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Multiple Choice: The Vitamin Debate

Should you pop at least one pill every morning? Or do vitamins offer only a false sense of security? Here's how to get the daily nutrients you need.

By Sally Kuzemchak, R.D.

Q. I eat a healthy diet. Do I really need to take a multivitamin?

If your eating habits are stellar—you consume a wide variety of foods from all food groups, including whole grains, protein sources like lean meat, poultry, or fish, low-fat dairy products and nine servings of fruits and veggies daily—you may not need a vitamin. When it comes to getting nutrients, "food first" is the best course of action. "That's because foods contain important components that you don't always get in a pill, such as disease-fighting phytochemicals," says Rosalyn Franta Kulik, R.D., author of the American Dietetic Association position paper on fortification and nutritional supplements. Real health benefits, such as lower cancer risk and stronger bones, probably come from elements in foods working together—such as calcium interacting with protein in milk, or vitamin C and folate with the fiber in broccoli. In a recent study, postmenopausal women who got most of their calcium from foods had higher bone density than those who relied on supplements.

But the reality is, between busy schedules and bad choices most people don't eat well every day. The latest government food surveys show we're falling short—especially on magnesium and vitamins A and C found in fruits and vegetables, and vitamin E from nuts and seeds. A multivitamin can pick up some of the slack.

"Taking a multivitamin provides some nutritional insurance," says Paul Coates, Ph.D., director of the National Institutes of Health Office of Dietary Supplements in Bethesda, Maryland. "But it's not a license to eat poorly." A reasonable compromise: Aim for a healthy diet, but pop one vitamin on the days that well-rounded nutrition isn't happening. And rest assured that a basic multi is considered safe—whether or not you really need it.

Q. Can taking a multivitamin give me more energy?

It can help if you're lacking in certain nutrients. The body acquires energy through calories—and although vitamins and minerals don't contain any calories, they do play a key role in energy production. The B vitamins—such as the folate in asparagus and the riboflavin in milk—help release energy from foods for the body to use, so skimping on those can make you sluggish. You can also feel tired and weak if you're iron deficient, because iron helps bring oxygen to cells, where it's used to create energy. Women are more prone to having iron-poor blood, thanks to losses through menstruation and lower intakes of iron-rich foods such as red meat. "If you can undo these deficiencies, through diet or a supplement, you'll definitely feel perkier," says Kulik. But before you load up, keep in mind that exceeding the recommended amount of any vitamin or mineral won't lift your energy level to greater heights.

Q. Should I buy a "special" multivitamin, like a women's formula or one for heart health?

Taking a gender-specific vitamin makes sense. Women's formulas often have extra calcium, folic acid, and iron. And while basic multis contain iron, which women need, men tend to get enough through food. Extra iron can be dangerous for males if they have hemochromatosis, a condition that can damage the liver and heart. So men might be better with a men-specific formula. Otherwise, these special multis are mostly marketing, says Tod Cooperman, M.D., president of ConsumerLab.com, which evaluates health products. When pills pack extra ingredients, such as lutein for eye health, it's hard to know whether the amount is enough to make any real difference.

Q. Do my kids need a multivitamin?

Skip it if your child's a great eater who likes lots of different foods—including dairy products, fruits, vegetables, grains, and protein-rich and fortified foods. But talk to your pediatrician if your child is:

Very picky: Extremely choosy eaters who consume only a few foods may need the added boost from a multi until they expand their food horizons.
Vegetarian or vegan: Animal products like milk and meat pack essential nutrients—such as zinc to support the immune system and calcium to build bones—that these kids may miss out on.
Superbusy: On-the-go tweens and teens often have hectic schedules that make healthy eating difficult. Skipping meals (even just breakfast) or regularly grabbing fast food at lunch can be a detriment to their daily nutrition.

Q. What about taking some extra antioxidants?

There's some hope that antioxidant vitamins such as E may help stave off cardiovascular disease, but research is mixed. Several years ago the large and long-term Nurses' Health Study found that women who took vitamin E supplements had lower rates of coronary heart disease. But in new research from Harvard Medical School, women who popped extra E, C, and beta-carotene had no greater protection against heart attacks, heart disease, or stroke than those who didn't take them. Another recent analysis of studies actually revealed a higher risk of death among those who took extra beta-carotene and vitamins A and E. "People seem to respond differently to these extra doses, and that's probably due to genetics," says Kulik. Talk to your doctor before taking vitamins or minerals beyond a regular multi—some may be unsafe given your health history or even interact with other medications you're taking. Another warning: Smokers shouldn't take high amounts of vitamin A or beta-carotene since research shows they may promote cancer.

Q. Are store-brand vitamins as good as pricier name brands?

In most cases, yes. Flashy labels and high prices don't mean the supplement is any better. In fact, when the Center for Science in the Public Interest analyzed multivitamins in 2003, several of its top picks were store brands from CVS and Kroger. If you do go with a store brand, choose one from a well-established chain. "It's more likely to use the same raw ingredients as the big manufacturers," says Coates. The store brands should also contain the same Daily Values as their name-brand counterparts—compare the labels to be sure.

Q. Should I take extra doses of some vitamins or minerals?

A standard multi is perfectly fine for most people—plus piling on supersize doses can be risky. For example, too much vitamin A can cause birth defects and liver damage. Excess vitamin C can lead to kidney stones in some people—and Australian researchers recently found no evidence that extra C helps prevent colds or reduces their length or severity. "Too much of a good thing isn't better," says Coates. With people eating so many fortified foods (including cereal, waffles, orange juice, energy bars, and vitamin-packed water), the chances of getting too much is even greater if extra supplements are taken.

But there are a few exceptions: Women who are not getting enough calcium from foods (most aren't) should consider a calcium supplement (with added vitamin D and magnesium) for bone health. Multis contain only about a quarter or less of your daily requirement because calcium is too large to fit in the pill. Plus, calcium has to be taken a couple of times a day since your body can't absorb more than 500 mg at a time (and you need more than 1,000 mg a day). But if you have disease or condition such as cancer or colitis, ask your doctor if you should be taking any extra vitamins or minerals.

A Multi-tude of Options

With aisles of bottles to pick from, selecting a multivitamin is tricky—but scanning labels can help. Here are five key things to look for.

Daily values (DV): You'll find these values listed on the right side of the Supplement Facts panel on all pill bottles, and they should be at or below 100%. Don't be wowed by superhigh DVs, since any excess of water-soluble vitamins (like C and B) will simply get flushed out through your urine. That's harmless in most cases, but megadoses of vitamin C can trigger diarrhea, and too much niacin can cause itching. Steep amounts of some vitamins (such as A) can be toxic to the body, and high doses of certain minerals (like zinc) can prevent others (like copper) from being absorbed.

Expiration date: The date on the bottle should be at least six months away. Ingredients can degrade over time and lose potency.

Reasonable cost: "Price is not a good indicator of quality," says Dr. Cooperman of ConsumerLab.com. One that costs roughly 5 cents to 10 cents a pill is reasonable—those far beyond that are probably not really worth it.

Quality control: Many bottles carry a seal indicating the product was tested by an independent organization. Seals to look for: ConsumerLab (CL) or United States Pharmacopeia (USP). You can also find out which products make the grade at consumerlab.com.

No crazy claims: A multivitamin can't cure disease, make you smarter, or burn fat. A lot of claims aren't regulated by the FDA—and most just aren't true.

What Are You Missing?

Even with the very best diet, some people may still need the extra boost from a multivitamin—or even more. Are you one of them?

If you are...Premenopausal
Be sure to get...Folic acid
Folic acid offers protection against neural-tube defects in fetuses, but it's most critical right before conception and in the first few weeks of pregnancy. Since about 50% of pregnancies are unplanned, you should get 400 mcg of folic acid every day (the amount most multivitamins contain) just to be safe.

If you are...Age 50 or older
Be sure to get...Vitamins B12 and D
As you age you lose the ability to fully absorb vitamin B12 from food. Elderly adults may also need vitamin D, especially those who are not exposed to much sunlight. Ask your doctor for a simple blood test that measures levels of both—and look for a multivitamin that's labeled "senior" formula.

If you are...Having heavy periods
Be sure to get...Iron
Heavy bleeding can leech iron from your body, making you feel tired and look pale. Most regular multis contain about 18 mg of iron, the amount that premenopausal women need daily. Ask your doctor if you should take more.

If you are...Vegetarian or vegan
Be sure to get...Vitamins B12 and D, calcium, and zinc
These nutrients are typically found in animal foods like meat and milk, so taking a multi and calcium supplement is smart (especially for vegans, who avoid all animal products).

If you are...Dieting
Be sure to get...All of them
It's almost impossible to meet your nutrient needs from food alone if you eat less than 1,600 calories a day. A basic multi will help you cover your bases.


Originally published in the July 2008 issue of Family Circle magazine.

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