C O V E R S T O R Y

THE MULTIVITAMIN

toss out the overpriced shams, and home in on a multi that has enough of what you needand not too much of wtiat can harm you? Here's what you need to know.

* J Watch out for too little. ^^ Watch out for too much.A good multi should supply roughly100 percent (or more) of the Daily Value(DV) for most vitamins and minerals.Exceptions:

• Calcium and magnesium are bulky,so the only multis that have a day's worthrequire you to take two or more capsules aday. Don't bother. Look for 100 milligrams(mg) of magnesium (25 percent of theDV), which can easily fit into a single pill.Get your calcium from foods or a separatesupplement.

• Chromium, selenium, and zincshould be there, but may he missing. OurBest Rites didn't have to have 100 percentof the DV for each, though, because theDVs haven't been lowered to match thelatest recommendations from the Instituteof Medicine (see p. 6).

Among the popular brands that fallshort of the lOM's recommended levelsfor selenium: Geritol Complete, GNC Pre-ventron and Solotron, One A Day (Active,Essential, and Maximum), Whole roodsDaily, and Centrum (regular. Silver, andt^bewables) and its copycats.

• Vitamin K. The DV is 120 micrograms(meg), but research suggests that peopleneed more to reduce the risk of a hipfracture. Many multivitamins have littleor no vitamin K, probably because it caninterfere with blood thinners like Couma-din (warfarin). If you take a blood thinner,check with your doctor before taking amutti that contains vitamin K.

We gave Best Bites to multis with lowerlevels of vitamin K—at least 2S meg for

^ men and premenopausa! women and atm least 10 meg for anyone 50 or older—onlyS because in each case it was tough to findI more. You can also get vitamin K fromI leafy greens like romaine lettuce andi Spinach.

In their competition for customers, somemultivitamins go overboard. Our chartincludes only brands that limit their beta-carotene, iron, magnesium, phosphorus,and vitamin B-6 to safe levels. Best Bitesalso limit vitamin A acetate or palmitate,vitamin E, and zinc. Here's why:

• Vitamin A acetate or paimitate(retinoi). Too much can raise the risk ofhip fractures. The Tolerable Upper IntakeLevel—the most you can take withoutworrying about any adverse effects—is10,000 lU (International Units) a day, butif you get that much in a multi, whateveryou get from foods would put you overthe top. Among the multis with at least10,000 lU: KAL (Mega Vita-Min and Multi-Four-H), NOW Vit-Min 75-I-, Solaray (Multi-Vita Mega-Mineral, Provide, Spectro, andThree Daily Super-Energy), and TwinLabVita Quick.

• Vitamin E. The Vitamin Shoppe Multi-Vitamins pack has 1,000 IU of vitamin E.That's too much, considering that ananalysis of 19 trials found that the risk ofdying rose steadily as the vitamin E doseincreased from 100 IU to 2,000 IU a day.

• Iron. The highest safe level is 45 mg,from supplements and food combined.Given how much iron people get from redmeat and other foods, the 25 mg in somemultis could bring you close to that max.Too much iron from pills can cause con-stipation or (if you're genetically suscep-tible) iron overload. The jury is still out onwhether excess iron can increase the riskof heart disease and cancer.

• Zinc. You need only 8 mg (women) or11 mg (men) per day. Too much zinc canmake it hard to absorb or retain copper.(At doses close to 300 mg a day, zinc canalso impair the immune system.) Thehighest safe level is 40 mg, but that in-cludes zinc from food. So it's wise to avoid

the .-id to ,i,S nig in some tnrnuilas and the50 mg in Solgar Male Multiples and TheVitamin Shoppe Mature Male paek.

~ What do YOU need?For some nutrients, how much you needdepends on who you are:

• Iron. Many brands have 18 mg becausethat's the Daily Value, but only premeno-pausal women (who lose iron during men-strual periods) need that much. Men andpostmenopausal women need 8 mg a day,but the 9 or 10 mg in many multis is closeenough. Think twice before you switch toan iron-free multi, though, if you rarelyeat red meat, you may run short on iron,especially if you donate blood regularly.

• Vitamin B-12. The DV is only 6 meg,but some experts recommend 25 meg aday if you're over 50. In theory, j>eoplewho take acid blockers like Pepcid, Prilo-sec, Prevacid, Tagamet, or Zantac may beless able to absorb B-12, but few studieshave looked. To play it safe, take 250 to500 meg a day of B-12 if you take aeidbloekers daily (you'll probably need aseparate supplement). High levels of B-12have no known side effects.

• Vitamin K. if you take blood thinners,ask your doctor how much vitamin K youcan take.

^ ^ Check chewables &liquids.Don't assume that a cbewable or liquidmulti has the same nutrients as a pill withthe same name. For example. CentrumChewables has no selenium and CentrumSilver Chewables has no vitamin K.

Many liquids are low in nutrients.For example. Centrum Liquid is missingcalcium, copper, folie aeid, magnesium,selenium, and vitamin K.

N U T R I T I O N A C T I O N HEALTHLETTER • MARCH 2 0 0 6

C O V E R S T O R Y

1 . Basic criteria: Every multivitamin-and-mineral in

this chart has at least 100 percent of the Daily Value (DV)

for vitamins B-1 (thiamin), B-2 (riboflavin), B-3 (niacin),

B-6, B-12, C, D, E, and folie acid. Each also has no more

than 15,000 IU of beta-carotene, 18 mg of iron, 350 mg of

magnesium, 350 mg of phosphorus, and 100 mg of

vitamin B-6,

2. Best Bites: To qualify for a Best Bite, a multi also has

to have at least 35 meg of chromium, 0.9 mg of copper,

100 mg of magnesium, 50 meg of selenium, and 11 mg of

zino. And it can have no more than 4,000 IU of vitamin A

acetate or palmitate (retinoi), 100 )U of vitamin E, or 23 mg

of zino.

3. Additional Best Bite criteria:

50 Plus (women or men): no more than 10 mg of ironat ieast 12 meg of vitamin B-12at ieast 10 meg of vitamin K

Premenopausal women: 18 mg of ironat least 25 meg of vitamin K

Men under 50: no more than 10 mg of ironat least 25 meg of vitamin K

Our circles shovw whioh multis have enough magnesium

and seienium and not too much retinoi (vitamin A acetate

or palmitate) and vitamin E. The more quadrants that are

filled In. the better If all quadrants are filled in but a multi

is not a Best Bite, It probably has too little vitamin K and/or

B-12.

If a section is shaded, the muiti has:

No more than4,000 IU of retinoi--

At least 50 megof selenium ---''^

No more than100 IU of vitamin E

At ieast 100 mgof magnesium

Within each category, muttivitamins are listed in alpha-

betical order (the number of pills or capsules in a daily

dose is in parentheses follovi/ing the name). The last eol-

umn gives a rough estimate of hovi/ much a month's supply

oosts: $ (less than $5), $$ ($5 to $10), $$$($11 to $15),

(more than $15).

Looking for store brands? Equate (Wal-Mart), Kirkland (Costco),

Nutrilite (Amway). Equaline (AlbGrtsons), Spring Valley (Wal-Mart),

Thefagran-M (Walgreens), Trader Darwin's (Trader Joe's).

The information far ttiis article was compiled by Heather Jones.

4 NUTRITION ACTION HEALTHLETTER • MARCH 2006

Eckerd Therapeutic M (1)

Equate 50 Plus One Daily for Mature Adults (1)

Kroger Thera Plus (1)

Nature Made for Her 50+ (1)

Nature Made for Him 50+ (1)

One A Day 50 Plus

Prevention High-Potency for Men (2) or for Women (2)

Theragran-M (1)

Theragran-M Premier 50 Plus (1)

Walgreens Ultra Choice Mature (1)

Rite Aid Whole Source (1)

Shaklee Vita-Lea with Iron (2)

Sundown Complete Daily (1)

Theragran-M Premier (1)

Walgreens Ultra Choice (1) or Ultra Choice Adult (1)

Best Bites - Men Under 50Eckerd Therapeutic M (1)

Kroger Thera Plus (1)

Nature Made for Her 50+ (1)

Nutrilite Daily (1)

Prevention High-Potency for Men (2) or for Women (2)

Shaklee Vita-Lea without Iron (2)

Theragran-M (1)

Walgreens Ultra Choice Mature (1)

/

Best Bites - 50 Plus (Women or Men) ^j ^

AARP Maturity Formula (1) ^ 10 0

28 9

20 0

28 9

50 0

10 0

20 0

80 0

28 9

10 0

80 0

Best Bites - Premenopausal WomenKirkland Premium with Herbs (1) ^ R 80 18

80 18

80 18

25 18

25 18

80 18

28 9

28

50 0

80 6

80 0

80 0

28 9

80 0

Note: several women's formulas are Best Bites for men under 50.

Other Muiti vitamins365 Whole Foods Adult (1) 0 18

365 Whole Foods Adult Iron Free (1) 0 0

AARP Alphabet Vitamins A to Zinc (1) 26 18

AARP Megavitamin (1) 10 0

AARP U.S. RDA Formula without Iron (1) 0 0

Centrum (1) 25 18

Centrum Chewables (1) 10 18

Centrum Performance (1) 25 18

Centrum Silver (1) 10 0

CVS Natural Mega (i)

CVS Spectravite (1)

Eckerd Central-Vite for Adults Over 50 (1)

Eckerd Vitamin A-Day (1}

Equaline Central-Vite Select for Mature Adults (1)

Equaline One Daily Maximum (1)

Equate Mature Compiete (1)

Equate Maximum One Daily for Active Aduits (1)

Geritol Complete (1)

GNC Premium One fr;

GNC Premium One without iron (1)

GNC Preventron (4)or Solotron (1)

GNC Solotron without Iron (1)

KAL High Potency Soft Multiple (2)

KAL Multiple Energy f̂ J

Kirkland Daily (i)

<irkland Mature Aduits Daiiy (1)

•Kroger Complete Performance (1)

Kroger Complete Senior (i)

<roger One Daily Essential (1)

Kroger One Daily Maximum (1)

Lcngs One Daily Essential Iron Free (1)

Matrol My Eavorite Muitiple Energizer (1)

Matrol My Eavorite Muitiple Take One (1)

Natroi My Favorite Muitiple Take One Iron Eree (1)

Nature Made Daily (1)

Mature Made for Her (Tj

Nature's Bounty Green Source (3)

Nature's Bounty Muiti-Day Pius Minerals (1)

^Jature's Way Alive! Whole Eood Energizer (3)

Nature's Way Completia Healthy Heart (1)

Nature's Way Ccmpletia Healthy Heart Iron Free (1)

NOW Daily Vits r/J

NOW Eve (3)

Olay Vitamins Complete Woman's (1)

Oiay Vitamins Complete Woman's 50+ (1)

One A Day Aotive (1)

One A Day Cholesterol Plus (1)

One A Day Essentiai (1)

One A Day Maximum (1)

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100

0

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80

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Prevention Age-Defying for Men 50 Plus (2)

Prevention Age-Defying for Women 50 Plus (2)

Puritan's Pride ABC Plus (1)

Puritan's Pride ABC Plus Senior (1)

Puritan's Pride Mega Vita-Min (1)

Rite Aid Central-Vite Select (1)

Rite Aid Whole Source Mature Adult (1)

Safeway Select Central-Vite Senior Formula (1)

Safeway Select Essential One Tablet DailyIron Free (1)

Safeway Seiect Maximum One Tablet Daily (1)

Schiff Prime Years (1)

Schiff Single Day r'j

Solaray Multi-Vita Mega-Mineral (4)

Solaray Once Daily High Energy Multi-Vita-Min (

Solgar Formula V VM-75 r?;

Sclgar Formula VM-Prime for Adults 50+ Iron Free

Spring Vailey Mature Sentury-Vite for Adults 50+ f

Spring Vailey Naturaity Compiete (1)

Sundown Complete 50+ (1)

Sundown Complete Ultra (1)

Target for Adults 50+ (1)

Target Complete (1}

Target Daily Maximum (1)

The Vitamin Shoppe Mega-Vites "75" (1)

The Vitamin Shoppe One Daily (1)

Trader Darwin's Men's One-Per-Day (1)

Trader Darwin's Super Crusade (2)

TwinLab Daily One Caps with Iron (1)

TwinLab Daily One Caps without Iron (i)

Vitamin World ABC Plus Senior (1)

Vitamin World Adult Chewable (/;

Walgreens AthruZ (1)

Whole Foods Complete without Iron (1)

Whole Foods Daily (1)

Whole Foods High Potency (i)

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Source: manufacturers. The use of information from this article for cornmercialpurposes is strictly prohibited without written permission from CSPl.

NUTRITION ACTION HEALTHLETTEB • MARCH 2006 S

C O V E F

HOWTA MULT

Tlhis made-up multjvitamin label shows how much of each vitaminand mineral we need to get every day {from food plus supple-ments), according to the National Academy of Science's Institute of

Medicine (lOM). The IOM's recommendations vary slightly by age and

VITAMIN A (retinoi). The Daily Value (5,000 IU. cr International Units) is outdated, Ycu needonly 3,000 IU a day ot vitamin A. Too mucti retinci {listed on labels as vitamin A palmitate oracetate) may increase the risk of hip fractures, liver abnormalities, and birth defects. Beta-carotene, which the body converts to vitamin A, doesn't cause those problems, but very highdoses (33,000 to 50,000 tU a day) may increase the risk of lung cancer in smokers, Our ad-vice: Don't get more than 4,000 IU of retinoi or 15,000 IU of beta-carotene from your multi (lassretinoi would be even better). Instead, load up on beta-carotene-rich fruits and vegetables likecarrots, cantaloupe, sweet potatoes, and broccoli, which may help prevent cancer,

VITAMIN D. It helps ycu absorb calcium. Yet many people over 50 get too little D from sun-shine (especially in the winter) or from their food. The Institute of Medicine (lOM) recommends200 IU a day for adults 50 and under, 400 IU for people aged 51 to 70, and 600 IU (some ex-perts say it should be 1,000 iU) for anyone over 70. Those amounts include what you get fromthe sun, from saimon and other fatty fish, and from fortified foods iike miik, breakfast cereals,and some brands of yogurt, margarine, and orange juice. They also include the vitamin D that'sadded to many calcium suppiements. Look for a multi with 400 IU of vitamin D (100% of theDV), even if you're under 50.

THIAMIN {B-D, RIBOFLAVIN {B-2), NIACIN (B-3), and B.6. Whiie there s no reason to getmore than the DV for these B vitamins, the high doses lound in some multis are harmless. Butthat doesn't mean the sky's the iimit. More than 100 milligrams (mg) a day of B-6 can cause(reversible) neurological damage. Super-high doses of niacin (3,000 mg a day or more) maycause liver damage, though you're unlikeiy to find that much in a multi,

VITAMIN B-12. Most multivitamins have at least 6 meg (the DV), which is fine for peopie un-der 50 and vegans (who may not get B-12 from their food because they eat no meat or dairy).People older than 50 may lack the stomach acid needed to extract B-12 from food, so theyshould get at least 25 meg (micrograms) a day from a multi, a separate suppiement, or fortifiedfoods. People who take acid biockers may need 250 tc 500 meg a day. A B-12 deficiency cancause irreversible nerve damage and may masquerade as Aizheimer's disease.

IRON. Many people are deficient, but too much can cause constipation or iron overload if you'resusceptible. To play it safe, men and postmenopausal women should look for a multi with nomore than 10 mg of iron. The DV (18 mg) is fine for premenopausal women.

MAGNESIUM. Americans get too little from their foods (among the best sources: whole grainsand beans), A deficiency may increase the risk of diabetes and coion cancer. Look for a multiwith at least 100 mg, just for insurance. The lOM recommends 320 mg a day (women) and420 mg (men). More than 350 mg a day from a supplement may cause diarrhea,

SELENIUM. Many leading multis (like most Centrum formulas) have considerably less thanthe DV (70 meg) or the IOM's latest recommended level (55 meg), A large study is under wayto see if a high dose (200 meg a day) ean lower the risk of prostate cancer. Taking more than800 meg a day can make your nails or hair brittle (or fall out), so the lOM set Ihe highest safeievel at 400 meg,

IODINE, MANGANESE, MOLYBDENUM, CHLORIDE, and BORON. Ignore There's no evi-dence that people need more than what they get from their food.

6 NUTRITION ACTiON HEALTHLETTER • MARCH 2006

Nutrition FactsSUGGESTED USE: Adults-Oi

Date: JAN 2008

Thnflflvin^iVitamin B-2)(Vitamin B-3)

Molybdenum

S T O R Y

~) READ

Igender. In most cases, we picked the highest ievel for aduits, excludingpregnant and breastfeeding women. The iabei aiso iists the Daily Value(DV) for each nutrient. The DVs, v^hich haven't been updated since the1970s, are stiil used on muitivitamin iabels.

>mm*ndatlon3.00Q IU

90 m

DAILY VALUE (DV), it means the same as "USRDA" (U.S. Recommended Daily Allowance).Labels use them interchangeably. The Daily Value for each vitamin or mineral is the Fcod andDrug Administration's advice on how much to shoot for each day {from food and supplementscombined). In some cases it doesn't reflect the most current research.

VITAMIN C. The DV (60 mg) is lower than the new Institute of Medicine (IOM) recommen-dations: 75 mg a day for women and 90 mg for men. Roughly 250 to 500 mg saturates thebody's tissues, so more than that is probably excreted. Taking more than 1,000 mg of vitamin 0at one time in a supplement may cause diarrhea,

VITAMIN E. The DV is 30 IU. In large studies, high doses didn't protect against heart disease,strol̂ e, ordementia.andmayhaveraisedtheriskof dying. Studies are under way to see if 300 IUto 400 IU a day prevents prostate cancer. Tc play it safe, stick to 100 iU or less.

VITAMIN K. The IOM now recommends 120 meg a day, and recent studies suggest that 150to 250 meg a day may be best to reduce the risk of hip fractures. Yet most multivitamins havemuch less than the DV (80 meg). You can get K from leafy greens, some calcium supplements(like Viactiv). and vitamin K supplements. Vitamin K can interfere with bicod-thinning drugslike Coumadin, so people who take them should check with their doctor before taking a multiwith vitamin K,

FOLIC ACID. Look for the DV (400 meg) to reduce the risk of birth defects {fcr vwomen whocould become pregnant) and to keep a lid on homocysteine, an amino acid that may damagearteries. It's unclear if folio acid reduces the risk of heart disease, stroke, or colon cancer.

BIOTIN and PANTOTHENIC ACID, ignore. You'd have tc eat a bizarre diet to run shcrt.

CALCIUM. To reduce the risk of osteoporosis (and possibly colon cancer), shoot for 1,000 mga day (if you're 50 or younger) or 1,200 mg (if you're over 50), But men shouldn't go overboard,since 2,000 mg a day or more may increase the risk of prostate cancer. A day's worth of cal-cium won't fit in a one-pill multivitamin. So if you don't eat three or four servings of low-fat milk,yogurt, cheese, or caicium-fortified orange juice every day, take a 300 mg caicium supple-ment for each serving you miss,

PHOSPHORUS. Unnecessary. The less you get in your muiti, the better. Too much may Impaircalcium absorption, and we aiready get more than we need from our fcod.

ZINC and COPPER. Look fcr 8 mg (women) or 11 mg (men) cf zinc and 0.9 mg of copper.There's no harm in taking a mutti vi/ith the DV for each (15 mg for zinc and 2 mg for copper), butdon't take extra zinc. Getting more than 40 mg a day (from pills and fcods like meat, poultry,beans, nuts, dairy foods, and fortified cereais) may make your body lose copper. Higher dosesof zinc (cicse to 300 mg a day) may depress your immune system.

CHROMIUM. The iOM recommends only 20 tc 25 meg a day (tcr wcmen) cr 30 to 35 meg (fcrmen). Many brands have eloser tc 120 meg (the DV), whieh is safe.

POTASSIUM. Ignore. It may help prevent high blood pressure, kidney stones, and osteoporo-sis, but amounts in multivitamins are low. Instead, eat plenty of fruits and vegetables.

NICKEL, SILICON, TIN, and VANADIUM, ignore It's not clear that they re needed,

NUTRiTION ACTION HEALTHLETTER • MARCH 2006

C O V E R S T O R Y

THE MULTI'MEGA-VITA'SELLMost supplement claims are unregulated, so companies often stretch the truth.

Here's the scoop behind some popular claims.

MEN'S FORMULA. Men need 8 mga day of iron. Until ongoing studies are

done, we won't know if high ieveis ofselenium (200 meg), vitamin E (400 IU),

and iycopene(15 mg) reduce therisk of prostate cancer.

ANTIOXIDANTS. So far, studieshaven't shown that antioxidants

iike vitamins E or C or zincprevent cancer or heart disease

or protect the brain.

ENERGY. "Performance," "Active,"and "Energy" formulas sound

impressive, but there's no goodevidence that any vitamin or herb

makes you more energetic orboosts athietic performance.

WOMEN'S FORMULA.Premencpausal women need

18 mg a day cf iron, from foodand supplements combined.

Postmenopausal wcmen needhalf as much.

USP. The United StatesPharmacopeia (USP) tests

supplements if manufacturerspay fees tc ccver the test-

ing. This mark means that theiisted ingredients are in the

supplement and will dissolveor disintegrate, noMhatthe

supplement is safe or has anybenefits.

PHARMACIST RECOMMENDED. IgncreSome Nature Made muitivitamins carry a"Pharmacist Recommended" seal. Whiie

it's true that 5.9% cf pharmacists surveyedsaid that they recommended Nature

Made to their customers, the sealdoesn't let shoppers know that

6.4% recommended One A Day and64.4% recommended Centrum.

HIGH POTENCY. Most people assume that"High Potency" means more than the DailyValues (DVs). Net necessariiy. To the FDAit simply means that at ieast two-thirds of amulti's nutrients have at least 100% of the DV"Advanced," "Compiete," and "Maximum"formulas can mean anything.

EIGHT

Stress Formu

MULT

This produa has not been evaJuated by the ^Administration, Thij product is rwt intended to diagrfljsacure. Of prevent any disease.

WEIGHT CONTROL. Extra calcium burns fatin studies from a researcher with a patent onthe claim. In ether studies, it doesn't. There'snc good evidence that extra chromium meltsaway the pounds cr that green tea extractboosts metabolic rate.

STRESS FORMULA. There's no gccdevidence that their extra B vitaminsand vitamin C reduce stress or repairthe damage stress causes, and theyoften lack minerals.

SENIORS. "Mature," "50+," or"Senior" formulas often havemore vitamin B-12 (good), lessiron (good), and less vitamin K(not good). Unless you're takingbiood thinners like Coumadin,your muiti should have vitamin K,which may reduce the risk of hipfractures.

LUTEIN. Even if lutein dees helpprevent cataracts, the 250 megin a typical lutein-ccntainingmulti is less than two percentcf the 14,000 meg (largely fromgreen vegetables) consumed bypeople who had fewer cataractsin seme studies.

LYCOPENE. Despite labelclaims, there's hardly any evidencethat it "helps promote a healthyheart." The FDA rejected a claimthat iycepene prevents prostatecancer (though lycopene-richtomatoes may).

DISCLAIMER. The FDA requires thisdisclaimer when the suppiementmakes a "structure-or-function" claim,which uses words like "maintains,""promotes," or "supports" hearthealth, immunity, prostate health, etc.These ciaims require no approval,and many are backed by little or noevidence.

GINKGO & GINSENG. In the best studies,large doses of ginseng (at least 200 mg) don'tboost energy and it's unelear whether largedeses of ginkgo (180 to 360 mg) sharpenthe mind. There's no evidence that the smailameunts in many supplements do anything.

8 N U T R I T i O N A C T I O N H E A L T H L E T T E R • M A R C H 2 0 0 6