Best Multi-vitamin

[amirm]

OK, so I have been taking Centrum for 10-15 years. Started with my GP suggesting I take a multi-vitamin and that was the convenient brand.

Long time ago, a friend who was into health food said to take vitamins which don't have artificial color. To this day, every time I pop one of those pills, and see the bright color, I wonder if I should take something better.

So with all the physicians and health professionals here, is there a consensus for the best multi-vitamin?

 

[Bruce B]

I'd surely recommend anyone who is over 40 and active also take Glucosamine and Chondroitin. These are 2 drugs have actually been proven in clinical trials and approved by the FDA to work, unlike so many so-called vitamin supplements.

For anyone not knowing what these 2 do together, in laymans terms, they lubricate your joints.


Regards,

 

[RBFC]

Some of the MDs I know, including the state's top pathologist, recommend www.lef.org for vitamins and supplements. Apparently, their products meet the highest pharmaceutical levels of purity. I've been taking their multi-vitamin for some time.

The yellow color you see is the B vitamins, not the artificial color from what I've been told.

Lee

 

[MylesBAstor]

OK, so I have been taking Centrum for 10-15 years. Started with my GP suggesting I take a multi-vitamin and that was the convenient brand.

Long time ago, a friend who was into health food said to take vitamins which don't have artificial color. To this day, every time I pop one of those pills, and see the bright color, I wonder if I should take something better.

So with all the physicians and health professionals here, is there a consensus for the best multi-vitamin?

Let's dispense with the debate whether we need to take a MV! The AMA actually after years of debate endorsed the use of MV. There are actually two very compelling reasons. First, the NHANES study shows some very disturbing trends-the scariest being that the food that we eat doesn't contain the levels of macro and micronutrients we assume they should. (this is one good argument for organic food since it is grown to maturity, and is fresher due in part to being grown locally.) This is in part because we yank the food out of the ground as fast as possible to get it to the shelves. Second, I know very few people who eat a balanced diet where say they eat 35 different types of food/week. Most people eat the same thing every day for breakfast (if they eat breakfast) and lunch. The only variation is for dinner.

So as not to burst your bubble Amir, Centrum is really junk (but I can't tell you how many clients tell me they use Centrum). The reason I say that is Centrum and many other vitamins do not contain the levels of micronutrients shown on the label (I can't remember the site, but there is one website that checks vitamins for their accuracy). Some levels can be for instance 5X what is stated on the label. And many times, Centrum will crow about having say lycopene-when in reality, the levels are far below what are recommended.

There are three vitamins that I recommend and all are made to pharmaceutical standards and say in the case of Shaklee, have packaged the vitamins in multiple pills since different vitamins and trace elements are absorbed in different parts of the small intestine. For instance, the divalent cations like Fe, Ca, Mg are all absorbed by the same transporters in the upper part of the jejunum and can actually interfere with the others absorption eg. too high Ca can block absorption of Fe (if you have seen the movie "Bigger, Stronger, Faster" you would see that anyone can makes supplements on their kitchen table and market them.)

The first, possibly the best and highest priced vitamin is from Pharmatech(http://www.pharmatech-usa.com). The ones that I use are Shaklee (www.shaklee.com) and many of their products are tested in controlled clinical trials. They tend to have the highest recommended levels of micronutrients plus a few other things such as probiotic bacteria. (and in fact, you should see this year or next, the FDA up the recommended RDA for vitamins.) The other one comes from Apex Fitness (www.apexfitness.com). The market two types of vitamins, one for people eating a high protein diet and another for those eating a high carb diet (now I don't know if that makes a difference, but intuitively is should). The reason is that for instance, someone eating a high protein diet will lack adequate levels of say some B vitamins that aid in the biogenergetic pathways, say entry into the Krebs cycle.)

 

[Steve Williams]

Myles I agree completely about Centrum. Flintstones that we give to our kids is probably as good or better. Sorry Amir

I agree with what you say about iron absorption but because iron is absorbed so high in the intestine (upper jejunum) the more that is absorbed ,the higher the side effects. So many of the oral iron preparations are fumarates, glutamtes etc because these are absorbed lower in the jejunum, hence less absorbed by the gut and fewer side effects

If people need iron supplement with the best absorption (IMO) and fewest side effects I always gave my prenatal patients "Slow-Fe" which is Ferrous Sulphate and the sulphate has the best absorption in the upper jejunum but the way the pilkl is made (slow absorption) it comes with minimal if any side effects which BTW is gut ache.

Finally if you are above age 50 and/or family history of colon cancer at the very least you should have a Hg/Hct stool wipe for occult blood and at the very most colonoscopy (esp if family history of colon cancer), before you start oral iron.

Just my $0.02

 

[MylesBAstor]

Myles I agree completely about Centrum. Flintstones that we give to our kids is probably as good or better. Sorry Amir

I agree with what you say about iron absorption but because iron is absorbed so high in the intestine (upper jejunum) the more that is absorbed ,the higher the side effects. So many of the oral iron preparations are fumarates, glutamtes etc because these are absorbed lower in the jejunum, hence less absorbed by the gut and fewer side effects

If people need iron supplement with the best absorption (IMO) and fewest side effects I always gave my prenatal patients "Slow-Fe" which is Ferrous Sulphate and the sulphate has the best absorption in the upper jejunum but the way the pilkl is made (slow absorption) it comes with minimal if any side effects which BTW is gut ache.

Finally if you are above age 50 and/or family history of colon cancer at the very least you should have a Hg/Hct stool wipe for occult blood and at the very most colonoscopy (esp if family history of colon cancer), before you start oral iron.

Just my $0.02

Thanks for your insight! I think the other side effect of Fe that I hear from esp. my female clients (some of whom were diagnosed as anemic), is constipation. I know, TMI

 

[amirm]

Thanks guys. Great info so far.

Myles, I am sold on Vitamins. I remember a couple of days after I started taking them, noticing an immediate boost in overall well being.

And no worries about Centrum. Choosing it was simply due to power of advertising and brand awareness!

I have gone to the web sites of these companies and it is overwhelming as far as all the different products they offer. And of course prices ranging everywhere up to $3/day! So taking shaklee as an example, which one do I pick? Am I on the right page here: http://www.shaklee.com/category.php?main_cat=nutrition&sub_cat=Foundation&type=sub

It is a pain for me to take multiple pills because I travel so much and have to then carry a lot of different things. But if you say it makes a big difference, then what do I pick there?

On the joint lub supplements, I did a bit of googling and it said it was good for people with joint pains and such. I don't have that. Should I still take them?

 

[Steve Williams]

Amir, even though Bruce commented about studies showing efficacy once again I say caveat emptor. I have seen it sold in so many versions, so many strengths etc etc, that just because the label says glucosamine and chondroitin it is a matter of dose and percent absorbed. Having said that I am not convinced as to efficacy other than saying there is no harm in using it but for long term as that is perhaps where lies the benefit. IMO it is not a cure and some would challenge it even as a treatment. They build cartilage but I would like to see convincing evidence such as by MRI to convince me of efficacy.

 

[MylesBAstor]

Thanks guys. Great info so far.

Myles, I am sold on Vitamins. I remember a couple of days after I started taking them, noticing an immediate boost in overall well being.

And no worries about Centrum. Choosing it was simply due to power of advertising and brand awareness!

I have gone to the web sites of these companies and it is overwhelming as far as all the different products they offer. And of course prices ranging everywhere up to $3/day! So taking shaklee as an example, which one do I pick? Am I on the right page here: http://www.shaklee.com/category.php?main_cat=nutrition&sub_cat=Foundation&type=sub

It is a pain for me to take multiple pills because I travel so much and have to then carry a lot of different things. But if you say it makes a big difference, then what do I pick there?
On the joint lub supplements, I did a bit of googling and it said it was good for people with joint pains and such. I don't have that. Should I still take them?

The Shaklee MV I use is called the "Vitalizer" with 80 nutrients. What I like about their packaging is all you need to do is tear off a strip for each day you're away-and they don't take up much space at all.

As far as glucosamine goes, the more one investigates, the more confusing the picture becomes It seems that Glucosamine HCl was the better absorbed form but at a recent meeting, there was some data to show that a mixture of different types including glucosamine sulfate was the better form. One of the problem with many supplements is that if a company actually measures uptake into the bloodstream, they don't say in the case of creatine (a supplement that is recommended for all strength/power athletes) actually show how much of the compound is taken up into the muscle cell itself. Just because the compound gets into the bloodstream doesn't necessarily mean it gets to its target

One joint supplement worth looking at is: www.glcdirect.com.

 

[MylesBAstor]

Oh and of course, the use of joint supplements will vary if we're talking about "normal" asymptomatic individuals or someone with "arthritis." In speaking with my orthopod, it seems that Glucosamine works best with early to moderate athritis. But of course there are very few side effects from glucosamine, the only one I'm aware of is to potential for interaction in diabetics.

 

[Steve Williams]

Thanks for your insight! I think the other side effect of Fe that I hear from esp. my female clients (some of whom were diagnosed as anemic), is constipation. I know, TMI

Then we used Ferrosequels but you are correct that the better the iron the higher the side effects. BTW, we knew they were taking there meds if they complained of constipation

 

[Albertporter]

I've been taking vitamins since about 1972, I purchased the first ones from a health food store and followed that success ever since. I never bought drugstore brands, most commonly Solgar (New York since 1947) and Twin Labs (1968).

My current regimen every day:

Co Q 10, 120 mg
B-Complex, 100 mg
Natural Vitamin C With Rose Hips, 1500 mg
Potassium Magnesium Aspartate
B-Complex 100 Vegetable
Maxi L-Carnitine, 500 mg
Niacin (Vitamin B3), 500 mg
L-Lysine, 500 mg
(1) 80 or 325 mg Bayer aspirin

It's funny, my doctor fussed at me many years ago when I filled out my personal information and included my vitamins. He thought it excessive but has recently changed his mind.

He recently prescribed Niaspan which is nothing more than super dose of B3 Niacin (Abbot Labs) to reduce cholesterol. The funny thing is I've avoided drugs all these years by following common sense rules, at least until recently when old age finally caught up with me :^).

 

[rblnr]

My sister is a nutritionist, used to write for shape and self mags., run diet studies at Columbia etc -- so I trust her beyond the fact that she's my sister and very sharp. She was telling me the other day that the latest study on Glucosamine/Chodroitin showed no benefit -- a bummer to me because I've been taking it and have had a couple of knee surgeries, etc. Seems that studies often flop back and forth, but that nothing is an obvious must have out there. FWIW, outside of someone who has a deficiency or some diet-related condition, she's not much on supplements beyond the 100% reqs. and maybe some probiotics and fish oil. In her opinion, the payoff of most of the stuff is expensive urine.

This article open my eyes to an issue w/fish oil supplements, and I'll be looking around for an alternative to the Trader Joes version I'd been taking:

http://www.nytimes.com/2009/12/16/opinion/16greenberg.html?_r=1&scp=1&sq=fish oil supplements&st=cse

 

[Steve Williams]

I take 1200 mg of fish oil daily.

As for glucosamine and chondroitin I did say several days ago caveat emptor.

Now my advice for best multivitamin if this is truly something you wish to use I would recommend any name brand "prenatal multivitamin pill" due to the high amounts of RDA

 

[rblnr]

Got it Steve. Good to hear the thoughts/habits of a doctor.

I take some stuff but I think much of it is peace of mind. Would be nice to believe that a pill can make a difference. The one thing we all know that works is exercise.

 

[MylesBAstor]

My sister is a nutritionist, used to write for shape and self mags., run diet studies at Columbia etc -- so I trust her beyond the fact that she's my sister and very sharp. She was telling me the other day that the latest study on Glucosamine/Chodroitin showed no benefit -- a bummer to me because I've been taking it and have had a couple of knee surgeries, etc. Seems that studies often flop back and forth, but that nothing is an obvious must have out there. FWIW, outside of someone who has a deficiency or some diet-related condition, she's not much on supplements beyond the 100% reqs. and maybe some probiotics and fish oil. In her opinion, the payoff of most of the stuff is expensive urine.

This article open my eyes to an issue w/fish oil supplements, and I'll be looking around for an alternative to the Trader Joes version I'd been taking:

http://www.nytimes.com/2009/12/16/opinion/16greenberg.html?_r=1&scp=1&sq=fish oil supplements&st=cse

With all due respect to your sister, I have to disagree. Like in audio, there are those nutritionists who are flat earthers who say the only thing that counts is calories and then there's the other side who believe that every person is an individual and you can't apply the one size fits all approach. I fall into the latter group.

What I would say is this. As I pointed out before, there is the longitudinal National Health and Nutrition Survey, one of our best sources for nutrition info. (Like the Framingham study has been for many other areas of disease!) One of the most important findings is that the nutritional content of our food is markedly less than we assume. So the result is if your sister or I go to a nutrition book or computer program and look up a given food, the levels of micronutrients contained is way off in many cases and by significant margins. So the one way to make sure everyone is getting their RDA of these micronutrients is thru multi-vitamins.

And as I also said, in my many years of doing nutrition, it's rare to see anyone who eats a balanced diet (to wit, the idiotic Atkins diet).

As far as supplements go, ISSN (Int. Soc. for Sports Nutrition), a group of the leading nutritionists in the world, recommends several supplements esp for athletes. To wit, creatine has now been shown in 40+ studies to benefit and improve the many strength/power of many athletes. There are B vitamins in women that are based on caloric intake that are often low. And of course, we can't forget about the importance of Ca for women (I won't go into that at present since one could write a chapter on that).

 

[Gregadd]

The real problem with supplements is absorption. It's a shame to buy expensive vitamins only to have them run thru your body. The real way to go is to eat whole fruits and vegetables and grains. Raw if possible. Unfortunately so may fruits and vegetables are picked green before their nutrients have fully developed. We actually have a restaurant in DC that does not cook anything. I got this from a bodybuilder. He used to tell me, if you can't eat the whole thing don't bother. It was fun to watch him eat an unpeeled orange or banana. Eat the peeling and throw the inside away. I'd probably be a lot healthier if I had followed his advice.
Centrum? No offense but any real health food store can beat that.

 

[MylesBAstor]

The real problem with supplements is absorption. It's a shame to buy expensive vitamins only to have them run thru your body. The real way to go is to eat whole fruits and vegetables and grains. Raw if possible. Unfortunately so may fruits and vegetables are picked green before their nutrients have fully developed. We actually have a restaurant in DC that does not cook anything. I got this from a bodybuilder. He used to tell me, if you can't eat the whole thing don't bother. It was fun to watch him eat an unpeeled orange or banana. Eat the peeling and throw the inside away. I'd probably be a lot healthier if I had followed his advice.
Centrum? No offense but any real health food store can beat that.

Greg:

While its seems intuitive that vegetables should be most nutritious raw, that's not always the case. Take for instance spinach. Fe is bound to oxalic acid and unless one blanches the leaves for say 15 sec. before eating, the Fe doesn't get released for absorption (cooked spinach has ~3.5 X the level of Fe as does raw spinach). Oxalic acid in high concentrations can also interfere with Ca absorption (The poisonous Rhubarb leaf is an example of extremely high oxalic acid content--but there isn't any need to worry about oxalic acid in other vegetables). One can also eat some oranges with the spinach since Vit. C acts to enhance the absorption of Fe.

And it was Jack LaLanne that said in response to the question about his secret for his longetivity at a recent Arnold Classic, "If man made it, don't eat it."

 

[Steve Williams]

And of course, we can't forget about the importance of Ca for women (I won't go into that at present since one could write a chapter on that).

I would also add the importance of calcium in men as well. That is why I suggested that if one were to take the best vitamin supplement it would be prescription strength prenatal vits (a folic acid content of 1 mg makes it an Rx)

 

[MylesBAstor]

I would also add the importance of calcium in men as well. That is why I suggested that if one were to take the best vitamin supplement it would be prescription strength prenatal vits (a folic acid content of 1 mg makes it an Rx)

Absolutely and of course Vitamin D and Mg.

One important thing about Vitamin D. Physicians are now classifying many more individuals as Vit. D deficient because they don't get enough sunlight (particularly an issue in senior citizens and people living in northern climates!). if I remember correctly, the recommendation is 15 min of sunlight a day. The Vitamin D that is made in the kidney via cholicalciferol via sunlight exposure is unfortunately not quite identical to the orally taken form. And in rare cases, if someone doesn't get enough cholesterol (the building block of Vit D and the sex hormones), one could conceivably be Vit. D deficient.