Contributed by Dr. Amy Whittington, Trilogy’s Naturopathic Physician

I probably don’t need to begin this article with the declaration that I’m a believer in vitamins. We have great studies on a myriad of nutrients that show efficacy in decreasing symptoms, correcting deficiencies, and treating illness. However, a common question that I get is: what about a multiple vitamin? Should you bother, and if you do, how in the world do you pick between the thousands of choices?

It is first important to note that I don’t put all patients on a multiple vitamin. Often when setting up nutritional regimes for patients, we have a frank and more focused conversation on important things to take care of. I’m more likely to initiate particular support with focused antioxidants, calcium, fish oil, CoQ10, etc. However, I do think that a good multiple can be useful. I often describe a multiple vitamin as the equivalent of an umbrella insurance policy. A lot of people live without them, but if you want to take out the extra insurance to ensure the proper intake of the most common nutrients, then you should take one.

{Insert the most popular response: “Don’t Americans have the most expensive urine because we wastefully take a multiple?”} Well, maybe. Multiple vitamins give you a little bit of everything based on daily values for all of us. You, in particular, are not going to be low in every nutrient, and many of those that you have plenty of will be moved right out of your system. However, the ones in which you are deficient will be kept and used!

So, if there is room in your regime and budget for a multiple, go for it, but do take some time to make sure you are getting a quality one. Step one is to look for quality ingredients. By reviewing a few of the ingredients in a multiple, you can determine whether the producers used high quality components or whether they tended towards cheaper, but less bioavailable, forms. A great place to start is reviewing the B-vitamins. Vitamin B12 should be in the more available form of methylcobalamin versus cyanocobalamin. Folate should be listed as opposed to folic acid, or even better, a reduced form of folate called 5-methyltetrahydrofolate (5-MTHF), which replaces folate even for those who have been shown to have a methylation deficiency (a common inability to process folate that leads to a deficiency and a host of health deficits). In addition to the B-vitamins, a glance at both calcium and magnesium can help to determine quality of ingredients. Calcium is not always included in a multiple, but if it is, it should be as a calcium citrate or malate, versus a carbonate or oxide, and magnesium should be as magnesium glycinate or citrate, versus oxide or stearate. With any multiple, if the scientific vitamin names are not listed (ie. it just says “B12” or “Vitamin C”) you could presume that the cheaper, less bioavailable forms were used.

Even high quality multiples will not contain high amounts of magnesium, and may not include calcium at all. Both of these nutrients are very bulky and tend to be taken separately to get any significant dosage. If your one-a-day (or even two) claims high amounts of either of these, it is a definite red flag. Vitamin D will also not be in a significant amount because of its potential for toxicity, but when included should be as cholecalciferol or Vitamin D3. Because of these variations, it can be difficult to choose a vitamin based on percentages of daily values, but in general, other than those just noted, a good quality multiple will be well over 100% daily value for most nutrients included.

There is usually no need for a multiple vitamin that is specific for men or women. Typically, these will include a small amount of botanical components to help balance hormones. Many people don’t need these, and if you do, the small amount included in a multiple is typically not enough to significantly influence health.

In general, the most vetted supplements are deemed “physician-grade,” and are sold either through physicians or in compounding pharmacies. These nutrients are tested for quality and consistency and meet the highest of production standards. Not everyone has access to these sources, however, and there are some good over-the-counter options. I prefer for patients to shop for their supplements at health food stores versus big box or pharmacy chains, which typically have more poor quality supplements to wade through in order to find the good ones.

In general, I am not a fan of direct-marketed supplements, as they tend to be very hard to vet. When those of us in the field look at studies for efficacy, we look at particular nutrients or nutrient combinations. Nutrients tend to be non-patentable, and as such, no one has a highly vested interest in the study outcome. Studies behind direct marketed, typically noted as “proprietary blends,” are generally on the supplement itself instead of on a specific amount of an ingredient. Even if it looks like a university or independent company studies it, someone had a vested interest in getting not only a study done, but for it to have a positive outcome. There are no magical supplements that only one company is producing, which is why in most integrative physicians offices, you will see and be guided to multiple brand options as long as the correct ingredients are there.

You also probably don’t need a different multiple based on your age. If you are a male or a female over 50, do pick a multiple without iron, as iron supplementation should not be necessary for you and can increase cardiovascular risk. My favorite multiples do add a variety of plant-based antioxidants, which do provide additional anti-aging and cardiovascular protection.

Surveys show that most American diets fall short of satisfying the minimum daily requirements for several vitamins and minerals, even though most Americans certainly don’t have overt deficiencies. A good quality multiple can be an easy way to fill in some of these gaps. Do take the time to research what you are going to use and following these simple guidelines will help ensure you are getting the nutrients you need.

Stay healthy & be well!

-Dr. Amy Whittington, NMD