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

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!

Avatar
Erika Krumbeck

Erika Krumbeck, ND is founder of NaturopathicPediatrics.com 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.

Comments:

  • Avatar
    Lindsey Scranton
    September 5, 2021 at 8:46 am

    Hi There! Thank you for this article! I’m noticing on both the Seroyal and Klaire Labs websites they are requiring either a code from a healthcare professional or are only allowed to be ordered from a healthcare proessional.

    Any chance you have a code for Klaire labs?

    Thank you!

    -Lindsey

  • Avatar
    Tolea Smith
    May 15, 2020 at 3:00 pm

    Thank you so much for the information. However, I feel like I’ve been lost in a crack. I am 48 years old, I do not want to have any more children, but you only mention prenatal vitamins or postmenopausal vitamins. I still haven’t gone through menopause and I still have my monthly. What do you suggest that is not a prenatal? Thank you!

  • Avatar
    Oksana
    August 1, 2018 at 12:00 pm

    Hi Erika,

    Thank you so much for such a comprehensive article! Could you give your opinion regarding multivitamins for a 6-year-old petite girl. 1) Pure encapsulations for junior, 2 )Animal Parade Gold, 3)Thorne Research basic nutrients for. I also wondering if Thorne and Pure Eapsulations have too much B12. Regarding Animal parade gold, I’m not sure if “aminoate complex” is a good form of some of the nutrients. I also was thinking of buying 4) Seeking Health Chewable, but saw magnesium stearate in other ingredient’s list. Your opinion would be very helpful.

  • Avatar
    Kelly LeSage
    June 29, 2018 at 2:51 pm

    What would dosing be for the Klaire Labs vitaspectrum powder for a 23 pound 18 month old? 1/4 tsp?

  • Avatar
    Teresa
    April 20, 2017 at 8:26 am

    Hi, What do you think of the supplement VeganSafe B-12 manufactured by Global Healing Center?

  • Avatar
    Teresa
    April 20, 2017 at 6:29 am

    Hi, i was wondering what brand of supplements, particularly Vitamin B12 supplements, you recommend for vegan children. I read the 2 articles you have on this website on multivitamins but i wanted to know about more specific vitamins. Also, i wanted to know if a vegan diet starting at age 4, can affect the onset of menstruation in girls or the ability to conceive later in life.

  • Avatar
    Erin
    April 5, 2017 at 1:55 am

    Hi! I was wondering what your thoughts were on the Honest Company whole food based prenatal was, and if the the type of folate (l-methyfolate) was okay to use for women with MTHFR?

  • Avatar
    Shawndra
    February 22, 2017 at 2:11 pm

    I thought I had found the Holy Grail, to give to my teenage boys, when I found Ben Lynch’s chewable Optimal vitamin. However it has the California Proposition 65 warning right on the label. Supposedly there’s lead and cadmium(extremely toxic metal) in the supplement, not something you want to ingest into your body, especially if you’re trying to be healthier. 🙁 What a big disappointment.

  • Avatar
    Erin
    January 29, 2014 at 8:38 pm

    Hi Dr. Erika,
    Do you have recommendations as to good brands of probiotics for toddlers?
    Erin

  • Avatar
    Lauren
    January 13, 2014 at 12:35 pm

    Dear Dr. Krumbeck,

    I too am on the hunt for a safe and beneficial pre-natal vitamin. I really appreciate your post, and I respect your work here because you are drawing attention to some of the significant issues with many commercially available vitamins and supplements (methylcobalamin > cyanocobalamin, etc). I was excited to see you recommend Thorne’s prenatal, as I hadn’t come across it before and I hoped that perhaps it would be the one. But I just have a quick question about it: half of its Folate comes as Calcium Folinate. From information from the NHS here in the UK, and a few other sites around (WebMD, etc), I was under the impression that Calcium Folinate was very *bad* for pregnant women to be taking. But my research into the various B9-related vitamins and supplements (folic acid, folate, folinate, folenic acid, L-5-methyl-tetrahydrofolate, calcium folinate…) has me a bit confused to begin with…I have a grip on the difference between folic acid and folate, but where does calcium folinate fall within the spectrum, and why is it controversial for pregnant women?

    Second question (which may be falling into the paranoid?): I thought I had struck gold when I found New Chapter’s Perfect Prenatals a while back, but then I read that New Chapter was sold to Proctor & Gamble (infamous megachain with a bad reputation for using cheap and toxic ingredients without changing labels, the whole Monsanto debacle of “Food, Inc” lore, etc) in 2012. I’m just concerned that New Chapter will lose what is so great about it: quality ingredients. What kind of risk do you think there is that they will just keep the packaging the same since the Perfect Prenatals are so well-regarded and have such a large following, but secretly alter what’s inside? Should I even be worried about that?

    Right now, the highest-scoring prenatal on my spreadsheet is Pure Encapsulations Prenatal Nutrients. But I believe they use Folic Acid. I know we should be trying to get lots of natural Folate from foods, but when it comes to a prenatal, what is your take on Folic Acid vs. Folate?

    Thanks so much for your help!

    – Lauren

      • Avatar
        Lauren
        January 24, 2014 at 6:13 am

        Thanks so much for your quick reply. I’ve done a bit more poking around and would be very grateful if you might share your thoughts on a couple more questions…

        1. In the debate about folinate or folate supplements as opposed to folic acid supplements, what is the general consensus now about folic acid? Is it that folate–being more like the natural folate we would get from foods–is more absorbable by more people and therefore likely to bring more benefits, or is there something actually wrong with folic acid that would make it harmful/not beneficial? If I were to try to cover my bases and divide up my recommended prenatal B9 into 3: taking a half dose of the Thorne and so getting 250mg from L5, 250mg from Calcium folinate, and a separate supplement to get 400 from traditional folic acid, and then aim for lots of leafies…is there anything theoretically inadvisable about this plan (I know you can’t officially advise)? Is there anything in the literature to suggest that folic acid might *counteract* or cancel out the folate/folinate?

        2. Switching gears to my husband’s multi. Good heavens is it difficult to find a mens multi (read: no iron) that contains the right forms. The Clinical Nutrients multi you recommended seemed ok but it has its B12 as cyanocobalamin. The best I can find seem to be either Thorne Basic Nutrients or Pure Encapsulations Nutrient 950 Without Iron. I’m really impressed by these (in either case I think he should halve the dose), but the only thing that seemed strange was just how high the Vitamin E content was…even halving or thirding the dose it’s still over 100iu. I can’t seem to find any support for that high of Vitamin E–especially not for men! Am I missing something??

        Thank you so much for your help!
        Lauren

  • Avatar
    Nat
    October 24, 2013 at 3:42 pm

    Dr. Erika,
    Thank you for the helpful post. I’ve been going crazy trying to find the best prenatal vitamins to take. I keep finding issues with all of them (too much lead, silica, potentially harmful folic acid instead of folate, etc.). I see that one of the prenatals that you recommend is New Chapter Organics Perfect Prenatal Multi. What are your thoughts on the high Vitamin A content of this prenatal? I keep reading that Vitamin A should be avoided during pregnancy and this multivitamin seems to be one of the worst offenders as far as its Vitamin A dosage goes.

    I would appreciate your input.
    Thanks!

      • Avatar
        Nat
        October 24, 2013 at 4:43 pm

        Thank you for your quick feedback! Do you know if there is a simple blood test that can check how well one converts beta-carotene to Vitamin A?

          • Avatar
            Nat
            October 25, 2013 at 12:11 pm

            Ah, ok. Thanks again for the info!

  • Avatar
    Carmella Mckinzey
    June 8, 2013 at 11:54 pm

    ß-Carotene is a strongly-colored red-orange pigment abundant in plants and fruits. It is an organic compound and chemically is classified as a hydrocarbon and specifically as a terpenoid (isoprenoid), reflecting its derivation from isoprene units. ß-Carotene is biosynthesized from geranylgeranyl pyrophosphate..^^,

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  • Avatar
    Amanda
    May 17, 2013 at 11:51 pm

    Hi Dr. Erika. Can you share if/why you believe titanium dioxide should be avoided? (internally and/or on skin)
    Thanks!

      • Avatar
        Amanda
        May 20, 2013 at 9:45 am

        thank you for the reply!

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