Nutrition
Choosing the best multivitamin
by Marcelle Pick, OB/GYN NP
Choosing the right multivitamin is vital but it can be confusing. There are conflicting claims about nutrients and dosages. Because of weak regulations, the labels on products are incomplete and misleading. Science in this area is rapidly evolving. And the number of choices at the vitamin store can be overwhelming. How do you decide what to do? Here’s our guide to finding the best nutritional supplements.
Understanding the essential nutrients your body needs
There’s a danger to you in the way nutritional supplements are marketed. Most of those marketers would have you believe there’s a different product for every problem — the antioxidant vitamin, the vitamin B-complex, mood boosters, energy vitamins, herbal nutritional supplements — the list of vitamins and herbs goes on and on. Maybe each one of those supplements does have its own role. But too many women come to us taking dozens of supplements and herbs, sometimes in extreme doses, and that concerns us.
The interaction of so many supplements is unknown. And this approach ignores the basic wisdom of your body: your body will naturally seek to balance itself if you give it the right foundation of nutritional support. That’s why we make sure every patient at our practice is on a sound foundation of a pharmaceutical-grade multivitamin, multi-mineral, and essential fatty acids (EFA’s).
This approach is based on how our bodies really work. Every day our bodies need certain raw materials to support the vast biological mechanisms that fuel our physical and mental activity, support our immune defenses, and regenerate skin, muscle, blood, tissue, and bone. This fuel comes in the form of macronutrients — protein, carbohydrates, and fat — and micronutrients: vitamins and minerals (which fall into four more categories: water-soluble vitamins, fat-soluble vitamins, major minerals, and trace minerals).
Some of these nutrients are familiar from the labels on food and vitamin packages. Fat-soluble vitamins like A and D have the capacity to be stored in our bodies. Others, like vitamin C and some of the Bs, are water-soluble, which means they are eliminated in our urine and sweat and must be replenished regularly. We also require essential fatty acids, which are often overlooked.
Our bodies need a ready supply of all these nutrients on hand to function properly. They serve as antioxidants, chelating heavy metals and attracting free radicals to detoxify our systems. Some help fight infection, clot blood, heal wounds, and strengthen bones. Others contribute to hormone production, convert food into energy and support healthy cell regeneration. Adequate levels of EFA’s help prevent inflammation and contribute to stable cholesterol levels which affect hormonal balance.
In this way, every essential nutrient has a vital task in our bodies. Moreover, each one usually works in concert with one or several others. For example, vitamin E works more efficiently in the presence of vitamin C. Calcium has a much higher absorption rate when taken with magnesium. And zinc may assist a variety of other nutrients to bolster the immune system. It’s impossible to isolate the effect of each vitamin — just as it’s impossible to isolate a single vitamin deficiency as the cause of any given symptom. For example, vitamin B deficiency can result in symptoms resembling vitamin D deficiency, and so on. That’s why the best vitamin supplements are well-rounded — to ensure that we benefit from the synergistic effect of all the nutrients working together.
Bioavailability: the acid test of a multivitamin
Not everything we swallow is absorbed by our bodies. Every nutrient has to survive the chemicals and turmoil of the digestive system, be absorbed through the intestinal wall, and get past the liver to reach the bloodstream.
Scientists use the term bioavailability to measure what’s absorbed by the body versus what’s wasted. Unfortunately in ordinary multivitamins, a great deal of the nutrients don’t benefit the body at all — because they’re not bioavailable. The scandal is that you would never know that by reading their labels. The label only shows what’s in the multivitamin; it gives you no idea how much is bioavailable.
A basic problem is getting past the digestive system. In a pharmaceutical–grade vitamin supplement, many of the nutrients are chelated, or tied to another molecule which acts as an escort until it reaches the bloodstream. Both universities and private companies have developed and patented such chelated compounds. Because they are relatively expensive to license they are rarely seen in ordinary multivitamins.
A second problem is processing methods. Many ordinary multivitamins use inexpensive processes and rely on additives. These processes can destroy the nutritional value of the supplements or render them unrecognizable to the body.
This is why the half of Americans who take multivitamins aren’t noticeably healthier than the half that doesn’t. Many of them are taking ordinary vitamins that lack the range of nutrients their bodies need or low-price or discount vitamins that are less effective due to their processing methods and the limited bioavailability of their nutrients.
At Women to Women, we’re very concerned that the labeling regulations are so misleading for consumers. But bioavailability is a relatively new area of nutritional science that is evolving rapidly, and we don’t expect to see standardized measurements of bioavailability of nutritional supplements for many years. In the meantime, you have to rely on the quality of the research and the manufacturing methods that are behind your vitamin supplements when choosing a multivitamin.
The controversy over RDA's and vitamin dosages
A few of us may remember growing up when rickets and scurvy were commonplace. These diseases led to the development during WWII of the Required Daily Allowances (RDA’s) for vitamins and minerals, and the familiar Food Pyramid as an eating plan. Cereals and white flour were fortified with basic nutrients. Now “deficiency diseases” like rickets are common only in third world countries.
Unfortunately the RDA’s are not a good guide for consumers who want to use nutritional supplements to support optimal health and prevent disease. That’s because RDA’s were meant to be bare minimums, not optimal dosages. And while nutritional science has made stunning progress in the last 60 years, there is no consensus yet about optimal dosages for multivitamins or multi-minerals.
A good example is the new information surfacing about vitamin D. Not only is it important for calcium absorption, it also appears to help in weight loss, strengthen bone, and protect against cancer and depression. Our bodies seem designed for large amounts of vitamin D, as we create 20,000 IU of vitamin D in just 20 minutes of sun exposure. Yet the RDA for vitamin D is only one-tenth of that — 200 IU for a woman age 31–50.
What we do know today is that significantly higher doses of vitamins and minerals are needed for optimal health than are recommended in the RDA’s. A study in the Journal of the American Medical Association, for example, established therapeutic dosages many times higher than the RDA’s. What’s needed is long-term study of the effects of different dosages, plus a better understanding of how nutritional supplements might be personalized to each individual’s needs. In the meantime, our approach is to recommend a conservative but therapeutic dose based on the latest nutritional science.
The Institute of Medicine, which advises the FDA, has undertaken a complete revision of RDA’s based on the latest findings. These new Daily Reference Intakes (DRI’s) will be based on RDA’s but reflect our changing need for nutrients as we age and provide for a broader range of dosages. I hope it will rectify some of the larger gaps left in our nutrition by the current guidelines. It will use updated RDA’s as minimums and over time establish upper limits on what is recommended. Of course, that process will take many years.
So what is the best multivitamin?
We have strong views about the qualities of the best multivitamin for women. Here is how we would describe the perfect formulation:
- Complete. Based on the latest nutritional science, women need at least 30 vitamins and minerals, plus a rich essential fatty acid formula (i.e., EPA and DHA).
- Bioavailable. The nutrient forms must be the most bioavailable. There are six patented chelated formulas we recommend be included. And of course it must meet USP standards for solubility.
- Natural. No artificial preservatives, dyes, allergens or other contaminants. The fatty acid formula (derived from marine lipids) must be certified to be free of mercury and lead.
- Reliable. We’ve been waiting over 10 years for the FDA to issue manufacturing standards for nutritional supplements. In the meantime, there are several sets of standards that have earned international recognition. The manufacturer must meet at least one of these recognized standards.
- Laboratory tested. As is true for pharmaceutical drugs, every production batch of a nutritional supplement must be tested in a laboratory (i.e., “standardized”) to ensure that it contains exactly what is on its label.
- Makes a difference. You are the final test. If the nutritional supplement doesn’t make you feel better within the first 30 days, try another formula. It may not resolve all your symptoms in that time, but you should feel a real improvement.
Because women need a nutritional supplement they can trust, we decided to provide one ourselves. Called Essential Nutrients, it is an exceptionally good foundation for all women, and it has all the qualities outlined above. We have visited the manufacturer, talked with their scientists and reviewed their processes and controls. We take the product ourselves.
There are only a few companies in America capable of producing a nutritional supplement of this quality, but I don’t want you to think we claim to have the only one. You may find another multivitamin that suits you as well or better. Just be sure the nutritional supplement you choose has the qualities listed above.
In short, we don’t care which multivitamin you take, as long as it’s a good one and it works for you. You will be amazed at the difference it can make. Patient after patient — even the most skeptical — cannot say enough about how good the Essential Nutrients make them feel. And that is what abundant nutrition is all about — feeling fit, energized, and well.
At Women to Women, we don’t think it is enough to live longer. We want you to live well and enjoy every minute in the best of health. We know this can be possible with the help of pharmaceutical-grade vitamins — and we know of no case in which anyone has been harmed by our multivitamin. So really, the only thing we all have to lose by not following this advice is our health — and who can afford that?
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at 1-800-798-7902. We're here to listen and help.
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Original Publication Date: 11/30/2004
Last Modified: 06/15/2009
Principal Author: Marcelle Pick, OB/GYN NP