The Co-op Food Stores of New Hampshire and Vermont

added 09/08/10

Whether or not you need a multivitamin and mineral supplement (“multi”) depends on many factors. Which foods you eat and which you skip, which fortified foods you consume, your gender, age, activity level and calorie needs all factor into the equation.

Some nutrition experts recommend a multivitamin and mineral supplement for everyone, while others stress the lack of convincing evidence that taking a daily multi actually does any good and the strong evidence that a healthful diet is the key to disease prevention.

There are, however, at least four points that nearly all the experts agree on: 1. Supplements do not replace healthy food choices. 2. There are dangers to overdosing on certain nutrients. 3. A low dose multi is unlikely to cause harm. 4. A multi will not contain adequate calcium, fiber, or the multitude of phytochemicals found in food.

Nutrients from a diet based on healthful food choices have much more evidence of benefit than a daily multi, but a multi or individual nutrient supplement may be helpful in certain situations.

A good multi should fill in the gaps between your needs and the nutrients you get from whole foods and from vitamin and mineral-fortified foods such as breakfast cereals and sports/energy bars and drinks. It should be formulated to fit your needs based on your gender and age. This is a tall order and one which none that I have examined, actually fills.

To begin, let’s look at the gaps there might be in your eating plan to see which nutrients might need a boost and which foods would add the missing links to your day. In most cases, real foods are a better choice for nutrients because of the synergy effect of all the nutrients, known and as yet undiscovered, working together. Also, it’s hard to get an overdose of the vitamins and minerals in foods.

Gap: Not Enough Fruits and Vegetables

If you are not eating the equivalent of at least two and a half cups of colorful vegetables plus two cups of fruit each day, you may be lacking adequate vitamin A (in the plant form of beta-carotene), vitamin C, folate, potassium, and fiber. Also, you are missing healthful phytochemicals that may be as important as more familiar vitamins and minerals at protecting us from disease.

Gap: Not Enough Whole Grains

If you are skipping whole grain breads and cereals, you are missing out on soluble and insoluble fiber, important for intestinal health and cholesterol lowering, selenium, as well as small amounts (that quickly add up) of B vitamins, iron, and folic acid, calcium, magnesium, zinc, and copper. You are also missing out on those naturally occurring, disease-fighting phytochemicals.

Gap: Not Enough High Calcium and Vitamin D-containing Foods

Skipping dairy foods or calcium and vitamin D-fortified foods such as fortified OJ, yogurts, and breakfast cereals can leave you short on these bone-building nutrients.

When Food Sources Aren’t Enough

Sometimes certain diets, such as a vegan or vegetarian diet; certain life stages such as pregnancy or aging; extremely low calorie diets; and certain diseases or medications that cause nutrient deficiencies mean that a specific vitamin or mineral supplement or a multi is needed.

Vitamin B12 Strict vegans who eliminate all forms of animal products from their diet, and those over age 50 who may have difficulty absorbing the vitamin from food may benefit from a vitamin B12 supplement. The recommended daily intake for men and women is 2.4 micrograms.

Folate Adequate folate (called folic acid when in supplement form) is critical for all women of childbearing age to prevent serious birth defects.

A vitamin D supplement is necessary for those: with limited milk intake, who obtain inadequate sunlight exposure (such as those of us living north of Boston), or who absorb vitamin D from the sun inefficiently (older adults, those with intestinal absorption disorders, and sunscreen users). Note: sunscreen use is essential to prevent skin cancer risk.

Calcium as a supplement or in fortified foods is essential for people with lactose intolerance who avoid dairy products, for those with dairy allergies, and for those who do not meet their daily calcium requirement.

Iron is especially important for vegetarians, whose requirement is twice that of omnivores because the body doesn’t absorb iron found in plant foods very easily.

Zinc Vegetarians may also need a zinc supplement since phytates in whole grains and legumes can interfere with zinc absorption.

An actual multi is necessary for those following a strict weight loss diet that severely restricts calories and/or important food groups. For those who have a diagnosed nutrient deficiency, a high dose supplement of the nutrient they lack is essential and should be monitored by a health professional.

Choosing A Multi

Because of all of the different nutrients it contains, a multi must be chosen very carefully. It might contain too much of something you don’t need, such as too much iron in a supplement for men or post-menopausal women, or not enough of a nutrient you do need, such as calcium and vitamin D for strong bones.

If you choose to take a multi or individual nutrients, carefully read the “Supplement Facts” label for the serving size (how many tablets you have to take for one serving) and the amount of each nutrient in the serving. For example, if the serving size is based on three tablets a day and you only take one, you will be getting only a third of the listed amounts of nutrients. Also, check the “Nutrition Facts” labels of the fortified foods you eat such as breakfast cereal, energy bars, shakes and powders because these can also provide added vitamins and minerals.

The Criteria for a Good Multivitamin

A well formulated multi should contain at least 100% of the adult Dietary Reference Intake (DRI) for the nutrients that adults are most likely to have an inadequate intake of: vitamin B12, folic acid, vitamin D, vitamins C and E. They also shouldn’t have unsafe levels above the Tolerable Upper Limits set by the Institute of Medicine. You can find these values at http://iom.edu/ Search for DRI values in the search box.

Calcium, Potassium, Magnesium and Vitamin D- No Multivitamin Measures Up-

No multi contains enough calcium because it would make the pill too large. Most are very low in magnesium and potassium and many contain too little vitamin D as well.

But Food Does!

Calcium is found in dairy foods as well as dark leafy greens and fortified juices, cereals, sport bars and soy products. Magnesium is found in foods such as whole grains, beans, nuts and seeds, fish, and dark chocolate. Potassium is found in foods such as tomatoes, citrus, beans, greens, milk, potatoes, and fish. Vitamin D can be found in foods such as specially fortified yogurts and non-dairy fortified foods such as fortified soy milk, OJ, and cold cereals.

It is always a good idea to speak with a knowledgeable healthcare provider about the supplements you are taking and to tell your doctor so they can be listed in your medical record as some supplements react with medications you may be taking.