Skip the Centrum! (A guide to a good multivitamin)

I’m not a “supplements” doctor.

I know many naturopathic patients who have had the experience of coming home from a visit with a bagful of pills and potions.  I really try not to do that. My long-term goal as a physician is always to treat the underlying cause so we can permanently restore health.  When that happens my patients no longer need to be on a supplement regime, they can use diet and lifestyle to maintain their health. (With maybe an occasional multivitamin and probiotic – because if you have a refrigerator, you probably need a probiotic.)  That said, getting people back to restorative health can take some work, and by the time they arrive in my office they are usually in need of some type of support.

So here’s the deal: as in life, with supplements you pay for what you get.

I would rather my patients throw their Costco multivitamin in the garbage and not take anything at all.  It sounds rather harsh, but I cannot in good faith have my patients take something that I know is harmful.

In the last few years several studies have shown an increased risk of death when taking multivitamins.

Yikes.  Here is one study in older women. Here’s another that shows cancer deaths are increased. Here’s one that shows that women who take calcium have a higher risk of cardiovascular disease (heart disease, heart attack and death).  And here is an older, landmark study that showed that taking beta-carotene causes increased risk of death in smokers.

Yet, in many other studies multivitamins or single vitamins have been shown to decrease certain cancers, prevent neural tube defects (and autism!), reduce the risk of heart disease, decrease the risk of osteoporosis, and on and on.

Okay, so what’s going on here?

The first thing you should know is that where a vitamin comes from is very important.  In the beta-carotene study the researchers were shocked to discover that supplemental beta-carotene was associated with higher death rates.  They were studying it because they knew that smokers who consumed high levels of beta-carotene in their diets were much, much less likely to die.  So what gives?  Well, the supplement they manufactured for the study was synthetic.  It is simply not processed in the body the same way as natural beta carotene.

The second thing you should know is that many molecules have chirality, or “handedness”.

Technically your left hand is identical to your right hand – but they aren’t, right?  One is a mirror image of the other.  In nature most molecules are “left” handed.  But when molecules are made in a laboratory it is difficult to sort out the left from right handed molecules.  Both end up in the supplement, and where one may prevent a disease, the other may cause it!

You should also be aware that there are many different forms of vitamins and minerals.

Some are better absorbed, some are better utilized and some are the equivalent of flushing the vitamin straight into the toilet.  Vitamin B-12, for example, can come in cyanocobalamin or methylcobalamin.  Methylcobalamin is much better utilized by the body, but most multivitamins only contain the cyano type.  Folic acid can also come in a 5-methyltetrahydrofolate form (say that 3 times fast), which is absolutely essential for the ~20% of the population with an MTHFR gene defect (come see me if you want to get tested).  Iron in the form of ferrous sulfate is fine for “normal” people, but people with gut dysbiosis tend to get dramatically worse on it.  Instead I advise using iron picolinate which greatly increases absorption.

Finally, there are the fillers.

Titanium dioxide, polyethylene glycol, modified food starch, hydrogenated palm oil, modified corn starch (GMO), Red No 40 Lake, Blue No 2 Aluminum Lake, Yellow No. 6 Aluminum Lake are all found in the most popular brand of vitamin.  Many food dyes are carcinogenic, and for the majority of my sensitive patients they aggravate the nervous system (causing ADHD, migraines and other symptoms). Other fillers are cheap additives to fill space and hold the tablet together.

So skip the multivitamins that contain these types of fillers or synthetic versions of the vitamins.  See a nutritionist or naturopathic physician to get a personalized recommendation for a multivitamin as each person can benefit from a slightly different formula.

Here are some of Dr. Erika’s favorites.  They all contain the correct “handedness,” and are forms that are absorbable and useable by the body. Remember though, that each person may need something slightly different, you should always check with your doctor first. These companies literally test every single batch that comes off the assembly line for purity and potency, and that is why Dr. Erika trusts them.

First: a note on where to buy. These supplements are all “physician-grade” products, meaning most are not available over the counter.  I highly recommend checking with your naturopathic physician’s office first before buying a supplement online.   BEWARE of look-a-like products that are sold on Amazon or other independent online retailers. (I actually have a colleague whose patient broke out into hives after using a “Thorne” product she bought off of Amazon.)   Most of these supplement companies require physicians and pharmacists to sign an agreement that we will only sell these products to our own personal patients.  The quality is so good and the concentration of nutrients is so high that these should really only be taken under a physician’s supervision.  The few links in the blog post below are for Dr. Ben Lynch’s supplement company, which is one of the very few companies who sells directly to consumers.  (I think it is pretty safe to trust his products.)

Babies/toddlers: VitaSpectrum by Klaire labs or Pediatri Vite by Genestra/Seroyal.  (Note: I do not believe that most breastfed babies need a multivitamin.)  These do not contain iron – have your child’s iron levels checked before adding a liquid iron, or food-based iron (no need to supplement iron if they have good iron levels).

Kids: Optimal Multivitamin Chewable by Seeking Health.  Kids this age usually do need iron, though you may want to consider the iron-free formula for kids who have digestive complaints or are on the autistic spectrum.  For children on the autistic spectrum I recommend Klaire Labs VitaSpectrum powder, or Kid’s Optimal Multivitamin by Seeking Health.

Women of childbearing age: Thorne Basic Prenatal multivitamin, New Chapter Organics Perfect Prenatal Multi, or Optimal Prenatal by Seeking Health.  Women who are breastfeeding MUST continue taking a prenatal!

Postmenopausal women: Vitanica’s Senior Symmetry or Meta-Fem by Thorne.

Men under 40: Clinical nutrients for Men by Integrative Therapeutics.

Men over 40: Al’s Formula by Thorne, or Clinical Nutrients 50+ by Integrative Therapeutics. (Men under or over 40 can also take Optimal Multivitamin by Seeking Health, but it does not have the supportive herbs of the other two products.)

Athletes, or anyone undergoing intensive detoxification: Nutrient 950 by Pure Encapsulations, or another personalized multivitamin (depending on their specific biochemical needs).  This has very high levels of active nutrients, which are needed for anyone under oxidative stress.  Anyone who has been exposed to heavy metals, pesticides or is doing a detoxification program should be on a similar high-level multivitamin.


So seriously, skip the Centrum!

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Erika Krumbeck, ND
Erika Krumbeck, ND
Erika Krumbeck, ND is founder of and the owner of Montana Whole Health, a naturopathic clinic in Missoula, Montana. She received her Doctorate of Naturopathic Medicine from Bastyr University and is a licensed physician in the state of Montana. Dr. Krumbeck is one of few physicians specializing in the treatment of chronic health conditions in children. 

Dr. Krumbeck likes to practice her own healthy lifestyle with her wonderful husband Jason, a physical therapist, and their children Annika and Leopold. 

She is a professional member of the Pediatric Association of Naturopathic Physicians.

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