Multivitamins

Multivitamin ingredients are measured in terms of the Daily Value (DV). This recommended amount of each vitamin and mineral is established by the U.S. Food and Drug Administration (FDA), and is based in part on the Recommended Dietary Allowances (RDA). Experts say that you should look for a multivitamin that provides 100% of the DV for most of the essential vitamins and minerals in one pill. The exception is calcium, which is too large to fit in one pill, but which can easily be consumed through diet or additional supplements.

To add to the confusion, there are two different benchmarks for nutrients: RDA and DV. According to Erin Dummert, Registered Dietitian and President of Madam Nutrition LLC, the Recommended Daily Allowance is the basic amount of a nutrient needed daily to meet basic needs of healthy people. The RDA is one of the factors used to determine Daily Values, which are the amounts recommended to help prevent against disease -- those amounts are often higher than the RDA. The DV is what's presented on food labels, while the RDA is mainly used by health professionals. Consumers should consider the DV percentage as a guideline, says Dummert. This value indicates that the food has a certain percentage of the DV for each nutrient.

The newest standard for nutrient requirements is Dietary Reference Intake (DRI). The DRI system was developed by the US National Academy of Sciences' Institute of Medicine in consultation with Health Canada and is currently used in both countries. The DRI recommendations are made up of three components: the Estimated Average Requirements (EAR), a level nutritionists say should meet the needs of 50% of the people in a defined age and gender group; the RDA or, where no RDA has been established, the Adequate Intake (AI); and the Upper Limit (UL), meaning the highest level that experts consider to be safe.

If all that leaves you confused, you're not alone. Even among research and nutrition professionals there's considerable debate about optimal levels and safe upper limits. Part of the problem is researchers don't yet understand completely how these substances work in the body.

Some research is well-enough established that it doesn't provoke much controversy. Experts agree, for instance, that women who get at least 400 micrograms of supplemental folic acid, or folate, per day are less likely to have a baby with a neural tube defect. Because the neural tube develops before most women know they're pregnant, experts recommend that all women of childbearing age include a folate supplement as part of their daily routine. While it's still important to eat a balanced diet including natural folate sources like whole grains and leafy greens, nutritionists say this is one case where supplementation is prudent.

That's not always the case. According to the Institute of Medicine, vitamin A is critical for immune function, normal vision, gene expression, reproduction and embryonic development, but high supplemental vitamin A doses, especially if they're in the form of retinol, can cause problems. Medical studies published in the New England Journal of Medicine and other sources have found that taking more than 100% of the DV of vitamin A can cause some birth defects, and it can contribute to hip fractures in postmenopausal women. While the official UL is much higher, most health experts say it's best for adults to choose a multivitamin with no more than 5,000 IU of vitamin A with at least some of it in the form of beta-carotene.

Beta-carotene, found naturally in a variety of plant foods including carrots, pumpkin and kale, belongs to a family of nutrients called provitamin A carotenoids, which the body can convert into vitamin A. Because of the risks associated with excessive retinol supplementation, some nutritionists recommend beta-carotene instead. Unfortunately, even that isn't without risk. According to the Berkeley Wellness Letter, a study called the Carotene and Retinol Efficacy Trial (CARET) found that people at high risk for lung cancer - smokers, former smokers and asbestos-industry workers – were actually more likely to be diagnosed with lung cancer when they took beta-carotene supplements. Experts now advise smokers to avoid taking beta-carotene. However, eating foods rich in carotenoids, including beta-carotene, has the same potential benefits as supplementation without the risk of negative side effects.

There's also a lot of controversy around vitamin E. Some experts call for a maximum daily dose of 100 milligrams while others say 100 milligrams should be considered the bare minimum. At the heart of the issue is a well-publicized 2004 meta-analysis from Johns Hopkins that linked daily vitamin E intakes over 400 milligrams with a slightly elevated risk of death. For that reason, some publications including Nutrition Action Healthletter won't recommend any multivitamin that contains more than 100 IU of vitamin E. According to the Berkeley Wellness Letter, however, three separate studies have since failed to confirm the Johns Hopkins findings, suggesting that vitamin E supplementation doesn't in fact pose an increased risk of premature mortality.

The Institute of Medicine places the Upper Limit for vitamin E at 1000 milligrams per day for adult men and women, and the minimum at just 15 milligrams. Within that wide range, there's little consensus about the perfect daily adult dose. Lyle MacWilliam, author of "Nutrisearch Comparative Guide to Nutritional Supplements" recommends 600 IU, roughly 270 milligrams, while the Berkeley Wellness Letter says: "Get vitamin E from foods -- nuts, seeds, vegetable oils, whole grains, and leafy greens. There is no reason to take vitamin E supplements."

Vitamin D is a different matter. It's almost impossible to get enough from food sources (you'd need to drink a quart of fortified milk per day or eat more than the recommended amount of fatty fish like salmon or tuna). The best source of vitamin D is actually sunlight rather than food, and experts say that just 15 minutes of sun exposure – without sunscreen – twice a week should be enough for light-skinned people who live in the southern two-thirds of the United States.

But what about everyone else? People who live in Canada> or the northern third of the United States are at risk of vitamin D deficiency because it's very difficult for them to get enough year-round sun exposure. The same goes for anyone who's housebound. The lighter your skin is, the better it absorbs vitamin D, so, if you're dark-skinned, experts say you should consider taking a supplement. The current RDA for vitamin D is just 200 IU for adults under 50, 400 IU for people between 50 and 70 years old, and 600 IU for everyone over 70. However most experts, including the editors of the Berkeley Wellness Letter, are now saying people over 70 years old should aim for 1000 IU a day. Too much vitamin D can lead to problems like kidney stones, but only if you take more than 2000 IU a day. Too little has been linked to problems like breast cancer, prostate cancer and multiple sclerosis.

Best multivitamin for men

Experts say there's very little difference in vitamin needs between men and women, with a couple of notable exceptions. Health professionals say that men generally don't need more than 8 milligrams of iron a day, an amount which is easy to get from diet alone. However, premenopausal women often need iron because iron is lost during menstruation cycles. So men's and women's multivitamin formulas often differ in iron content. One-A-Day Men's Health Formula (*est. $10 for 100 tablets) contains no iron, plus it has 150% of the DV of selenium and vitamin E, both of which may help prevent prostate problems. This amount is based on a 12-year study currently under way to determine whether high amounts of selenium and vitamin E prevent prostate cancer. Until proof is in, the modestly higher amounts in One-A-Day Men's may offer prostate benefits while still being a safe level for consumption.

Centrum Silver (*est. $15 for 150 tablets) is another iron-free option. However, Centrum Silver only contains 79% of the DV of selenium and 167% of the DV of vitamin E. If you have a family history or other risk factors for prostate cancer, you might opt for One-A-Day with the higher dose of selenium instead. Centrum from A to Zinc (*est. $13 for 180 tablets) contains 18 milligrams of iron, double the DV for men, although still well under the 45 milligram UL.

Rainbow Light Men's One Multivitamin (*est. $25 for 90 tablets) claims to be the "Number One Selling Natural Men's Multivitamin," but it contains well above the DV for several nutrients. These include 1667% DV of vitamin B1, 1471% DV of vitamin B2, and 1250% DV of vitamin B6. Because cereals and breads are fortified with B vitamins, experts say there's no reason to take more than the DV in a multivitamin, although higher levels of B vitamins (within reason) won't hurt you. We think that unless your diet is severely lacking, there's no reason to choose the higher-priced Rainbow Light over the multivitamins mentioned above unless you prefer to buy natural products in general.

Now Adam Superior Men's Multivitamin (*est. $10 for 60 tablets) also has some very high B-vitamin levels including 1250% DV of vitamin B6, 1670% DV of vitamin B1, 1470% DV of vitamin B2, and 4170% of vitamin B12. It also failed Consumer Lab's testing for being above the UL for niacin and failing to break apart properly.

Best multivitamin for premenopausal women

Premenopausal women lose iron during menstruation, so experts recommend that women in this age group take a multivitamin with 18 milligrams of iron, such as Centrum from A to Zinc (*est. $13 for 180 tablets) . This Centrum formula also contains 500 micrograms of folic acid, which is essential for preventing neural tube defects (like spina bifida) in babies. Because the neural tube develops before most women know they're pregnant, experts recommend taking folic acid routinely during childbearing years. This Centrum formula contains 3,500 International Units (IU) of vitamin A, of which 29% is beta-carotene. Experts say the higher the percentage of beta-carotene, the better, since too much vitamin A in the form of retinol palmitate or acetate (i.e., non-beta-carotene) can contribute to birth defects. Centrum from A to Zinc contains several other nutrients, which experts say aren't really necessary, but they won't hurt you. These include ingredients like nickel, silicon, tin and vanadium. Other ingredients, like lutein and lycopene, are advertised as preventing cataracts and promoting heart health, respectively, but experts say the small amounts in most multivitamins are too minimal to have much of an effect. In a 2007 survey by Pharmacy Times, 64.1% of pharmacists said they recommend Centrum to shoppers.

For a less expensive alternative, you might consider a store brand. Walgreens Advanced Formula A Thru Z (*est. $10 for 400) has the same ingredients in the same amounts as Centrum from A to Zinc, but for about a third of the price. You can easily test your own vitamins for dissolvability (so you can be sure they dissolve quickly enough to be absorbed by the body). See the Alternative Considerations section below on how to do this.

One-A-Day Women's (*est. $10 for 100 tablets) is the counterpart to One-A-Day Men's, above. Like Centrum from A to Zinc, One-A-Day Women's contains 18 milligrams of iron. However, One-A-Day contains only 400 micrograms of folic acid. It also has less vitamin A than Centrum, at 2,500 IU, of which 20% is in the form of beta-carotene. Another difference is the 450 milligrams (45% DV) of calcium offered by One-A-Day versus 200 milligrams (20% DV) in Centrum from A to Zinc. If you don't want to bother with a separate calcium supplement, you might choose One-A-Day over Centrum, since you can fairly easily make up the remaining 55% DV of calcium through your diet.

Nature's Plus Especially Yours Women's Multi-Vitamin Supplement (*est. $17 for 90 tablets) has only 150 milligrams (15% DV) of calcium, but the 10,000 IU of vitamin A (all from beta-carotene) and 40 milligrams of iron are more than most experts recommend. Other ingredients like Suma Root, Damiana and Dong Quai Root don't have established Daily Values, and experts generally recommend skipping them until more research has been done. Another cause for concern is that this multivitamin failed Consumer Lab's testing when it didn't break apart properly.

Viactiv is known for their chocolate Soft Calcium Chews (*est. $10 for 60 chews) , but they also have milk chocolate and chocolate cherry Multi-Vitamin Chews ($10 for 60 chews) . On the plus side, Viactiv has 400 micrograms of folic acid along with nearly 100% of the DV for most other essential vitamins and minerals. However, Viactiv doesn't contain any iron, an essential for women, and all of the 2,500 IU of vitamin A is in the form of retinol palmitate.

Best multivitamin for pregnant and lactating women

Pregnant and lactating women need more from their multivitamin, including increased folic acid and a slightly higher percentage of vitamin A in the safer form of beta-carotene to prevent birth defects. 21st Century Prenatal (*est. $5 for 60 tablets) has 800 micrograms of folic acid and 4,000 IU of vitamin A (50% in the form of beta-carotene), along with between 15% and 167% DV of other essential vitamins and minerals. Stuart Prenatal (*est. $30 for 100 tablets) is similar, but 100% of its 4,000 IU of vitamin A is in the form of beta-carotene. While it's clearly more expensive, you get all your vitamin A as the safer beta-carotene.

GNC Women's Prenatal Formula with Iron (*est. $17 for 120 caplets) contains 800 micrograms of folic acid, 15 milligrams of iron, and 500 milligrams of calcium. It also has 5000 IU of vitamin A, and all of it's in the safer beta-carotene form. GNC Women's Prenatal Formula was one of three prenatal multivitamins listed as approved by Consumer Lab at the time of our visit. The other two are Pregnancy Plus Multivitamin (*est $17 for 60 tablets) and Twinlab Pre-natal Care Multi Vitamin Caps (*est. $17 for 120) .

Pregnacy Plus Multivitamin has the usual ingredients for a prenatal supplement including 5000 IU of vitamin A as beta-carotene, 27 milligrams of iron and 600 micrograms of folic acid. It also has no artificial dyes, which may make it easier for some women to tolerate. Several Amazon.com contributors report that these vitamins have a very strong vegetable odor. Twinlab Pre-natal Care Multi Vitamin Caps have 800 micrograms of folic acid, 400 micrograms of calcium and 20 milligrams of iron per two-capsule dose but the 8000 IU of vitamin A is nearly double what most experts recommend. Since too much supplemental vitamin A during pregnancy has been linked to birth defects, experts say women are better off taking a multivitamin that doesn't have more than 5000 IU.

Pregnancy and childbirth are big business, and it's not unusual to pay more for products claimed to benefit mothers and babies. This is true for prenatal vitamins as well, which makes it even more worthwhile to consider generic or store brands. The key ingredients to look for are: No more than 4,000 or 5,000 IU of vitamin A, with all of it in the form of beta-carotene; at least 600 micrograms of folic acid; and 27 milligrams of iron. A little extra of the other included vitamins and minerals may be beneficial too, especially in the early months of pregnancy when nausea and vomiting might limit food intake, but these amounts don't need to be excessive.

Best multivitamin for men and women over 50

Like the other groups mentioned, people over 50 also have unique needs from their multivitamin. As we age, we lose the ability to absorb vitamin B12 from food, so, although the official DV of vitamin B12 remains at 2.4 micrograms throughout adulthood, some experts advise people over 50 to look for 25 micrograms in their multivitamin. One-A-Day Women's 50+ Advantage (*est. $10 for 50 tablets) and One-A-Day Men's 50+ Advantage (*est. $10 for 50 tablets) both contain 25 micrograms of vitamin B12 plus 20 micrograms of vitamin K, which can help protect against hip fractures. However, vitamin K can interfere with blood-thinning medications like Coumadin, so people taking such medications should consult their doctor before taking supplements. One-A-Day 50 Plus contains no iron, since iron overload can be a concern in people over 50, and the men's formula has 150% DV of selenium, which may help prevent prostate cancer. This multivitamin has been deemed a "Best Bite" by Nutrition Action Healthletter since 2003.

Centrum Silver (*est. $15 for 150 tablets) makes an appearance again here. It passed testing by Consumer Lab, contains 25 micrograms of vitamin B12 and has no iron. Centrum Silver has 30 micrograms of vitamin K but only 55 micrograms of selenium, which is more than the amount in One-A-Day Women's 50+ Advantage but less than the 105 micrograms in the men's 50+ version.

In Nutrition Action Healthletter's label analysis, store brands did exceptionally well in the 50 Plus category. Kroger, Equate, Walgreens and Theragran (sold by Bristol-Myers Squibb to Walgreens in 2005) brands all made the "Best Bites" list. The ingredients in these products especially change frequently, though, so the best advice is to check the label before you buy. Key ingredients to look for in a store brand for people over 50 include: No iron, 25 micrograms of B12, at least some vitamin K (although people taking blood thinners like Coumadin should check with their doctor), 400 IU of vitamin D (since many seniors don't get enough from sunlight and food), selenium if you're a male at risk for prostate cancer, and no more than 4,000 IU of vitamin A, with at least some of it in the form of beta-carotene since retinol may increase the risk of hip fractures.

Best children's multivitamin

The argument over children's vitamins is about the same as for adults -- experts say there's no clear-cut evidence for or against them, and while a balanced diet is the best source of vitamins and minerals, it's probably okay to give your child a multivitamin if it gives you peace of mind. Pediatricians warn, however, to never give more than one vitamin per day, and to keep vitamins out of your child's reach. Children's vitamins are designed to appeal to children -- sweet and in fun shapes, just like candy. But if a child ingests several at once, especially if the vitamins contain iron, the consequences could be harmful or even fatal.

Children's nutritional needs are very different from adults', so never give your child an adult multivitamin. The higher amounts in adult formulas can be harmful or fatal to children, again, especially if they contain iron. Children's needs also vary by age group. For example, 2- to 3-year-olds need 500 milligrams of calcium, whereas 4- to 8-year-olds need 800 milligrams. The best guideline is to follow your pediatrician's recommendations.

Flintstones Children's Complete Chewable Vitamins (*est. $8 for 60 tablets) are fruit flavored and contain child-appropriate amounts of essential vitamins and minerals. In the 2007 Pharmacy Times survey, 44.2% of pharmacists said they recommend Flintstones to shoppers looking for a children's vitamin. Flintstones Complete also passed Consumer Lab's testing of multivitamins. Flintstones comes in several formulas, depending on your child's eating habits. Flintstones has a growth chart on their website to help parents determine which formula is best for their child.

Centrum and One-A-Day also have children's formulas. Centrum Kids Complete (*est. $10 for 100 tablets) and One-A-Day Kids (*est. $7 for 50 tablets) both have label directions based on age group -- half a tablet for children 2- to 3- years old, and a whole tablet for children older than 4 years. The ingredients are similar between both brands, with the exception of vitamin K, slightly more vitamin A, and added nutrients like manganese, chromium and molybdenum in Centrum. These extras aren't really necessary, but they aren't harmful either. Like Flintstones, both Centrum Kids and One-A-Day Kids come in sweetened, chewable formulas in cartoon shapes.

Dr. Fuhrman Pixie-Vites Children's Multi-Vitamin (*est. $30 for 60 sticks) are approved by Consumer Lab with the caveat that their magnesium exceeds the upper limit for children between one and three years old. Pixie-Vites look like the old fashioned Pixy Stix candy. They contain a granulated powder in a striped drinking straw-shaped "stick." While Pixie-Vites do contain a longer list of minerals including vanadium, boron and inositol, they actually have lower levels of important nutrients like vitamin D, vitamin C and folic acid. One advantage of Pixie-Vites is that they don't contain aspartame or any other artificial sweeteners, although they do contain sugar in the form of cane juice, They also leave out the artificial dyes found in most children's multivitamins. That probably won't justify the extra cost for most parents, but it's good news for those who have their kids on a dye-free diet.

Puritan's Pride Children's Multi Gummies (*est. $12 for 60 gummies) is another Consumer Lab-approved children's multivitamin that contains sugar but no artificial sweeteners. Unfortunately they also contain less of some key ingredients including vitamin C, vitamin D and folic acid.

Important Features: Multivitamins

Reviewers say the following about shopping for multivitamins:

• Multivitamins can interfere with prescription medications. Consult your physician before starting a new multivitamin.

• Formulas for stress relief, energy, weight loss or "maximum benefit" haven't been tested for those claims. The extra ingredients included to support these claims are usually in such small amounts that they don't have much of an effect. This includes claims for lutein and lycopene.

• Steer clear of dollar store or ultra-cheap discount brands. In testing, many of these brands didn't contain the claimed amount of nutrients, or didn't dissolve properly. However, generic and store brands are a different story and can be just as good as higher-priced multivitamins. Just be sure to compare the labels.

• Choose a multivitamin that contains 100% DV of most of the essential vitamins and minerals. Calcium is an exception because that amount is too big to fit in one tablet. Don't take a multivitamin with excessively high levels of essential vitamins and minerals; at best, you'll just expel the excess through urine, and at worst, you could have health complications.

• Look for a maximum of 4,000 International Units of vitamin A, with at least some of it in the form of beta-carotene. Vitamin A comes in two forms: retinol (palmitate or acetate) from animal and dairy sources, and beta-carotene from fruits and vegetables (like carrots). Beta-carotene is converted to usable vitamin A in the body, and is considered the safest form of this vitamin. High levels of retinol have been linked with liver damage, birth defects and bone fractures.

• All women of childbearing age should take 400 micrograms of folic acid (folate) to prevent neural tube birth defects. The neural tube develops before most women even know they're pregnant, so experts advise all women of childbearing age to take folic acid.

• Don't assume that all forms of a multivitamin have the same ingredients. Chewable and liquid multivitamins may not contain the same amount of nutrients that their pill-form counterparts do. Compare labels before you assume.

• Always buy a children's formula for children. Children have different nutritional needs than adults. Never give a child an adult formula multivitamin.

Our Consensus Report shows how many times products are top-ranked by reviewers included in our
All The Reviews Reviewed chart.

# of Picks	Multivitamin (with Retailer Links)	Details from Amazon.com
3	Centrum from A to Zinc (*est. $13 for 180 tablets)	details
2	One-A-Day (*est. $10 for 100 tablets)	details
1 each	AARP Maturity Formula, Blackmores Men's Performance Multi, Blackmores Sustained release Multi Vitamin & Minerals, Blackmores Women's Vitality Multi, Creating Wellness Alliance Vitalize (Men's Formula, Women's Formula, Senior Women's Gold Formula), Douglas Laboratories Ultra Preventative (IX, IX with Vitamin K and X), Eckerd Therapeutic M, Equate Plus One Daily for Mature Adults, Flintstones Children's Complete Chewable Vitamins , Healtheries Men's Multi High Potency, Herron All-In-One Mega Multivitamins & Minerals, Kirkland Premium with Herbs Kroger Thera Plus, Natural Nutrition Mega Potency Men's Multi, Natural Nutrition Mega Potency Women's multi, Nature Made for Her 50+ , Nature Made for Him 50+ , Natures' Way Women's Energy Mega Multi-Vitamin , Nutrilite Daily, Pluravit Men, Prevention High-Potency for Men or for Women , Rite Aid Whole Source , Shaklee Vita-Lea with Iron, Shaklee Vita-Lea without Iron, Sundown Complete Daily , Theragran-M , Theragran-M Premier , Theragran-M Premier Plus, Truestar Health TrueBasic USANA Health Sciences Essentials, Walgreens Ultra Choice or Ultra Choice Adult, Walgreens Ultra Choice Mature

Well-known brands like One-A-Day and Centrum are mentioned the most by reviewers. However, several reviewers point out that store brands like Walgreen's, Equate

(Wal-Mart) and Kroger often do just as well in multivitamin testing at a much lower price.

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