When is it worth taking a multi-vitamin?

By Dr. Robyn Land

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I’ll admit it. I’m a big baby when it comes to swallowing pills. When it comes to taking any vitamin supplements or medication, there needs to be a really good reason for it. When it comes to nutrition, I am much happier getting what my body needs through eating a healthy, complete diet. So when my first-time patients apologetically say to me “I haven’t been taken my multivitamin,” my response is “That’s great!”

Over half of the population takes a multivitamin or dietary supplement on a regular basis, creating an over $12 billion per year industry in the United States. However, as published in the 2013 Annals of Internal Medicine, trials of over 400,000 participants showed no clear benefits of multi-vitamins in cardiovascular disease or cancer risk reduce. Another research paper looked at 6000 men over 12 years of multivitamin supplementation and found no decrease in risk for mental decline.

When it comes to taking multivitamins, the ingredients can vary wildly. Often, the multivitamins that we find on the shelf of our local health food store or grocery store have very low levels of a variety of nutrients, ensuring that they are relatively safe for a wide population to take without medical advice. These ingredients are often not in a form that are easy for the body to utilize and packed tightly into tablets that can be challenging for the body to break down.

There can actually be potential risks associated with taking a multivitamin. A multivitamin with beta-carotene (an isolate from the Vitamin A complex) rather than a full spectrum Vitamin A or getting Vitamin A from your diet has been shown to actually increase lung cancer risks in those who were past or are current smokers. While not a risk, for many people, multivitamins can cause an upset stomach or nausea. For others that eat a great, well-rounded diet, some multivitamins might just be a waste of your time and money.

While I rarely recommend people taking multivitamins, there are definitely some situations when I would highly recommend them:

  1. When you aren’t eating well
  2. When you are pregnant
  3. When you are working your body a lot

When you aren’t eating well:

While taking a multivitamin might be supportive if you aren’t eating well, it’s important to work with a naturopathic doctor, a holistic nutritionists or dietician to create a diet plan that will get you all your vital nutrients through food. If you are on a restrictive diet for medical reasons, then you might want to consult your healthcare practitioner about being on a multivitamin. For many elderly people, they will tend toward a “tea and toast” diet. While absorption of nutrients often diminish as we age, the lack of nutrients in diet can also have significant impacts on overall health, so a multivitamin might help to get in some key nutrients.

When you are pregnant:

There is a lot of debate about taking a prenatal multivitamin or not. The most important nutrient in this supplement is Folic Acid. Folic acid helps to prevent neural tube defects in early pregnancy which is why it’s recommended to take even before becoming pregnant. With supporting your own health and the health of your growing baby, I see a good prenatal multivitamin like an insurance policy in case your dietary choices aren’t spot on (or you have a lot of morning sickness and can’t get much food down!)

When you are working your body a lot:

I have seen several of my high-level athlete patients flourish when they started taking a well-made, athlete-specific multivitamin. Not only is there a higher demand for nutrients with their training schedule, but a good multivitamin for athletes helps support both muscle recovery and nervous system recovery to be able to train hard, and then relax and recover appropriately.

If you are going in to invest in a multi-vitamin, you might as well invest in something that is going to support your health. Here are a few key things to look for on the label that might tip you off that this is a better multi-vitamin then others. Hint: more expensive isn’t always better!

Folic Acid as 5-MTHF

In all of the genetic research that is available now, scientists are realizing that a large part of the population have at least one genetic variation, called a single nucleotide polymorphism (SNP), that reduce or prevent the conversion of certain vitamins from their simple forms into their active or “methylated” forms. An easy-to-avoid SNP concern is folic acid (Vitamin B9). Most multi-vitamins contain folic acid or folate, which has to go through 4 conversions steps to get to the active form called 5-methyltetrahydrofolate (5-MTHF). I encourage people to look at the label for 5-MTHF. If its listed there, I believe it shows company is focused on providing people with the most bioavailable form of the vitamin.

Vitamin B12 as Methylcobalamin

Similar to folic acid, Vitamin B12 goes through a conversion cascade as it starts with cobalamin, gets converted to cyanocobalamin and then into Methylcobalamin which the body uses in its energy production. Make sure Methylcobalamin is listed on in brackets beside Vitamin B12.

It is challenging for the body to absorb Vitamin B12 if you have any concerns with your stomach acid or if you are on any acid-lowering medications. Low stomach acid makes it harder for the body to bind B12 in our food, which can lead to long-term impacts such as numbness and tingling in extremities and a condition called peripheral neuropathy. Your vitamin B12 levels can be assessed through lab testing and low levels might be a situation where supplementing with B12 is indicated.  Another option might be a B12 injection from your naturopathic or medical doctor to help correct any deficiencies.

No Magnesium Stearate:

Many multivitamins are coated in a substance called magnesium stearate, which is a lubricating agents. Factories use this lubricant in their machines to increase their yields. However, as the pills slip through, they get coated in the same lubricants. This makes the pills slide through your digestive tract faster, making it harder for them to be digested.  There are some multivitamins that are so pressed together and then coated in magnesium stearate that patients have reported passing the entire capsule in their stool as it hasn’t had the chance to break down! Look in the non-medical ingredient section for this additive and avoid when possible.

Your best plan is to work with a licensed naturopathic doctor to determine what supplements (if any!) you might need beyond your dietary intake. Often the supplements that I recommend are more affordable than what you’d find on the shelf at your local pharmacy and will have a lot more therapeutic benefit!

Publisher’s Note: Dr. Robyn Land is a Naturopathic Physician and owner of Local Health Integrative Clinic in Vancouver, BC. She is also an adjunct faculty member at the Boucher Institute of Naturopathic Medicine and the Program Director for ProHealth Yoga & Retreats .