Vitamins, Minerals, and Dietary Supplements for Optimum Health
I believe that everyone should take a multivitamin with mineral as a form of health insurance, in addition to eating a healthy diet. Read the label when choosing a multivitamin, and consider choosing one with a maximum of 3000 IU of preformed vitamin A, and no iron (unless you are a menstruating woman). Many multivitamins have small amounts of a variety of botanicals or herbs – I recommend choosing a multivitamin without these additional ingredients. With regard to quality, Consumer Reports has reported that as long as multivitamins are not purchased as “deep discount” stores, quality of virtually all brands tested was good. The multivitamin I take is VitaPrime®, marketed by ProThera®, a company which does not sell directly to consumers. Locally, this multivitamin can be purchased at Pine Pharmacy. I suggest only one tablet per day of VitaPrime, half of the daily dose which is suggested on the label. For years, the multivitamin I took and recommended to my patients was MultiSential® Plus, marketed by Solanova®. In March 2010, Solanova changed the ingredients in MultiSential Plus and I don't consider the new formulation optimal, so I have switched to the VitaPrime (at a dose of one tablet daily). For information on how to choose a high quality multi, I consider this website a good resource.
I recommend 1000 - 2000 IU/day of supplemental vitamin D from October – May in northern climates (most multivitamins contain 400 IU of vitamin D). I also recommend supplemental magnesium 100 - 300 mg/day - most multivitamins contain relatively small quantities of this mineral (it is bulky, and thus a small quantity takes up a lot of physical space in a multivitamin) and a USDA survey has concluded that 62% of Americans don’t obtain the RDA! I recommend intake of 200 micrograms (mcg) daily of selenium. Selenium content of multivitamins is variable, with some containing as much as 200 mcg/day. Brazil nuts are an excellent food source of selenium - each Brazil nut contains approximately 100 mcg of selenium. Data published in 2007 indicates that selenium intake of 200 mcg daily may increase the risk of developing diabetes. Nonetheless, I believe that for most individuals, the benefits of selenium 200 mcg per day outweigh the risks.
I also recommend supplemental fish oil, such that daily consumption of EPA + DHA from food plus the fish oil is at least 1 gram per day. Most multivitamins do not contain fish oil. To determine the quantity of EPA and DHA in each serving of fish oil, look at the "Nutrition Facts" box on the label.
For women, I recommend calcium 300 - 500 mg daily in supplement form (it is fine to take a combined calcium/magnesium supplement or a combined calcium/vitamin D supplement). I don’t recommend supplemental calcium for most men, based on data that calcium intake in men in excess of 1200 mg/day is correlated with an increased risk of prostate cancer. I concur with Walter Willett, MD, DrPH that the RDA for calcium is currently set too high and that with sufficient intake of vitamin D, total intake of 800 - 1000 mg of calcium per day in men and women is adequate. Dr. Willett in Chapter 9 of his superb book, Eat, Drink and Be Healthy, fully explains the rationale for a lower RDA for calcium. Green leafy vegetables are an excellent food source of calcium.
For individuals over age 50, the amount of vitamin B12 in a multivitamin may not be sufficient. Most individuals produce less stomach acid as they get older, and thus absorb less of the protein-bound vitamin B12 in food (B12 is found only in animal foods, so vegans obtain no vitamin B12 from their diet). If ones multivitamin does not contain 100 mcg of vitamin B12 per serving, consider additional vitamin B12 100 - 1000 mcg daily.
If finances permit, I suggest that everybody also take a ‘green supplement’ daily. With regard to the oxidative stress to which we are all subject as a byproduct of energy production in each of our cells and from exposure to the sun (as well as exposure to environmental pollutants), I have come to realize that the antioxidant vitamins (beta-carotene, vitamin C, and vitamin E) and the anti-oxidant minerals (copper, manganese, selenium, and zinc) are ‘the tip of the iceberg’ with regard to antioxidants which we obtain from our food and/or dietary supplements. The ‘iceberg’ is the hundreds and thousands of antioxidants found in the dozens of different fruits and vegetables. Thus, along with eating a variety of fruits and vegetables every day, I suggest a ‘green supplement’ daily. The green supplement which I take is Fruit4Life and Veggies4Life, marketed by Swanson®. This whole food product is produced via high quality manufacturing practices, including a low heat process which does not destroy the phytonutrients present in the fruits and vegetables. Another high quality 'green supplement' is Juice Plus +®, available through network marketing or at their website. Juice Plus + is also a whole food product produced via high quality manufacturing practices, including a low heat process. Furthermore, there is a substantial body of published research in peer-reviewed journals showing a variety of health benefits associated with Juice Plus +.
Coenzyme Q 10 (Co Q 10), which is consumed in our diets and can be synthesized in the body, is an essential cofactor with regard to energy production in our bodies at a cellular level. It is also a potent antioxidant. The amount ofCo Q 10 which we synthesize steadily decreases with age. Thus, if affordable, all individuals over age 50 should consider taking a supplemental dose of 50-100 mg daily of Co Q 10. For many years, Co Q 10 was available as a dietary supplement only in its oxidized form (ubiquinone). It is the reduced form of Co Q 10 (ubiquinol) which functions as the antioxidant in our bodies, and the reduced form became available as a dietary supplement in 2006. Ubiquinol is marketed as various brand names by several different companies, and is an alternative to ubiquinone supplementation. The supplement I now take is Swanson ubiquinol, available here. Another high quality ubiquinol product is UBQH TM, marketed by Integrative Therapeutics TM, and available for sale at Pine Pharmacy. For several years, prior to the availability of reduced Co Q 10 as a dietary supplement, I took Q gel®, a highly absorbable form of ubiquinone.
My thoughts on supplemental vitamin C and vitamin E have been in a state of flux for the past several years, as I continue to read and study more about these anti-oxidant vitamins. I no longer recommend supplemental vitamin C for a healthy adult, although I do recommend high dose vitamin C (500 - 1000 mg every 3-4 hours) short-term at the onset of upper respiratory symptoms. Vitamin E exists in nature (in the oil of plants, to prevent oxidation of the oil in the plant) as a complex of 8 compounds – alpha, beta, gamma, and delta tocopherols and alpha, beta, gamma, and delta tocotrienols. Most vitamin E on the market is d, l alpha tocopherol (only one of the l of the 8 forms that exist in balance in nature). ‘Natural’ vitamin E, which in the test tube has greater anti-oxidant effects than synthetic vitamin E, generally refers d-alpha tocopherol (again, only one of the l of the 8 forms that exist in balance in nature). I believe that if one takes supplemental vitamin E, it should be in a form in which all 8 compounds are present in the supplement. A product which contains all 8 compounds is Tocospan® Vitamin E (a reformulation of TocoSential E), marketed by Solanova, and available at Pine Pharmacy or here. While 400 IU of a ‘mixed’ vitamin E product is probably safe, I suggest a daily vitamin intake of "only" 100 - 150 IU per day. Along with my multivitamin, I take Tocospan Vitamin E 400 IU, 1 capsule per week. E Gems Elite®, marketed by Carlson Labs®, is another vitamin E product containing all tocopherols and tocotrienols in each capsule.
Disclaimer: the preceding is intended as educational material and not as individual treatment recommendations.
Page Updated February 3, 2016