So just know that when you are at a general store, like Pharmaca or Whole Foods or any kind of vitamin store, that they're not going to have multivitamins, for the most part, over the counter that you're going to be able to hurt yourself with anyways. And when it comes to a vitamin, I actually really do recommend you do take things that are higher potency. One A Day is one capsule or tablet or something, and you just can't fit that much stuff – like, you can't fit an exhaustive list of vitamins and minerals and antioxidants and essential fatty acids and all these claims into one small pill. Not going to happen. So that’s not your optimum wellness oriented vitamin.

Some personal favorites: I do really like this multivitamin from Thorne. It’s called Extra Nutrients. And the reason I like it is because it’s high potency. So let me say again: High potency really means like, six capsules a day. So this means you do like three capsules with breakfast and three capsules with lunch. It’s a lot. If you are not a pill person, then I would really recommend that you do a multivitamin powder or a liquid because if you think about the amount of nutrition you can fit into like, a tablespoon of a powder or a capful of a liquid, it’s very easy to get it down.

And elderly people will often have a lot more dryness in their throat, so it’s really hard for them to swallow a lot of pills sometimes. I’m making a generalization. Sometimes people have no problems swallowing lots of things, but I don’t like swallowing a lot of pills, so if you don’t like swallowing a lot of pills, I kind of…when I’m first formulating a treatment plan for my patients, I talk to them a lot about what’s going to work for them – like how do they like to think things so that we can custom-formulate something that’s going to work for them.

And one thing I do very commonly is get people on a breakfast smoothie if they’ll do it, if they're into it. If they're not, that’s no problem. But one thing you can do is get yourself a basic protein powder. You could do whey; you could do rice protein; hemp; egg. There are all different kinds of proteins, so it really depends on one that you're going to tolerate in your system and not going to have a food allergy to. So if you know you're sensitive to certain categories, just think of that in terms of the type of protein you're choosing.

Whey is really great in that it’s a precursor to glutathione, but a lot of people have dairy allergies, so if you think you have a dairy allergy, then I would go with something like a rice protein or a pea protein because it’s much more hypoallergenic. Soy, egg, dairy tend to be more allergenic for people who are prone.

And then you can mix something like a multivitamin of your choice. You could do liquid, or you could do powder. You can add the lovely fiber that we see up here. You could do either psyllium or you could do flaxseeds, and you can get that all into your morning smoothie. Some of my patients are even go-getters and they throw their fish oil directly in their smoothie. Personally, I mean, I don’t use fish oil that tastes fishy, but I still think that’d be far too fishy for me, so flax oil can also go in a smoothie, and so it’s just a really nice way to start the day and get yourself going.

Pharmaca has some nice multivitamin health lines here, too. Again, though, I would not recommend doing them as a one capsule; I would recommend doing three to six if you really want to get high potency. And so mostly in a multivitamin, what you're going to find are things that are water soluble – so your B vitamins are water-soluble. There will be certain fat soluble things like vitamin A and vitamin D and vitamin E, but typically, they're so low potency in a one capsule just because you can't fit it in there. I mean, you really just can't physically fit that much in one capsule, but they also know that people are going to be using three and six of these a day, and so they don’t load them that high so you don’t need to be worried about overdosing when you're taking a multivitamin like that.

One word of caution for anybody who is of child-bearing age: Vitamin A, in general – you know, we have all these toxicity scares about vitamin A that are really just a little overblown, but if you are someone who is thinking about conceiving or is pregnant, you don’t want over 2,500 IU of actual, actual retinyl palmitate, which is vitamin A. There’s a lot of beta-carotene in supplements, so just look because a lot of times, it’ll just say, “General Vitamin A,” but then it lists out what it is. Actual retinyl for a woman who’s trying to get pregnant or is pregnant, should not be over 2,500 IU. That’s really the only thing you need to think about.

And then the other thing I want to call to attention with multivitamins is that there has been kind of some debate in the media circle around folic acid. And so there is a little bit of a controversy, and it looks potentially we don’t know yet. Like, some folic acid may actually increase certain cancer risks, so to steer clear from that, what I would recommend is when you are choosing a multivitamin, to choose one that says, “folate” versus “folic acid.” And so again, back to this little Thorne multivitamin. It does say “folate,” and so does the Pharmaca multivitamin. So that would be a safe form of folic acid to get into your body.

There are two questions about multivitamins: One was about folate and dose, so I’ll just address that. I think that anywhere between 400 milligrams to 1,000 milligrams is perfectly great in a multivitamin. The second one was about milk thistle and whether it’s something that can be used on a regular basis to kind of clean out, support the liver. I love milk thistle.

I don’t include it in the regular stuff because people get really overloaded with the amount of pills, but if you have any issues around your liver, if you drink a little bit more than maybe we should sometimes, anything like that. Or just knowing how much work the liver does – how much it’s important in regulating hormone metabolism, cleaning us out all the time. Milk thistle’s a really kind thing to do to your liver on a regular basis, and I give my patients 500 milligrams once or twice a day in capsules.

High potency in a regular multivitamin: So for the vitamin A content, 2,500 to 5,000 IU of actual vitamin A. The mixed or beta-carotenes, 5,000 to 25,000 IU. Vitamin D, no lower than 400 IU and up to 1,000 IU, and actually, you'll see in a minute, we’ll talk about vitamin D. I actually really recommend supplementing vitamin D on top of a multivitamin because there’s just so much great research on vitamin D and how protective it is against cancer. And most of us are really not outside enough. And even outside, I have people who are runners – so they're outside daily – and they still come back with really low levels in their blood.

Vitamin C, 500 to 1,000 milligrams in a multivitamin, and you can always supplement with extra, and we’ll talk about vitamin C. It’s a great antioxidant. Vitamin E, I really want you guys to pay attention that it says D-Alpha or mixed tocopherols. No DI-Alpha. That is synthetic, and it’s really not beneficial to your health. So with vitamin Es, you want it to just say just D-Alpha or mixed tocopherols, and 400 to 1,000 IU in a multivitamin is a great dose.

So note: If you're taking capsules and there's things like vitamin A and vitamin D and vitamin E that are fat soluble in there, it would be a great thing to do to take that with a little fish oil or some fat. So just taking it with a meal is a good thing to do, and you don’t want to take a multivitamin on an empty stomach because B vitamins really can kind of cause some nausea. The B vitamins, I really like to see it so that it says that we’re in the thousands of percentages of the RDAs because Bs are so important for stress, and we’re all so stressed out.

They're really important for protein repair; they're important for good cognitive health and neural function; they're important for adrenal health. There’s a lot of things that the B vitamins are really important for. Manufacturing more energy in the body. So you can't overdose. They're water soluble. If you take too much, you'll pee really yellow, and that’s okay. And if you have a really hard day, you'll have more in your system to help you get through what you need. It’s better to have more of a raw ingredient to help your body manufacture the specific things that it needs to do than to not have enough and have a rate-limiting step so that you're more tired.

I think zinc is a really good thing to have in your mineral section of the multivitamin mineral, and copper and selenium. So doses like 15 to 45 milligrams of zinc, and you always want to balance that with one to two milligrams of copper because they compete. And if you take a lot of zinc without copper, you can end up with a deficiency. Selenium, a great antioxidant. So looking at 100 to 200 micrograms to get a decent dose. You could have more – you could have 400 micrograms. It’s perfectly fine.

So magnesium and calcium, most of them will have 250 to 500 milligrams of each, and I think that’s really sufficient. I don’t supplement my patients with extra calcium unless there’s an osteopenia or osteoporosis issue, and even then, I work with other issues that are causing the mineral depletion. We eat far more calcium in our diets in this area of the world than in other areas of the world, and we have far higher osteopenia and osteoporosis, so I don’t think it’s all about calcium supplementation.

And there are some preliminary studies that show that we might want to be careful with supplementing more than 500 milligrams of calcium a day anyways and that there appears to possibly be more calcification of the arteries going on when we do that. So we want to do a lot of the things like vitamin D and vitamin K and things that get the calcium and magnesium – that get the calcium into the bone – but I don’t really think we want these crazy, excessive calcium levels.

For people who just really are not great at having 20 million multivitamin formulas, this is a really nice one, too. It’s not as high potency, but I like that it’s a good across-the-board one. This is by Pharmax. It’s called Four Pillars multivitamin, and what they have in here is one multivitamin mineral, one omega fatty acid, one antioxidant, and one probiotic. Again, kind of on the low potency spectrum, but it’s one strip that you just kind of tear off and just have with you if you're traveling or if you're just not a person who can quite handle branching out into too many bottles at this point.

Multivitamin Potency Suggestions

MINERALS
Zinc: 15-45mg
Copper: 1-2mg
Selenium: 100-200mcg
Chromium: 200-400mcg
Magnesium: 250-500mg
Manganese: 5-15mg
Molybdenum: 25-100mcg
Calcium: 250-500mg
Potassium: 100mg
Boron: 5mg
Vanadium : 50-100mcg
Silica: up to 25mg
Iodine: 50-250mcg
Iron: up to 30mg

VITAMINS
Vitamin A: Retinol Palmitate - 2500-5000iu (unless pregnant -- in that case less than 2500iu); Beta/mixed Carotenes - 5000-25,000iu
Vit D: (D3 - cholecalciferol) - 400-1000iu
Vit C: (ascorbic acid, ascorbate - 500-1000mg
Vitamin E: 400iu -- 1000iu as d-alpha tocpherol or mixed tocopherols
Vitamin K: up to 1mg (caution if you are on blood thinning meds)
Thiamin: (B1) 50mg
Riboflavin: (B2, R-5-P) 10-50mg
Niacin: (B3, Niacinamide) 100-200mg
B5: (pantothenic acid) - 50-500mg
B6: (pyridoxine, P-5-P) 50-100mg
Biotin: 100-1000mcg
B12: (methylcobalamin) 400-1000mg
Folate: (5-Methyl-tetrahydrofolate)400-1000mg
Choline: 10-100mg
Inositol: 10-100mg

Interview with Dr. Angela Agrios, ND