What are they?

While the exact inclusion criteria of multivitamins isn’t standardized, they’re usually a combination of different vitamins and minerals, and often include other ingredients like amino acids and herbs.

In 1912, Casimir Funk chose the word vita amine (Vita= Life, Amine=Nitrogen in latin) to describe a substance that was present in rice bran that could cure beri-beri. Vita amine is now known as thiamine, which is Vitamin B1. Funk eventually shortened “vita amine” into “vitamin” to describe a general class of compounds that had beneficial health effects, but were found in food items.(1)

Vitamins can be water-soluble or fat-soluble, and there are important differences to know between them.

Water-Soluble Vitamins Fat-Soluble Vitamins
Absorption type Water Fat
Excretion method Urine Stool
Body retention No Yes
Vitamins B Vitamins, Vitamin C Vitamins A,D,E,K

 

You might not think of it, but multivitamins are already in much of the foods that we eat day to day. Commonly eaten foods like flour, cereal, and orange juice are all typically enhanced or “fortified” by the addition of different vitamins and minerals. Sometimes new vitamins and minerals are added to staple foods to make sure people are getting them. For example, iodine is added to table salt to make sure nobody is deficient in iodine.(2)

Oftentimes, vitamins and minerals are re-added to foods that lose them in the manufacturing process. For instance, white flour is often enriched with vitamins that would be found in whole wheat flour.

It’s recommended that everyone get at minimum the Recommended Dietary Amount (RDA) of vitamins and minerals each day. If food sources aren’t enough, a multivitamin supplement can help fill the gap.

mutlivitamin supplements nutrients

How are they made?

Multivitamins, as the name suggests, contain various different kinds of ingredients, and they each have their own associated manufacturing process. Single ingredients are manufactured individually by a raw material supplier, and get sent to the multivitamin manufacturer. There, the single ingredients chosen for the multivitamin are mixed into a blend, and then divided into the final product. Most multivitamins don’t have any special storage concerns, but there are occasionally multivitamins with additional ingredients like probiotics that do require the product to be kept in the fridge. Always check your bottle to make sure.

If you’re concerned about additives in your supplements, capsules tend to have less additional ingredients than tablets because a tablet needs to have some binders in the product to help it hold its shape. Tablets also have a higher chance of being coated with a shiny lacquer to make sure the product keeps well.

At Fullscript, we often receive requests for FoodState® or “natural” multivitamins from our practitioners. These are vitamins and minerals extracted directly from plant sources and not manufactured synthetically. If this is something you’re looking for, then you need to search explicitly for the source material of the ingredients within a product.

Source material isn’t actually mandatory to report on product labels! If you don’t see that information on the label, contact the manufacturer of the product directly, or choose another product that is explicit about its sources.

Fullscript Multivitamins Smart Dispensary integrative health

In which forms are they available?

Multivitamins are available as capsules, tablets, gelcaps, powders, and liquids. As we discussed earlier, the main ingredients in multivitamin supplements are vitamins and minerals, and they can each be found in multiple forms.

These are some of the most common forms:

Vitamins

Hydrochloride Salts

  • These are the standard and most common forms of vitamins available on the market. They’re well absorbed and applicable for most of the population.

Methylated Vitamins

  • Methylated vitamins have side chains added to them that allow them to support specific metabolic processes. As nutrigenomics have become more prominent in medicine, these forms of vitamins (like 5-methyltetrahydrofolate) have gained prominence as well because they can impact the methylation cycle and can even affect gene transcription.(3)

Minerals

As a group, minerals dissolve readily in water, but when they’re bound to other ingredients, they have important differences between the organs, tissues, and disease states that they affect:

Inorganic Salts

  • These are typically the lowest cost because the minerals are readily found in nature, so these forms don’t take much money or effort to produce. Ex: Magnesium Oxide

Organic Salts

  • They’re called organic salts because the mineral is bound to a molecule containing carbon. They typically have better absorption compared to inorganic salts. Ex: Zinc Citrate

Chelates

  • Chelates are molecules where the mineral is bound to various kinds of amino acids, which are the building blocks of proteins. These chelate molecules are the best absorbed because they move easily across the membrane of the intestines through special protein transporters that are built for amino acids. Chelates also tend to carry a higher price point because they’re more challenging to manufacture. Ex: Iron bisglycinate(4)

B Vitamins

There are many vitamin supplements that are exclusively B vitamins, as they have a more defined role in energy metabolism and deficiency symptoms, several B vitamins are linked with the same health conditions.

Antioxidants

Antioxidants are often included in multivitamin products. They are a subset of vitamins and minerals that have the ability to counter the many metabolic and environmental agents that can cause oxidation. Examples of oxidative agents include cigarette smoke, nitrites from smoked meat, or exposure to heavy metals.

Vitamins A, C, and E, zinc and selenium, and plant components like polyphenols are commonly found in antioxidant supplement products. Antioxidant multivitamins will sometimes have additional non-vitamin or mineral ingredients such as herbs and fruit extracts as well.

Condition Specific

Some multivitamins are developed for specific conditions. They may have additional ingredients particular to a health concern or health condition. Cardiovascular formulas may have a multivitamin with additional fish oils, while digestive formulas may have a combination product of probiotics and a multivitamin.

How do they work?

Ingredients in multivitamins will fall into one of two categories: essential nutrients or non-essential nutrients. The differentiator lies in the fact that some vitamins can actually be made by the body, while others cannot. Essential vitamins are the ones that we must consume in our food or supplements to be able to benefit from them, while non-essential nutrients are ones that the body can make on its own.

Vitamin C is an essential nutrient because the body has no way of making it on its own without eating vitamin C rich foods or supplements, while vitamin D is a non-essential nutrient because the body can actually make its own based on how the skin uses the UVB rays from the sun.

Overall, multivitamin supplements work by augmenting vitamin and mineral intake that would normally be found in food. It’s especially important when nutrition is nutrient-poor (low fruit/vegetable), or patients have certain health conditions.

How can multivitamins help?

Multivitamin supplements have been frequently studied, and the general consensus is that vitamins and minerals are best when they come from a varied and healthy diet. When this kind of diet isn’t possible, multivitamin supplements can help to prevent disease because they prevent deficiency across many vitamins and minerals.

Multivitamin supplements have been most notably studied for the following conditions:

  • Cardiovascular disease prevention(5)
  • Cognitive disease prevention(6)
  • GI conditions that cause malabsorption(7)

While not necessary for absolutely every patient, a multivitamin supplement that provides ½ of the RDA has been recommended in a recent trial on cognitive disability and aging as prudent.(6) As mentioned above, this is particularly applicable for patients that don’t consume a large variety of food items, especially if they have a diet that lacks fruits and vegetables.

What are the side effects?

A very benign side effect of multivitamins is that patients notice their urine gets really bright, often described as “fluorescent” yellow. This happens because of the Riboflavin content in many multivitamin supplements. “Flava” is the word for yellow in latin, which is how Riboflavin (vitamin B2) gets its name. The bright colour has no negative health effects, but it can be alarming if you’re not expecting the bright colour when you go to the bathroom.

One of the standard vitamins in a multivitamin supplement is vitamin A. For a lot of people, it’s a health-promoting vitamin. One analogue of vitamin A, called beta carotene, can however be dangerous for patients who smoke. A large study(8) was released in the early 90s on antioxidant supplementation in smokers, with the idea that smokers would have needed more antioxidants because they were inhaling dangerous chemicals in the cigarette smoke. Rather than being health promoting, the group of patients in the study receiving beta carotene that were smokers had a HIGHER risk of death from lung cancer and death from multiple causes. Beta carotene did the exact opposite of what the researchers thought.


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  1. Eggersdorfer, Manfred, et al. “One Hundred Years of Vitamins-a Success Story of the Natural Sciences.” Angewandte Chemie , vol. 51, no. 52, Dec. 2012, pp. 12960–90.
  2. Commissioner, Office of The. Consumer Updates – Fortify Your Knowledge About Vitamins. Office of the Commissioner, https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm118079.htm. Accessed 23 Mar. 2018.
  3. Moore, Lisa D., et al. “DNA Methylation and Its Basic Function.” Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, vol. 38, no. 1, Jan. 2013, pp. 23–38.
  4. Ashmead, S. D. “The Chemistry of Ferrous Bis-Glycinate Chelate.” Archivos Latinoamericanos de Nutricion, vol. 51, no. 1 Suppl 1, Mar. 2001, pp. 7–12.
  5. Rautiainen, Susanne, et al. “Multivitamin Use and the Risk of Cardiovascular Disease in Men.” The Journal of Nutrition, vol. 146, no. 6, June 2016, pp. 1235–40.
  6. Dror, Yosef, et al. “Vitamins in the Prevention or Delay of Cognitive Disability of Aging.” Current Aging Science, vol. 7, no. 3, 2014, pp. 187–213.
  7. Rossi, RE, et al. “The role of dietary supplements in inflammatory bowel disease: a systematic review.” Eur J Gastroenterol. Hepatol, 2016 Dec;28(12):1357-1364.
  8. Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. “The Effect of Vitamin E and Beta Carotene on the Incidence of Lung Cancer and Other Cancers in Male Smokers.” The New England Journal of Medicine, vol. 330, no. 15, Apr. 1994, pp. 1029–35.