Multivitamins: Your Insurance Policy for an Imperfect Diet
What you need — and don't need — to boost nutrition.
There’s plenty of information out there to help us make healthy eating choices. But with our busy lifestyles and those eating habits we just can’t break, we may not be getting all of the vitamins and minerals we need.
That’s why there are multivitamins.
“I think of multivitamins as an insurance policy against an imperfect diet,” says Michael Roizen, MD, Chairman of Cleveland Clinic’s Wellness Institute.
Any multivitamin is better than none
There are multivitamins for men, women, young women, seniors and people worried about specific diseases, such as heart disease and macular degeneration. But are specific formulations really necessary?
“For most of us, taking half of any multivitamin twice a day — morning and night — is good,” says Dr. Roizen.
Tips for older men and women
“Men and women over age 50 can take the same multivitamins,” he adds. Formulations for men may not deliver on their promises. “Men’s vitamins often have ingredients touted as good for prostate health, but randomized data do not show that these make an important difference. Let’s call it a potential difference,” says Dr. Roizen.
Lutein, an element added to protect against macular degeneration, the most common cause of vision loss after age 55, may not be necessary. “If you eat a green leafy vegetable or two every day — and I hope everyone eats a fistful of broccoli every day because it also has anti-cancer effects – you get plenty of lutein,” says Dr. Roizen.
Advice for young women
On the flip side, Dr. Roizen feels that all younger women should take a prenatal multivitamin because 50 percent of all pregnancies are unplanned. Prenatal multivitamins have folate and other ingredients needed by pregnant women. Most contain DHA, the omega-3 fat needed for brain and eye development, for example.
Young women also tend to be iron-deficient, so vitamins with extra iron are available. However, Dr. Roizen suggests taking iron supplements instead. “It’s important to take iron several hours apart from calcium and vitamin C,” he explains.
Check the amounts on the label
Because the ingredients in multivitamins are found in different amounts, verify that your vitamin contains the recommended daily amount of calcium, vitamin D and magnesium.
“Ideally, you should ingest 600 mg of calcium, the most your body can absorb at one time, plus 200 mg of magnesium and 500 IU of vitamin D two times a day,” advises Dr. Roizen. “And I advise my patients to take the vitamin D with 2 grams of fish oil or 600 mgs of DHA, since vitamin D and all fat-soluble vitamins are absorbed better when taken with some fat.”
Then split your multivitamin down the middle, and take half in the morning and half at night. “You urinate out soluble vitamins in 12 to 16 hours, so this will keep the level in your body steady,” says Dr. Roizen.
One a day means just that
Do not take two multivitamins a day. “That would give you too much of certain vitamins such as A, and too much A can increase bone demineralization, and risks of liver cancer as well as lung cancer in smokers,” he says.
Published September 2009
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Comments
Pre-natal vitamins for all young women
Submitted by VM (not verified) on Thu, 09/30/2010 - 13:13.
I have a serious problem with Dr. Roizen's advice that all young women should take a pre-natal vitamin as their daily multi "because 50% of pregnancies are unplanned." He then later notes that one should be careful not to take too high a dose of certain vitamins (although his list is in no way exhaustive).
Pre-natal vitamins generally contain higher doses of vitamins/minerals (including iron) than regular multivitamins, for obvious reasons. Just because a woman has the physical ability to become pregnant does not mean that she needs to expose herself to unnecessarily high doses of vitamins/minerals on a daily basis for no reason. Pre-natal vitamins should be taken once pregnancy is confirmed (or perhaps at least suspected).
I also agree with the commenter who said that iron levels should be checked prior to beginning iron supplements. Women on the pill, etc., will have varying iron levels and may not need supplements at all. Taken without supervision, iron supplements can be dangerous. This article really should be modified to present facts in a less misleading way.
Since less than 1/10 of 1% of
Submitted by Clevelandclinic... on Fri, 10/01/2010 - 15:44.
Since less than 1/10 of 1% of the 26 million people who took the nutritional test on RealAge.com get the right amount of vitamins and minerals from diet (it is possible but it is usually unlikely) I believe it prudent all take half a multi vitamin morning and night as an insurance policy against an imperfect diet. The reason this should be a prenatal vitamin when a woman might potentially get pregnant is that fetal brain development is dependant on the mother’s nutrition 3 months before conception. The risk of a prenatal vitamin to most non pregnant woman is negligible while potential damage to fetal brain development due to lack of these vitamins is great. It seems easiest to make the half of the multi vitamin you take during the potentially pregnant years to be a prenatal vitamin — the non prescription varieties cost little more than a regular multi but add DHA and the iron of which most women are short. Your point about getting an iron test is absolutely appropriate if you have the wherewithal to pay for that test. — Michael Roizen, MD
Purity of calcium supplements
Submitted by Anonymous (not verified) on Mon, 07/05/2010 - 11:06.
Dr Roizen, how can we be confident that the over-the-counter calcium supplements that we purchase in our local health food stores, are consistently providing the levels of vitamin that they represent, considering they are not FDA approved and unregulated?
Alos, have you reviewed any manufacturers and would recommend any particiluar manufacturer that may have higher quality control over others?
Thank you kindly - Rob
I've the read the article on
Submitted by Anonymous (not verified) on Thu, 07/01/2010 - 12:17.
I've the read the article on multivitamins, even though there are no data shows the data, I still would like to take supplements every day. What do you recommend? 26 years of age, i want all of my nutrients, i want to reduce illness, i want good memory for if i make it old etc.
Where is the evidence that
Submitted by Anonymous (not verified) on Fri, 02/19/2010 - 10:40.
Where is the evidence that people who eat healthy diets and take no vitamins are worse off than people who eat healthy diets and take vitiamins OR people who eat unhealthy diets and take no vitamins are worse off than people who eat unhealthy diets and take vitamins?
So much biodiversity in human beings. Where is the evidence that vitamins help already healthy people live longer, stronger lives?
The money people waste on vitamins could be spent on a juicer and vegetables.
Healthier or not healthier is
Submitted by Anonymous (not verified) on Mon, 09/20/2010 - 19:30.
Healthier or not healthier is hard to prove even with clinical trials.
Heres a simple way to reflect upon your question:
1) Think back to only ONE DAY in which you had your healthiest meals.... JUST 1 DAY!! (if you dont eat healthy meals... then the healthiest person you know).
2) Would all the different fruits and Vegetables you (or they) consumed that day give you a little bit of all the vitamins and minerals your body needs on a DAILY basis to function?
3) Would a once daily complete multivitamin?
4) Now what if you split the "one a day" and ate 1/2 with each meal (lunch and Dinner)??
Yes it is always better to eat healthy, but in todays fast pace society its quite possibly impossible. Sure fruits and vegies give you fiber but there are supplements for that too. To get the same amount of vitamins and minerals that are in a complete multivitamin, one would have to eat a small piece of every known fruit and Vegi at every lunch and dinner not just one or the other. Most people fail to realize that a simple salad isnt going to cut it, not without a supplement. You need to be hardcore, like eat a bite of everything in the grocery store..... OK i might be exaggerating a bit there LOL. Currently being in the hectic curriculum of medical school, I think its simpler for me AND healthier to have my subway and 1/2 my ONE a DAY!!
By the way my generic multivitamins cost me less then $10 and last almost a year....
Response
Submitted by Clevelandclinic... on Thu, 02/25/2010 - 11:32.
There are no data — the studies haven't been done — so we must choose what is logical. Because 99.85 percent of Americans do not get their daily value of vitamins and minerals from their diet (according to self-reported dietary questionnaires), vitamins seem like a reasonable and inexpensive alternative. It costs less than $15 for a bottle of multivitamins (split into half in the morning and half at night), plus calcium and magnesium. There is plenty of evidence of a health benefit from spending another $10 a month for vitamin D3 plus $20 a month for DHA or fish oil (if you do not eat salmon or trout).
Finally, plenty of studies show that for selected groups, the benefit of taking two baby aspirins (or half a regular aspirin as I prefer) every day is greater than the risk, and costs just $6 for a six-year supply. — Michael F. Roizen, MD, Chairman, Cleveland Clinic Wellness Institute
I can only speak for myself,
Submitted by L (not verified) on Fri, 02/19/2010 - 17:37.
I can only speak for myself, but since I've been taking 5,000 IU of vitamin D a day, I haven't had a cold -- even the sniffles -- or the flu. It's been two years, and I've never felt healthier! Some vitamins, such as vitamin D, are too hard to get through food sources so a supplement makes sense. I also take high doses of B vitamins for energy. I think the bottom line is that you have to know your own body.
Correction
Submitted by Daisy1 (not verified) on Mon, 01/03/2011 - 17:47.
I meant I000 IU not mg in my reply... used mg when I should have used IU... sorry.
Vit D
Submitted by Daisy1 (not verified) on Mon, 01/03/2011 - 17:42.
I recently had a blood test for Vit D levels. It came back that I was on the border line of needing an increase. So I went from taking 1000 mg to taking 2000 mg. After about 4 months of 2000 mg, I started to have signs of an overdose taking place in my body. I had all the symptoms of vit. D overdose. I have since stopped taking all vitamins and let my body regain its normal levels then start taking 1000mg and see how my body does with that level. The overdose affected my eyes to the point I had to see the eye doctor. It also effect my body in a way that I was becoming dehydrated.
I am ok now .. but will watch all vitamins I take in the future.
flaxseed oil vs fish oil
Submitted by Anonymous (not verified) on Mon, 01/11/2010 - 15:53.
I've read that flaxseed oil is preferred over fish oil. If it is, could you tell me why, and what is the recommended intake?
Flaxseed oil has many health
Submitted by Clevelandclinic... on Wed, 01/13/2010 - 13:01.
Flaxseed oil has many health benefits, but fish oil is the superior supplement for cardiovascular health.
Flaxseed oil is a good source of the polyunsaturated fat Alpha-Linolenic Acid (ALA). ALA is converted into two essential fats that have been studied for their role in preventing heart disease. There is ample research to show that diets rich in ALA (not specifically from flaxseeds or flaxseed oil, but also from foods such as walnuts, canola oil, leafy greens and soybean oil) are linked to lower rates of cardiovascular disease, as well. But the conversion of ALA to these essential fats in the human body is very poor, so some of their many benefits would not be realized if you took only a flaxseed oil supplement.
Instead of limiting yourself to flaxseed oil, which contains only the ALA, consider adding ground flaxseeds to your diet. The ground version of this tiny, versatile seed is great sprinkled over cereal, oatmeal, in muffin or bread recipes, or over sauteed vegetables. Flaxseeds are a good source of dietary fiber and contain some soluble fiber to help lower cholesterol; are a source of the already mentioned ALA; and are also a source of lignans, which have some cancer-fighting benefits.
So enjoy flax, along with walnuts, canola, soy, and leafy greens, with some oily fish each week (or a fish oil supplement) and rest assured you are two steps closer to a healthier heart.
— Melissa Ohlson, MS, RD, LD
Multi vitamins the same for men and women?
Submitted by Anonymous (not verified) on Wed, 12/09/2009 - 18:25.
I thought the one significant difference, is that men's vitamins remove the iron supplement, which is detrimental if you're not menstruating every month?
Not being over 50 yet, perhaps women's vitamins also remove the iron supplement at that point.
Multi's & too much A
Submitted by Anonymous (not verified) on Wed, 10/14/2009 - 17:16.
I cannot find a multi that does NOT have too much Vitamin A. Why is that? What can you recommend? Please advise.
Most
Submitted by Clevelandclinic... on Mon, 11/30/2009 - 11:20.
Most multivitamin/multimineral supplements have between 50-100% of the % Daily Value. Not sure what you consider “too much,” however the Reference Daily Intake, which appears as the “% Daily Value” on the label, established for adults and children four or more years of age is 5,000 international units (IU) based on a calorie intake of 2,000 kcal per day. — Cindy Moore, MS, RD, LD, FADA
Multivitamins: amts on the labels
Submitted by Anonymous (not verified) on Wed, 09/09/2009 - 22:01.
Not only does the multivitamin I have not meet Dr. Roizen's recommendations, I would have to take about 8-10 pills a day to meet them (breaking rule to take only one a day). The fish oil supplement has 1200 mg of fish oil and DHA 144 mg, EPA 240. Where is this product and where can I get it? (Centrum Cardio and Nature's Bounty fish oil are the ones we use now)
Vitamins
Submitted by Renney (not verified) on Thu, 01/07/2010 - 21:56.
You might want to check out Purtian Pride (maker of many vitamins and supplements). I have been using them for years and find them to be trust worthy and efficient. Their site is : www.Puritan.com.
A Multi to meet Dr Roizens reccomendations
Submitted by Anonymous (not verified) on Thu, 12/10/2009 - 13:46.
I take Vemma. It's a liquid multivitamin/multimineral, Then I add fish oil to that. From what I've heard Dr. Roizen had some input in the formulation of Vemma. but don't quote me on that...anyways from what I've seen its the best multi out there.
Article: Multivitamins: Your Insurance Policy for an Imperfect D
Submitted by Jerry (not verified) on Wed, 09/09/2009 - 14:00.
In the article: "Multivitamins: Your Insurance Policy for an Imperfect Diet" it says: “Ideally, you should ingest 600 mg of calcium, the most your body can absorb at one time, plus 200 mg of magnesium and 500 mg of vitamin D two times a day,” advises Dr. Roizen. “And I advise my patients to take the vitamin D with 2 grams of fish oil or 600 mgs of DHA, since vitamin D and all fat-soluble vitamins are absorbed better when taken with some fat.” This is obviously wrong for Vitamin D. 500 mg of Vitamin D is 20 Million IU (International Units). That is 50 Thousand time the Recommended daily requirement of 400 IU.
Correction
Submitted by Clevelandclinic... on Thu, 09/10/2009 - 10:17.
The article incorrectly listed "mg" when it should have said "IU" in relation to Vitamin D. We regret the error and have made the correction.
Thanks for reading.
Multivitamins
Submitted by Bob W (not verified) on Wed, 09/09/2009 - 13:26.
As a user of multivitamins for over 50 years I think Dr. Roizen provides very good advice. My only complaint is that I cannot find any commercial source of multivitamins that meets his recommendations for calcium, magnesium and vitamin D.
I have been looking for a
Submitted by Anonymous (not verified) on Thu, 02/11/2010 - 16:41.
I have been looking for a good multivitiman adult or womens that is smaller and easier to swallow. Any suggestions?
Natural Multi Vitamins
Submitted by Carmen (not verified) on Thu, 09/10/2009 - 09:41.
Hi,
I'm currently taking twice a day a pack of natural multivitamins. One is omega 3, Calcium and 2 Multivitamins. I take them in the morning and Lunch time, but I leave the calcium for evening.
I'm I over using these vitamins. This is part of a Womens wellness program to improve my metabolism and energy level. Please advise, I'm concern about the liver and lung function.
Thank you for your advise.
Carmen
Please keep in mind that
Submitted by Clevelandclinic... on Mon, 11/30/2009 - 11:21.
Please keep in mind that nutrition supplements should be just that — supplements to a well balanced diet. Dietary needs may not be met by our food choices, and then supplements can help to improve our intake. Depending upon your stage of life, calcium needs range from 1000-1300 mg daily. If food sources, such as low fat dairy or fortified soy products, almonds, broccoli and other fortified foods are not consumed in sufficient quantities, a calcium + vitamin D supplement is wise. Omega 3’s are found in fatty fish such as salmon, mackerel, trout and fortified eggs. If these foods are not eaten frequently or at all, supplemental omega 3 fatty acids are beneficial. Studies on multivitamins have not shown conclusively that they improve health. In some populations, such as older adults, multivitamin/multimineral supplements may provide some protection since calorie needs are less because of reduced muscle mass, activity and absorption. It would be a very rare occurrence for someone to need two multi’s on a daily basis, and this should be discussed with your physician. — Cindy Moore, MS, RD, LD, FADA
Taking vitamins and having chronic kidney disease?
Submitted by Ernie (not verified) on Wed, 09/09/2009 - 11:26.
What is good advice for a person with stage 3 ckd regarding vitamin pills?
A vitamin designed to meet
Submitted by Clevelandclinic... on Mon, 11/30/2009 - 11:22.
A vitamin designed to meet the needs of individuals with chronic kidney disease is recommended when someone progresses to stage 3. This multivitamin should have no or lower levels of minerals and smaller amounts of vitamins A and C than in other multivitamin supplements. Vitamin D (D3) is now recommended. — Cindy Moore, MS, RD, LD, FADA
A very good fish oil is
Submitted by Anonymous (not verified) on Mon, 09/06/2010 - 01:10.
A very good fish oil is Ascenta EPA DHA,I take a teaspoon a day.As for Multi-Vitamin-I take Dr. Weil's Multi.For those unfamiliar with Dr. Weil i highly recommend you check out his website.
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