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Yes, multivitamins can work (but careful which brand you choose)

The supplement industry in the U.S. is a 12 billion dollar behemoth, which means most of us take some kind of dietary supplement, or at least know friends who do.

Maybe you take magnesium for sleep, or fish oil to quell inflammation. Whatever the case, you want to know you’re taking the best quality product and that it’s having a positive impact on your health.

Enter the multivitamin, which offers the promise of complete nutrition in a pill. Very tempting, and the sales pitch is usually that you cover all the holes in your diet with the broad spectrum approach of adding every micronutrient known to man in one formula. It makes sense in theory, but my concern is actually just the opposite – that I would be getting large doses of stuff I don’t need, at least not in the amounts packed into my multivitamin.

For example, most multivitamins contain large doses of Vitamin A. It’s not a concern of mine, but large doses of Vitamin A supplements in the form of retinol have been linked to increased risk of bone density loss and hip fractures. An older woman taking a multivitamin with a high Vitamin A count could be negatively impacted.

Another issue is the quality of ingredients. Many supplement providers are white labelers, meaning they slap their logo on someone else’s formula, or they are small fish, forcing them to use cheap ingredients to make a margin.  B12 and folate are two ingredients where many of them cut corners. Cyanocobalamin is a cheap form of man-made B12 that makes its way into many multivitamin brands as does folic acid, or synthetic B9. Folic acid is a real problem for people with MTHFR “mutations” as they don’t do a good job of converting folic acid into a form of B9 the body can use effectively. There is evidence that methylcobalamin is better absorbed than synthetic B12.

So, yes, not all multivitamins are created equal.

How then can consumers decide between brands?

As we did with our popular review of fish oil supplements, we went back to our “Industry Insider,” a friend of mine who works at one of the best supplement manufacturers in the country, to ask him how the “sausage is made.”

Industry Insider Interview

What are most multivitamins made with? What percent is just filler?

Beyond the obvious vitamin and mineral component, depending on the dosages of ingredients, specific raw materials being used, manufacture philosophy, and tablet vs capsule, “other” ingredients can vary. In the case of capsules, powder filling the capsule must have consistent flowing characteristics and capsules must be mostly full to guarantee consistency from capsule to capsule. The use of excipients (flow agents, lubricants, fillers) is necessary to maintain flow and fill of powders to ensure friction does not harm either the nutrients or the manufacturing equipment. These ingredients include: silica, microcrystalline cellulose, magnesium stearate, etc. Tablets generally contain more of these “other” ingredients and require additional binders, disintegrants, and coating agents.

I would estimate that your run of the mill multivitamin; fillers, flow agents and lubricants might make up 0.5% to as much as 5% of the total capsule by weight. Tablets are going to require a lot more “extras” including; binders, disintegrants and coating agents. These are not harmful substances but are more demanding of the digestive tract. Unless there is a specific reason for a tablet, like bypassing gastric acids (applicable to something like proteolytic enzymes) I would always opt for a capsule, which will breakdown faster, allowing access to the nutrients.

A simple eye test would be to drop a capsule and a tablet side by side in a warm glass of water and see which breaks down faster.

Do multivitamins have impurities?

Reputable manufacturers should have robust quality control measures in place (raw material testing, quality checkpoints throughout the manufacturing process and extensive post batch testing) to ensure that no impurities exist in the finished product. While it is not unheard of, supplements of any kind should not contain any impurities.

How old is most multivitamin inventory?

I can’t say… most vitamins and minerals are pretty stable. Again, reputable manufacturers should be doing post batch stability testing allowing them to verify label claims at the date of expiration. As long as the product is consumed within this therapeutic window, you can be relatively sure you are getting what is listed on the supplement facts box. Having said that,  there are rumors that certain big brands don’t do post batch stability testing, so you can never know for sure unless you really vet your supplier.

What is post batch stability testing?

Post batch stability testing is the process of verifying the levels of ingredients in a formula at multiple points in time. All raw materials degrade over time, some faster than others. Vitamin C, for instance, has a degradation rate of 14% over a (12) month period, in an ideal climate. Probiotics might degrade at a rate of closer to 50% over a (12) month period, again in an ideal climate, while a mineral will be significantly more stable.

Stability Testing validates that a product contains, at a minimum, what the supplement facts box claims it does at date listed on the bottle. This date will either be an expiration date or a manufacture date. The FDA does not require supplement manufacturers to date products with an expiration date the way they require a drug company (and validate label claim at this date). Supplement manufacturers, if they choose to, can get away with labeling a product with a “Born on” or “at time of manufacture” date. In this instance, the manufacturer is responsible for nothing more than what the label claims on the day of manufacture. These products likely DO NOT contain what the label claims even 1 or 2 months after this date. This is very common in the probiotic marketspace as they tend to contain more expensive raw materials and in order to account for degradation rates, which is something you must do to meet label claim at the expiration date, a manufacturer must manufacture the product with intentional overages (an additional cost). You always want to be sure your formula contains an expiration date to ensure you are getting the levels of nutrients listed on the bottle.

What makes one multivitamin better than another?

The quality of raw materials is a big one. Also, the forms of vitamins and minerals and therapeutic dosages… more isn’t necessarily better, but you’ll want to ask if the multi-vitamin contains relevant levels of critical nutrients difficult to get depending on your diet (Vitamin D, Vitamin K2, folate, magnesium, selenium).

I would definitely opt for capsules over a tablet and make sure your multi has an expiration date and not a manufacture date (MFG).

USP grade vitamins are a good place to start to validate the quality of a formula, however, vitamins and minerals with poor bioavailability can be USP grade. Minerals are always the starting point for me when determining the quality of a product. If you can, avoid words like: carbonate, oxide, chloride and aspartate. These cheap mineral salts are generally larger molecules that have low bioavailability and can cause GI upset. Ideally, you want to seek out a product that contains Albion mineral chelates which have superior bioavailability and very gentle on the GI tract.

Are there any “must have” multivitamin ingredients to make sure I have?

This would depend on one’s individual needs and would largely be dependent upon diet and lifestyle. For the average health conscious individual, I would look for something with relevant doses of: Vitamin D3 (at least 1,000 iu), Vitamin K2 (ideally as MK-7, at least 40 mcg), Folate (ideally as a glucosamine salt), and Magnesium (~200 mg). These are very foundational nutrients that, even in someone who eats a well rounded diet, for one reason or another, are often deficient.

The 5 Rules for Multivitamin Quality

Ok, so based on that interview, we distilled our Industry Insider’s information down to 5 rules to follow for both men’s and women’s multivitamins. We will use these rules to pick a winner in both categories.

  1. Conservative dosing of controversial nutrients
  2. Capsule not tablet
  3. Expiration date not manufacture date
  4. USP grade vitamins
  5. Quality B vitamins as a proxy for overall high-end ingredients and no carbonate, oxide, chloride, and aspartate in the mineral blends.

As a 6th rule, you could also throw in the absence of probiotics as they are unlikely to retain potency in the multivitamin formula.

Picking a Winner

Well folks, as we dug into the products available on the market, this was a tough one. Some of the highly ranked multivitamins on sites like Lab Door, such as Rainbow Light Men’s One (which has very attractive branding) use cyanocobalamin, folic acid and the minerals are all bound to oxides and carbonates (cheap and not good for the tummy).

Garden of Life Vitamin Code for Men contains only 17mg of magnesium (not clear the type) in 4 pills! The Vitamin C in the product is not USP grade. I couldn’t tell from the labeling what form of B vitamins they are using and they throw all sorts of probiotics in the mix, even a small dose of S. Boulardii. According to an iHerb listing, the product has an expiration date.

Oy Vey.

Pass.

You can pretty much take every single multivitamin listed on the Lab Door site and throw them all in the garbage. Another highly rated men’s multivitamin, Nature’s Way Alive “Max Potency,” also uses low-quality folic acid and B12, and you guessed it, their magnesium dose is in the form of magnesium oxide. The Vitamin C is not USP grade, nor are any of the other ingredients. The calcium is calcium carbonate and the dose of Vitamin A is huge at 300% of daily value. On the bright side, this product does appear to have an expiration date.

I like the Now Foods Adam Men’s multivitamin’s conservative dose of B12 at 120 mcg (for more on B vitamin dosing check out this blog post), but the blend is a combination of the low-quality cyanocobalamin and the higher quality methylcobalamin. Magnesium is magnesium citrate, which isn’t terrible. I couldn’t see an expiration date but they were using a mineral chelate system, so this was the best of a fairly rotten bunch I saw over at Lab Door.

After hunting around and reading what seems like the same label over and over, I found what I believe is the best multivitamin on the market, and it doesn’t come as a surprise that it’s made by Thorne, one of the best supplement manufacturers available to non-medical professionals (I also like Ortho Molecular, but they only sell to doctors).

Thorne as a brand is NSF, cGMP and TGA certified.

Why do I like the Thorne Multi Vitamin Elite?

Well, let’s put the ingredients through our 5 tests:

  1. The Thorne product has a relatively high dose of Vitamin A (wish they would just leave it out), and they blend in beta carotene to offset the retinol. Despite the research linking beta carotene to increased risk of cancer in some groups of smokers (the same risk was not found in non and former smokers), the dose in the Thorne product is larger than in the smoker studies, which were in the range of 20-30mg. The Thorne product has about 60 mg of beta carotene alone, BUT try to find a multivitamin without Vitamin A, they all include it, so this issue is a wash. Nevertheless, the B vitamin doses are more conservative and Thorne uses methyl B12 instead of the synthetic form, as well as methyl folate rather than folic acid, so some kudos are in order there. This discussion on dosing is part of the reason why it’s probably a good idea to cycle on and off of multivitamins (if you decide to take one at all).
  2. The Thorne product is in capsule, not tablet form.
  3. Thorne products use expiration dates, not manufacture dates.
  4. Thorne uses some very high end ingredients, including a special Curcumin blend, but from what I can see, the ingredients are not USP grade.
  5. As I mentioned, the B vitamins are the highest quality, as are the other ingredients. For example, our industry insider warned us against cheap minerals in multi-vitamins and he even went as far as to say that he uses the minerals as a big part of his analysis as to whether a product as a whole is top shelf. In this case, Thorne uses all Albion mineral chelates which have superior bioavailability and are very gentle on the GI tract. Box checked there.

John O'Connor

John O'Connor is the founder of Gene Food and an Integrative Health Coach, trained at Duke IM. He lives in Austin, Texas.

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