They’re cheap and plentiful, but will they do you any good at all?
As the quality of our food diminishes, so the humble multivitamin has
become one of the most popular health supplements in the world.
Yet,
taking supplements can be expensive. One option is to buy low-dose
multis from large, reputable manufacturers that are able to price their
products competitively and, being more in the public eye, may feel more
obliged to offer a quality product.
But low-dose multis are just
that - low dose - containing 100 per cent, or less, of the Recommended
Daily Allowance of a nutrient. At this level, you get enough to stave
off a deficiency disease (like scurvy), but not enough to have a
therapeutic effect.
Because of this, some consumers
contemplating a low-dose supplement may well ask the very reasonable
question: will it do me any good?
Where’s the evidence?
Surprisingly,
even though specific nutrients such as vitamins C and E, zinc, calcium
and magnesium have been widely studied, data on the benefits of taking
multivitamin/mineral supplements of any kind are sparse.
It is
important to remember that multivitamins are not targeted nutrients,
but simply provide a broad base to support other healthy practices. A
recent study found that taking multis with or without extra vitamin E
did not prevent or improve respiratory tract infections among the
elderly (JAMA, 2002; 288: 715-21). But had the subjects exercised or
cleared their homes of known allergens in addition to taking
supplements, the results may have been different.
Other problems
associated with vitamin studies include the fact that the study
population may be using different kinds of multis containing varying
amounts of nutrients, and that the use of a multi may reflect a
generally healthier individual who takes care of himself in other ways
as well.
A study of the heart-protective benefits of multis in
a group of healthy US physicians is testimony to this, showing as it
did that, in such subjects, a daily multi did not significantly reduce
the risk of heart disease (Arch Intern Med, 2002; 162: 1472-6).
However,
data do show a trend towards benefit even with low-dose multis,
especially among populations with poor nutrition. Multis containing 100
per cent of the RDA of a range of nutrients can improve B-vitamin
levels in elderly persons in just eight weeks (J Nutr, 2000; 130:
3090-6), an important benefit, as it is associated with lower levels of
homocysteine, a chemical that increases the risk of heart disease and
stroke.
Other studies confirm that a low-dose daily multi is
associated with a reduced risk of many chronic diseases in older adults
(J Am Coll Nutr, 2000; 19: 613-21).
For instance, a daily multi
in combination with extra vitamins C, E and A can reduce the risk of
heart and cardiovascular disease by as much as 15 per cent in some
older people (Am J Epidemiol, 2000; 152: 149-62). Multis are also
associated with a lower risk of cataracts (Am J Ophthalmol, 2001; 132:
19-26).
In women of childbearing age, a multivitamin at the
time of conception and during pregnancy can help reduce the risk of
birth defects and childhood brain tumours (Am J Epidemiol, 1999; 150:
675-82; Am J Med Genet, 1996; 62: 179-83; Int J Cancer Suppl, 1998; 11:
17-22).
Children can benefit, too. In a group of
‘working-class’ children in the US, a low-dose multi (with only 50 per
cent of the RDA) resulted in dramatic gains in IQ (J Altern Complement
Med, 2000: 6: 19-29).
The general population can also benefit.
Daily low-dose multis can provide a modest reduction in prostate cancer
risk (Cancer Epidemiol Biomarkers Prev, 1999; 8: 887-92), though not as
much as high-dose, targeted nutrients like vitamins C and E, and zinc;
multis containing folate combined with a healthy lifestyle can reduce
the risk of colon cancer (Cancer Epidemiol Biomarkers Prev, 2002; 11:
227-34).
Daily low-dose multis (not unlike those in this survey)
have been proved to combat the effects of stress in highly stressed
individuals (South Afr Med J, 2000; 90: 1216-23), and to reduce the
risk of cardiovascular disease (Am J Epidemiol, 2000; 152: 149-62). The
ongoing Nurses’ Health Study found that a daily multi containing the
full RDA of folate reduced the risk of breast cancer particularly among
women who drank more than 15 g of alcohol per day (JAMA, 1999; 281:
1632-7).
The products
To find out what’s in ‘good-value’
vitamins and which were the best buys, we endeavoured to compare like
with like. As testing every substance in every tablet is a gargantuan
task, we only looked at the vitamin C content. This vitamin degrades
quickly, so its quantities provide a reasonable indication of whether
the manufacturer has produced a quality product.
Our laboratory
found that all the products in our road test included more than the
stated amount of vitamin C - albeit by insignificant amounts in some
cases.
When purchasing low-dose multis, there are several things
to look out for. Most don’t contain enough vitamins C and E, and are
likely to be low in certain essential minerals, particularly calcium
and magnesium. This was certainly the case with all of the products in
our survey. In fact, because these nutrients take up a lot of space in
a tablet, including 100 per cent of your RDA of these would make a
tablet too big to swallow.
Cheap multis rarely contain
important cofactors such as bioflavonoids, which aid vitamin C
absorption. Indeed, only one of the products reviewed contained rutin.
Similarly, none contained essential amino acids (though these could be
manufactured from a well-balanced diet). And while the majority
included a wide range of minerals, these were generally in the form of
oxides and sulphates - not the most readily absorbable forms (see box
above).
Cheap vitamins are also more likely to be made from
synthetic sources, as was often the case here. While this may not be a
problem with the water-soluble vitamins (C and B-complex), there is
evidence that the fat-soluble vitamins (A, D, E and K) are better, and
safer, from natural sources.
Finally, all of the supplements tested contained a range of fillers and additives, and many used unacceptable colours.
Taking
cheap multis can be a false economy. Quality products such as Solgar’s
and BioCare’s one-a-day vitamins, which got top marks from us (PROOF!
vol 6 no 1), offer many times more of the expensive nutrients, such as
the fat-soluble vitamins. For only 10 p more a day, you may get three
times as much of many nutrients. But if you are on a tight budget,
these products are certainly better than nothing.
EuRho Multivitamin and Mineral Tablets
Distributor: Lidl Stores
Price: £3.59 (100 tablets)
Rating: ****
Lidl
discount supermarkets are popping up all over the UK, and these multis
are among their own-brand products. They claimed 60 mg of vitamin C;
our lab found 63 mg. The expiry date was Nov 04 so, by that time, it
may have degraded considerably.
Its 800 mg of vitamin A is 25
per cent beta-carotene, vitamin D is the easily absorbed D3, and it has
relatively good levels of magnesium and calcium - 100 mg and 162 mg,
respectively. It delivers 1671 mg of vitamin C for your £ (the most in
our road test) and costs only 4 p/day. Were it not for the coal-tar
synthetic colouring ‘sunset yellow’, this might have earned top marks.
A-Z Multivitamins & Minerals
Manufacturer: Superdrug
Price: £3.29 (special offer; 60 tablets)
Rating: ***
This
product has a safety cap (only one of three that did) and no synthetic
colours. It has a small amount of beta-carotene, but reasonably high
levels of calcium (200 mg - among the highest we found) and magnesium
(100 mg). It also uses the more easily absorbed vitamin D3. This was
one of two products not to contain the trace element molybdenum.
The
label claims 60 mg of vitamin C and our lab found 68 mg, not overly
generous for a sell-by date of Dec 03. Nevertheless, you get 1094 mg of
C to the £, and taking this tablet will only cost you 5 p/day.
Centrum Complete From A to Zinc
Manufacturer: Wyeth Consumer Healthcare
Price: £4.59 (30 tablets)
Rating: ***
A
comprehensive and popular supplement for adults, this product contains
31 nutrients. Its calcium and magnesium levels are reasonable - 162 mg
and 100 mg, respectively. However, it is not clear from the label what
the sources of vitamins A, D and E are - but 25 per cent of the vitamin
A is beta-carotene, a reasonable proportion.
Centrum declared
60 mg of vitamin C; we found 63 mg. You get a very low 392 mg of
vitamin C for your £, at a cost of 15 p/day. Again, though, we would
like to see the coal-tar-based ‘sunset yellow’ removed.
To all
intents and purposes, this is the same product as Lidl’s EuRho (see
above) but, given the higher price tag, with considerably less value
for your money.
A-Z Multivitamins + Minerals
Distributor: Waitrose
Price: £4.99 (60 tablets)
Rating: **
A
clear label, but the vitamin E is a mix of natural and synthetic,
vitamin A is synthetic retinyl acetate (including peanut oil, a
potential allergen), and it uses vitamin D2, thought to be potentially
more toxic. So, this gets points for clarity, but its content is not
really up to scratch. Calcium and magnesium are reasonable at 162 mg
and 100 mg, respectively, but it uses suspect colours like allura red
and quinoline yellow.
The label declares 60 mg of vitamin C and we found 70 mg, giving you 721 mg of vitamin C for your £ at a cost of 8 p/day.
Multibionta
Manufacturer: Seven Seas Health Care
Price: £4.59 (30 tablets)
Rating: **
The ingredients are printed on the throw-away box, not on the bottle, making it difficult to refer to them if necessary.
But
plus points go to Seven Seas for including probiotics and for using
vitamin D3 (cholecalciferol), the safest and most easily absorbed type.
But the vitamin E is a mix of natural and synthetic
(D,L-alpha-tocopherol), and it’s not clear what the 'vitamin A
preparation' is. As with others in this road test, many of the minerals
are in the less absorbable oxide and sulphate forms.
It
declares 60 mg of vitamin C; we found 77 mg. You get 392 mg of vitamin
C for your £, one of the least amounts in our survey (shared with
Centrum), at a cost of 15 p/day.
Sanatogen Gold A to Z
Manufacturer: Roche Consumer Health
Price: £4.39 (30 tablets)
Rating: **
Along with Seven Seas, Roche is one of the UK’s largest manufacturers of over-the- counter medicines and supplements.
The
label offers no clues as to the type of vitamins D or E used, but
states 800 mg of vitamin A (source not identified) and 400 mg of
beta-carotene, a tiny amount. But it also contains the eye-protecting
carotenoid lutein, the only one in our survey to do so.
Roche
claims 60 mg of vitamin C and we found 67 mg. With an expiry date of
Oct 03, though, this product may be rapidly degrading. You get around
410 mg of vitamin C for your £, at a cost of 15 p/day.
Complete Multi Vitamins and Minerals
Manufacturer: Boots Company PLC
Price: £3.80 (30 tablets)
Rating: *
The
labelling alone is a good reason to avoid this product. Instead of
individual contents, the label lists the fillers (a considerable
number), and states 'multimineral compound' and 'multivitamin compound'
in the midst of all this. Calcium levels are high at 220 mg, but
magnesium is low at 60 mg.
The label claims 60 mg of vitamin C; we found 79 mg. Rather pricey at 13 p/day, you only get 474 mg of vitamin C for your £.
Multi Vitamins Plus Minerals
Manufacturer: Seven Seas Health Care
Price: £5.99 (60 tablets)
Rating: *
A
product specifically for vegetarians and vegans, we’re not sure how
this can satisfy their requirements. Vegetarians are often deficient in
B vitamins, specifically B12 and, although levels here range from
175-300 per cent of the RDA, they are still very low. It has iron and
zinc, but is missing important minerals and trace elements like
potassium, magnesium, manganese and selenium. It uses vitamin D2, a
synthetic derived from plants thought to be less well absorbed and more
potentially toxic than D3.
The label promises 90 mg of vitamin
C and we found 103 mg, giving you 901 mg for your £, but at a cost of
10 p per day - expensive given how much is not in it.
Radiance Multivitamins & Minerals
Manufacturer: Holland & Barrett
Price: £2.19 (60 tablets)
Rating: *
This
value supplement doesn’t contain the full range of vitamins/minerals
and levels are generally less than the full RDA. Notably absent are B5,
biotin, inositol, potassium, magnesium, manganese and selenium. Yet,
this includes the flavonol rutin to aid the absorption/action of
vitamin C, and brewer’s yeast to boost B levels. Vitamin A is the
synthetic retinyl acetate, but the vitamin E is from a natural source.
This
claims 50 mg of vitamin C and we found 66 mg - good value at 1370 mg
per £ and 4 p/day. But the brewer’s yeast may not be suitable for those
with Candida.
If you are perfectly healthy, have a good diet and no evidence of
poor absorption, you may be able to get away with taking a low-dose
multi. Adjusting your diet and adding high-dose, specific nutrients
according to your personal needs may further improve your health. If
you are taking a daily standard multivitamin/mineral tablet, the
general advice is to take it with food so that your body can draw
cofactors from your food resources to aid absorption.
Consider the following to help you choose the best supplements:
* Check the label. Make sure your chosen multi includes the full range of essential minerals as well as vitamins
*
Check the label again. Look for the words ‘citrate’, ‘picolinate’,
‘aspartate’, ‘glycinate’, ‘glutamate’ and ‘amino acid chelate’. These
refer to the way the vitamin/mineral is processed (and usually follow
the name of the nutrient, as in chromium picolinate) and are considered
the easiest forms for the body to use. Compounds such as carbonates,
sulphates and oxides are generally less well absorbed
* Look for
the expiry date. Supplements can lose potency over time, especially in
hot and humid climates. Choose supplements with an expiry date as far
into the future as possible. If a supplement doesn’t have an expiration
date, don’t buy it
* Reject junk. Watch out for excipients such
as binders, fillings and coatings. In tablets, these are part of
processing the supplement, but you can reject those with unnecessary
additives such as artificial colours, and sweeteners such as glucose,
lactose, mannitol and xylitol
* Buy from reputable shops and
manufacturers. The bigger the shop and/or manufacturer, the more they
are able to demand quality ingredients in their products
* Keep
it simple. Avoid supplements that use a ‘kitchen-sink’ approach to
formulation, with added herbs, such as ginseng, alfalfa, bee pollen and
Ginkgo biloba. These are seldom present in therapeutic quantities and
are usually only there to jack up the price. If you truly require these
things, take them separately
* Avoid specialist formulas, such
as ‘women’s formulas’, ‘men’s formulas’ or ‘over-50s formulas’. These
are not usually based on any solid science and are more expensive. The
exception is for very young children, who may benefit from the lower
doses of vitamins found in some children’s products.
The Recommended Daily Allowance (RDA) is now an almost meaningless
term since it refers to the minimum amount of each nutrient considered
necessary to prevent a deficiency. There is often a huge gap between
the RDA of a nutrient and its therapeutic amount.
To find out
how much we should be getting of the main vitamins and minerals each
day, we canvassed our PROOF! panel members. The table below sums up
their advice. Remember that these amounts can come from food as well as
supplements. Also, these are general guidelines for healthy adults and
do not apply to children or pregnant women. Your individual
requirements could be different from these. To determine what you
should be taking, it is best to consult a qualified, experienced
nutritionist before taking supplements.
Vitamins
Vitamin A 1600-2000 mgRE (5328-6660 IU)
Vitamin B1 (thiamine) 50 mg
Vitamin B2 (riboflavin) 50 mg
Vitamin B3 (as niacin) 50 mg
(as niacinamide) 100 mg
Vitamin B5 (panthothenic acid/pantothenate) 50-300 mg
Vitamin B6 (pyridoxine/pyridoxal) 50 mg
Folic acid 400-800 mg
PABA (para-aminobenzoic acid) 500 mg
Vitamin B12 (cobalamin) 100 mg
Biotin 200-1000 mg
Vitamin C at least 50 mg, preferably 1-3 g/day
Bioflavonoids 100-1000 mg
Vitamin D 400 IU (10 mg)
Vitamin E (D-alpha-tocopherol) 100-600 IU (70-420 mg)
Choline 500-700 mg
Inositol 600 mg
Minerals
Boron 3 mg
Calcium 500 mg
Chromium 100 mg
Copper 2-3 mg
Iodine 500 mg
Iron 10 mg
Magnesium 200-400 mg
Manganese 5-25 mg
Potassium 300-600 mg
Selenium up to 200 mg
Zinc 15-30 mg