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Multiple Vitamin

Multiple vitamin formulas are now the most commonly used nutritional supplement. "What's the best multiple?" is a question I hear frequently. Because one size doesn't fit all, my response goes something like this: I measure the "best," not in terms of quality or quantity of ingredients, but rather how well it "fits," or matches, an individual's existing nutritional levels. The best quality ingredients, if not properly matched to the individual's actual need, quickly becomes the worst. Would you add oil to your car without first checking the dipstick? The same goes for adding supplemental vitamins to your body. This question of the best multiple is best answered, therefore, by professional nutrition testing. The best advice is to first establish a nutritional baseline/profile and then select a vitamin accordingly. Having tested thousands of individuals over the past 15 years in practice as a clinical nutritionist, certain recurring themes have emerged. I've translated some of these trends into general guidelines here for selecting a multiple vitamin-mineral formula. Still, there is no substitute for an individualized supplement program based on a comprehensive personal nutrition evaluation.

Avoid single-dose, one-a-day type products. 

Just as we do not eat just one meal per day, so we should not take a multiple vitamin only once. Just as a garden is more effectively watered with a trickle hose than with a fire hose, balanced nutrition is best accomplished in a "timed-release" fashion, where the body's cells have adequate time to "drink up" supplied nutrients - be they from food or pills. Supplements are just that: designed to fortify, not replace, the food we ear. For this very reason, so-called Timed-Release vitamins have over the years been popular. However, such products, no matter what the label claims, will last only 10 hours at best. The only way to really cover yourself nutritionally around the clock is to divide the total dosage at least once, taking the supplement at two different times, say breakfast and dinner. Rather than a "mega-dose" type of product, look for a multiple that requires two to six tablets to supply the full dosage. This not only allows you to divide the dosage into smaller, more frequent servings, but also to exercise greater flexibility of potency, using more on high-stress, low-quality food days and less on days when you're able to eat well. Additionally, such products tend to be more complete since a vitamin manufacturer can cram only so much into one pill. By the way, while some minerals and certain specialty supplements are best taken on an empty stomach, most vitamins, including multiples, are better utilized and better tolerated when taken with food, during or after a meal.

With or without iron?

 Iron is a "fine-line" mineral; essential and nourishing up to a point, past which it can be as toxic as lead and as damaging as a lack of antioxidant protection. In fact, if one has a normal blood iron level, any amount of supplemental iron will have pro-oxidant, cell-damaging effects promoting such conditions as cancer, heart disease, arthritis, inflammatory disorders, and other degenerative diseases. Although true iron deficiency still remains one of the greatest medical myths, iron overload is actually more common; that is, when definitive and differential blood testing is adequately performed. (Hematocrit alone is not sufficient to determine iron deficiency.) Several studies show that even in groups who are at risk for iron deficiency such as pre-menopausal and pregnant women, and athletes, when actually tested, they turn out not to be deficient. Men and postmenopausal women even more rarely  need iron - even the relatively small (5-15 milligram) amounts commonly found in most multiples. I'm appalled when patients tell me they've been taking 300 milligrams of iron for two years and were never instructed about how long to continue nor about re-testing. A list of iron-free multiple vitamins and proper blood testing procedures is available from Nutrition Resource.

Tip the calcium balance in favor of magnesium.

Although calcium seems to get all of the attention, deficiencies of magnesium are increasingly common. Both in clinical research and the mineral testing in my own practice, we actually find more deficiencies of magnesium than of calcium. In fact, building healthy bones requires not one, two or even three minerals, but the proper balance of 28 different minerals. Overall mineral balance is far more important than the quantity of any single element. No one nutrient ever works alone. Traditionally, the ratio of calcium to magnesium has been 2 to 1 (two parts calcium to one part magnesium). Yet, newer research confirms that a 1 to l ratio is more effective for virtually everyone. In some cases, where individuals have been tested, a reverse ratio of 1 to 2 (one part calcium to two parts magnesium) is indicated. While most multiple vitamins on the market today still over-emphasize calcium, some supplement manufacturers are catching up to the idea of equal parts. Ultimately, individual mineral testing is your most accurate guide. Also, keep in mind that multiple vitamins contain relatively low levels of these minerals. Often, a separate cal-mag formula is necessary for some people. In this case only professional-quality brands contain equal parts.

Have a professional Dietary Analysis performed to determine the nutrient composition of the foods you eat, since it is your diet that is being supplemented.

While testing of actual body tissue nutrient levels is ultimately the most reliable way to determine individual supplement needs, a dietary analysis cannot be overlooked, and is usually the first step when tailoring vitamins. The results of one of my favorite Dietary Analysis report shows a listing of every imaginable vitamin and mineral, including important ratios, in two separate columns: one reveals the nutrient levels of the foods only, while the second column combines nutrient values for food plus any supplements used. This makes it obvious how one's supplement either complements, or conflicts, with the nutrition supplied by the diet. A free sample report of a Dietary Analysis is available from Nutrition Resource

Use the Multiple Vitamin Worksheet

The Worksheet contains a comprehensive model formula that serves as a standard of comparison. Several different columns are provided with ingredient-by- ingredient listings. Next to each different product listing is a blank column allowing you to enter the product you're using (or considering) to compare it against this standard of completeness. Copies of the Worksheet are available from Nutrition Resource or by clicking here.

The above mentioned literature is available individually or as part of a complete information packet entitled "Nutrition Evaluation for Sensible Supplementation." Call Nutrition Resource (360) 770-8486 to request copies.

Karl J. Mincin is a clinical nutritionist who specializes in nutrition assessment, the process of evaluating individual nutrient needs. He operates Nutrition Resource, a specialty vitamin & herb store and professional consulting services. Karl may be reached at (360) 770-8486.