin versus placebo on subjective health and wellbeing: a double-blind qualitative analysis of a randomised controlled trial. Nutrition Journal. 2012;11(1):1-10.
  5. Harris E, Macpherson H, Vitetta L, Kirk J, Sali A, Pipingas A. Effects of a multivitamin, mineral and herbal supplement on cognition and blood biomarkers in older men: a randomised, placebo-controlled trial. Human Psychopharmacology: Clinical and Experimental. 2012;27(4):370-7.
  6. Tang G, Qin J, Dolnikowski GG, Russell RM. Short-term (intestinal) and long-term (postintestinal) conversion of β-carotene to retinol in adults as assessed by a stable-isotope reference method. The American Journal of Clinical Nutrition. 2003;78(2):259-66.
  7. Wang J, Wang Y, Wang Z, Li L, Qin J, Lai W, et al. Vitamin A equivalence of spirulina β-carotene in Chinese adults as assessed by using a stable-isotope reference method. The American Journal of Clinical Nutrition. 2008;87(6):1730-7.
  8. Tang G, Qin J, Dolnikowski GG, Russell RM, Grusak MA. Golden Rice is an effective source of vitamin A. The American Journal of Clinical Nutrition. 2009;89(6):1776-83.
  9. Vitamin B12 Deficiency. New England Journal of Medicine. 2013;368(21):2040-2.
  10. Freeman AG. Cyanocobalamin–a case for withdrawal: discussion paper. Journal of the Royal Society of Medicine. 1992;85(11):686-7.
  11. Matte JJ, Guay F, Girard CL. Bioavailability of vitamin B12 in cows’ milk. British Journal of Nutrition. 2012;107(01):61-6.
  12. Koyama K, Usami T, Takeuchi O, Morozumi K, Kimura G. Efficacy of methylcobalamin on lowering total homocysteine plasma concentrations in haemodialysis patients receiving high‐dose folic acid supplementation. Nephrology Dialysis Transplantation. 2002;17(5):916-22.
  13. Ashokkumar B, Mohammed ZM, Vaziri ND, Said HM. Effect of folate oversupplementation on folate uptake by human intestinal and renal epithelial cells. The American journal of clinical nutrition. 2007;86(1):159-66.
  14. Kelly P, McPartlin J, Goggins M, Weir DG, Scott JM. Unmetabolized folic acid in serum: acute studies in subjects consuming fortified food and supplements. The American journal of clinical nutrition. 1997;65(6):1790-5.
  15. Smith AD, Kim Y-I, Refsum H. Is folic acid good for everyone? The American journal of clinical nutrition. 2008;87(3):517-33.
  16. Wright AJ, Dainty JR, Finglas PM. Folic acid metabolism in human subjects revisited: potential implications for proposed mandatory folic acid fortification in the UK. British Journal of Nutrition. 2007;98(04):667-75.
  17. Troen AM, Mitchell B, Sorensen B, Wener MH, Johnston A, Wood B, et al. Unmetabolized folic acid in plasma is associated with reduced natural killer cell cytotoxicity among postmenopausal women. The Journal of nutrition. 2006;136(1):189-94.
  18. Huang H-Y, Appel LJ. Supplementation of Diets with α-Tocopherol Reduces Serum Concentrations of γ- and δ-Tocopherol in Humans. The Journal of Nutrition. 2003;133(10):3137-40.
  19. Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, et al. Vitamin D supplementation for prevention of mortality in adults. The Cochrane database of systematic reviews. 2011(7):Cd007470.

This article written by

Cliff Harvey – ND, Dip.Fit, PhD (c)

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