Who would have thought that the Jetsons were right and we would try to get everything from one pill? Whether you are eating a poor diet and trying to fill in the gaps with a multivitamin, or eating a balanced diet and taking a multivitamin for insurance against deficiency, multivitamins are a part of more than 30 percent of an American’s diet. Are multivitamins necessary? This is a common question for average humans and athletes alike, and a popular topic in the medical field.
How Are Multivitamins Made?
You will find the following processes that are used to make a multivitamin: whole food, naturally derived and modified, synthesized from yeast or fermentation. Typically there isn’t a multivitamin that doesn’t contain some synthesized or “scientifically formulated” nutrients since they cannot be reached to high enough levels from food to hit the target amounts. The majority of “whole food multivitamins” actually use a nutrient rich broth, added synthetic vitamins and the yeast saccharomyces to metabolize and convert them, then use small amounts of fruit or vegetable blends as filler.
The difference is if those forms are in the biologically available and active form. This is where the claims can fall in a gray area. There are certain synthetics like vitamin E and beta-carotene that have performed poorly and at a detriment in studies, whereas L-ascorbic acid has performed very well. Magnesium citrate, malate, and glycinate show superior absorption over oxide or carbonate forms. Folic acid may now be questionable due to gene mutations, with methylfolate being the preferred form (very important during pregnancy and for subsequent generations).
The Major Studies on Multivitamins
1. A large randomized double placebo clinical trial in 2012 looking at 16,451 male doctors over 50 with a history of cancer followed for more than a decade found that those who took a multivitamin had an 8% lower incidence of cancer returning, however, it did not have any effect on prostate cancer or men without a history of cancer. It also did not show any reduction in heart attacks or strokes.
2. A 2006 study looked at the efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults. In a poorly nourished Chinese population, combined supplementation with beta-carotene, alpha-tocopherol, and selenium reduced the incidence of and mortality rate from gastric cancer and the overall mortality rate from cancer by 13% to 21%. In a French trial, combined supplementation with vitamin C, vitamin E, beta-carotene, selenium, and zinc reduced the rate of cancer by 31% in men but not in women.
Multivitamin and mineral supplements had no significant effect on cardiovascular disease or cataracts, except that combined beta-carotene, selenium, alpha-tocopherol, retinol, and zinc supplementation reduced the mortality rate from stroke by 29%. A combination of 7 vitamins and minerals stabilized visual acuity loss in a small trial, and combined zinc and antioxidants slowed the progression of advanced age-related macular degeneration in high-risk persons. No consistent adverse effects of multivitamin and mineral supplements were evident, and the conclusion was that it couldn’t be proven or disproven if multivitamins helped prevent cancer or chronic disease.
3. The study from JAMA looked at 68 trials with over 230,000 participants taking different varieties of antioxidants (A, C, E, beta-carotene, selenium) and concluded that “treatment with beta-carotene, vitamin A, and vitamin E may increase mortality. The potential roles of vitamin C and selenium on mortality need further study.”
Anyone that has read numerous positive studies on vitamin C might have frowned at that conclusion. A closer inspection shows that the cherry picking of these studies looks like something Inspector Clouseau might have worked on. According to Dr. Houston from Vanderbuilt Medical School, “from an original pool of 815 studies, the researchers excluded a whopping 747 of them (91.5%) for one reason or another, leaving just 8% on which to base their conclusions. Of the excluded studies, 405 were rejected simply because none of the participants in these studies had died. But how can the researchers possibly prove that antioxidants have no effect on mortality if they’ve eliminated almost half of the studies in the data pool specifically because there was no mortality?”
In all the final studies pooled, the antioxidants were synthetic and chronically ill people were mixed in with healthy people. Closer inspection shows a VERY wide dosage from only 60mg of vitamin C to 200,000 IU of vitamin E in a single day! Professor Balz Frei, the Director of the Linus Pauling Institute at Oregon State University commented on the study saying “all the new study really demonstrates is a bias toward identifying studies or research that show harm caused by antioxidants, and selective removal of research that shows benefits.”
Do You Need a Multivitamin?
A better question is “do you need a multi-mineral?” Dr. Linus Pauling, winner of two Nobel Prizes once said, “You can trace every sickness, every disease and every ailment to a mineral deficiency.” While I cannot find the document online, the chemist Raymond Francis in his book Never Fear Cancer Again states “a 1992 Earth Summit Report suggested that 99 percent of Americans are mineral deficient.”
What about vitamins? Water soluble vitamins like all of the b-vitamins and vitamin C are what I see to be a major problem due to the lack of access to freshly picked foods. Both of these deplete quickly post-harvest, and the majority of clients I see are deficient in these nutrients. Magnesium is also a major mineral lacking in our water and soil. On the other side, people may need to avoid folic acid (synthetic form) in fortified foods and in multivitamins because it blocks folate receptors if they have a slow DHFR enzyme and have a homozygous MTHFR C677T enzyme. Be careful with methylfolate dosage and don’t assume that more is always better.
Top 5 Common Arguments for Vitamin and Mineral Supplementation
1. Chemical agriculture has depleted, polluted and destroyed the soil and our water supply. If the minerals are not in the soil, they are not in the food. If the water is stripped of its minerals and polluted, and crop rotation and composting is not practiced, then the food is in a sorry state to begin with. Vitamins are highest when foods are freshly picked, and many decline rapidly post-harvest, both chemically and organically grown. Worldwide shipping and storage of fruits and vegetables give us further depleted food. For example:
- Spinach and asparagus lose 50-70 percent of their folate when kept at room temperature for three days.
- Vegetables such as asparagus, broccoli, and green beans typically lose 50 percent of their vitamin C before they reach the produce counter
- Potatoes lose as much as 78 percent of their vitamin C during long-term storage at 36 degrees.
- Nitrogen fertilizers used in non-organic agriculture may lower vitamin C content in fruits and vegetables
- Blanching of vegetables prior to freezing can destroy half the vitamins
- Freezing meat can destroy up to 70 percent of its vitamins
2. We are no longer growing our own food or collecting it from the wild fresh. Processed food has become a staple for a large percentage of the population, feeding people food that is calorie rich and nutrient poor. Very few people can obtain a daily diet based on our hunter-gatherer and farming ancestors.
3. Sugar, refined carbohydrates, stress, coffee and alcohol consumption has created depletion on top of toxicity.
4. A highly chemical environment, diet, medications and personal care products have put new demands on the human body that it has never had to deal with the history of mankind. Deficiencies of certain minerals increase the uptake of heavy metals. Lead will take the place of calcium, cadmium will take the place of zinc, aluminum will take the place of magnesium, and nickel will take the place of manganese.
5. An indoor, sedentary, high-stress environment puts additional demands on the body that increase the need for numerous vitamins and minerals that are also needed to offset the toxic byproducts of stress hormones.
Top 5 Common Arguments Against Multivitamins
1. They don’t work.
Answer: One standard formula for an entire population is bound to fail for those with individual biochemical needs where it may only take one nutrient or mineral needed in higher amounts to make the difference.
2. You can get all the RDA vitamins and minerals from food. Supplements are not necessary.
Answer: Remember that the RDA is the absolute minimum needed to prevent things like scurvy, not the amount required for optimal health. However, you can get above the RDA for certain vitamins and minerals with a good diet.
3. They cause more harm than good.
Answer: This could be true for formulas using food dyes, artificial sweeteners, toxic forms and high amounts of certain vitamins and minerals. Pharmaceuticals are connected to over 125,000 deaths per year. According to the U.S. National Poison Data System, there were zero deaths linked to supplementation as of 2010. You can find thousands of clinical studies showing the efficacy of supplementation without side effects or toxicity. You cannot compare a cheap synthetic vitamin in the wrong form or toxic forms of antioxidants with the form found in nature and call them equivalent. Each time vitamin E and beta-carotene is brought up to cause harm in studies, people fail to mention the ones used were synthetically made into the wrong form and have no biological activity.
4. Many people consume too many calories, and therefore are able to get the extra amount of vitamins and minerals required.
Answer: Not likely. We are a calorie rich and nutrient poor nation. We are creating more vitamin and mineral deficiencies due the depletion caused by sugar and refined flour based carbohydrates (depletes b-vitamins, vitamin C, magnesium and calcium just to name a few).
5. If you need extra vitamins, you should eat fortified foods.
Answer: You will not find dieticians recommending supplements, but you will find them recommending fortified foods. Let the irony settle in for a minute. Why would they say not to take supplements, but to choose food with added poorly made synthetic vitamins? Because the American Dietetic Association is funded by processed food companies. This is how a diet of fortified cereal, fortified orange juice, low-fat dairy and artificial sweeteners became forced on the public. This is also why many will not use the dietician title now due to the loss of credibility.
The Worst Multivitamins
While supplements are immune from the death statistics, they are not without their problems. While it’s not proven that supplements were the main cause, Consumer Reports states that 6,300 serious adverse events were possibly associated with supplements. I wouldn’t be surprised if some supplements are associated with adverse effects because without regulation and accountability, untested products are going to find their way into mainstream stores. Everyone has different sensitivities, and certain additives and versions of vitamins can cause issues for some but not others.
You need to do your homework on reputable companies that do purity tests and clinical studies backing up their claims. One incident happened to Gary Null, who was almost killed by his own product when Gary Null’s Ultimate Power Meal almost became his last meal with an overdose of vitamin D (2 million instead of 2 thousand IU).
The following matched one or more of the previous criteria for my opinion of the worst multi-vitamins:
1. Flintstones Vitamins
When I was a child, my mom (also a nutritionist) would do lectures using Flintstones vitamins as an example of what not to buy. She would take a lighter to the vitamins and it would melt down to a mound resembling oil, from the coal based artificial colors. The #1 children’s multivitamin in the US and the top vitamin recommended by Pediatricians is produced by the pharmaceutical company Bayer and contains the neurotoxin aspartame, cupric oxide (a potentially toxic form of copper), coal tar artificial colors, hydrogenated GMO soybean oil and GMO corn starch.
2. Centrum Multi-Vitamin/Mineral
Made by the pharmaceutical company Pfizer, and brings in close to 1 billion in sales. Centrum uses synthetic vitamin E (dl-alpha-tocopherol) and beta-carotene, the same kind that has been found to cause detrimental health problems like prostate and lung cancer. It uses the oxide form of magnesium, which only 4% is absorbed. It contains hydrogenated palm oil, a trans-fat highly correlated to heart disease, not to mention all the horrible artificial colors including FD#C Blue #2, Yellow #6 and Red #40 found to disrupt mitochondrial function (the power house of a cell).
A study published in the Journal of Food and Chemical Toxicology found that the dyes actually enter the bloodstream through the skin or digestive system, debunking previous expertise that the skin blocked it and the digestive system destroyed it first. This is alarming because these dyes have already been linked to ADHD, allergies, and asthma, but due to the dye’s ability to inhibit cellular respiration, a whole cascade of health effects.
3. Bayer One a Day
Vitamin A is labeled (14% as beta-carotene). When the source of the beta-carotene is not listed, that means it may be synthetic. Synthetic versions of beta-carotene have been shown to increase the risk of cancer in heavy smokers and drinkers, and accelerated the death and shortened the life span of rats exposed to radiation. But the natural form of beta-carotene decreased the death rate and significantly increased the life span of exposed rats. Synthetic vitamin E is used and seen as dl-alpha-tocopherol acetate. It has been shown to have little or no anticancer effectiveness, and may even increase prostate cancer. Magnesium oxide and zinc oxide are used, a poor choice for men especially.
4. GNC Ultra Mega Gold
This formula has many carbonate and oxide forms, and in particular copper, magnesium and zinc in oxide form in my book are considered “bad form.” While this is detrimental for women and men for different reasons, men especially need good sources of magnesium and zinc for the heart and prostate. Make sure you are getting citrate, malate glycinate or picolinate forms. There are many ingredients that look added for the wow factor, but almost all of them are so low that they are insignificant. While the tocotrienol complex is admirable, 900 micrograms is not going to do much when the effective dose starts at 375 milligrams or more according to A.C. Grace. On the other ingredient section, it says “sucralose” while below it states “no artificial flavors.” Get the facts straight GNC. These should obviously be avoided, but why would you put artificial flavors in something that you are not even eating? It’s maddening.
5. PaleoBalance All in One WholeFoods Multi-Vitamin
You are probably shocked to hear me put a multi-vitamin with the name “Paleo” in it on the bad list. Well, thou shall not use the word Paleo in vain. As I have learned more about the manufacturing process, I have learned how to spot companies cutting corners to create a cheaper product.
If you look at the label closely, there is nothing impressive about the vitamin and mineral profile. The oxide and carbonate forms are the cheapest to use, and also the most poorly absorbed (only 10 percent of oxide forms are absorbed). Magnesium and zinc use the oxide forms in their formula (both important for neurotransmitter health) and the calcium used is carbonate. Vitamin E should also be used with mixed tocopherols, not just d-alpha. The vitamin D is D2 (often synthetic) while D3 is considered to be much more effective. Iron is missing, so if you are female you will want something with iron. Vitamin K is missing, which is probably the first time I’ve seen a multi-vitamin missing vitamin K.
PaleoBalance uses cheap vitamins and minerals, and from what I can see non-organic blends. In general, blends are usually very small amounts, so I question how effective these are in the first place and I suspect they are added for marketing. If you look at the omega 3 profile, it is plant based (only 11mg of ALA, barely if any will convert to EPA and DHA where 200-300mg are usually standard). After receiving multiple emails about this product, I wanted to set the record straight that this isn’t what I would deem up to Paleo standards.
How to Choose What Vitamins and Minerals You Need
My opinion is that multivitamins may actually prevent people from choosing more nutrient dense foods in their diet and continue bad eating habits, using a multivitamin as false insurance. How do you know which vitamins you are lacking? The way you find out exactly which ones are most likely missing is going to be strictly due to the individual’s food choices, activity, soil, cooking preparation, constitution, genetic biochemistry, stress, environmental pollutants and other factors. In other words, challenging without a professional analysis.
What we do know is that there are certain vitamins and minerals that are harder to get in today’s world and require a much higher need for the majority.
What do the majority of multivitamins lack? Calcium, magnesium, choline, enough vitamin C, K2, omega-3 fatty acids,sufficient iodine, b-vitamins in the active bioavailable form, vitamin E in all eight forms, true vitamin A (not just beta carotene) and enough vitamin D.
The Guidelines to Designing Your Own Multivitamin
After doing thorough research on the vitamin and mineral ratios, dietary intake and learning more about the process of certain multivitamins from scientists, I believe the best approach is focusing on minerals and supplementing with a select few nutrients based on your needs while getting the rest from food.
Here is the new article explaining my analysis on how I arrived at this conclusion, how you can determine your needs, and a handy chart for what foods should be consumed for each nutrient: How to Create Your Own Multivitamin with Food.
For Macro and Microminerals:
For one very common mineral deficiency in the population: Magnesium
See the article “How Have We Become So Magnesium Deficient?”
For B-Vitamins: Avoid Folic Acid
Choose food with a focus on folate, B6 and B12, or B-Complex Plus for methylated B-vitamins important especially for MTHFR/MTR/MTRR mutations.
According to this review, when consumed in increasing amounts in food, six of these nutrients (folate, vitamin B12, niacin, vitamin E, retinol, and calcium) are associated with a reduction in DNA damage, whereas three others (riboflavin, pantothenic acid, and biotin) are associated with an increase in DNA damage to the same extent observed with occupational exposure to genotoxic and carcinogenic chemicals.
Increasing one’s calcium intake further enhanced the genome-protective effect of a high-folate diet whereas a high riboflavin intake further exacerbated genome damage associated with a low-folate diet. This is consistent with epidemiologic studies showing that cancer rates tend to be higher among populations that consume more red meat (which is very high in riboflavin), more alcohol (which depletes folate), and fewer vegetables (a rich source of folate). It is the balance that is important.
If you are homozygous MTHFR 677 or heterozygous MTHFR 1298 combined with a heterozygous MTHFR 677, you may require higher amounts of folate (800mcg in studies) to maintain healthy homocysteine (inflammation) levels. If you are pregnant, you want to make sure to get adequate folate daily (not folic acid!) to for a healthy pregnancy, but not too much.
A new study from John’s Hopkins University looked at 1,391 mother-child pairs in the Boston Birth Cohort, a predominantly low-income minority population. The researchers found that very high circulating folic acid doubled the risk of autism, and B12 levels that were very high tripled the risk of autism. If both levels are extremely high, the risk that a child develops the disorder increases 17.6 times. Since folic acid (not folate) was highlighted, this most likely was due to a diet high in processed fortified foods along with supplements containing folic acid. I explain the mechanism behind how this can be problematic in this article. Cyanocobalamin is the synthetic B12 form found in cheap multivitamins and fortified foods. Both folic acid and this form of B12 could be causing methylation issues, leading to high levels of folic acid and cyanocobalamin in the blood, blocking entry into the cell.
Aim for 200-400 mcg folate most days for healthy DNA and cancer prevention. If you can’t hit the targets of folate with food, supplementation in the right form becomes necessary.
Zinc deficiency may affect 2 billion people, due to low levels in our food, the major drop in shellfish and organ meat consumption, and the high intake of grains that block zinc absorption. Zinc is concentrated in the brain, adrenals, eyes and prostate, and disorders of these usually are connected to zinc deficiency. If you are older, diabetic, vegetarian, have low stomach acid or take certain medications, you are even more at risk. I recommend Zinc Picolinate.
Vitamin A and D increase zinc absorption. “A sustained rise in plasma zinc concentration (and therefore its potential bioavailability) was obtained only when the zinc was augmented with both vitamins A and D (in RDA concentrations).” Another reason cod liver oil is awesome.
Research shows that nine out of 10 Americans don’t get enough choline. Choline is required for acetylcholine, a neurotransmitter of the vagus nerve that enervates multiple organs including the lungs, heart, liver, stomach and temporal lobe of the brain. A deficiency could affect all of these.
One study found that women with higher choline intake have the lowest anxiety. Non-Alcoholic Fatty Liver Syndrome occurs from a choline deficiency. PEMT gene polymorphisms are common in women and increase choline needs even further. Pregnant and nursing mothers require the highest amounts of choline, crucial for a baby’s brain development.
The recommended range keeps changing upward and is currently between 425-550mg for a daily intake up to 930mg for pregnant women in their third trimester. Eggs and liver have the highest amount, followed by meat, fish and smaller amounts in nuts, seeds, Brussels sprouts, cauliflower and collard greens. If you do not eat eggs or organ meats, you are likely deficient and may require Phosphatidylcholine.
For Vitamin C:
See the article Is Vitamin C the Most Important Nutrient for You?
Best Basic Multivitamin (Updated 2016)
After numerous comments and emails, I have been on the search for years to give a recommendation for a basic multivitamin that is worth purchasing. Not only do you want the right formulation, but you want to see GMP certification and other documentation to assure the product produced has the identity, strength, composition, quality and purity that it is represented on the label. You can choose either a multivitamin or a multimineral based on your needs. The multivitamin contains both vitamins and minerals, while the multimineral only contains minerals, but higher amounts of calcium and magnesium.
The multimineral I recommend is Citramins II without Iron and Copper (2 daily is sufficent), and if you are looking for a multivitamin that gives only a foundational amount of vitamins and minerals in the right form, I have narrowed it down to these two.
1. Thorne Research Basic Nutrients 2 a Day
Cost: $27.99 for 60 capsules
What I like about this one:
- Contains the right form of B12, B6 and folate for everyone including MTHFR mutations
- Contains 15mg of highly absorbable zinc bisglycinate chelate
- Contains the right doses of manganese, copper and boron
- Uses the correct dosage of vitamin E in the mixed tocopherol form, not dl-alpha tocopherol or isolated alpha-tocopherol
- Uses natural mixed carotenes (including beta-carotene) from the marigold flower
- Uses K2 instead of just K1
- Contains selenium as selenomethionine, not selenate and selenite
- Contains iodine
- Contains a higher dose of vitamin C from L-ascorbate
- Contains 2,000IU of vitamin D instead of 800IU or less
- It requires 2 capsules instead of the 6-8 capsules often required of higher quality multivitamins
- It is affordable. A higher cost doesn’t always mean higher quality, and I try to seek these out for people. It does not contain any harmful fillers or food dyes. I have also found some clients to be sensitive to citrate forms, and this formula does not contain any.
- They are conducting double-blind, placebo-controlled clinical trials.
- Certified by GMP, TGA from the Government of Australia (Australia’s FDA), as well as by the prestigious NSF International for quality control, purity, and manufacturing.
It should be noted that calcium, magnesium, vitamin C (although 250mg is better than most), choline and omega-3 fatty acids need to be higher in the diet or with supplementation, which is true of every multivitamin. You also may only need 1 a day, reducing the price considerably. While this one is not perfect (there isn’t one) and I still recommend a nutrient target approach along with diet, this will be the best choice for those who prefer a multivitamin.
Cost: $29.22 for 60 capsules (2 capsules daily)
**There are two MegaFood multivitamin formulas. You want the one that was just released and has the label shown below.
As of June 2016, MegaFood has created a new formula to include methylfolate, methylcobalamin and active B6 P-5-P. This formula is a blend of organic whole foods, USP vitamin and mineral fed yeast and synthesized nutrients. I have chosen to add this as a lower potency multivitamin alternative that represents a blend of all the current processing technology. Be aware that yeast-bound vitamins and minerals still remain untested for absorption and people with yeast sensitivities may not do well with this formula.
You will see that I chose the “Over 40” for the Men’s formula because for some reason they decided to only put 100mcg of methylfolate in the regular formula. The “Over 40” has 200mcg and I would recommend this one for every adult male because this is the minimum dosage for healthy DNA. Plus most men are not eating a lot of folate-rich vegetables and greens. It also has more vitamin D (1,000IU vs 800 IU). It does not have calcium, magnesium, boron or vitamin A (beta-carotene must be converted to vitamin A, and this range varies based on genetics, fat intake and other factors) and low levels of vitamin C (200mg).
For the women, the “Over 40” has 200mcg and the regular women’s formula has 400mcg. You will need to decide which one is best for you despite age based on your MTHFR function and sensitivity to methylfolate. This formula contains a similar profile to the men’s formula but with 15mg of iron. Both formulas contain 200mg of choline, which is a major bonus for women especially. If you are a female concerned about bone health, make sure to be getting sufficient boron, calcium, and magnesium outside of this formula.
MegaFoods is GMP registered with NSF, soy free, dairy free, gluten free, pesticide and herbicide free and GMO free.
The new label should look like this: (Women’s Formula shown)