The love-hate relationship with multivitamins
Multivitamins seem like the cat’s meow when you are trying to put together a healing plan that involves a lot of supplements. Everything in one place, for one price…seems like a lot of bang for your buck, right? Have you considered the dark side(s) of multivitamin use? They give you that warm fuzzy, “I got this” feeling, because it is an easy button, one pill, all done, move on with the day. Well, I am going to help you hash out whether a multi vitamin is REALLY all it’s cracked up to be, or if it’s just the right balance for you.
Let’s start with the clarification of what a multi-vitamin is.
Seems simple enough, many vitamins in one capsule or formula, but it’s not that simple, because there are a dizzying array of multi-vitamins on the market. There’s the true “one-a-day” multi vitamin with every possible nutrient, polyphenol, macro and micro nutrients, greens, you get the point…and then there are complexes. B vitamin multis, for example, are a complex of all of the B vitamins that are necessary to be taken together to create the synergy of metabolism within the body. It is truly important to get all of those nutrients together, the way they would enter the body in nature, through food. And the same goes for an amino acid complex, all together for the sake of synergistic absorption and utilization. And of course, there are all kinds of variations of the above, including specialty complexes and multis with specific goals in mind like a mitochondrial cocktail of nutrients in one complex, or nutrients put together with specific conditions in mind and so on. It’s mind-numbing how many options are available in the nutritional supplement world. And it can be confusing to know which can be trusted and worth their money.
The caveat.
Just like anyone else, I love a good easy button. Hand me the supplement that does it all and I’m a customer for life. Problem there is, I know to much to fall for that. Anything that includes EVERYthing you need, every day, is too good to be true. We don’t all need everything, every day and we don’t all tolerate everything, every day. In fact, some people don’t tolerate supplements that are seemingly in just about every multi vitamin made. Herein lies the problem I see on a regular basis. I will break down some examples of what I mean.
Vitamin C.
It’s essential to human function, but generic supplemental recommendations are literally everywhere: advertisements, doctor’s offices, CoVID prevention and recovery protocols, detox protocols, it’s in just about every multivitamin on the market to varying degrees, many with very high doses. So what’s the harm in getting some extra vitamin C you ask. To the average person, probably not a big deal and it certainly has it’s benefits in our diets. But how do you know you are an “average” person who will do well with larger doses of vitamin C, if you haven’t done testing to confirm it?
Vitamin C, especially the form known as ascorbic acid, when taken orally, has the potential to convert into an organic acid known as oxalic acid. Without getting too deep into the biochemistry of oxalate metabolism, I will share just a little of what excess oxalate in the body looks like. I will try to keep this at entry level, but deep enough to give you the full picture of why you should care if you have a problem with accumulating oxalates in your body. But first, it’s important to know how we become exposed to oxalates on a day to day basis, because it’s not just from vitamin C. Oxalates are primarily known as a natural pesticide, produced in plants to prevent pests from gobbling them up. Oxalates damage the pests from the inside out. 😳 Sounds gnarly, no? Because oxalate is a natural substance in virtually everything that grows from the ground or a tree, the contents will vary according to soil condition, water/drought, sun/shade exposure, minerals and even pest exposure volume. Thankfully, there are ways to test the oxalate content in foods and a wonderful spreadsheet has been developed by a team of people who run the Trying Low Oxalates FB group along with Susan Owens. Anything else on the internet is bound to be outdated.
Exposure to small amounts of oxalate from our diet is a normal part of normal human physiology. However, when in excess it becomes a major issue. Oxalate can travel via circulation and deposit to form crystals in various tissues including:
Kidney & Urinary tract
Coronary arteries & Myocardium
Thyroid gland & Spleen
Lymph nodes & Testis
Intestine & Bone
Eyes & Skin
Liver & Brain
Joints & Muscles
Blood vessels, Lungs and Heart
Even the Brain
After deposition, oxalate mechanically shreds the surrounding tissues. However, not only does oxalate deposit in tissues, but micron and nano-sized crystals can even enter into the cells. Once inside the cell, oxalate progressively wreaks biochemical havoc:
Apoptotic and necrotic cell death
Ruptures cell membranes and leads to cell swelling
Lysosomal rupture
Cell and nuclear shrinkage
Destruction of cellular organelles
Make no mistake, oxalate is a poison. It destroys mitochondrial function, alters redox homeostasis via depleting intracellular antioxidants such as glutathione and superoxide dismutase, disrupts the mitochondrial membrane potential and halts ATP (energy) synthesis. Oxalate also blocks the action of several enzymes involved in energy metabolism such as pyruvate kinase , and the biotin-dependent enzymes pyruvate carboxylase and transcarboxylase. Furthermore, oxalate has been shown to trigger the activation of the NLRP-3 inflammasome – a multicomponent piece of machinery inside the cell responsible for danger-signalling, cellular defense, and which contributes to long-term, chronic inflammatory processes.
Testing oxalate levels is important because oxalate accumulation can be physically dangerous to our organs. Oxalate crystals have a sharp physical structure that can cause oxidative damage, increase inflammation, cause pain, and damage tissues. High oxalic acid can hinder the proper function of vital bodily functions, poison the mitochondria, and contribute to kidney stones. In the GI tract they may significantly reduce absorption of essential minerals such as calcium, magnesium, zinc, and more because they bind with minerals, chelating them from the body. Oxalates may form in the bones, crowding out bone marrow cells. This can lead to anemia and immunosuppression. Identifying elevated oxalate metabolites is significant for people with chronic pain, joint issues, kidney stones, autism, PANDAS/PANS, ADHD and other health issues.
Was that more than entry level? Sorry. 😬 It does require some detail to grasp the seriousness of oxalate accumulation. Sadly, this is a very under-recognized condition that I see slipping through the hands of many well-intentioned physicians, purely because of a lack of knowledge on this subject. But as you can see, if you are accumulating oxalate crystals, you would want to know that before adding fuel to the fire with daily high doses of vitamin C supplementation! I see it all the time. So what is the solution?
You can order your own OAT (organic acid test) online, yes, without a doctor! It’s a simple urine test. I interpret OATs for my coached community members.
B Vitamins.
Again, I don’t want to understate how essential these nutrients are to homeostasis, but when we are using a B complex, which includes all forms of B vitamins, we have to consider the individual effects of each vitamin on the person taking them. There are a number of issues that I regularly see surfacing when it comes to B vitamin supplementation and two of these issues have to do with individual genetic expression.
According to our personal genetic expression (notice I said “expression,” not mutations, because we can express ANY genes, whether we are genetically predisposed to expressing them or not, although it would be more common in those who are genetically predisposed with polymorphisms in those genes) there are variables that can hinder our ability to convert and utilize certain forms of B12 and folate. This can get into a lot of epigenetic mumbo-jumbo to explain fully, so instead, I will just say this. Some people will literally back up their detoxification pathways using methylated forms of B12 and folate before supporting their methylation cycle. In fact, one way to assess this is to notice an increase in negative or hyperactive behaviors when introducing a methylated supplement. In those instances, it’s beneficial to consider using other forms like: hydroxo B12, adeno B12, a combination of both or folinic acid instead of methylfolate. And even when these proper forms are chosen, sometimes the timing of their introduction needs to be staggered, meaning you wouldn’t want a multi with B12 and folate included, if you wanted to stagger in your B vitamins accordingly. You would want a foundational B Complex WITHOUT these nutrients included, so you can control when and what type you want to include. With that said, there are also MANY, too many commercial supplements made with forms of B12 (cyanocobalamin) and folate (folic acid) that are disastrous for a certain percentage of the population dealing with genetic polymorphisms in their methylation pathways so in essence, by supplementing improperly, you could actually do a lot of harm by backing up your detox channels, rather than encouraging health. For pregnant women, I highly recommend this prenatal which although it does contain methylated forms of B12 and folate, at least it doesn’t contain the more crude forms that all other prenatals include. I actually know quite a few women who kept using this supplement long after giving birth, as well.
Quality and quantity.
This is actually my biggest gripe with multivitamins. You have no control over the source of vitamins when using a multivitamin. If you are going to choose a multi, because it really does appear to work for you in quality, quantity and formulation, just be sure you are diligent about the brands you choose. I am not generally a fan of too many off the shelf brands from stores. There are a few decent brands out there, but it’s like finding a needle in a haystack. Do your research, look at fillers, know the forms of the vitamins included and then research how much of each vitamin you are supposed to be getting in a day, according to your specific needs. For example, when someone requires more thyroid support and they begin to research the Iodine Protocol by Dr. Brownstein, they quickly learn that they were significantly under the dosing guidelines (up to 50mg versus fractions of a mg) for iodine/iodide supplementation and they thought they were getting enough, because they were taking a multivitamin that contained iodine. Again here, we also have an issue of both quality and quantity, because with iodine, you need both forms, iodine AND iodide, in the ratio produced by the Lugol’s formula. Anything else is not going to sufficiently saturate the thyroid and your cells with proper forms and quantities of iodine. You can’t just increase your multi in an attempt to get more iodine either, because you would be increasing other vitamins that could potentially become toxic, like selenium, which requires very careful dosing. With multivitamins, you lose all control over quality and quantity. I like to be able to adjust our dosing according to need, which is clearly impossible with a multi. If you are going to add in extra vitamins to address those discrepancies in dosing, over and above a multivitamin, you will have to be careful with your calculations to make sure you are accounting for every ingredient you are overlapping.
Over dosing.
No one intends to overdose, but when you have so many supplements in one capsule, it is important to cross-reference your intake with other supplements you are taking, to make sure you aren’t double dosing on something that could become toxic, like a fat soluble supplement.
It is actually more common for multivitamins to under-dose, offering a false sense of nutrient rebalancing. It is common place to see too little, rather than too much of a nutrient in a multivitamin, however, when pairing with others, it’s really important to monitor each and every nutrient overlap.
But what about supplements you don’t want to increase, because you don’t need them…but, they are in the multi? Do we ignore that? It’s easy to continue dosing something you either don’t need or worse, shouldn’t be getting more of, like copper in a copper-toxic person. It’s only 1-2mg, shouldn’t be harmful, right? But it absolutely can be, especially to a person who is toxic in one nutrient, but requires the others. This again is where bio-individualism really must be considered.
The take-away.
Multivitamins appear to be a quick and easy answer to our ever-growing nutritional needs, but are they really? Most multivitamins are made without much thought about individual requirements and they are designed with a general need in mind, based on inefficient RDA nutrient recommendations.
If you are just looking for a little boost in nutrition, you know you don’t have issues with any of the forms included, and you are choosing a high quality brand, awesome, go for it! But if you have a condition you are trying to negotiate and you have specific needs that take you out of the general population, a multivitamin isn’t going to be your best best. Easy? Yes. Effective? No, and maybe even harmful. So I recommend not taking multivitamins lightly, educate yourself before you pop that pill! With that said, there are many condition and target-specific complexes available on the market that could make life easier and contain well-thought-out and high quality ingredients. Just be sure to learn as much as you can about your needs and the ingredients first.
In my coached community membership, we often discuss nutrient requirements, dietary interventions, vitamin brands, forms, and possible testing strategies to arm yourself with the best education possible when you are making decisions about your nutritional lifestyle.
Resources:
Dr. Jocker’s, Elliot Overton, Dr. Brownstein