What's in Your Multivitamin & Why It Matters

When it comes to vitamins and other nutrients, experts agree on only one thing: Insofar as possible, it's best to get them from food.
Why? Foods contain a wealth of nutrients, all bundled together the way that evolution has shaped our bodies to use them. In addition to protein and carbohydrates plus essential fats and vitamins and minerals . . .

• plant foods—including vegetables, fruits, beans and whole grains—contain fiber and important phytochemicals
  
• fish contains vital omega-3 essential fatty acids
  
• nuts contain healthful unsaturated fats and other nutrients
  
   

all of which help our bodies fight off cancer and heart disease and diabetes, the major killers of the 21st century in industrialized countries. However, it is sometimes difficult to obtain enough of a particular nutrient from food. Processing can destroy nutrients. Lifestyle choices can lead to inadequate intake of some nutrients. Special circumstances, such as pregnancy or reduced absorption by older people, can lead to higher needs for various nutrients. Even though fortification of foods has done its best to close these gaps, taking a multi-vitamin can be a wise strategy to ensure getting enough. And many Americans do. Multivitamin/mineral formulas are the most widely purchased supplement in the marketplace. Which variety of multi is best?

Regular tablet or time release?
Here again, opinions vary. A regular tablet discharges all its nutrients into the stomach in a single burst, while time-release formulas are intended to produce more of a steady-stream effect over the course of a day. One scientist recommends the time-release formulation, because any nutrients that the body cannot use within a few hours goes to waste, and are excreted through the urine or perspiration or stool. Another scientist points out that the human gut is designed to absorb specific nutrients in particular "sweet spots" along its length. Any nutrients that are released "downstream" of those absorption points are simply wasted. Probably the best strategy for the minimalist approach is to cut a single tablet into halves or thirds or quarters, and take one with each main meal of the day. Our bodies are designed to absorb vitamins and minerals together with the foods that normally contain them.

Synthetic or natural?
Most vitamins are made now synthetically—which means they are assembled in state-of-the-art chemical laboratories. This process ensures that they are identical both to one another and to the "naturally occurring" forms made by plants and animals. The main exception where the "naturally occurring" nutrient is superior to the synthetic is vitamin E, which consists of eight forms in nature and is better absorbed by the body. The essential minerals are all atomic elements (in other words, like hydrogen and oxygen), and their natural forms are usually some variety of rocky ore. Plants absorb these minerals from the earth and water where they grow, and use them in many different ways. In multi-mineral formulas, the minerals are supplied in a variety of different molecular forms. Questions about which molecular forms are better absorbed by the body could fill an entire article in itself, and will not be addressed here. We recommend that you ask a nutritionist to review any claims about absorption that you wish to know more about. Generally speaking, the labels of multi-mineral formulas are required to say how much of the mineral is supplied and in what form. For example, "500 mg calcium (as calcium carbonate)" should mean that your body will be supplied with 500 mg of calcium, and that the source is calcium carbonate. Alternatively, "500 mg calcium carbonate" would mean 500 mg of the entire mineral—which means getting considerably less calcium because it is only part of that mineral! Unscrupulous manufacturers have been known to use misleading language, so read labels carefully and compare brands.

Does your multi-vitamin dissolve properly?
Some manufacturers claim that many brands of vitamin tablets are so hard that they go through the body undissolved, and quote nurses who find vitamin pills in the bedpans of their patients. While this can happen, here's a simple "acid test" you can apply to find out if your multi—or any other pill!—dissolves properly:

1. Place approximately one cup of white vinegar in a small bowl and warm it to 98 degrees or so by placing it inside a larger bowl of water that you "top up" several times with warm water from the tap. (The goal is to keep the vinegar reasonably close to 98 degrees for half an hour.)

2. Drop your multi-vitamin (or other pill) into the vinegar, and jostle it about every five minutes or so by gently shaking or swirling the cup. While you can also stir the mix with a wooden stick or toothpick, be careful not to touch the tablet itself.

3. The tablet should dissolve within 30 minutes. (This is the USP standard for all pharmaceutical tablets.) If it doesn't dissolve within a full hour, it's not doing you much good. Get another brand!

What about all those "inactive" ingredients on the label?
Inactive ingredients in vitamin tablets—technically called excipients—serve several functions.

Fillers: Sometimes the active ingredients in a tablet would result in a pill too small to hold. Or as in multi-vitamins, the formula can include "oil and water" ingredients that don't mix with one another. In these cases, the manufacturer adds one or more filler ingredients to the brew so it can be formed into a tablet either big enough or stable enough to hold. Fillers can be a problem for people who are allergic to them. Read the ingredient and "does not contain" lists for substances you are concerned about. Common fillers include lactose (milk sugar), microcrystalline cellulose, corn starch, sugars (including sucrose, mannitol, sorbitol, fructose, dextrose), whey and yeast.

Binders: These do exactly what the term implies: They are sticky or gluey substances that hold the pill together. Commonly used binders can include povidone, xanthan gum and Carbopol (an acrylic resin). Some fillers may also act as binding agents.

Coatings: These help hold the tablet together so it doesn't break apart in the mouth. They also mask any unpleasant tastes, and often contain colorants. If you prefer to avoid dyes, these should appear in the list of ingredients.

Lubricants: These assist the manufacturing process in releasing tablets from the tablet-forming machines. Commonly used lubricants include magnesium stearate, stearic acid, sodium stearyl fumarate, polyethylene glycol, and hydrogenated vegetable oil.  All excipients used must be listed in the US Pharmacopeia or National Formulary (for products sold in the USA), and are usually either food products and thus digested normally, or chemically inert so that they pass through the body and are not absorbed.

Does price matter?
Yes and no. When the formulas for two brands are essentially the same, purchase the cheaper one unless:

• you wish to avoid specific excipients
• the tablet does not dissolve in the "acid test" described above
• the brand has not passed GMP inspections

Good manufacturing practice (GMP) procedures establish methods of ensuring that raw materials are indeed what they are supposed to be, and that the final product contains the ingredients and potencies listed on the label. Inspections are crucial because they ensure that the manufacturer actually follows these GMPs.

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