Self-Help Tips From Dr Sarah Brewer

The Best Multivitamin Supplements

An estimated one in two people now take a multivitamin and mineral supplement, but how to do you select which multivitamin is right for you? Health food shops, pharmacies and supermarkets offer a large selection of multivitamin tablets and capsules aimed at different age groups and budgets. As a medical nutritionist who has prescribed and taken multivitamins for over twenty years, I have firm opinions on how to select the best products, based on published evidence and my own clinical experience. Here are my best tips on how to select the ideal multivitamin for you.

Do you need a multivitamin?

Quick summary: These are the multivitamin supplements I recommend from Healthspan, and

The official government line is that we can get all the vitamins and minerals we need from our food, with the exception of vitamin D during autumn and winter, and folic acid during early pregnancy.

While diet should always come first, national surveys consistently show that few people get all the nutrients they need from their food. Even when average intakes appear fine, an average is only an average and some are getting more while others are getting less than the recommended amounts. I’ve analysed many people’s diets and have not yet found anyone who obtains all the vitamins and minerals they need from their food alone. One person who was confident of success did have an impressive intake of vitamin C but was low on magnesium, selenium and vitamin E.

A scientific review of over 150 clinical trials published in the Journal of the American Medical Association confirmed that lack of many vitamins is a risk factor for heart disease, stroke, some cancers, birth defects, osteoporosis, bone fractures and other major chronic health problems.  And, while they emphasised the importance of not overdosing, the authors stated in an accompanying editorial that ‘Pending strong evidence of effectiveness from randomised trials, it appears prudent for all adults to take vitamin supplements.’

While diet should always come first, a good multivitamin and mineral supplement acts as a nutritional safety net, especially for those who are:
• cutting back on food intake to lose weight or for other health reasons
• avoiding certain foods such as eggs, dairy or wheat, due to intolerances
• following a mainly plant-based diet and avoiding meat or other animal products
• planning a baby
• over the age of 50 – when absorption of certain nutrients starts to decline.

Multivitamins and age

One of the most important factors in selecting a multivitamin is your age. This is especially vital for children, who need different levels of ingredients at different stages of growth, and for older adults as your need for many vitamins and minerals increases from middle-age onwards. This is partly because your metabolism needs more to function at the same efficiency as in your youth, and partly because of reduced production of stomach acids and intestinal juices. Known as hypochlorhydria, this slows the absorption of certain nutrients, especially B vitamins and calcium. At the same time, you make four times less vitamin D in your skin by the time you are in your 60s, than you did in your 220s. You will usually benefit from a supplement providing lower levels of iron, however, as excess appears to be detrimental to long-term good health.

Multivitamins and quality

Ensure your chosen supplement is made to pharmaceutical standards to ensure the product is checked at every stage of production for purity and consistency of dose.

In the UK, compliance with GMP regulations is assessed by the MHRA (Medicines and Healthcare products Regulatory Agency).

In the US, the Food and Drug Administration (FDA) oversees compliance with regulations relating to the Dietary Supplement Current Good Manufacturing Practices (CGMPs) for quality control.

Either check the manufacturer’s website for a GMP statement or Google the manufacturer’s name plus the term ‘GMP’ or ‘Good Manufacturing Practice’.

These standards ensure that every stage of production is documented, all raw materials are tested to confirm their identity and purity, and that finished products are tested to ensure they contain the right amounts of each ingredient.

Most little-known, value ranges are not produced to GMP standards as these processes significantly increase manufacturing costs.

Multivitamin labels

Look at the labels to see how each supplement compares. The level of vitamins and minerals present in each supplement is described in terms of how they contribute to your daily needs.

In the US, labels show the percentage of the Daily Value (DV) provided, while in the EU the term used is the Nutrient Reference Value (NRV).

These values are set in an attempt to define the needs of almost all the adult population although different criteria are used in different countries.

Multivitamin ingredients

The best supplements will provide micronutrients in the most bioavailable form. Vitamin E is most active in the natural, d-alpha tocopheryl form, rather than as the synthetic form, dl-alpha tocopheryl. Similarly, vitamin D is best absorbed as vitamin D3 (cholecalciferol) which is 20% – 40% more effective in maintaining your blood vitamin D levels than the vitamin D2 (ergocalciferol) form.

Minerals that are chelated with amino acids are also better absorbed, although these tend to be more expensive and you need a greater amount to obtain the same quantity of elemental mineral (as the amino acid part is relatively heavy).

As well as ingredients that are present, those that are absent are just as important. For example, are you looking for a supplement that is designed as vegetarian or vegan friendly, or which is gluten, yeast, lactose or dairy free? Is it free from added sugar or artificial sweeteners? This may not matter to you, but many people prefer to avoid aspartame, for example, and to avoid sugar in children’s chewable multivitamins to protect their teeth.

Are the tablets/capsules foil-sealed for freshness? When buying more than a few month’s worth of tablets/capsules at a time, this will retain the nutritional quality of the vitamins for longer, by reducing deterioration through contact with air.

Finally, check the use by date. Supplements that are nearing the end of their shelf life typically contain lower levels of vitamins due to their natural degradation. Manufacturers add an ‘overage’ to ensure their stated levels are still present by the time the product expires. Once the use-by-date is past, you are better off ditching the product and replacing it.

Children’s multivitamins

A children’s formula will usually provide around 50% to 70% of the daily vitamins needed by children aged 3 to 12. Only give supplements to children who are old enough to chew properly to avoid choking.

Adult multivitamins

A basic adult multivitamin formula will provide the most important vitamins (A, B group, C, D, E, folic acid) plus key minerals such as copper, iodine, manganese and zinc, at up to 100% of the recommended daily amount (DV/NRV). Calcium and magnesium are usually present in lower quantities to avoid creating a one-a-day pill the size of a toy car.

A complete A to Z formula will typically include all the important micronutrients, including vitamin K, selenium, boron, chromium and molybdenum. These are often too large to create a single tablet or capsule, and the recommended dose may be two or more a day. Some are specifically aimed at men, and some at women.

An enhanced multivitamin formula usually combine boosted amounts of certain vitamins and minerals with additional ingredients such as probiotic bacteria (to aid digestion), bioflavonoids (as antioxidants and to boost absorption) or herbal extracts (eg ginseng, ginkgo). These top-line formulas tend to cost more as they include more expensive ingredients, such as chelated minerals, or food-state ingredients that are better absorbed and used in the body – a factor known as bioavailability.

Targeted multivitamin formulas are designed to meet a particular health need, such as overcoming tiredness, boosting energy, helping to lower blood pressure, or to support heart function. These tend to lack other vitamins and minerals that do not contribute to the stated health problem they are designed to meet.

Vegetarian and vegan multivitamins

People who follow a plant-based diet may sometimes find it difficult (although not impossible) to obtain particular nutrients from their food, such as vitamin B12, zinc and iron.

Ingredients for vegetarian and vegan multivitamins are sourced from mineral salts, plant extracts, algae, yeasts and from bacterial fermentation.

Pregnancy multivitamins

During pregnancy and breastfeeding, the need for many vitamins and minerals increases. At the same time, your appetite may be reduced by nausea and feelings of exhaustion and bloating during the early weeks. Good nutrition with optimal intakes of vitamins and minerals is vital to help nourish the growing baby whose cells are dividing rapidly.

Good supplies of folic acid are especially important to help reduce the risk of certain abnormalities known as neural tube defects. Folic acid is best started before you try to conceive and is included in preconceptual supplements that are designed to help boost fertility.

Multivitamins designed for use during pregnancy will also include folic acid and, if they include vitamin A, this will be in the form of betacarotene or mixed carotenoids, rather than in the retinol form (excess of which has been linked with certain developmental problems).

The long-chain omega-3 essential fatty acid, DHA, is important for the baby’s developing brain. This is also included in many pregnancy supplements. Avoid omega-3 fish oils not designed for pregnancy, as these may contain too much of another essential fatty acid, EPA, which is less beneficial during pregnancy due to its blood thinning action. Similarly, avoid cod liver oil (and other liver products) during pregnancy as the retinol vitamin A they contain is best avoided during pregnancy unless medically indicated for a proven deficiency.

Vitabiotics’ Pregnacare is the supplement I took throughout both my pregnancies – including one with twins. They provide 19 vitamins and minerals, including recommended amounts of folic acid and boosted levels of vitamin D, B vitamins, iron and zinc. Pregnacare provides vitamin A in the form of mixed carotenoids.

Multivitamins for the over 50s

Multivitamins aimed at people aged 50+ typically provide 150% to 200% of the RDA/NRV for key nutrients, especially B vitamins to account for reduced intestinal absorption. They often contain additional beneficial ingredients such as antioxidant bioflavonoids or herbal extracts, such as ginkgo, that offer age-related benefits. These formulas also tend to contain less iron.

Menopause multivitamins are formulated for women going through the ‘change of life’ and tend to focus on providing bone-friendly nutrients such as calcium, magnesium, vitamin K and boron, plus soy isoflavones which provide a useful plant hormone boost.

Multivitamins for the over 70s

Multivitamins designed for people aged 70+ are becoming increasingly popular. These multivitamins typically offers 200% to 300% of the key nutrients which you absorb less efficiently in later life.

These multivitamins tend to provide more vitamin D, B vitamins, and ingredients such as antioxidants such as alpha lipoic acid, l-carnitine or coenzyme Q10 that are beneficial for ageing cells.

Some multivitamins for the over 70s also contain additional herbal ingredients in small amounts, such as Siberian ginseng for energy and immunity, or Ginkgo biloba extracts to aid memory.

Chewable Multivitamins

One of the nicest ways to take supplements is as tasty, chewable pastilles, gummies or tablets, which give you something to look forward to every day. While chewable multivitamins are likely to contain a small amount of sugar, or a sweetener such as xylitol to make them palatable, they are rapidly growing in popularity.

Avoid multivitamin megadoses

High intakes of certain vitamins and minerals are just as harmful as not enough. Nutritional scientists have identified tolerable upper safe levels (USLs or ULs) for long-term intakes of many vitamins and minerals. As with the recommended daily amounts, these differ slightly from country to country.

Mega-doses are best avoided except under the advice of a nutritional therapist or healthcare professional to treat a proven, severe nutritional deficiency.

Do not exceed recommended doses. If you are pregnant or breast-feeding, only take supplements designed for use at these times, as excess vitamin A (including that found in cod liver oil) may be harmful.

What do you take?

Do you take a multivitamin and mineral supplement? Which brand did you select and how did you decide on it? Was it the price, because it was produced by a trusted manufacturer, because someone recommended it, or because it targeted your particular needs? Do leave a comment below as I’m interested to know your thoughts.

Image credit: maxxyustas/bigstock

author avatar
Dr Sarah Brewer ex-Medical Director (20 years)
Dr Sarah Brewer MSc (Nutr Med), MA (Cantab), MB, BChir, RNutr, MBANT, CNHC, Dip IoD qualified from Cambridge University with degrees in Natural Sciences, Medicine and Surgery. After working in general practice, she gained a master's degree in nutritional medicine from the University of Surrey. Sarah is a registered Medical Doctor, a registered Nutritionist and a registered Nutritional Therapist. She is an award winning author of over 70 popular self-help books and a columnist for Prima magazine. Her debut novel is White Powder Of Gold. Dr Sarah Brewer is a registered medical doctor, nutritionist, nutritional therapist and author of over 70 self-help books.

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