Ask the Coaches: What Should I Look For In a Multivitamin?

Q: Everybody knows they should be taking a multivitamin every day, but with so many options, how do you find what’s right for you? Are they all the same? Can you get everything you need from a one-a-day vitamin?

Can you please help me better understand what I should be looking for in a multivitamin…and if I even need one in the first place?

Thanks,
Dude

A: Hey, Dude, this is a GREAT question. Better said, these are fantastic questions. And let’s begin with the last part of your question: Do you need a multivitamin?

While it is certainly possible to get all the vitamins and minerals you need through a healthy, balanced, and varied diet, the fact of the matter is that virtually no one does. In fact, the average person—and even the majority of health-minded folks—don’t even come close to meeting expert recommendations for fruits, vegetables, whole grains, and other nutrient-dense foods.

For example, a recent study published in the Journal of Nutrition found that almost everyone falls short of the average requirements for vitamin D and vitamin E, and more than half fall short of the average requirements for calcium, magnesium, vitamin C, and vitamin A via food intake.1

According to the most recent USDA Scientific Report of the Dietary Guidelines Advisory Committee, there are several “shortfall nutrients,” which are commonly under-consumed, including:2

  • Vitamin A
  • Vitamin C
  • Vitamin D
  • Vitamin E
  • Folate
  • Calcium
  • Magnesium
  • Potassium

The USDA identifies these as “nutrients of concern” because, when suboptimal, they “pose a substantial public health concern.” For example, deficiencies in various vitamins and minerals can lead to or be associated with:

  • Memory problems and cognitive impairment
  • Muscle weakness and discomfort
  • Fatigue, lethargy, and difficulty concentrating
  • Digestive discomfort
  • Poor carbohydrate management and metabolic function
  • Suboptimal thyroid/metabolism
  • Suboptimal levels of sex hormones (e.g., testosterone, estrogen)
  • Difficulty with weight management
  • Poor cardiovascular health

Simply put, experts agree that there is a nutritional gap between today’s diet and what’s required for optimal health—a nutritional gap that can be filled by taking a high-quality multivitamin supplement.3

Along those lines, researchers from the prestigious Harvard School of Public Health, “a daily multivitamin offers safe, simple micronutrient insurance.” In other words, a daily multivitamin is a “nutrition insurance policy.”4 Even the Journal of the American Medical Association—not usually known as a supporter of dietary supplements—agrees that everyone should be taking a multivitamin supplement daily.5 A multivitamin is a keystone of optimal health and good nutrition.

Not surprisingly, multivitamins are by far the most popular dietary supplement with 75% of supplement users taking a multivitamin. But moving on to the crux of your questions, are all multivitamins the same? What should you look for in a multivitamin? Are you willing to settle for a “cut-rate” insurance policy? Or, are you looking for the BEST nutritional insurance policy money can buy?

Vitamins Women Should Take Daily

5 Things to Look For in a Multivitamin

Just like a top-rate insurance policy, you want comprehensive coverage when it comes to a multivitamin. In other words, the purpose of a multivitamin is to ensure you have all your nutritional bases (in terms of vitamins and minerals) covered.

Believe it or not, even though there is no “official” regulatory definition of multivitamin supplements, they are often categorized as any supplement containing at least three vitamins and minerals.6,7 This is quite a broad definition, especially considering there are nearly 30 vitamins and minerals (depending on who you ask) that we need to get through food or supplements. A better guideline is that multivitamins should at least provide the vitamins and minerals commonly under-consumed in appropriate amounts.8

Of course, there are exceptions, such as iron. While it is an essential nutrient, not everyone requires supplemental iron. Along those lines, there are times when you may be looking for a single vitamin (vitamin D, for instance) or combination of vitamins (for example, the B vitamins) to address personal deficiencies. In those cases, you should know exactly what and how much you should be looking for. But when it comes to a multivitamin, full coverage is your best bet.

1. The Optimal Amount of Vitamins and Minerals

Just like you’d expect from a good insurance plan, a high-quality multivitamin provides you all the coverage you need, assuring you are getting at least the recommended daily amount of most vitamins and minerals, which support:

  • Bone health
  • Brain health
  • Eye health
  • Healthy aging
  • Healthy metabolism
  • Heart health
  • Hormone health
  • Immune support
  • And more…

Unfortunately, many multivitamins do not include optimal amounts of vitamins and minerals. This is especially true of gummy and one-a-day vitamins, which I prefer to jokingly call “none-a-day” vitamins since it’s virtually impossible to fit optimal levels of the key micronutrients (in their appropriate forms) into a single capsule.

2. The Best Forms of Vitamins

B vitamins are essential for producing energy (from the food you eat), feelings of wellbeing, cognitive health and function, and cardiovascular health. Several B vitamins play a critical role in a process called methylation, which is a major component of the body’s ability to detoxify.

The unfortunate reality is that traditional multivitamins use cheap, inferior forms of B vitamins (such as folic acid and cyanocobalamin), which need to be converted to their bioactive forms by the body. Unfortunately, many people lack the enzymatic capacity to do so. In fact, up to 60% of people don’t have the capacity to convert inactive folic acid into its active form (L-Methylfolate).9–11

Not only do the vitamins go unused, this can impair the body’s ability to detoxify, leading to the accumulation of potentially toxic compounds (e.g., homocysteine) that can negatively impact brain health and function, cardiovascular health, mood, and more. You want “bioactive” forms of B vitamins (e.g., methylfolate, methylcobalamin) that are more bioavailable.

Another example is vitamin D, which functions way beyond healthy bones. In fact, inadequate levels of vitamin D are associated with obesity and weight gain, poor insulin sensitivity and carbohydrate metabolism, decreased mood and feelings of wellbeing, and much more.

Sadly (and you may have seen this coming), many multivitamins contain vitamin D in D2 (ergocalciferol) form as opposed to D3 (cholecalciferol). Why is that important? Great question. Randomized controlled trials have shown that vitamin D3 is up to 3 TIMES more effective than vitamin D2 at elevating blood levels of vitamin D.12,13

Another example is vitamin K, which is important for blood clotting, building and maintaining strong bones, and supporting healthy, flexible arteries. Vitamin K1 (phylloquinone) is often found in multivitamins. However, it’s estimated that only about 10% of that is actually absorbed. On the other hand, vitamin K2 (menaquinone) is a much more bioavailable form.14

3. The Best Forms of Minerals

Along those same lines, many multivitamins contain cheaper forms of minerals. Guess what? As with most things in life, you get what you pay for, as these inferior forms typically have lackluster bioavailability. For instance, many manufacturers opt for the cheaper inorganic magnesium oxide over the organic magnesium salt (magnesium citrate), which is more readily absorbed.

In one randomized, double-blind, placebo-controlled study, researchers from the United Kingdom found that the bioavailability of magnesium citrate was over 3 TIMES greater than magnesium oxide. ALL cells require magnesium, which is involved in over 300 enzymatic reactions. And considering it is one of the most common nutrient deficiencies (which can impact everything from energy production to metabolic rate to blood glucose control to protein production and more), this has significant implications.

Other minerals often provided in inferior forms include calcium, chromium, and zinc.

4. Potency and Stability

Most multivitamin manufacturers do very little in terms of stability to ensure that their products retain potency over their entire shelf-life. A number of very common physical and chemical factors can affect the stability of micronutrients. For example, exposure to moisture (high-level humidity) during storage significantly increases the rate vitamins are degraded by chemical reactions (such as oxidation). A similar statement could be made about exposure to elevated temperatures or strong light during storage.

Obviously, you can’t reap the benefits of a multivitamin if you’re not getting appropriate amounts of the nutrients. Along those lines, you want a multivitamin that’s built to last and one that’s been tested to ensure it’s pure and potent throughout its shelf-life.

5. Easy-to-Use

As you may have experienced, many multivitamins stink, taste bad, or are hard to swallow. In the grand scheme of things, compliance is king. In other words, if you can’t tolerate consistently taking your multivitamin, you can’t routinely cover your nutritional bases. Along those lines, you want a multivitamin that’s easy to use. That is, one that isn’t hard to swallow and doesn’t stink or taste bad.

References

  • 1. Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Foods, fortificants, and supplements: Where do Americans get their nutrients? J Nutr. 2011;141(10):1847-1854. doi:10.3945/jn.111.142257
  • 2. USDA Scientific Report of the 2015 Dietary Guidelines Advisory Committee. USDA; 2015. http://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf.
  • 3. Ward E. Addressing nutritional gaps with multivitamin and mineral supplements. Nutr J. 2014;13:72. doi:10.1186/1475-2891-13-72
  • 4. Harvard T.H. Chan School of Public Health. Nutrition Insurance Policy: A Daily Multivitamin. Nutr Source. http://www.hsph.harvard.edu/nutritionsource/multivitamin/.
  • 5. Fletcher RH, Fairfield KM. Vitamins for chronic disease prevention in adults: clinical applications. JAMA. 2002;287(23):3127. doi:10.1001/jama.287.23.3127
  • 6. Bailey RL, Gahche JJ, Lentino CV, et al. Dietary supplement use in the United States, 2003 - 2006. J Nutr. 2011;141(2):261-266. doi:10.3945/jn.110.133025
  • 7. Huang H-Y, Caballero B, Chang S, et al. Multivitamin/Mineral Supplements and Prevention of Chronic Disease. Agency for Healthcare Research and Quality (US); 2006.
  • 8. Blumberg JB, Cena H, Barr SI, et al. The use of multivitamin/multimineral supplements: a Modified Delphi Consensus Panel Report. Clin Ther. 2018;40(4):640-657. doi:10.1016/j.clinthera.2018.02.014
  • 9. Mayor-Olea Á, Callejón G, Palomares AR, et al. Human genetic selection on the MTHFR 677C>T polymorphism. BMC Med Genet. 2008;9(1):104. doi:10.1186/1471-2350-9-104
  • 10. Wilcken B. Geographical and ethnic variation of the 677C>T allele of 5,10 methylenetetrahydrofolate reductase (MTHFR): findings from over 7000 newborns from 16 areas world wide. J Med Genet. 2003;40(8):619-625. doi:10.1136/jmg.40.8.619
  • 11. Bagheri M, Abdi Rad I. Frequency of the Methylenetetrahydrofolate REDUCTASE 677CT and 1298AC mutations in an Iranian Turkish female population. Mædica. 2010;5(3):171-177.
  • 12. Trang HM, Cole DE, Rubin LA, Pierratos A, Siu S, Vieth R. Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr. 1998;68(4):854-858.
  • 13. Armas LAG, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89(11):5387-5391. doi:10.1210/jc.2004-0360
  • 14. Maresz K. Proper calcium use: vitamin K2 as a promoter of bone and cardiovascular health. Integr Med Clin J. 2015;14(1):34-39.
  • 15. Stringham JM, Stringham NT. Serum and retinal responses to three different doses of macular carotenoids over 12 weeks of supplementation. Exp Eye Res. 2016;151:1-8. doi:10.1016/j.exer.2016.07.005
  • 16. Stringham NT, Holmes PV, Stringham JM. Lutein supplementation increases serum brain-derived neurotrophic factor (BDNF) in humans. FASEB J. 2016;30(1 Supplement):689.3-689.3.
  • 17. Stringham JM, O’Brien KJ, Stringham NT. Contrast sensitivity and lateral inhibition are enhanced with macular carotenoid supplementation. Invest Ophthalmol Vis Sci. 2017;58(4):2291-2295. doi:10.1167/iovs.16-21087
  • 18. Stringham NT, Holmes PV, Stringham JM. Supplementation with macular carotenoids reduces psychological stress, serum cortisol, and sub-optimal symptoms of physical and emotional health in young adults. Nutr Neurosci. February 2017:1-11. doi:10.1080/1028415X.2017.1286445