After fifteen years of studying, teaching and practicing therapeutic nutrition, I am convinced that the best initial recommendation that I can make to my patients is to regularly take a good quality, multivitamin-mineral (MVM) supplement. This is not to take the place of recommending a healthy, well-balanced diet, but such diets are a real challenge for most people to comply with.
A MVM supplement makes sense for several reasons:
Sometimes a healthy diet isn’t enough. Knowing how to choose a multi vitamin can help you improve your health.
- It will guarantee that diets that are less than perfect will not put the person at risk for micronutrient deficiencies.
- It will provide a high level of certain nutrients that are beneficial at levels above what is possible to obtain from diet alone.
- It is easier to comply with taking one supplement daily than a number of pills.
How do we choose the best MVM supplement?
There are many good candidates available from professional suppliers and a few from retail outlets. Rather than list the names of those I have been impressed with, I would like to educate the reader on what to look for in a quality MVM supplement.
The greatest challenge for a supplement manufacturer is to balance cost, quality and convenience in a single product. Higher cost ingredients are justified when they truly improve the quality of the product in terms of effectiveness or safety. Using high cost ingredients merely to “dress up” the label serves no one but the manufacturer.
Convenience is key to compliance.
Unfortunately, the large amount of nutrients required to make a “complete” MVM formula usually necessitate a dose of four to eight tablets or capsules per day in order to achieve an intake close to 100% of the daily requirements for all of the known vitamins and minerals. Of course, even the worst diet provides some micronutrients, so it may be adequate to supply as little as 50% of daily requirements. Even then, manufacturers producing formulas requiring only one or two doses per day will have to leave out large proportions of the bulkiest nutrients, such as calcium. Adding a separate supplement containing the missing nutrients or paying close attention to obtaining good dietary sources may be necessary.
In general, the comparisons on the label to the Daily Value for each nutrient are useful for deciding if one or more nutrients are not supplied in appropriate amounts. This is often the case for more expensive ingredients, such as vitamin E, vitamin K, and the ultratrace elements, as well as for bulky ingredients, such as calcium, magnesium and potassium. Controversy exists over whether some nutrients should be supplied at Daily Value levels or much lower. Vitamin A, phosphorus and iodine are considered by some to be overabundant in the US diet as it is, while extra iron and possibly copper may be potentially hazardous for individuals who already consume adequate amounts from the diet.
Vitamins and related factors
Vitamin A may be supplied by including retinol or beta-carotene in the MVM formula. Beta-carotene has the advantage of very low toxicity potential as well as being a superior antioxidant to retinol. Moreover, natural (but not synthetic) beta-carotene may have the best combination of vitamin A activity, antioxidant potential, and safety. Some individuals, however, such as those suffering from diabetes or hypothyroidism, may not adequately convert beta-carotene to vitamin A. Including some retinol (2000 IU/day for example) in an MVM supplement is important for these people.
Vitamin D deficiency has become an increasing concern, especially among the aged and in populations not receiving much daily sun exposure. For those patients who do not get regular exposure to sunlight or vitamin D fortified foods, 400 IU/day may be an optimal supplemental intake. However, individuals with increased risk for osteoporosis may benefit from as much as 800 IU per day. Finally, vitamin D deficiency has been recently linked to higher risks of diabetes, hypertension, autoimmune diseases, and certain cancers, so it may now be more important to guarantee adequate intake of this vitamin.
Vitamin E is an important antioxidant and many authorities believe it should be supplied at levels well above the Daily Value of 30 IU/day. Many authorities recommend 100-400 IU/day for the prevention of age-related degenerative diseases such as cancer and atherosclerosis. Most natural health care providers prefer the natural d-alpha form of this vitamin, though some successful clinical trials have used the synthetic dl-alpha mixture, which is also less expensive.
Vitamin K has only recently been added to some MVM formulas due to recent evidence of an association with bone loss. Supplementation with this vitamin is especially important to patients with a history of chronic antibiotic therapy or intestinal malabsorption.
The vitamin B complex is a very misunderstood group of vitamins. Each member is a separately functioning coenzyme in widely disparate parts of human biochemistry. Their discovery in the early part of this century when chemical analysis was primitive led to the mistaken belief that there was only one vitamin B. Later it was discovered that many individual vitamins made up the original “vitamin B” and that the different members were present in different foods in a wide variety of concentrations. The idea that all B-vitamins must be consumed simultaneously in a precise “balance” is a simplistic notion that has never been proven.
The common practice of including up to 5000% of the Daily Value or more for some B-vitamins is questionable and increases cost. Furthermore, many patients report nausea after taking supplements with very high levels of B-vitamins. Long term side effects are also possible. It should be sufficient to have each B vitamin represented in amounts at or moderately above the human requirements for each member. I can see no purpose in providing more than 5 or 10 times the Daily Value for most patients. If a patient has a specific condition for which a single B vitamin is therapeutic, then a separate supplement of this vitamin may be added to the MVM regimen.
Vitamin C is another important antioxidant and should be supplied at levels above the minimum requirements. Nevertheless, 200-400 mg/day may be the optimum dose, since these levels have been shown to saturate body tissues. Higher daily intake only temporarily raises blood levels, though this could be beneficial. Many authorities, however, encourage higher intakes up to 1000 mg/day on the basis of therapeutic trials and animal studies. More research is needed to determine the most beneficial and cost-effective amount for vitamin C in an MVM supplement.
The addition of bioflavonoids to an MVM formula is often done to provide so-called cofactors for vitamin C. This is likely not the purpose of bioflavonoids in the human body. While useful levels of bioflavonoids for therapeutic purposes begin at 500 mg/day for certain health conditions, lesser amounts have no known benefit. The typical human diet is estimated to contain as much as 1000 mg/day from foods and beverages alone. Therefore, a truly valuable daily supplemental dose is probably in the range of several hundred milligrams.
The presence of small quantities of other quasi-vitamins, such as choline and inositol, in an MVM formula is probably not important for the same reasons as discussed above for bioflavonoids. Too often, these trivial amounts are included in order to increase the number of ingredients and claim greater “completeness.”
Minerals
A common debate heard between various supplement manufacturers concerns absorption and bioavailability of mineral compounds. Often these arguments persist without the advantage of solid research to decide who, if anyone, is right.
Some supplements may not dissolve because of poor manufacturing practices, others may be designed to rapidly break down even in the most unfriendly environments. Most reputable manufacturers typically subject their products to artificial “digesters” to establish the solubility of their products.
Calcium should be the mineral in greatest quantity in a mineral supplement because its requirement is over two times larger than all of the other minerals combined. Unfortunately, many manufacturers attempt to reduce daily tablet requirements by lowering the calcium content in the daily total. As mentioned previously, at least six tablets per day of a MVM supplement is usually necessary to provide enough calcium. It may be more practical to take a separate calcium supplement if you are at risk of deficiency.
Various forms of calcium exist and some are better than others for certain conditions. However, the calcium (s) that offer optimum absorption include calcium citrate-malate and microcrystalline hydroxyapatite.
Phosphorus is often omitted from multiple mineral supplements because of its widespread availability in the diet as well as a suggested negative effect on calcium balance in animal studies. Phosphate may also interfere with iron absorption from the same tablet. It is probably wise to choose a formula that provides a calcium-phosphorus ratio of more than 2:1 or no phosphorus at all.
Magnesium is often discussed with calcium as the two share a common absorption pathway. This means that large amounts of one may inhibit the uptake of the other. However, this should not be a problem if the total of the two minerals is kept below 500 mg per single dose. Albion’s TRAACS magnesium lysinate glycinate is a form of magnesium bonded with an amino acid, providing optimum absorption. However, if not used to treat a specific condition and simply for daily health, any form of magnesium is adequate.
Potassium is often included in multiple mineral supplements at doses around 100 mg per tablet. This compares to a recommended intake of 2000 mg or more! Clearly this amount is insignificant, but it appears to be illegal by FDA ruling for manufacturers to include more than this amount. Our patients will have to depend on fruits, vegetables, salt substitutes or liquid supplements to obtain their optimum potassium intakes.
Many manufacturers offer MVM supplements with or without iron due to concern over excessive iron accumulation in men and post-menopausal women. For those patients who need iron, most forms are well absorbed but ferrous sulfate can be irritating to the gastrointestinal tract and should be avoided, as should other mineral sulfates.
Zinc and copper are thought to be interdependent in human biology, so supplements should not contain large amounts of one at the expense of the other. A 15:1 zinc-copper ratio is considered ideal with an acceptable range of 10 to 30. Again, sulfated compounds may be irritating to some people.
Manganese has received a lot of attention in the chiropractic profession due to its role in connective tissue metabolism. Most MVM supplements provide only a few milligrams, but this satisfies the minimum requirements. Iodine is not generally considered a nutrient at risk any longer due to extensive sources available in water, salt and many foods. Still, manufacturers may supply up to the RDA without risk of excessive intake.
Chromium is important in sugar and lipid metabolism and should be present in any complete mineral formula. Many authorities believe optimal intake to be at least 100 mcg per day. Organically bound chromium (any available form except chloride) is known to be much better absorbed than inorganic chromium chloride. While there has been recent debate over the relative merits of chromium picolinate versus other forms of chromium for certain conditions, neither form has been shown to be better than any other organic form for general nutrition purposes.
Selenium has been identified as an important antioxidant cofactor and may be important in cancer prevention. A new, lower RDA has been recently established at 55 mcg/day but many formulas contain as much as 200 mcg per daily dose, which is the amount used in cancer prevention trials.
Some MVM supplements include such recently appreciated trace minerals as boron, molybdenum and vanadium. It is unclear what intake levels are optimal for these elements. MVM supplements will also at times include enzymes, botanical extracts, lactobacillus cultures, etc. In my estimation, none of these substances are provided in large enough amounts to contribute significantly to daily intake.
As always, we are open for questions and concerns regarding your choice of supplements. We have a large selection of hand picked products in our office that we proudly stand behind. If you have questions regarding supplementation or would like to schedule a nutritional consultation, contact us at 303-651-7003, or contact me directly at [email protected].