Multivitamin users have been chastened for their health choices in recent years by the media for trying to support their health by taking a daily multivitamin. Multiple literature reviews have pointed at the lack of beneficial outcomes with multivitamin/mineral (MVM) use, which one summary study from the January 2017 issue of Nutrition concludes by stating “In particular, there were no significant differences between treatment and placebo groups.”1Another concludes “Evidence is insufficient to prove the presence or absence of benefits from use of multivitamin and mineral supplements to prevent cancer and chronic disease.”2Popular media of course takes these conclusions and runs with them, telling everyone are foolish to waste their money in this manner. Not surprisingly, MVM use has declined between 2000 to 2012 from 37% to 31% of those surveyed.3However, what is neglected with this simple summary and broadly broadcasted message are further details about what the supplements are that are being taken.
Over-the-counter supplements: plagued by poor bioavailability and poor-quality ingredients
Part of the problem with MVM supplementation is that even though a label may state that a supplement contains 100% of the recommended daily intake (RDA), our absorption of these substances can be dramatically less than this. Many individuals experience hypochlorhydria and insufficiency of other digestive secretions which are necessary to break down tablets due to fillers and other agents which enable processing and tabletization.4,5,6These necessary digestive secretions generally diminish with age, however factors such as chronic disease (particularly gastrointestinal conditions), alcohol and nicotine use also have an impact.7,8,9
The quality of supplement ingredients also is an issue when cheaper drug-store type supplements are sought.Numerous lower-cost nutritional supplements use ingredients sourced from Asia which may have contaminants or use toxic substances in their processing.10,11,12Many supplement ingredients manufactured in China have been found to contain higher amounts of lead, mercury and aluminium, as well as a wide variety of other undesirable substances.A recent Australian study from the University of Adelaide found that 92% of traditional Chinese medicinal combinations purchased over the counter at random contained undeclared substances or some form of contamination.13This included detection of pharmaceutical agents such as warfarin, dexamethasone, diclofenac, cyproheptadine and paracetamol; heavy metals including arsenic (up to 10 times the acceptable limit), lead, and cadmium; and DNA of undeclared plant or animal taxa in 50% of the samples.
The format of nutrients also is an issue. Low-cost supplements most often contain cyanocobalamin for vitamin B12 and folic acid because these ingredients are cheaper than the more bioavailable active form of these nutrients. For some individuals with genetic variants which impact B12 and folate metabolism, it is very important to have these nutrients in active forms (such as methylcobalamin and folinic acid) which the body needs.14,15
Dietary deficiencies abound
Despite our knowledge about nutrition, our diets have considerable deficiencies. The estimated average requirement (EAR) for nutrients is often not met in our diets even with the use of MVM supplements as a 2010 National Health and Nutrition Examination Survey (NHANES) showed.16Dietary inadequacies (despite supplemental MVM use in 51% of the population) were observed to exist for vitamin D (74% of population), vitamin E (67%), magnesium (46%), calcium (39%), vitamin A (35%), and vitamin C (31%). Smaller proportions of the population had intakes below the EAR for (in decreasing prevalence) zinc, folic acid, vitamin B6, iron, copper, thiamin, vitamin B12, vitamin B2, phosphorus, niacin, and selenium. Other studies support these findings, and have shown that deficiencies also are common in vitamins B12, B6, and folate, particularly with increasing age.17,18,19
This micronutrient gap is not always one which will outwardly manifest in disease as more severe shortages are usually necessary for symptoms of deficiency disease. However, this micronutrient gap does impact the ability of our body to function optimally, and subtle shifts in performance and metabolism do exist – they just won’t be something showing up on a standard lab test. We need these essential vitamins and minerals – which is why they have been deemed essential in the first place. But we need a format that our body can absorb and utilize, and they won’t just be flushed down the toilet.Making sure supplements are of a high quality is imperative for the many reasons discussed, even more so when supporting detoxification.
Advanced supplement delivery formats
Advanced liposomal and nanoemulsifieddelivery systems offer unmatched bioavailability for both fat- and water-soluble ingredients. Thetiny, nano-size particles are not broken down by the harsh acids of the digestive system as they enter circulation with rapid absorption immediately in the mouth. This enables direct delivery of bioavailable nutrients to the bloodstream and cells of the body. Phospholipids, specifically phosphatidylcholine, form the external sphere of the liposomal and nanoemulsified particles.These phospholipids are additionally utilized by the body, and are important for cellular membrane health and function.20Dietary deficiencies of choline, which phosphatidylcholine provides, also are common, and the inclusion of it in a supplement further enhances health at a cellular level for this reason.
Perhaps not surprisingly, individuals who use dietary supplements are already more health conscious, a choice which is reflected by their diet, tendency for a lower body mass index, and higher physical activity level.21We are a population that cares about our health, and are making proactive choices in many ways. Electing to use a higher quality multivitamin and other supplements also is a choice – but one from which you actually reap benefits rather than the low-cost minimally absorbed counterparts that are easily found on shelves of health food and drug stores.
2Huang HY, Caballero B, Chang S, et al. The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference. Ann Intern Med. 2006 Sep 5;145(5):372-85.View Abstract
5Nilsson-Ehle H. Age-related changes in cobalamin (vitamin B12) handling. Implications for therapy.
Drugs Aging. 1998 Apr;12(4):277-92.View Abstract.
6Rothenbacher D, et al. Prevalence and determinants of exocrine pancreatic insufficiency among older adults: results of a population-based study. Scand J Gastroenterol. 2005 Jun;40(6):697-704.View Abstract
11Budnik LT, Baur X, Harth V, Hahn A. Alternative drugs go global: possible lead and/ or mercury intoxication from imported natural health products and a need for scientifically evaluated poisoning monitoring from environmental exposures. J Occup Med Toxicol. 2016 Nov 8;11:49.View Full Paper
13Coghlan ML, et al. Combined DNA, toxicological and heavy metal analyses provides an auditing toolkit to improve pharmacovigilance of traditional Chinese medicine (TCM). Sci Rep. 2015 Dec 10;5:17475.
15Paul C, Brady DM. Comparative Bioavailability and Utilization of Particular Forms of B12 Supplements With Potential to Mitigate B12-related Genetic Polymorphisms. Integr Med (Encinitas). 2017 Feb;16(1):42-49. Review.View Abstract