Multivitamins

As with any true debate, the argument over the need for multivitamins persists with nutrition literature and holistic providers on the pro side and various medical professionals on the other. The studies aren’t exactly straightforward. A National Institute of Health report in 2006 did not find compelling evidence to support a daily multivitamin, but did find that certain vitamins were beneficial. This only confuses the discussion, as most of these vitamins are found in standard multivitamins.

According to a 2002 article in the Journal of the American Medical Association (JAMA), “suboptimal levels of vitamins, even well above those causing deficiency syndromes, are risk factors for chronic diseases such as cardiovascular disease, cancer, and osteoporosis. A large proportion of the general population is apparently at increased risk for this reason.” Translation, the Standard American Diet provides insufficient amounts of these vitamins. Mark one up for the pro-multivitamin crowd.

As we’ve covered, the SAD does not provide an optimal level of nutrients. Should those who consume these diets consider daily supplementation, or should they just consider improving their overall nutrition? What about those who already have sound nutrition? This is actually the group most likely to take a daily multivitamin, but do they need it?

Scientific evidence may never answer these questions, but in my opinion, a multivitamin is a good idea for nearly everyone. Overall, it’s a great insurance policy for meeting optimal nutrient levels every day. Even those nourishing themselves properly cannot guarantee their foods come from high-nutrient soils. The environment provides a lot of stress to our cells in the form of radiation and toxins, and a multivitamin can help ensure adequate intake of antioxidants for added protection.

A multivitamin should never be the primary source of nutrient intake. There are no substitutes for what whole, natural foods provide the body, not even a vitamin.

Optimal wellness priority list:

1. Eat right. It is the foundation of wellness, as without it, all other efforts are less effective. Proper nutrition can obviate the need for all other steps (with the exception of regular exercise). Once established, supplementation is only necessary for correcting specific issues or as an insurance policy.
2. Exercise regularly. This is equally as important as proper nutrition. Regular exercise can prevent diabetes, heart disease, cancer, arthritis and Alzheimer’s disease. It’s also the best defense against anxiety and depression.
3. Specific supplementation. Based on personal or family history, you might need specific supplementation to help support inadequacies or specific illnesses. Choices of supplements and doses may be based on specific blood levels (vitamin D), or trial and error combined with listening to your body (i.e. supplementing with magnesium and adjusting dosing based on bowel tolerance).
4. General multivitamin:Optimize: Although there are recommended daily guidelines, they were established merely to prevent deficiency. When looking to achieve optimal wellness, you should have a goal of optimal nutrient intake, but remember these levels might be difficult to reach. Individual needs will vary based on environment, digestion and nutrition, to name a few. Insurance: This would apply to those who already consume a balanced diet strong in fresh fruits, vegetables, beans and nuts, combined with lean sources of protein and anti-inflammatory omega-3 fats. Although most days the optimal levels of all vitamins and minerals are consumed, this isn’t guaranteed. Taking a multivitamin daily will insure that these nutrients are obtained. Some vitamins and minerals will be taken in excess, but as long as daily intake remains in the safe range, there is no reason for concern. The Standard American Diet: If you fall into this category, the need for supplementation is a no-brainer. Though the SAD includes some nutrients at levels that prevent deficiency, most nutrients are suboptimal and others lacking altogether. In addition, the vitamins and minerals that are added to highly processed foods can be insufficient in dosage or type. For example, most vitamin D fortification is done using vitamin D-2, or ergocalciferol, not the recommended form, vitamin D-3. One should also assume the food industry is not using pharmaceutical grade minerals due to cost. Medication use: Many medications have the side effect of altering vitamin and mineral levels in the body. For example, long-term use of acid-suppressing medications has been shown to effect adequate absorption of certain B vitamins and selenium. There’s a laundry list of medications that alter the levels of magnesium, B vitamins and COQ10.

Evaluating your need.

Testing an individual’s specific vitamin levels is becoming more popular. This is a great, although expensive, way to evaluate your need, or lack thereof, for a multivitamin. The key is to check the levels inside the cells. For most nutrients, blood level readings are meaningless because the body goes to great lengths to keep levels in the normal range. To do this, it steals certain nutrients from the cells, where they are most needed. With this measurement, you can truly learn whether supplementation is necessary, and if necessary, a program can be tailored to your specific needs. Follow-up testing is available to confirm that optimal levels have been reached.

I’ve decided to take a multivitamin. What should I look for?

I have yet to find the perfect multivitamin, but there are certainly options that are better than others. Let’s go over what’s important and in what form.

Chromium

With a significant role in the body’s control of blood sugar, chromium has long been known for its effect on sugar metabolism. This mineral assists in moving insulin out of the bloodstream and into the cells that need it for fuel.

Chromium is useful for those with adult-onset diabetes, where patients lose the ability to move sugar out of the bloodstream effectively. In fact, many diabetic and nondiabetic patients report that the nutrient can help curb sugar cravings at a minimum dosage of 600-1200 mcg a day. Typically, sugar cravings will not be completely resolved when consuming chromium, but it does provide support for a desire that can contribute to significant health issues.

Chromium can also be beneficial to those with high blood sugar, however supplementing for use as a fat-burner or to fight depression has been poorly supported by data.

Supplements of this safe nutrient typically come in 200-500 mcg dosages. Adult-onset diabetes patients can typically begin with 500-600 mcg daily and track any possible effects on the blood sugar through home monitoring. If the blood sugars continue to run high, the dosage can be increased to 800-1000 mcg per day, in divided doses.

Signs of low blood sugar, such as fatigue, light-headedness, irritability or weakness, are rare but might occur in patients with a history of this condition. In this case, the dosage might need to be lowered or discontinued.

Kidney disease is a common complication in the progression of poorly controlled diabetes. Patients with kidney disease should always consult their physician before starting any aggressive supplement program. Chromium can still be beneficial, but starting doses should be low, 200-400 mcg daily.

Iron

Iron has long been equated with good health. On store shelves, packaging promotes iron content as a selling point for products. That’s because this vital mineral is essential to life and optimal body function. Everyone needs a consistent intake of iron, which can mean supplementation for those with low levels.

Iron is needed to carry oxygen. Without it, we couldn’t live as we would lack the ability to bring oxygen to body tissues. Also, iron allows muscles to store oxygen needed for optimal muscle function. Children need regular sources of iron for proper growth, as do women who are having menstrual cycles or breastfeeding.

Most of the iron in the body resides in the blood. Logically then, blood loss leads to iron loss. Once menstrual cycles have stopped completely, iron is no longer routinely leaving the body at a significant rate. Adult men and postmenopausal women typically need iron in much smaller quantities. These needs don’t mean that everyone should take iron supplements. In fact, excess iron can wind up acting as a damaging oxidant, and result in cancer, increased risk of infection and heart disease.

Some circumstances do require individuals to supplement iron. Women often experience a low blood count or iron load during pregnancy. Occurrences such as auto accidents, surgery or blood loss through the bowels might require extra iron to raise the blood count. A physical examination can give clues to an existing iron deficiency. Typical suggestive symptoms include fatigue, hair loss and pale skin. Those suffering from muscle cramps or restless leg syndrome should work with a physician to evaluate iron levels.

Certain medications can affect a person’s ability to absorb iron. The list of common offenders includes: Thyroid hormone, antacids and proton pump inhibitors (i.e. Nexium and Protonix), captopril (possibly other -pril blood pressure medications) and multivitamins [Source: Consumer Lab].

If you are debating about taking extra iron, simple blood tests to assess levels can help. If the test displays deficiency, physicians will instruct you to consume foods higher in iron, and perhaps supplement as well. All men and postmenopausal women should check their multivitamin to make sure it does not contain iron, unless their physician has instructed them to take it for deficiency.

Most substantial food sources of iron are protein-based. Red meat, chicken (especially the dark meat), salmon, oysters and tuna are all great sources. Additionally, eggs, beans, Brazil nuts, almonds, oatmeal, and tofu contain the mineral. Iron is also in vegetables and grains, but is not thought to be absorbed as well. Vitamin C helps the body absorb iron. With this in mind, spinach and broccoli provide both.

Vegetarians can maintain adequate iron through plant-based sources, but run a higher risk of insufficient levels compared to omnivores. Many of these sources contain phytates which may lessen the quality of absorption.

It’s advised that patients not supplement without consulting a professional. The exception to this rule is menstruating females with moderate to heavy flow, who should consume iron in a multivitamin.

Only after detecting low levels through lab testing, supplementation should begin with the lowest dose, for the shortest duration needed to achieve normal levels. Iron can cause constipation. To minimize this risk and maximize iron absorption, supplements should be taken on an empty stomach with orange juice or supplemental vitamin C (500-1000 mg). During this time, work on increasing dietary intake.

Magnesium

Magnesium, a critical mineral, is used in more than 300 bodily functions, and can be obtained through foods such as spinach, oatmeal and mixed nuts. For several years experts have suggested that the quantity of magnesium in the soil has significantly decreased. This, in combination with diets low in whole grains and fresh fruits and vegetables, has led to a general deficiency in the population. Sources estimate that nearly 70 percent of Americans get inadequate doses of magnesium every day.

Magnesium is an all-star nutrient that assists in energy production, maintains healthy bone density and aids the electrical conduction of the heart. Often thought of as food for the muscles, it works as a relaxant to significantly improve cramps. Those suffering from asthma are often given magnesium for its relaxing effects on lung airways.

Through diet and supplementation, magnesium should be considered for anyone with restless legs, fatigue, headaches or constipation. Fibromyalgia, muscle spasms and trigger points involve tight muscles that need to be relaxed. Patients commonly experience these effects due to a lack of magnesium in their diet. Constipation sufferers often hail magnesium as one of the top treatments for regulating the bowels.

Headaches and neck spasms benefit from this nutrient as well. Pain syndrome patients have long felt the benefits of soaking in Epsom salt baths. This remedy contains magnesium, which acts topically to relax muscles. These baths are also comforting for ill children.

There are several forms of magnesium: Magnesium oxide, glycinate, aspartate, citrate, malate and chelated magnesium. Many of these can be effective, though symptom relief will vary with how well the supplement is absorbed. Magnesium oxide is the least expensive and most common form in over-the-counter offerings. If results are not occurring, consider switching to a different form.

Dosage should be based on symptoms. Most patients are started on 2 capsules a day (usually 400-600 mg total) which is then increased by 1 capsule each week until they experience relief. Once symptoms have resolved, the dosage can be maintained at any successful level. The main side effect of magnesium is loose bowels. Certain forms will cause this more than others. Those suffering from this effect should decrease their daily dosage by 1 capsule. Magnesium glycinate is recommended for these patients. It’s advised to start low and gradually increase the dosage until magnesium-related symptoms subside.

How do I know if my symptoms are related to magnesium deficiency?

It’s true most of the symptoms caused by magnesium deficiency have many other potential culprits. Anyone with any symptoms should begin by incorporating a balanced wellness program into their life. Proper nutrition with whole grains, nuts and fresh produce, regular exercise, stress management and a spiritual life, is essential. Despite this, magnesium and other supplementation may be needed. There are two ways to determine if magnesium supplementation is right for you:

1. Have your levels checked. The amount of magnesium in the cells is what’s important. The body does all it can to keep the blood levels normal, so if there is a body deficit, it will be found within the cells. Work with a practitioner that will check your RBC-magnesium level (the level of magnesium in red blood cells), and supplement to achieve a normal level.
2. Magnesium supplementation is safe as long as you listen to your body. Consider the dosing guidelines above and adjust slowly and accordingly to see if symptom resolution occurs.

What are some other indications of magnesium deficiency?This condition causes over-excitability of the cardiac and nervous systems. Feeling the heart beating out of the chest (heart palpitations), anxiety, nervousness and panic are all conditions where magnesium supplementation can be of benefit. Anyone suffering from any cardiac symptoms should first be evaluated by their physician to rule out any other causes.

Sources of Magnesium

Magnesium is an essential nutrient; the fourth most abundant mineral found in the body, with approximately 50 percent found in the bones. Magnesium is needed for more than 300 reactions in the human body, including the production of protein, the production and transport of energy, enzyme function, the contraction and relaxation of muscles, blood glucose regulation, blood pressure regulation and immune system support.

The large majority of magnesium comes from dark green leafy vegetables, such as spinach. The center of the chlorophyll molecule (which gives green vegetables their color) contains magnesium. Fruits, nuts, legumes (peas and beans) and whole grains contribute to the daily dietary needs for magnesium, while refined grains are generally low in the nutrient. In the refining process, the magnesium-rich germ and bran of the grain are removed. Bread made from whole-grain sources provides more magnesium than bread made from white refined flour.

The recommended daily allowance (RDA) for men ages 19-30 is 400 mg daily. Males over the age of 31 are recommended 420 mg daily. The amount of magnesium recommended for females is slightly lower. The RDA for women ages 19-30 is 310 mg daily and 320 mg daily for women over 30. To obtain more magnesium in your diet, try adding the following foods to your daily intake:

• Almonds (1 ounce) = 80 mg magnesium
• Spinach (1/2 cup) = 75 mg magnesium
• Shredded wheat cereal (2 rectangular biscuits) = 55 mg magnesium
• Black-eyed peas (1/2 cup) = 45 mg magnesium
• Long-grain brown rice (1/2 cup) = 40 mg magnesium
• Avocado (1/2 cup) = 35 mg magnesium
• Banana (1 medium) = 30 mg magnesium
• Whole-wheat bread (1 slice) = 25 mg magnesium

The following are some simple ways to obtain magnesium:

• Opt for whole grains; quinoa and cracked wheat (bulgur) are particularly rich in magnesium.
• Snack on pumpkin seeds.
• Sprinkle 1 ounce of slivered almonds on top of your cereal.
• Choose legumes (such as black beans, white beans and soy) as a protein source a few times a week instead of meat.
• Consume 3 servings of low-fat dairy foods every day.

The body’s magnesium levels are influenced by the status of the digestive system and kidney function. Healthy kidneys can limit the amount of magnesium excreted in urine to compensate for a low dietary intake. GI disorders that impair absorption, such as celiac disease and Crohn’s disease, can limit the body’s ability to absorb magnesium. Excessive vomiting and diarrhea can also result in magnesium depletion. Some medications, poorly controlled diabetes and alcohol abuse can also lead to magnesium deficiencies. The best way to obtain magnesium is through a diet that includes a variety of vegetables, legumes and whole grains. If blood levels of magnesium are low or symptoms of muscle spasm or heart palpitations are present, your provider may recommend magnesium tablet supplementation.

Boron

As underappreciated minerals go, boron might just be one of the hardest working members of the group. Despite the lack of awareness, this trace element’s growing reputation for aiding bone health, arthritis and mental sharpness unarguably builds the case for adding it to your wellness program [Source: Harvey].

Because it is a trace mineral, boron is needed in significantly lower doses than the more popular minerals, magnesium and calcium. These two relatives are dietary all-stars when it comes to benefiting the bones and heart. Osteoporosis was generally thought to result from calcium deficiency, but nutrients like vitamin D and boron are now known to be just as important for strong bones [8]. The body also needs boron to better manage calcium, as boron deficiency can lead to extra calcium loss [Source: Nielson].

Arthritis remains a common complaint as people, and joints, age. Most conventional therapies have focused on suppressing inflammation around the damaged joints while nutritional strategies offer additional, safer support for troubled areas. Boron can be added to the existing list of nutritional supplements used to fight arthritis, as it contributes to improved bone health and decreased inflammation [Source: Travers].

The argument in favor of boron includes its support for the aging brain. Higher levels of boron in the diet have demonstrated positive benefits in memory and mental function, compared to boron-deficient diets [Source: Penland]. Higher boron intake has also been proven to reduce the risk of prostate cancer [Source: Zhang].

Foods highest in boron include leafy green vegetables, raisins, apples and grapes. The boron content of any food will depend on the amount of the mineral in the soil. Research has referenced several studies showing correlations between boron content in area soil and the prevalence of arthritis in the local population [Source: Newnham]. This problem is compounded by the fact that nearly three quarters of Americans do not eat the recommended five daily servings of fruits and vegetables [Source: CDC]. Getting adequate portions of these foods not only increases boron intake, but also the other essential vitamins, minerals and antioxidants.

Boron hasn’t necessarily been a nutritional buzzword, but its benefits are certainly worth noticing. It’s an inexpensive mineral supplement that has a solid safety profile [Source: National Academy Press]. Typical doses for boron are 2-3 mg per day, with food. No specific drug interactions are known to occur at this dosage. Patients with a history of arthritis or osteoporosis should strongly consider boron as part of their treatment plan, while those wanting to protect mental sharpness should obtain boron through fruits and vegetables, as well as possibly supplementation.

Potassium

Potassium is an essential nutrient that quietly plays important roles in the body. Though it’s in the limelight far less than other minerals, like magnesium or calcium, potassium supplementation is fairly simple, in that adequate intake can usually be obtained through the diet.

Potassium is needed for cellular communication, which is important for balance of other minerals, such as sodium. Poor diets often disrupt this balance, causing blood vessels to dilate. This means, clinically, potassium plays a vital role in maintaining a healthy blood pressure [Source: Guyton and Hall, Cappuccino]. Those suffering from high blood pressure need to incorporate plenty of potassium-containing foods into their diet. Athletes may experience significant potassium loss through sweat, which can lead to muscle cramps. Compensate by packing snacks that contain potassium to eat before and after workouts.

Foods that are high in potassium include bananas, avocados, beets, cantaloupe, kiwi, milk, oranges and orange juice, raisins, spinach and prunes [Source: NIH]. In fact, it’s hard to pick a fruit or vegetable that does not contain some potassium. By eating foods high in this mineral, you’re also getting protection against heart disease and cancer from the countless other beneficial nutrients.

Certain blood pressure medications may actually deplete potassium. These include diuretics, or “water pills,” such as furosemide (brand name Lasix) and thiazide diuretics (hydrochlorothiazide). Patients on these medications should consider monitoring potassium levels to ensure they don’t drop too low. Some other blood pressure medications (notably, the ACE inhibitors that end in “pril”) can raise potassium levels. Obviously, this can get confusing, so anyone starting a blood pressure medication should ask their doctor how it affects potassium.

Kidney failure affects the body’s ability to excrete potassium, allowing levels to escalate quickly if not treated. Those with kidney failure should not supplement with potassium unless specifically advised to do so.

Blood tests may reveal that potassium levels in the blood are low. This could be due to inadequate potassium intake through diet, losses through sweat or because of medications. Often potassium supplementation is prescribed. Dosage usually starts at 200-300 mg daily. Note that magnesium can help the body absorb potassium. By adding some extra magnesium, potassium levels often respond when prior supplementation yielded poor results.

Keep in mind that getting enough fruits and vegetables now, may lessen the need for blood pressure medication in the future; yet another reason to pack your day full of produce.

Selenium

A powerful mineral that works with vitamin E to function as an antioxidant, selenium should be part of every adult’s daily intake. Oxidation occurs in the body, creating potentially dangerous free radicals capable of damaging cells and causing DNA mutations that can result in cancer cells over time. Preventing this by incorporating antioxidants into nutrition and supplementation is essential for optimal aging. Antioxidants prevent the creation of free radicals and help clean up existing ones. Selenium is also important for the adequate production of the thyroid hormone, and is thought to improve immune function.

Getting appropriate selenium in the diet requires living in an area with adequate levels of the mineral in the soil. Dietary sources include wheat germ, Brazil nuts, meat and seafood. Those consuming the Standard American Diet or taking acid-suppressing medications are most at risk for selenium deficiency. Because selenium is required for the adequate synthesis of thyroid hormone, those with thyroid problems should consider having their levels checked, or beginning supplementation.

Most of the evidence on selenium has been focused on its connection to decreased cancer rates. Other reasons to ensure adequate intake are its possible link with improved immune function and cardiovascular support, although the evidence is less substantial. High doses (900 mcg and above) should be avoided, as toxicity can occur.

General selenium supplementation is recommended, as dietary intake, due to varying levels of selenium in soils, is unpredictable. A daily intake of organically grown Brazil nuts is a great source. It’s easiest to incorporate selenium as part of a multivitamin complex, preferably in selenomethionine or selenium-rich yeast form.

• Those at average risk of cancer: 100 mcg daily
• Those with increased risk of cancer: 200 mcg daily

Can people already diagnosed with cancer take selenium in combination with other cancer-fighting medications?I have not seen any trials with selenium in already existing cancer. My gut tells me that supplementing with 100-200 mcg daily as part of a multivitamin is a good idea, but this should be discussed with your oncologist as some chemotherapies rely on oxidation to kill the cancer cells. Overdoing antioxidants during this time may work against you.

Are there any medications that increase the need for selenium supplementation?Any medications that decrease stomach acid, like the medications commonly used for gastroesophageal reflux disease, may decrease the body’s ability to absorb selenium. People taking these medications for long periods of time should strongly consider supplementation along with a general multivitamin.

Zinc

Long revered for its benefits to the immune system, zinc is now being commended for improvements to nearly all aspects of the body. Adequate zinc intake is a necessary partner to vitamins such as C and E, in addition to other minerals like iron, to provide optimal growth and development.

Many elderly patients, as well as those consuming the Standard American Diet (SAD), will unknowingly have a zinc deficiency that could be weakening their immune system [Source: Prasad]. Improving zinc levels can help restore specific body functions and provide extra ammunition for better immune defense [Source: Girodon, Golden].

The common form of zinc used to ward off colds comes in lozenge form and is most effective when taken at the first sign of a cold, which is true for most nutritional immune boosters [Source: Prasad].

More interesting findings from recent research:

• Zinc deficiency can affect testosterone and sperm numbers, causing a drop in male fertility [Source: Mohan, Abbasi].
• Zinc is needed for proper growth and sexual development of young children [Source: Wagner, Brown].
• Zinc benefits wound healing [Source: Bourdel-Marchesson].
• There have been improvements in markers of malnutrition by treating zinc deficiency [Source: Bates].
• A supplement containing 90 mg of zinc was used with traditional treatment to successfully improve outcomes in bladder cancer patients [Source: Lamm].
• A supplement regimen containing 500 mg vitamin C, 400 IU vitamin E, 15 mg beta-carotene, 80 mg zinc and 2 mg copper has shown benefits in the treatment of macular degeneration [Source: AREDS]. Macular degeneration is a condition of vision loss in the central part of the eye. Options are very limited, so any treatment that stops or slows its progression warrants attention. Please see the article on eye health for further recommendations.

The best sources of zinc are red meat and poultry. Zinc is also present in beans and nuts, but is not as easily absorbed from plant sources, leaving vegetarians at risk of suboptimal levels. In fact, many people in America and throughout the world share this risk for zinc deficiency due to insufficient diets and a general decrease of zinc in available foods [Source: Alaimo].

For most, zinc levels can be maintained through a healthy diet and simple supplementation. Adequate dosage for most adults is 10-15 mg, which can typically be found in a multivitamin. Because high doses of zinc have been shown to cause a loss of copper, daily doses of 30 mg of zinc typically require a pairing of 1-2 mg of copper. Most multivitamins that provide zinc add copper to alleviate this concern. Preferred forms include zinc picolinate or citrate. The lozenge form of zinc should be acetate or gluconate.

Zinc can limit the absorption of certain antibiotic classes, meaning the two should be taken at least 3-4 hours apart [Source: Pai]. A class of blood pressure medications called diuretics (most commonly hydrochlorothizide and furosemide) can increase the body’s excretion of zinc. Those on these medications, and patients older than 60, should consider supplemental zinc.

Though side effects of zinc aren’t common, some patients will experience indigestion if they take the mineral on an empty stomach (this may occur with other vitamins as well). Simply take your supplement at mealtime.

Though zinc supplementation can strengthen the immune system, too much can actually weaken the body. Doses at the levels used for macular degeneration should be done with physician supervision to ensure the proper formulation is given. Patients who suffer from frequent infections should consider discussing the role of zinc with their physician.

Lots More Information

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