How to Choose Multivitamins After 60: A Geriatrician Weighs in
Who among us haven’t stood in a pharmacy in front of a shelf full of different multivitamins, helplessly scratching one’s head? Choosing just the right one for you is daunting. It’s frustrating. I do it for a living and still find it overwhelming.
So, as a doctor, I decided to jot down a few ideas to help you navigate the ocean of multivitamins available out there.
Tablets, Capsules or Gummies?
While getting your vitamins in the form of yummy gummies is tempting, unfortunately they often contain significantly less active ingredients than the claimed amount. Consumer Lab, an independent organization monitoring the quality of supplements, found almost half of them lacking.
I make an exception for vitamin D, which I take in gummy form on top of my multivitamin. What is the benefit? I have never once forgot to take it.
Ingredients in tablets can be much more compressed, so they pack a better punch. On the other hand, vitamins in capsules are more reliably absorbed.
How Do I Spot Quality?
A lot of manufacturers have no compunction in naming their supplements “best” or “ultimate.” Price is not always a reliable guide, either. I’ve learned to look at the ingredients to tell a quality multivitamin from junk.
More specifically, I look at the sources of vitamins A and E. Contrary to popular belief, there isn’t just one substance called vitamin A. It is a family of antioxidants with similar structure and function. You know some of them well: beta carotene, lutein and zeaxanthin. All are a form of vitamin A.
Here is what to look for:
When looking at vitamin A supplements, here are the buzzwords: natural carotenes, cryptoxantins, zeaxantins, lutein and beta carotene.
Avoid vitamin A palmitate also called retinyl and retinol palmitate. This is a cheap, synthetic form of vitamin A. It has been suspected of causing cancer in mice with sun exposure.
With vitamin E, look for mixed tocopherols and tocotrienols. D alfa tocopherol is the most potent of them.
Avoid DL alfa tocopherol, which is a synthetic form of d alfa tocopherol.
Is It OK to Take More Than 100% of Daily Value?
Once you start looking at the vitamin labels, you quickly realize that many of them list ingredients well in excess of recommended DV (daily value). Is it safe, you may wonder?
It is important to know that daily values have been established as minimum doses that will prevent deficiency. For instance, daily value of vitamin D is the dose that will keep most of us from getting rickets.
This is a pretty low bar to clear. FDA has recognized that in 2016 and has consequently updated many daily values, including the one for vitamin D from 400 IU to 800 IU.
Aging affects the levels of some vitamins, most notably vitamin D and the B group vitamins. With age, our skin seems to have less ability to produce vitamin D from sunshine. As a result, a daily value of 800 IU is often not enough to get our level in good range.
I like to have at least 1,000 IU of vitamin D in my multi. Often, even that may not be enough, and you may need to resort to taking extra vitamin D in addition to the multivitamin.
Decreasing acidity in our stomach diminishes absorption of some nutrients, notably vitamin B12. Therefore, many of us may have insufficient levels of it despite balanced diet. The problem can be compounded by use of acid reducing medications such as omeprazole or ranitidine.
In any person with normal kidney function the vitamin B12 excess will be easily excreted. For that reason, it should be safe for most of us to take larger quantities of vitamin B12.
Anything Else I Don’t Want in My Multivitamin?
I suggest avoiding iron, unless you have a good reason to believe you are iron deficient. Too much iron increases oxidative stress and can be a cause of chronic inflammation. Fortunately, most multivitamins for women over 50 are iron-free.
Another microelement I’d like you to pay attention to is copper. Having enough copper is essential for the function of many enzymes. But inorganic copper, such as that found in supplements, travels in our body through different, less safe pathways than organic copper found in food.
And finally, if you are a smoker, be sure to check the source of vitamin A in your supplements. This particularly applies to combinations used for prevention of macular degeneration, as they typically will contain large amount of vitamin A.
High doses of beta-carotene, which otherwise is considered a desirable form of vitamin A, have been linked to increased risk of lung cancer. Look for alternatives containing combos of lutein and zeaxanthin.
I hope this shed some light on how to make better choices when shopping for your multivitamin.
What vitamins do you take daily? What questions do you have for Dr. Lamnari about choosing the right multivitamin? Please share them in the comments below.