The Multivitamin Quandary
By Jack Challem
The shelves of drug and health food stores practically sag with multivitamin tablets and other supplements, all begging you to buy them. But should you take a multivitamin, and if so, how do you know which one to get?
Do I need a multi?
Experts have been arguing about multivitamins for years. Many dietitians will say you can get all the nutrition you need from a balanced diet — but who really eats those five to nine daily servings vegetables and fruits? According to U.S. Department of Agriculture statistics, large numbers of Americans don’t consume the basic Reference Daily Intake (RDI) of vitamins. For example, 28 percent of us fall short on the RDI for vitamin B1, and almost 86 percent don’t get enough vitamin E. People with diabetes are often deficient in some nutrients — whether it’s due to diet, medications, or other causes — so shoring up the stores with a multi seems generally prudent.
At the very least, multivitamin tablets provide nutrition insurance against deficiencies; at best, they may have significant benefits. Studies have shown a variety of benefits of taking a supplement, including less inflammation, better moods, and slowing age-related cell damage. As nutrition scientists make new discoveries over time, RDIs change. But government recommendations are not easy or quick to change so they don’t always jive with the very latest research findings. For example, according to Fred Pescatore, M.D., a nutritionally minded physician in New York City, “the RDI levels of nutrients are overly conservative. I think most people would do well taking at least three or four times the RDI for most vitamins, except for vitamin A.”
What to look for
So, how do you decide which supplement to buy? You can get one that contains 100 percent of the RDI for vitamins. Or you could take Dr. Pescatore’s advice and opt for one with higher potencies. The key is to read and understand the fine print on the label.
• What’s a serving? Products must list the number of multivitamin tablets or capsules in the bottle and nutrient amounts per serving. And a serving might be one capsule or as many as four. A bottle of 60 tablets might seem cheaper than another brand with 30 tablets, but it may not be a great deal if you have to take two tablets daily instead of one. Also: Check the expiration date before buying.
• Teeny Amounts. The amounts of some vitamins are listed as international units (IU), a measure of their potency. Others are listed as mcg (micrograms), milligrams (mg), and maybe grams (g). All of these are tiny amounts. One pound consists of 454 grams, a mg is one thousandth of a gram, and a mcg is one thousandth of a mg. There are 1 million mcg in a gram.
• Huge Amounts. The fine print lists the amount (IU, mg, mcg) of each nutrient and the percentage of the DRI. But they can sound higher than they really are. For example, 300 mg of vitamin C would be listed as 500% of the DRI. That’s only five times the DRI, not 500 times.
• Vitamin D. The DRI for this vitamin is only 400 IU, but Michael Holick, M.D., of the Boston University Medical School, and many other experts now recommend 1,000 IU daily for every infant, child, and adult. Official government recommendations will likely increase in the next year or two.
• Vitamin K. Few multis contain this little vitamin, which recent research shows to be important in glucose tolerance. The DRI is 90 mcg for women and 120 mcg for men, but some supplements contain much more. Warning: Do not take vitamin K if you take the blood-thinning drug Coumadin (warfarin).
• Fillers. Every supplement contains excipients — binders and fillers that help companies manufacture consistent products. Because many people are sensitive to dairy, opt for supplements that use cellulose (which is from plants) instead of lactose.
Multivitamins may fall more into the “can’t hurt” category at this point in our nutrition science knowledge, but since it’s clear that most Americans are not getting all the nutrients they need — and that people with diabetes should hedge their bets and shore up their body’s defenses every way possible — there seems no reason not to add multivitamin tablets to your daily regimen.
Note: Before changing or adding any nutritional supplement to your regimen, talk to your health care provider.
1. – Agricultural Research Service, Products & Services. http://www.ars.usda.gov/Services/docs.htm?docid=11046 Accessed December 18, 2008
2. - Church TS, CP Earnest, KA Wood, et al. 2003. Reduction of C-reactive protein levels through use of a multivitamin. American Journal of Medicine 115:702-707.
3. - Gariballa S, S Forster. 2007. Effects of dietary supplements on depressive symptoms in older patients: a randomised double-blind placebo-controlled trial. Clinical Nutrition 26:545-551.
4. - Ribeiro ML, DP Arari, AC Squassoni, et al. 2007. Effects of multivitamin supplementation on DNA damage in lymphocytes from elderly volunteers. Mechanisms of Ageing and Development 128:577-580.
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