What's in Your Multi?

30 June 2004
by Wyn Snow, Managing Editor

When it comes to vitamins and other nutrients, experts agree on only one thing: Insofar as possible, it's best to get them from food.

Why? Foods contain a wealth of nutrients, all bundled together the way that evolution has shaped our bodies to use them. In addition to protein and carbohydrates plus essential fats and vitamins and minerals . . .

• plant foods—including vegetables, fruits, beans and whole grains—contain fiber and important phytochemicals

• fish contains vital omega-3 essential fatty acids

• nuts contain healthful unsaturated fats and other nutrients

. . . all of which help our bodies fight off cancer and heart disease and diabetes, the major killers of the 21st century in industrialized countries.

However, it is sometimes difficult to obtain enough of a particular nutrient from food. Processing can destroy nutrients. Lifestyle choices can lead to inadequate intake of some nutrients. Special circumstances, such as pregnancy or reduced absorption by older people, can lead to higher needs for various nutrients.

Even though fortification of foods has done its best to close these gaps, taking a multi-vitamin can be a wise strategy to ensure getting enough. And many Americans do. Multivitamin/mineral formulas are the most widely purchased supplement in the marketplace.

Which variety of multi is best? Here again, a pendulum of opinion ranges from the "minimalist" to the "optimal" approach.

The RDA minimalist approach

Mainstream health professionals, such as the American Medical Association and many nutritionists, now recommend that all Americans take a multivitamin supplement every day. The strategic thinking behind this advice is to ensure that everyone gets enough of these essential nutrients every day, even if one's food choices are less than ideal.

To aid Americans who wish to follow this approach, we have assembled two charts covering the nutritional needs of healthy men and women of various ages from the Institute of Medicine (IoM) of the National Academy.

• Recommended daily intakes of vitamins
• Recommended daily intakes of minerals

These charts also include information on IoM's recommended not-to-exceed maximums. For children ages 9-13, a good rule of thumb is that they need roughly half of the recommended levels for adults; for children younger than 9, consult a nutritionist.

Curiously, recommended intake levels have gone up for only two nutrients: vitamins C and K. Others have either remained the same or, for nine vitamins and eight minerals, gone down. These new recommended intake levels are not yet reflected in the daily value (DV) column on labels of dietary supplements, so you may want to compare the specific amounts shown in these charts with supplement bottles on store shelves.

For most nutrients, there is a comfortably wide gap between the minimum recommended daily intake level and the recommended maximum upper intake level. Ironically, for the nutrient magnesium, which is vital for cardiac health, recommended minimums for men are 420 mg/day, higher than the recommended maximum of 350 mg/day.

Caveats for the RDA minimalist approach

As we discussed in our previous article entitled RDAs And Safe Upper Levels: Solid Science Versus Bureaucratic Bias, more than a few of the recommended minimums, especially for children, are based on small research populations, extrapolations and guestimates rather than extensive scientific evidence. Also, scientific data for the recommended maximums is especially sparse. Furthermore, these recommended daily intake levels are intended only for healthy individuals and are designed to maintain health for only 95% of the population, meaning that one in twenty healthy individuals might need more than the recommended minimum in order to maintain health.

These facts—plus scientific research indicating that much higher levels of some nutrients appears to reduce the risk of contracting heart disease, cancer, and/or diabetes—has led some experts to espouse the "optimal" approach to nutritional supplementation.

The optimal approach

This point of view is best exemplified by the Life Extension Foundation (LEF), an organization that

• scrutinizes and analyzes all research that affects long-term health and longevity (and reports on this research to the public and their membership),

• funds some research on health issues affecting longevity, and

• manufactures dietary supplement products based on all of these research results.

Whereas ConsumerLab.com compares supplement products to formulas shown to be effective in clinical (human) research, LEF creates formulas based on such research.

The result? Their Life Extension Mix of vitamins-plus-minerals-plus-phytochemicals contains so many nutrients that the daily "dose" consists of 14 capsules or 9 tablets or 3 rounded scoops of powder. That's quite a lot to swallow—even when divided up among three or four meals per day!

(LEF also makes products with 2 tablets/day and 1 tablet/day that have a more modest, RDA-like formulation, for those of their members who prefer this.)

Should a multi include herbs or phytochemical nutrients?

LEF includes extracts from broccoli and raspberries and tomatoes in their Life Extension Mix, which makes sense for people who are restricting their caloric intake as a method of living longer—or as a method of dieting. (Caloric restriction has been proven to lead to longer lives in several mammals as well as other species, both vertebrate and invertebrate.) For many of the rest of us, however, eating actual broccoli and raspberries and tomatoes is a tastier method of gleaning these nutrients.

To LEF's credit, however, their formulas include the full dosage amount shown to be valuable in clinical research. Some supplement companies add only a small amount of an herb or other nutrient (such as saw palmetto or ginseng or ginkgo biloba), far less than the amount used in research studies, and then claim the full benefits of the research for their product. For most people following the minimalist approach, it makes more sense to take only the plain multi—plus a separate supplement in a full-strength formulation for the additional health benefits sought.

Regular tablet or time release?

Here again, opinions vary. A regular tablet discharges all its nutrients into the stomach in a single burst, while time-release formulas are intended to produce more of a steady-stream effect over the course of a day.

One scientist recommends the time-release formulation, because any nutrients that the body cannot use within a few hours goes to waste, and are excreted through the urine or perspiration or stool.

Another scientist points out that the human gut is designed to absorb specific nutrients in particular "sweet spots" along its length. Any nutrients that are released "downstream" of those absorption points are simply wasted.

Probably the best strategy for the minimalist approach is to cut a single tablet into halves or thirds or quarters, and take one with each main meal of the day. Our bodies are designed to absorb vitamins and minerals together with the foods that normally contain them.

Synthetic or natural?

Most vitamins are made now synthetically—which means they are assembled in state-of-the-art chemical laboratories. This process ensures that they are identical both to one another and to the "naturally occurring" forms made by plants and animals.

The main exception where the "naturally occurring" nutrient is superior to the synthetic is vitamin E, which consists of eight forms in nature and is better absorbed by the body.

The essential minerals are all atomic elements (in other words, like hydrogen and oxygen), and their natural forms are usually some variety of rocky ore. Plants absorb these minerals from the earth and water where they grow, and use them in many different ways.

In multi-mineral formulas, the minerals are supplied in a variety of different molecular forms. Questions about which molecular forms are better absorbed by the body could fill an entire article in itself, and will not be addressed here. We recommend that you ask a nutritionist to review any claims about absorption that you wish to know more about.

Generally speaking, the labels of multi-mineral formulas are required to say how much of the mineral is supplied and in what form. For example, "500 mg calcium (as calcium carbonate)" should mean that your body will be supplied with 500 mg of calcium, and that the source is calcium carbonate. Alternatively, "500 mg calcium carbonate" would mean 500 mg of the entire mineral—which means getting considerably less calcium because it is only part of that mineral! Unscrupulous manufacturers have been known to use misleading language, so read labels carefully and compare brands.

Does your multi-vitamin dissolve properly?

Some manufacturers claim that many brands of vitamin tablets are so hard that they go through the body undissolved, and quote nurses who find vitamin pills in the bedpans of their patients. While this can happen, here's a simple "acid test" you can apply to find out if your multi—or any other pill!—dissolves properly:

1. Place approximately one cup of white vinegar in a small bowl and warm it to 98 degrees or so by placing it inside a larger bowl of water that you "top up" several times with warm water from the tap. (The goal is to keep the vinegar reasonably close to 98 degrees for half an hour.)

2. Drop your multi-vitamin (or other pill) into the vinegar, and jostle it about every five minutes or so by gently shaking or swirling the cup. While you can also stir the mix with a wooden stick or toothpick, be careful not to touch the tablet itself.

3. The tablet should dissolve within 30 minutes. (This is the USP standard for all pharmaceutical tablets.) If it doesn't dissolve within a full hour, it's not doing you much good. Get another brand!

What about all those "inactive" ingredients on the label?

Inactive ingredients in vitamin tablets—technically called excipients—serve several functions.

Fillers: Sometimes the active ingredients in a tablet would result in a pill too small to hold. Or as in multi-vitamins, the formula can include "oil and water" ingredients that don't mix with one another. In these cases, the manufacturer adds one or more filler ingredients to the brew so it can be formed into a tablet either big enough or stable enough to hold.

Fillers can be a problem for people who are allergic to them. Read the ingredient and "does not contain" lists for substances you are concerned about. Common fillers include lactose (milk sugar), microcrystalline cellulose, corn starch, sugars (including sucrose, mannitol, sorbitol, fructose, dextrose), whey and yeast.

Binders: These do exactly what the term implies: They are sticky or gluey substances that hold the pill together. Commonly used binders can include povidone, xanthan gum and Carbopol (an acrylic resin). Some fillers may also act as binding agents.

Coatings: These help hold the tablet together so it doesn't break apart in the mouth. They also mask any unpleasant tastes, and often contain colorants. If you prefer to avoid dyes, these should appear in the list of ingredients.

Lubricants: These assist the manufacturing process in releasing tablets from the tablet-forming machines. Commonly used lubricants include magnesium stearate, stearic acid, sodium stearyl fumarate, polyethylene glycol, and hydrogenated vegetable oil.

All excipients used must be listed in the US Pharmacopeia or National Formulary (for products sold in the USA), and are usually either food products and thus digested normally, or chemically inert so that they pass through the body and are not absorbed.

Does price matter?

Yes and no. When the formulas for two brands are essentially the same, purchase the cheaper one unless:

• you wish to avoid specific excipients
• the tablet does not dissolve in the "acid test" described above
• the brand has not passed GMP inspections

Good manufacturing practice (GMP) procedures establish methods of ensuring that raw materials are indeed what they are supposed to be, and that the final product contains the ingredients and potencies listed on the label. Inspections are crucial because they ensure that the manufacturer actually follows these GMPs. (For details about GMP inspections, see our article Four Websites List Quality Products and Companies.)

For the past 10 years since the passage of the Dietary Supplement Health and Education Act (DSHEA), the FDA has been developing GMP regulations especially designed for supplements. Before DSHEA and until these regulations are finalized, supplement manufacturers have been and still are required to follow GMP regulations for foods. Some have chosen to follow GMP regulations for pharmaceutical drugs, which are far more stringent than those for foods.

Recommended brands

The bottom line on multivitamin quality

The following approaches are ways to find a multivitamin/mineral product of high quality.

For current product evaluations, ConsumerLab.com is an independent laboratory that tests supplement products that it purchases off the shelf. If a product passes their tests, this is a good indication that the brand is high quality—meaning that it contains therapeutic levels of the ingredients listed on the label, at the potency levels shown, and does not contain unwanted contaminants. At this writing (July 2004), the annual fee for seeing the names of all brands that pass—and fail!—ConsumerLab's testing information is less than $20.

Three other organizations are involved in inspecting manufacturing plants to determine if they are adhering to GMP standards. See our article Four Websites List Quality Products and Companies. These organizations list the names of passing brands on their websites.

If the product dissolves in 30 minutes of the "acid test" described above, the body will be able to absorb the active ingredients. If it doesn't dissolve within 60 minutes, choose a different brand.

Most products that contain additional herbs or phytochemicals—such as lycopene or saw palmetto—do not contain as much as of these ingredients as was used in the clinical trials that demonstrated health benefits. If you want to use supplements containing these kinds of ingredients, consult an herbalist or nutritionist to find out the therapeutic levels shown to be effective in the research. Websites that can help you find an herbalist or nutritionist are shown in our listing of Healthcare Practitioners and Alternative Medicine.

Whether you prefer the minimalist or the optimal approach to supplementation, the more you know, the better your chances of making a decision conducive to your good health. That said, the best source of vitamins and minerals is still food.

As the old saying goes: You are what you eat! So eat wisely and well!

Sources

Adrienne Forman, MS, RD. "Multis Deliver Nutrition Insurance: EN Helps You Make the Best Choice." Environmental Nutrition, 2004. (www.environmentalnutrition.com).

KareMor Manufacturing International, Ltd. "How are pills, tablets, and caplets made?" 2000.

Lee Reilly. "What's in this pill? - inactive ingredients in vitamins and other pills; includes a tip on finding out if a food supplement pill is vegetarian and a glossary of inactive materials in pills." Vegetarian Times, March 1998.

Louis M. Scarmoutzos, PhD. President, MVS Solutions, Inc. (www.mvssolutions.com). Private communication, June 2004.

Paul Thomas, EdD, RD. "Multivitamin-mineral Supplements." The Dietary Supplement, No. 13, September-December 2002.

Dave Tuttle. "Setting the Standard for Quality: The Life Extension Foundation continues to lead the industry in quality control and research." Life Extension Foundation website. (www.lef.org).