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By Dr. James T. Belanger

Because of todays environment, you should take a multivitamin even if you eat a very healthy diet. Food is being shipped from far away places such as California and Mexico and loses its nutrient content the longer in sits on the shelf or in an airplane. Certain pesticides, fertilizers, food additives and heavy metals have all been shown to interfere with the body's absorption and/or metabolism of various vitamins and minerals. Multivitamin & mineral formulas come in all shapes and sizes and it is helpful to follow a few guide lines when selecting one for your family member.

The first thing to look at in a multivitamin is how it is packaged. Read the label. If you see something called pharmaceutical glaze, avoid it. This glaze is usually shellac and is insoluble in the acidic medium of the stomach. Avoid any multivitamins with artificial colors such as FD&C yellow #5 (tartrazine). These artificial ingredients can interfere with the body's metabolism of certain vitamins such as vitamin B6. Make sure that the label states that the formula contains no corn, wheat, soy, milk, yeast, starch or lactose. Corn can be found in vegetable protein coatings that are on the surface of some multivitamins. Many people have hidden allergies to these substances.

Capsules are generally better absorbed than tablets. Hard gelatin capsules or cellulose capsules ("vegi-caps") are better than soft gelatin capsules. When coming in contact with digestive juices, soft gelatin capsules can form an oily, pasty capsule-shaped mass that does not dissolve or disperse readily and can interfere with the absorption of the multivitamin mineral formula. Soft gelatin capsules are also somewhat permeable to oxygen and it is possible for the contents to become partially oxidized after encapsulation. Tablets and some capsules have fillers added such as magnesium stearate or stearic acid. These substances are added for lubrication, but they can interfere with the absorption of the multivitamin and are best avoided. One should also, avoid children's formulas than have sugar added. Sugar coated tablets can repel the digestive juices and interfere with the formula's absorption.

When looking at the B vitamins in the formula, make sure both niacin and niacinamide are present. These two forms of vitamin B3 have different functions in the body and supplementing with only one form may not be adequate. Vitamin B6 should be in the form of pyridoxine HCL. Some of the newer vitamin pills are using something called P-5-P or pyridoxal-5-phosphate. Unless P-5-P is in large amounts, the phosphate group gets removed in the intestines. The phosphates released can interfere with the absorption of some of the minerals in the formula. P-5-P is also, more expensive and is in lower concentrations in multivitamins than pyridoxine HCL. Women under forty should look for a formula with a little extra vitamin B6 ( 90mg/day) because it can help prevent some of the mood swings associated with premenstrual syndrome. The B-vitamin folic acid is most highly absorbed when it is in the form of folinic acid such as calcium folinate and vitamin B12 is best absorbed and utilized if it is in the form of methylcobalamin or adenosylcobalamin rather than cyanocobalamin. It may be difficult to find an over the counter multiple vitamin with adenosyl- or methylcobalamin or calcium folinate, but they can be obtained by perscription.

The fat soluble vitamins in the formula include vitamins E, D, A, K and beta-carotene. Vitamin E should be in the natural form d-alpha tocopheryl rather than the synthetic form d,l-alpha tocopheryl. Some studies show that natural d-alpha tocopherol is almost twice as effective as synthetic vitamin E. D-alpha tocopheryl succinate is the best form of natural vitamin E in a multivitamin because it is highly stable. If you are not taking coumadin, look for a multivitamin that has some added vitamin K1 or phytonadione. This fat soluble vitamin is especially important for kids and people over 40 because it's needed for bone crystallization. Unless you are pregnant or have liver disease, find a multivitamin that has both beta-carotene and less than 10,000 IU/day of vitamin A. Only a small proportion of beta-carotene is converted to vitamin A in the body and this conversion is impaired if one has hypothyroidism. Many people in the United States, especially the elderly, in fact, consume less than the RDA for vitamin A. The last fat soluble vitamin, vitamin D, should be in the form vitamin D3 or cholecalciferol. This vitamin is essential for bone health and people over forty should get approximately 400IU/day.

When assessing the minerals in the formula look for words like citrate, aspartate or picolinate. Minerals bound to gluconate or oxide may not be absorbed very well. Calcium is best absorbed when it is in the form of calcium citrate or calcium citrate-malate. Avoid multivitamins that contain only calcium carbonate unless it is a pediatric formula. As one gets older, stomach acid levels decline and stomach acid is needed to absorb calcium carbonate. When looking at magnesium make sure it is in the form of magnesium citrate, magnesium citrate-malate or magnesium aspartate. Magnesium oxide may be poorly absorbed in people with decreased stomach acid.

It is best to get a multiple vitamin mineral formula with added copper, manganese, molybdenum, vanadium and iodine. Many people are deficient in these trace minerals and they can help keep bones and connective tissue strong, prevent asthma, control blood sugar and regulate thyroid function. In fact, studies using calcium combined with zinc, copper and manganese show that bone density increases after 1 year of supplementation. This effect is not seen when calcium is given alone. Women over 40 should also make sure their multivitamin contains boron because boron can help prevent urinary losses of calcium and magnesium and raise estrogen and testosterone levels. These changes can help prevent osteoporosis and menopausal symptoms. Women and men of this age group should also find a formula that has some silicon and possibly strontium. Silicon may help prevent heart disease and strengthen connective tissue and strontium can increase bone formation and decrease bone breakdown. Unless you are buying a multivitamin for your child, iron is not needed. Too much iron has been linked with cancer and heart disease. If you have iron-deficiency anemia, iron is best taken separately because it can potentially damage some of the antioxidant vitamins in the formula.

It is my opinion to avoid any multiple vitamins that contain herbs. Herbs should be specially selected for a person based on their individuality. Herbs like ginseng, don quai, licorice, etc. are not foreveryone. It is best to see a practioner trained in botanical medicines to help select the herbs which are best for you.

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