Do I Need to Take Daily Vitamin Supplements?
Yes. You need to take daily vitamin supplements (aka a multivitamin).
I could leave it at this and you could take it on my recommendation alone, but this would be an awfully short post.
While it is my opinion that you should be taking a multivitamin, I’d like to back up this with information that you need to know and research to support it.
When it comes to supplements, I have had my fair share of patients coming in that are on hundreds of dollars of supplements but NO MULTIVITAMIN. This is exactly the opposite of the direction that supplementation should take. There are a lot of scenarios where a patient is on five different individual supplements that are all found in a good quality (key term!) multivitamin.
WHY DO YOU NEED DAILY VITAMIN SUPPLEMENTS?
This is the most obvious question. Those physicians who are less educated will likely tell you that don’t need to take a daily vitamin supplement if you eat a good quality diet (which most could not then go on to define…). The other argument is that all you will do is make expensive urine because you’re just going to pee out all the extra stuff that was in the multivitamin that your body didn’t need. In other words, it’s a waste.
Quality of Nutrition in Our Food
So. You think you can get all the nutrition you need from the food you eat. You’ve got more confidence in the quality of our food supply than I do. There are legitimate concerns over the leeching of nutrients out of the soil and the genetically modified foods grown under unusual conditions. Are you eating organic fruits and vegetables? It has been established that organically grown produce has higher levels of certain nutrients. Beyond the typical vitamins and minerals, organically grown produce is going to be higher in protective compounds (like polyphenols and bioflavonoids) than conventional grown produce.
Even if you are eating organic fruits and vegetables, are you getting 8-10 servings a day?
These factors mean that there is going to be a high likelihood that some nutrient (or multiple) are going to be missing from your diet. I understand that, in MY lifestyle, which is better than the many of my patients, there is a good chance I’m missing certain nutrients at certain times. It may not be today or tomorrow, but next week my body may need extra magnesium due to a stressful (emotionally or physically) situation. I want to make sure that my daily vitamin supplement is going to cover this deficiency should it occur.
Taking a Daily Vitamin Supplement as an Insurance Policy
Let me give an example that may fall under the TMI category, but I’m going to use it anyway. The daily vitamin supplements that I take (I’ll disclose this later) has very solid levels of B vitamins, including riboflavin. Riboflavin is a well-absorbed B vitamin (B2, specifically) that has a very brilliant yellow color.
This is the vitamin that will make your urine practically glow.
So, I take my daily vitamin supplements consistently day after day, month after month, twice per day. Some days, my urine glows like a scorpion under a black light. Other days, with no change in my multivitamin dosing, my urine is the standard, non-pigmented color. This means that most days, I am taking more riboflavin than my body needs and the remainder is eliminated in the urine. But, for some reason, there are days when my body needs more riboflavin, meaning that it does not end up being eliminated in the urine and giving it that unique yellow glow.
I would rather take daily vitamin supplements that contains more nutrients than I need when I don’t need them than to NOT have the nutrients present when I DO need them. I consider taking a multivitamin as an INSURANCE POLICY FOR MY HEALTH.
This is a much different viewpoint on taking a multivitamin than most patients share. Yes—you should be getting your nutrients from your food. But your nutrient needs differ by the minute, by the hour and by the day depending upon what is going on in your life. Stress, environmental chemical exposure, dietary quality and activity levels can all change your nutrient needs.
You have insurance on your car. You have insurance on your house. You have insurance on your life. Why should an insurance investment (that is cheaper than all others) for your HEALTH be any different?
THE RESEARCH ON DAILY VITAMIN SUPPLEMENTS AND YOUR HEALTH
There have been more than a handful of studies over the years that have looked at the benefit of taking a multivitamin on overall health. A few things to consider in regards to these studies.
First, the vast majority of daily vitamin supplements used are low-quality multivitamins (to be discussed in the next section). This has two effects: a positive finding using low-quality vitamins really says a lot about what a better-quality multivitamin may do for your health. On the flip side, if there is no benefit seen in the study, I’m not really sure it tells us anything except the fact that a lower-quality multivitamin doesn’t help with “X” condition.
Sadly, in almost all the studies that I have come across, there are no objective markers of the quality of a multivitamin used—instead researchers just ask study participants if they take a multivitamin or not, with no regards to the quality of the multivitamin.
Second, there are literally thousands of studies that have found benefits of the individual components of a good quality multivitamin. Studies on chromium, selenium, vitamin E, beta-carotene, zinc and many others have generally been positive. All of these are going to be found in the best vitamin brands. That means that, although some of the following studies on are multivitamins, I’ve also included studies on the individual vitamins and minerals in multivitamins.
Lastly, multivitamins are not drugs. They were not designed to single-handedly tackle lifestyle diseases like heart disease, stroke and cancer. They are NOT drugs. Studies that are designed to see if daily vitamin supplement use can single-handedly lower your risk of chronic disease are set up to fail. This likely means that, if a multivitamin does show a positive response, it’s probably even more powerful than we could imagine.
Benefits of Daily Vitamin Supplements in Breast Cancer
First of all, nothing will ever replace a good quality diet and lifestyle. This is NOT the goal of a multivitamin. As I have mentioned, you need to consider that a multivitamin is an insurance policy to make sure you have enough of what you need when you need it.
In one study looking at whether multivitamins could have an impact on breast cancer outcomes, researchers looked at the data from the Women’s Health Initiative, a massive study looking at 7.728 women aged 50-79 who had been diagnosed with invasive breast cancer at some point while the study was ongoing. Here’s the details:
- 37.8% of women were multivitamin users at the beginning of the study period.
- For the entire group, 518 women died from breast cancer.
- For those in the group who were taking multivitamins, the risk of dying from breast cancer was 30% lower.
- This protection was on top of other factors like stage of breast cancer, estrogen-receptor and progestin-receptor status of the tumor, education, smoking status, body mass index (BMI), alcohol use, physical activity, self-reported health, and diabetes.
One thing I found a little disturbing was in the comments section on Medscape (one of the more popular medical sites geared towards doctors), mainly from oncologists. Comments such as “I think it is not true,” “There is no confirmation yet.” “It is still controversial!” “Also, according to other studies, taking multivitamins daily, might decrease life span,” “The effect seen is so small or seems not worth following with an RCT to discover if the hypothesis generated is true. Patients should be told there is no reliable evidence supple ration is beneficial” and “I am concerned that you are airing this type of material. You need to screen your sources better and not rely on magical claims.”
There weren’t a lot of comments, but these were some of the ones labeled as oncologists. It just struck me as sad how, when faced with good evidence to show a benefit from something that is natural, doctors can cry foul and say there is no evidence but turn around and use the SAME process to make treatment decisions on patients. Until this attitude is no longer pervasive, medicine will remain were it is.
Benefits of Daily Vitamin Supplements on Cancer in Men
There has been research over the years supporting the benefits of taking simple daily vitamin supplements. I have reviewed these in detail in a prior blog post, but here’s a short list:
- May help with depressive symptoms in the elderly.
- May improve mood and behavior in adolescents.
- Taking daily vitamin supplements may lower the risk of having a heart attack.
- Taking daily vitamin supplements may lower the risk of disability in elderly women.
- Multivitamins can preserve telomere length–a strong marker of how long your cells may live.
In one study, male participants of the Physicians Health Study II who had taken the prescribed daily vitamin supplements for men in the trial were evaluated to see if multivitamin use could lower the risk of cancer. Here’s what they found:
- Taking daily vitamin supplements for men had a reduction in overall risk of cancer by 8%.
8%. I’m sure no one is jumping up and down with joy at this number. But before you toss out your multivitamin, you need to know a few things.
First, 8% is still a very real number. It’s not like we’re talking about a massive overhaul of your lifestyle. It’s a multivitamin. That sounds like a pretty big payoff for spending maybe a mere 3 seconds several times per day.
Second, the multivitamin used in the study was the Centrum Silver (provided by the Pfizer drug company). Drug companies should stick with medications designed to interfere with the way the body works. Whenever they delve into lifestyle or supplementation they seem to screw it up. Let’s review Centrum Silver compared to what I recommend in a good quality multivitamin (I’ll go more into detail in the next section):
- Centrum is a “one per day” multivitamin. The entire “one a day” concept just doesn’t work. How many meals do you need in a day? One? Of course not. Why should this be any different with your multivitamin?
- You should avoid cheaper version of minerals like the oxides and carbonates. That’s pretty much the only forms used in Centrum.
- Crospovidone is used. AKA polyvinylpyrrolidone. Seriously? In a HEALTH related tablet?
- Do you really care what color your multivitamin is? Drug companies are so used to adding coal tar dyes (the reason they are numbered is because they had to be approved by the FDA) so that grandma remembers to take two of the purple pills and only one of the orange one.
- Sodium benzoate is a preservative, usually used in liquids. Last I checked, this was a tablet.
- Contains hydrogenated palm oil. While this is a small amount, there is no safe level of trans fats found in hydrogenated oils.
- The form of B12 used in cyanocobalamin. This form should be avoided and the methyl and hydroxy forms should be used.
- Polyethylene Glycol, Polyvinyl Alcohol are present. Sounds consistent with good health, right?
There are other reasons, but hopefully by now you should understand that this is NOT something we should really be willingly be putting into our bodies. It is clearly loaded with chemicals we do not need.
And yet, despite this, the taking daily vitamin supplements for men that is of this low quality still managed a respectable 8% reduction in total cancer risk. What kind of numbers do you think we might see with a higher quality multivitamin?
Given the results of this study, do you think doctors should begin to more strongly recommend taking a multivitamin for men to patients? (And female patients as well…?)
Daily Vitamin Supplements for the Over 55 Group
There was a study commissioned by the Committee on Responsible Nutrition to “examine the potential health care cost savings if people over the age of 55 use certain dietary supplements that have been shown to lower disease risks.”
The 125 page report goes into detail about the relationship between specific supplements and specific diseases but here’s a summary in case you don’t have an extra 3 days to read the full report:
- The use of omega-3 supplements = $2.06 billion savings on heart disease per year.
- The use of folic acid, B6, and B12 = $1.52 billion savings on heart disease per year.
- The use of phytosterol containing supplements = $4.23 billion on heart disease per year.
- The use of lutein and zeaxanthin supplements = $966.6 million on age related eye disease per year.
- The use of calcium and vitamin D = $1.52 billion of osteoporosis savings in women per year.
- The use of magnesium = $595.3 million for osteoporosis savings per year.
These are some serious numbers AND take into account the cost of the supplementation, which is minute compared to the cost of drugs designed for these same conditions. Side effects, as well, are minimal, again especially when compared to the drugs used to treat these conditions.
Before you run to the cabinet to throw out your supplements, you should consider what happens when we study conditions under which daily vitamin supplements actually make sense, instead of waste-of-money studies that don’t make sense.
Daily Vitamin Supplements and Disability as We Age
It seems almost too simple to be true, but a study published in 2006 found that higher levels of certain vitamins and minerals in the bloodstream (specifically vitamin B6, B12 and selenium) leads to better functioning as women get older. Here’s the specifics:
- Women with the lowest blood levels of B6 had a 31% higher risk of disability in performing activities of daily living (ADLs).
- Those with the lowest levels of vitamin B12 had a 40% highest risk of disability.
- Those with the lowest levels of selenium had a 38% higher risk.
While this study did not evaluate multivitamin use, a good quality multivitamin would supply adequate levels of these 3 nutrients, in addition to many more needed for healthy function.
HOW TO BUY GOOD QUALITY DAILY VITAMIN SUPPLEMENTS
When I look at any line of supplements, I always focus first and foremost on the multivitamin in that product line. If a company has a low quality multivitamin there is no way I’m going to trust anything else in that product line. So here are some tips to find a good quality multivitamin for your health.
Serving Size of Your Daily Vitamin Supplements
If I were to sit you down and ask you how many meals you should be eating every day to stay healthy, I’m pretty darn sure you wouldn’t respond with the answer that all we need is a single meal to get all the nutrients we need for the day.
Nope, you’d probably agree that at least two, more likely three, is a good number of meals to have per day.
So why on Earth should it be any different with your multivitamin? How did the “one-a-day” type of vitamins become the most common type of vitamin used (and most likely the type of vitamin used in studies on the benefits of multivitamins)?
Some of this may be because the larger “one-a-day” multivitamins are made by drug companies. And they know how to use marketing dollars to make you think that their product is actually a good idea for your health.
The VERY first thing I look at in a multivitamin is the serving size. If it’s a one-a-day type it’s off the list as a low quality vitamin. There is one brand of daily vitamin supplements that had a serving size of 2 / day, but most of the good ones start at 3 / day. My personal favorite (to be disclosed later) has a serving size of 6 / day.
Six per day???!!! Yup. Everyone wants their multivitamin to be need to be taken once per day, they want EVERYTHING they need in that single serving and they want it to be small. Short of some inter-dimensional Felix-the-Cat bag or TARDIS-like ability of that single, small multivitamin, it’s not going to happen.
So look for a multivitamin that has a serving size of at least 3 / day. This will ensure that the manufacturer is aware that it is just not possible to stuff everything needed in a good quality multivitamin into a single serving.
As a side note—these dosages need to be split up during the day. Ideally across your three meals. Personally, my afternoon meal is usually not convenient to take my daily vitamin supplements, so I break up the servings into a breakfast and dinner portion.
Forms of the Vitamins and Minerals in Your Daily Vitamin Supplements
This is a biggie and is a little more complex, but I’ll distill it down to a few tidbits:
- Avoid the cheaper, less absorbable forms of vitamins and minerals. This would include names like carbonate and oxides. Instead look for better quality forms like malate, citrate or the patented Albion forms (protein-bound, definitely more expensive).
- Vitamin B12 comes in three main forms: cyanocobalamin, methylcobalamin and hydroxycobalamin. Cyanocobalamin is NOT a form that you should be taking. Throw out your multivitamin if it has this form of vitamin B12.
- B vitamins need to be activated by the liver by a process called phosphorylation. Having phosphorylated B vitamins is quite a bit more expensive, but it’s an indication of a much higher quality multivitamin. Look for names like riboflavin-5-phosphate (R5P or activated vitamin B2) or pyrodixine-5-phosphate (P5P, or activated vitamin B6).
There are some other factors that require a little bit more biochemistry, but looking for #1 and #2 above, using #3 only when looking at more expensive multivitamins, will keep you on the path of the higher quality multivitamins.
Recommended Daily Allowances (RDA) in Your Daily Vitamins Supplements
There are some multivitamins that proudly advertise that they have 100% of the RDA of “X” number of vitamins and minerals. That sounds great, until you realize that the RDA is an absolute minimum needed to avoid named diseases like scurvy, pellagra, beriberi and rickets.
So, if you live your life every day in fear of your teeth falling out from scurvy, then make sure your multivitamin has the RDA of vitamin C. And you’ll know it when you see it, because as you look on the nutrition facts portion of the label, every single vitamin is listed at exactly 100% of the RDA.
It’s enough to make you feel all warm and fuzzy inside.
But, if you’re more concerned about the research on what levels of vitamins and minerals you should be taking for your optimal health, then you should look for a multivitamin that does not list 100% of the RDA for pretty much every nutrient on the supplement facts label.
Instead, a multivitamin manufacturer should take into account what OPTIMAL levels of different nutrients should be used. Take vitamin B12, for example. The RDA for vitamin B12 is a very small (just under 3 mcg) and yet there is evidence that dosages on the range of 1,000 mcg and above are considered optimal.
As an example of one of the multivitamins that I recommend:
vitamin A (as beta carotene)………………………………………………………………………25,000 iu (500% RDA)
vitamin D (as cholecalciferol / D3)…………………………………………………………………..800 iu (200% RDA)
vitamin E (as d-alpha tocopherol succinate)…………………………………………………….400 iu (1,333% RDA)
thiamin (as thiamin HCl) (B1)…………………………………………………………………………100 mg (6,667% RDA)
riboflavin (vitamin B2)……………………………………………………………………………………50 mg (2,941% RDA)
niacin (as niacinamide)………………………………………………………………………………….100 mg (500% RDA)
You can see from this that the RDA has nothing to do with the levels of the vitamins and minerals in this particular multivitamin. Rather the levels of vitamins and minerals are consistent with the latest research on what is ideal for OPTIMAL health, not just avoiding scurvy and beriberi.
What Form of Multivitamin Should I Use?
It can get confusing. Tablets, capsules, liquids? Powered? Heck—awhile back there was even a direct marketing company pushing spray vitamins.
So which one is it? Which form of multivitamins is the best?
The 98% absorbable myth
Hopefully I can clarify some of this. One way to do this is to dispel a common marketing myth used by some companies in an attempt to claim that their product is better.
Or something like that. Anytime you hear that you should run the other way because there are times when absorption in the gut happens only because the body needs certain nutrient at the time. Take calcium as the perfect example. Calcium is VERY tightly regulated in the blood stream; too high or too low can mean death or at least a trip to the hospital.
Calcium levels in the blood are part of an elaborate dance between hormones like vitamin D, parathyroid hormone (PTH) and calcitonin. Because of this, no form of calcium is 98% absorbable. If it was, there’s a very good chance you would die from taking it.
Given that thousands are not dropping dead daily from multivitamin use we can pretty much assume this is not the case.
There are definitely forms of vitamins (as discussed earlier) that are better absorbed than others, but don’t ever get hoodwinked into a company telling you that their product is darn near 100% absorbed.
The Sublingual absorption myth
Another common myth used has to do with oral absorption (sublingual) of multivitamins. The company that was marketing the spray had the idea that the oral mucosa in the mouth was a great surface to absorb vitamins and minerals.
Certainly alcohol begins its absorption in the mouth, but the vast majority of the absorption of alcohol happens in the stomach. This is no different than the pathway for vitamins and minerals. Absorption of vitamins and minerals occurs primarily in the stomach and intestinal tract.
Don’t fall for the “sublingual absorption” marketing hype.
Tablet forms of multivitamins
The two most common forms of multivitamins are tablets and capsules.
Tablets are a perfectly acceptable form of multivitamin, but require a few conditions. In general, the challenge with tablet multivitamins is to compress them hard enough so that they don’t just end up as powder in the bottom of the bottle when you open it up to use it.
On the flip side, if you compact the multivitamin hard enough it won’t actually break down during the digestive process, leaving you with “bedpan bullets” as the nurses used to call them. They can even show up on abdominal X-rays as small little pellets lining the intestines.
There are ways to keep this from happening, but these ways are NOT used by the lower quality multivitamin companies that promote a “one-a-day” type product.
Probably the most efficient way to make sure that a tablet multivitamin actually breaks open is to use compounds called excipients. Excipients are compounds like plant-based cellulose that expand when exposed to water. In other words, when the liquid in the stomach contact a tablet multivitamin, the multivitamin bursts apart, allowing it to be further digested in the stomach and absorbed in the rest of the GI tract.
So, when buying a tablet multivitamin make sure that plant based cellulose is on the ingredient label and you’ll be just fine. If you happen to see one of their direct marketing reps at some health fair dropping a multivitamin into a glass of vinegar to demonstrate why you should use his or her product.
But putting a multivitamin into vinegar with a pH of maybe 6 has no comparison at all to the pH in the stomach that is closer to 2 or 3, THEN hits to small intestine with a pH of 8 or 9. No comparison, so don’t fall for the trick.
That’s not to say that powdered multivitamins are not good, it’s just that they are rarely worth the money that the direct marketing company is going to charge you for it.
Capsule forms of multivitamins
Which leaves us with the capsule forms of multivitamins. Clearly this is probably the best form for your daily vitamin supplements because the shell of the capsule can be broken down in the stomach to release the contents for absorption.
Not a whole lot more to be said about this.
The Rest of the Ingredients on Your Multivitamin Label
Now we come to the final trick to decide whether or not to throw your current multivitamin into the garbage or continue to use it. Basically, if it takes a biochemistry degree to read the rest of the ingredients in your multivitamin, it’s not worth your time—just toss it. As for some of the things to avoid, this is best given to you as a list:
- Artificial colors. Avoid them. Do you really care what color your multivitamin is? Drug companies are so used to adding coal tar dyes (the reason they are numbered is because they had to be approved by the FDA) so that grandma remembers to take the purple pill and the orange one. There is NO purpose for any type of coloring in your multivitamin.
- Synthetic excipients like crospovidone should be avoided. AKA polyvinylpyrrolidone. Do you really want to have compounds with names like these in a supplement you are taking to improve your health?
- Preservatives should have no place in a good quality multivitamin. Sodium benzoate is a preservative, usually used in liquids. Last I checked, most multivitamins are in solid form.
- Some really low quality multivitamins contain hydrogenated palm oil. While usually only in small amounts, this oil contains trans fats and there is no safe level of trans fats for you to take in, especially in something that is FOR your health.
I’m sure there are other toxic compounds in multivitamins that you should be avoiding, but this short list should give you a great start on which ones to avoid.
Final Notes and My Recommendations for Good Quality Multivitamins
As I have noted several times in this article, while a good quality multivitamin is a necessity, it is not, and never will be, a replacement for a good quality lifestyle loaded with fruits, vegetables, spices, exercise and stress management.
The multivitamin should be use as a high-quality insurance policy for those times in your life when lifestyle is lacking (temporarily, of course) or life’s challenges become greater than your lifestyle can combat.
There are hundreds of multivitamins available on the market, ranging from pennies per day to $100 or more per month (although most of the multivitamins topping the $100 / month mark are tied to a direct / multilevel marketing company.
Our office has offered two multivitamins for many years now. They are both incredibly high quality, although one is clearly more complete than the other. Being a sport-car type person, I usually describe one as a Camaro SS and the other as a Dodge Viper. Both are awesome cars that no one should be disappointed to own.
Both are physician-only lines that can be found occasionally on the Internet.
Both of these are examples of the best quality multivitamins that you can find. If you can’t happen to find them near you, feel free to reach out to our office to see if we can ship them to you directly.