This month, I have decided to start work on a series of posts about vitamins and minerals, focussing in particular on multivitamin supplements.  I am very passionate about this topic and anticipate having lots to say, so I will be splitting it into several shorter essays so as not to bore everyone too much in one go!  At this stage I am not 100% sure what each post will cover, but in today’s post I plan to discuss in fairly general terms what sorts of things people should look out for when purchasing vitamin and mineral supplements.  In subsequent posts, I will talk about understanding label claims, especially the elemental yield of minerals, and I will discuss compound ingredients and labelling laws.  Later in the series, I will hone in on the particular considerations that people with interstitial cystitis need to keep in mind when choosing high quality, bladder-friendly vitamins and minerals.  I hope you will find the series informative and helpful! 

As ever, please remember that I am not a doctor and nothing in this post is intended to constitute medical advice.  You should always consult with a qualified healthcare practitioner before making dietary or lifestyle changes.

I subscribe to the school of thought that most people can benefit from supplementing with extra vitamins and minerals.  If you do not share that view then there will be nothing in this series, or probably this whole website, that is relevant to you!  While all readers are welcome here at Tiny Pioneer, please remember that the website caters mainly for people with chronic health conditions, especially bladder and bowel conditions.  It can be difficult for individuals in this group to achieve optimum nutrition through diet alone because:

• Certain food groups might exacerbate their symptoms.
• They might be allergic or sensitive to several foods.
• They might not absorb nutrients very well.
• They might have days where they’re not well enough to cook nutritious food.
• They might have days where they’re not able to eat very much.

Even among those without any underlying health conditions, it might be challenging to get all the required nutrients from diet alone because:

• Stress and pollution can deplete certain nutrients, thus increasing demand.
• Seasonal unavailability of certain foods might make it difficult to eat a balanced diet all year round.
• Intensive farming practices and use of chemicals can impact on the nutritional profile of soil and thus harvests.
• Sudden acute illness or trauma temporarily increases the need for certain nutrients.
• Personal preferences might lead people to regularly make unhealthy food choices.

It is therefore my personal opinion that a majority of people do not get all the nutrients they need for optimum health from their diet alone.  You’ll notice I used the phrase ‘optimum health’.  You might think you’re reasonably healthy, but here are some signs that you might not actually be as well as you could be:

• You’re often tired and you don’t have much stamina.
• You catch colds a few times a year, or you get frequent infections.
• You experience skin rashes.
• You experience constipation, diarrhoea, reflux, or other digestive discomfort on a regular basis.
• You have trouble concentrating or you experience brain fog.
• You have a really tough time with your menstrual cycle.
• You suffer with generalised anxiety or depression even though you have already eliminated any foods to which you are intolerant. 
• You get cold sores, cracks at the side of your mouth, or mouth ulcers.
• You have brittle nails and your hair is not in good condition.
• You experience skin breakouts or have dull, unhealthy looking skin.

Of course the above list does not even touch on conditions that commonly begin in later life, such as high blood pressure, heart disease, or joint aches and pains. 

I believe that food supplements can make an enormous difference to most people’s quality of life by helping them to address shortfalls in their diet.  It goes without saying that it is important to eat well, to avoid an excess of sugar and alcohol, to exercise, to get good sleep, and to take care of ourselves as well as we can.  No supplement can offset the effects of prolonged bad living.  However, my personal experience is that supplements can and do help many of us to achieve a healthier and happier life than we otherwise could. 

Vitamins and minerals can be supplemented individually, in small groups, or as broad spectrum multivitamin and mineral formulations.  Technically a multivitamin supplement contains only vitamins and a multi-mineral supplement contains only minerals.  However, the term ‘multivitamin’ usually refers to a combination of vitamins and minerals.  For the purposes of this series, the latter definition is the one I will use. 

I consider a high quality multivitamin supplement to be the cornerstone of most good supplement regimes.  Supplementing only with individual vitamins or minerals is something I don’t recommend unless you either have one very simple deficiency to correct, or you are very knowledgeable about nutrition.  This is because:

• Many vitamins and minerals require other vitamins and minerals to do their job properly.  For example, vitamin D requires vitamin K for the proper use of calcium.  Calcium in turn works closely with magnesium.  Vitamin C is required for the proper absorption of iron, while B vitamins work best with other B vitamins.  Taking single vitamins or mineral might mean you don’t get the best results from them. 
• An excess of some vitamins and minerals can lead to a deficit of others.  For example, long term intake of excess zinc can lead to a deficiency of copper.  Long term intake of excess calcium can deplete zinc. 
• It is easy to overlook trace minerals.  For example, boron improves magnesium absorption, while selenium works with vitamin E to provide antioxidant effects in iron-overload states.  Manganese helps with the formation of connective tissue, while molybdenum helps to break down uric acid.

Good multivitamins contain a broad range of nutrients, accounting for what most people already get from their diet, to provide a safe and sturdy base to which other more niche supplements can then be added if needed.  If your health requirements are quite basic, you might be able to find all that you need in a really good multivitamin.  However, if you have extra health requirements, you will almost certainly need to put other supplements on top.  With a well-designed multivitamin as your foundation, you should be able to do this more efficiently and with less risk of upsetting the delicate balance between nutrients. 

With so many multivitamins to choose from though, how do you know which are the good ones? 

First let’s talk about what a good multivitamin product should actually contain.  I won’t be going into what each ingredient actually does as that would take up far too much space in an already long series.  However, if you would like me to write a separate series at some point where I put the spotlight on one vitamin and mineral at a time, please let me know and I will be happy to oblige! 

In my opinion, a good multivitamin should contain:

• Vitamin A, ideally preformed and presented as retinyl acetate or retinyl palmitate.  Lots of people mistakenly believe that beta-carotene is the same as vitamin A.  It is not.  Beta-carotene is a precursor to vitamin A and although the body can convert it into vitamin A, the conversion is not terribly efficient.  Furthermore, it relies on good gut function and the presence of other nutrients, which might themselves be lacking.  In my opinion, a quality multivitamin should offer preformed vitamin A in a retinyl ester form, as this is more efficiently converted into the retinol, retinal, and retinoic acid that together make up the group of chemicals known as vitamin A.  I like to see at least 2000iu.
• Beta-carotene is not just a precursor to vitamin A – it is also a powerful antioxidant in its own right.  I always think it is nice when a multivitamin offers both preformed vitamin A and beta-carotene.  It’s not a deal breaker for me, but it’s a thoughtful addition. 
• Vitamins B1, B2, B3, B5, B6 (unless you have interstitial cystitis!), biotin, folate, and vitamin B12.  This group of nutrients very much work together, so they should all be present in a multivitamin unless there is some compelling reason to omit one of them; for example, a supplement aimed at people with B6 toxicity or interstitial cystitis would omit vitamin B6.  If B6 is present, it should ideally be in the form of pyridoxal 5-phosphate, which is the active and more efficient form of vitamin B6.  I consider pyridoxine hydrochloride to be a cheaper and inferior form.  Folate should be presented as methylfolate and not folic acid.  Folic acid is a synthetic and inactive form of folate that requires conversion before it can be used by the body.  Methylfolate is a biologically active form of folate – amongst other names you might see it on labels as L-methylfolate or methyltetrahydrofolate.  Vitamin B12 should be presented as methylcobalamin rather than cyanocobalamin.  I like to see at least 20mg each of vitamins B1, B2, B3, B5 and B6, along with at least 100mcg each of folate, biotin and vitamin B12. 
• Vitamin D, which should ideally be in vegan D3 form.  I like to see at least 1000iu in there, but as lots of people supplement with extra vitamin D anyway, I would not necessarily reject a multivitamin that used less than 1000iu as long as it contained at least 400iu. 
• Vitamin E – I like to see at least 100iu. 
• Vitamin K – lots of brands leave this out, but vitamin K2 works with vitamin D3 to ensure proper calcium use, so it is good to see some included.
• Zinc, at least 10mg.
• Manganese, chromium, selenium, iodine, molybdenum, and boron.  These are sometimes omitted, but they are important trace minerals.

Most multivitamins also contain:

• Vitamin C
• Calcium
• Magnesium

“Wait a minute!” I hear you cry.  “Aren’t those very important ingredients?  Shouldn’t ALL multivitamins contain those things?”  Well, yes and no.  The problem with vitamin C, calcium and magnesium is that we need quite a lot of them each day.  Unless a multivitamin has a serving size of several capsules a day or makes cuts elsewhere, it can be difficult to squeeze meaningful levels of these ingredients in there.  Many people choose to take extra vitamin C, calcium or magnesium on top of their multivitamin anyway.  For this reason, while most brands do include token amounts of these nutrients, it isn’t necessarily a sign of a bad multivitamin if they are omitted! 

Other ingredients you might find are:

• Copper.  Some people actively seek out a copper-free formula, but when you read the ingredients list make sure it is in there if you want it.  If a formula contains 15mg of zinc, you’ll be looking for around 1mg of copper.
• Iron.  Again, some people need to use an iron-free formula, but if you want it, check for it!  If it’s going to be in there, I like to see it at the full 14mg.  Avoid any products that use ferrous fumarate or ferrous sulphate and look instead for products that use iron bisglycinate.    
• Choline and inositol.  These are both required in fairly large amounts, so within a multivitamin only token amounts can be included.  For this reason, they are sometimes omitted entirely.  People do tend to get quite a lot of choline and inositol in their diet anyway. 
• Coenzyme Q10, which is a powerful antioxidant used, among other things, for cell growth and maintenance. 

Multivitamins are sometimes targeted at a very broad demographic, for example ‘adults’.  They are sometimes designed for more niche requirements, such as pregnancy, postmenopausal females, men over 50, or athletes.  The exact quantities of the nutrients listed above, as well as the presence of other vitamins, minerals, amino acids, or herbs will depend on exactly who the product is intended for.  It is obviously impossible for me to go into the ideal ingredients for every demographic, but hopefully the lists above will go some way to helping you weed out the wheat from the chaff! 

Now that we’ve discussed what a good multivitamin should contain, let’s talk about what information should be present on the label.  This is where things get interesting for reasons that will become apparent! 

Firstly, you obviously need to know what you’re buying.  That means you need a brand name, a product name, and the contents of the package.  For example, is the vitamin, mineral, or multivitamin presented as capsules, tablets, chewable gummies, liquid, or loose powder?  How many or how much are you getting?  And how much or how many do you need to take each day?  All of this information should be available to you.  I consider capsules to be the superior delivery form, because unlike tablets they do not require binding ingredients to hold them together.  Gummies and liquids require some kind of carrier ingredient, as well as flavourings to make them palatable.  Loose powders can be good for certain vitamins and minerals, but they’re not as practical for multivitamins unless they too are flavoured and processed in some way to make them mix easily in liquids. 

Although some multivitamins are formulated as ‘one-a-day’ capsules or tablets, the best ones will require you to take two or more capsules a day.  Products designed to be taken once daily always, always have to make compromises in the quantity and/or quality of nutrients included.  A standard sized capsule will hold about 500mg of powder (of course the exact figure depends on the density of the powder being used) while larger capsules can accommodate around 700mg.  Let’s say that we want our multivitamin to give us 20mg each of vitamins B1 to B6, along with 200mg of vitamin C, and 50mg each of magnesium and calcium – that’s 400mg of active ingredients right out of the gate!  Meaningful intakes of each nutrient soon mount up and usually one-a-day formulae make significant cuts to the B vitamins, to vitamins C and E, and to some of the minerals to squeeze everything in.

If you’re a generally healthy and robust person with no special health needs, a basic one-a-day formula might give you what you need most of the time.  However, a product that requires you to take two or more capsules a day is superior.  It allows more meaningful serving sizes of more of the nutrients, which might be a better option for those whose health is not so robust or who have special requirements.  If, for example, you suffer with PMS and hormonal issues, you’ll benefit from plenty of B vitamins, a good amount of vitamin E, zinc, magnesium and manganese.  You’re unlikely to find the quantities suitable for your needs in a one-a-day offering and so you’ll end up buying a greater number of extra products to top up.  Sometimes, paying more for a higher quality multivitamin that requires you to take more than one capsule a day works out to be more economical and efficient. 

Another reason why one-a-day multivitamins are not ideal is that they dump your entire days’ serving of vitamins and minerals into you all at once.  This is not a problem for the fat-soluble vitamins A, D, E and K, which can be stored by the body for use later.  However, it is not so good for the water-soluble vitamins B and C, which cannot be stored.  The body is only able to use finite amounts of water-soluble vitamins at once, with any leftovers being excreted in the urine.  If a whole day’s vitamins and minerals are taken in one serving at breakfast, there is the potential to waste a good portion of the water-soluble nutrients.  Particularly for people with interstitial cystitis, it might be easier on the kidneys and bladder to spread the daily dose of water-soluble vitamins into smaller, separate servings.  A multivitamin that requires two or more capsules to be taken each day allows you to leave time between servings.  This gives your body the opportunity to properly use more of each serving and it results in less nutrients being excreted in the urine in one go.  I’m not saying that one-a-day formulae are bad; I’m simply saying that most of the time two-a-day formulae are better, so the number of capsules to be taken each day can serve as a good indicator of product quality! 

Next, you need to know what nutrients are actually included in the product.  For vitamins and minerals, these should be presented in a table.  The first column should name the nutrients, the second should tell you how much of each nutrient is present, and the third should tell you what percent of your EU Nutrient Reference Value you are getting.  (Consumers outside Europe might see some other type of NRV or perhaps a Daily Value in this column.)  Not all vitamins and minerals have Nutrient Reference Values, so sometimes this column will be blank for some of the nutrients.  The table should make it clear whether the values relate to each daily serving or each individual capsule/tablet.  Either version is acceptable; which is best really depends on the product in question.  For a single ingredient product like a vitamin C capsule, it can be nice to see a ‘per capsule’ table.  For a formula with several nutrients, a ‘per daily serving’ table can be easier to work with. 

Not only do you need to know what nutrients you’re getting, you also need to know what form you’re getting them in.  This is definitely a reliable way to tell good products from bad ones – if this information is not available to you, simply do not buy the product!  A quality vitamin or mineral product will always, always tell you the form of each nutrient being used.  A brand whose label simply says things like ‘vitamin A’, ‘vitamin C’, or ‘zinc’ is not providing consumers with enough information and should be avoided.  There are a few ingredients which can appear without any kind of clarifying information – biotin and inositol are the two that immediately spring to mind.  However, most vitamins and minerals can be presented in lots of different forms and it is important that consumers know which type has been chosen. 

The form that each nutrient is presented in can reveal a lot about the quality of a product.  As mentioned above, quality products usually present vitamin A as a retinyl ester; vitamin B6 as P5P; and folate and vitamin B12 in methyl forms.  Good quality minerals might be presented as glycinates (for example, copper glycinate), bisglycinates (for example, iron bisglycinate), or citrates (for example, calcium citrate).  Chromium could appear as picolinate and zinc could appear as picolinate or gluconate, as well as (bis)glycinate.  Vitamin B3 would usually be in the no-blush form called niacinamide or nicotinamide.  Ascorbic acid is not necessarily a bad ingredient, but most interstitial cystitis suffers cannot tolerate it.  Given women’s propensity to bladder infections, I prefer to see mineral ascorbate forms of vitamin C used in multivitamins designed for women. 

Poor quality vitamins are likely to use forms of magnesium with greater laxative effects, such as magnesium hydroxide, magnesium sulphate, or magnesium oxide.  They might also use minerals that are cheap and poorly absorbed, like zinc oxide, or those that can produce unwanted side effects, like ferrous fumarate or copper sulphate.  In general, I would not purchase a vitamin and mineral supplement that contained more than one or two of these ingredients, especially if it was also using inferior forms of vitamin B6, folate and vitamin B12. 

I like to see the form of each nutrient written in brackets in the table of facts.  However, it is acceptable to show this information in the ingredients list instead.  An ingredients list is not an acceptable substitute for a table of nutritional facts and as far as vitamins and minerals are concerned, both should be present.  The table of facts is reserved for active ingredients, but the ingredients list should show the inactive ingredients as well.  This might include things like magnesium stearate, silicon dioxide, titanium dioxide, talc, rice flour, potato starch, gum Arabic, sunflower oil, microcrystalline cellulose, gelatine and maltodextrin, as well whatever the capsule shell is made out of.  Such ingredients can be used to fill up extra space in capsules, hold tablets together, help powders to run more smoothly through machines, keep the active ingredient from sticking together in clumps, or keep the active ingredient from degrading. 

A good quality supplement will use as few inactive ingredients as possible.  If you are buying a certain vitamin or mineral, look around at a few brands and if you see one that uses only one or two active ingredients while another uses four or five, you can probably make a guess that the latter product is inferior.  A product that uses no inactive ingredients is said to be ‘clean’.  You should be aware though that not every ingredient can be offered cleanly.  For example, vitamin D is taken in very small amounts and in order to get such a small amount into a physical format that a human can handle, it has to be mixed with something else.  Vitamin A is very sensitive to oxidation by air in the presence of light, so it is enrobed with other ingredients such as carbohydrates and antioxidants to improve stability and preserve potency.  Sometimes, brands will omit these extra ingredients from their label to make their product seem cleaner than it really is.  Astonishingly, this is not always illegal and it is something that I will devote a separate blog to later in the series so that we can talk about it in more detail!

The ingredients list should be given in descending order by fill weight.  Fill weight is not the same as nutritional table claim weight.  Consider calcium glycerophosphate:  100mg of calcium glycerophosphate does not give 100mg of calcium.  In fact 100mg of calcium glycerophosphate gives around 18mg of calcium.  Consider also magnesium ascorbate:  200mg of magnesium ascorbate gives around 12mg of magnesium.  A supplement containing 200mg of magnesium ascorbate and 100mg of calcium glycerophosphate contains more calcium than magnesium, but it contains more magnesium ascorbate than calcium glycerophosphate.  In the ingredients list, it is the fill weight that determines the order, so magnesium ascorbate would appear earlier in the list than calcium glycerophosphate. 

Sometimes, brands mislead consumers by using fill weights instead of nutrient weights in the table of facts.  In the example used above, they would put 100mg of calcium glycerophosphate into a capsule and would claim that it provided 100mg of elemental calcium when it actually only provides 18mg.  Within the context of a multivitamin where there are lots of different ingredients in a single capsule, it can be difficult to spot if this is happening.  It is very naughty, but quite widespread, and needless to say it is definitely a sign of an inferior product!  Good quality vitamin and mineral brands will never use the table of facts to mislead consumers!  Again, this is a topic that I want to elaborate on, so in my next blog post I will be talking about elemental yields, showing you how the nutrients in the table of facts should be presented, and teaching you how you might be able to tell if false claims are being made. 

Getting back to the topic in hand today, you can tell roughly how much of an inactive ingredient is present in a supplement by its position in the ingredients list.  If something like maltodextrin or rice flour appears high up the list, it means quite a lot has been used relative to the active ingredients.  If the active ingredients all come first and then rice flour or silicon dioxide appear right at the end of the list, it means the product contains more active ingredient relative to inactive ones.  This can be a good indicator as to the quality of a product, unless we are dealing with things like vitamin D or copper which are only taken in very small amounts. 

One very good indicator that a vitamin or mineral supplement is poor quality is the use of colourings in its manufacture.  Vitamin capsules and tablets are not Christmas decorations – there is no reason for them to be coloured, especially artificially.  I suppose it is more forgivable with gummies or liquids, but even then it’s not ideal.  I would avoid any vitamin capsule or tablet that uses titanium dioxide or E numbers for colouring purposes – it simply is not necessary. 

You might sometimes see a supplements table followed by a list containing ‘other ingredients’ where only the inactive ingredients are listed.  This tends to be on American products, so I presume that that must the approved way of showing information over there.  You don’t usually see it done that way on British vitamins and minerals.  However, whatever the country of origin, a reputable brand always makes it clear to consumers exactly what is in the product they are buying. 

Other information that should appear on the label of a good quality vitamin and mineral supplement includes:

• Directions for use – how many to take each day, an instruction to take with food if appropriate, an instruction to mix with cool liquid if appropriate, and so on.
• A warning not to exceed the recommended serving size.
• Any contraindications – for example, ‘do not take if pregnant’, or ‘do not take if you are using MAO inhibitors’. 
• A notice to keep out of sight and reach of children.
• Storage instructions.
• A best before date and a batch number.
• An address.  

The exact wording and format of this information might vary from country to country, but all reputable brands should include something along those lines. 

One tactic that cheap, inferior brands use to make their product seem better quality is by claiming that it provides 100% of the NRV of every nutrient.  To the novice consumer, this seems very desirable for two reasons.  First, it creates the impression that the product is a complete solution to their nutritional requirements, which will surely restore them to optimum health.  Second, it plays into the reasonable but erroneous assumption that to take more than 100% of the NRV of any nutrient might be dangerous. 

There is a lot of confusion and misunderstanding from consumers when it comes to NRVs.  They do NOT represent the maximum safe limit of vitamins and minerals.  This would actually be known as the Upper Tolerable Limit, which even then might, under professional guidance, occasionally be exceeded.  All reputable nutrition brands keep the Upper Tolerable Limits of nutrients in mind when they formulate their products and they also keep in mind how much of each nutrient people are likely to obtain from their diet.  What the NRV represents is the amount of each nutrient required daily by average, healthy adults to not suffer from deficiencies and thus deficiency-related diseases like scurvy or vitamin D.  I don’t know about you, but my standard of being in great health is a little higher than just not having scurvy!  Most nutritionists agree that for optimum health, many vitamins and minerals are required at levels much higher than the daily NRV.  For this reason, I would never buy a multivitamin that provided me with 100% of everything.  I want far more than that of things like vitamin B1, vitamin B2, vitamin B12, and vitamin D!  A good multivitamin will always provide it.     

Another couple of indicators about the quality of vitamins and minerals are where you buy them from and how much you pay.  Generally speaking, the ones you buy from supermarkets or pharmacies are not very good.  I’m sure there are exceptions, but most brands stocked in those places are cheap and nasty.  The ones stocked in large health food stores are not usually much better.  The best ones come from higher end supplement shops, websites that specialise in nutritional supplements, or directly from the brand.  You can get some really good, clean products on Amazon, but just be sure to look at images of the label and make sure that all the information is there. 

In general, you do get what you pay for.  I’d suggest that if you’re paying less than £15 a month for a multivitamin, it probably isn’t very good.  Ideally you’ll be paying between £20 and £40 depending on how comprehensive it is and how many additional products it allows you to dispense with.  If you’re paying more than about £45 a month for a multivitamin that is not catering extremely well to a niche health requirement, you’re being ripped off.  Prices for individual vitamins and minerals vary a lot, but the cheapest and most expensive ends of the spectrum are usually to be avoided.  (Do be sure to compare like with like price-wise though – as I explained in this post about aloe vera, you have to take potency and number of servings into account.) 

I am not going to give brand recommendations in this post, because as I said at the outset, this is only the first part of the series.  I’m loathe to name any brands at all, because each person’s requirements and intolerances will be different; whatever brands I name will be unsuitable for someone somewhere!  However, I know it is something readers will want, so I will include the names of some brands I like, but I’ll leave it until the end of the series.  Until then, don’t badger me!

I hope this first instalment of the series has been useful for you and please be sure to read the rest as and when they are uploaded!  

Wishing you the best of health,

Tiny

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