Filling in Nutritional Gaps With a Carefully Selected Multivitamin
by Dr. Louise Gagné

Introduction

Nutritional deficiencies are commonly experienced. Many North American diets are filled with calorie dense, but nutritionally depleted, foods.

Thus, I do think there is a place for supplements, not as a replacement for a healthy diet, but to fill in any gaps that someone might have in their diet. 

Always keep in mind that supplements are never going to take the place of healthy food, because it turns out food is incredibly complex. Fruits and vegetables are full of fibre, vitamins, minerals and hundreds of phytonutrients, or phytochemicals that are playing a big role in their beneficial effects.

Take carrots as just one example. They contain over 100 phytochemicals, and they also provide beta-carotene, B vitamins, vitamin C, magnesium, vitamin E, vitamin D2, potassium, copper, calcium, glutathione, iron, manganese, phosphorous, and sulfur. It clearly is not the same to take a beta-carotene supplement, as it is to eat a carrot.

Eating a wide variety of nutritionally dense, whole, unprocessed foods is the safest, best way to obtain nutrients.

The Value of a Good Multivitamin

When it comes to supplements, I am a fan of multivitamins. A good multivitamin can help fill in gaps in someone’s diet, or nutrient losses due to medication. It can also lower the risk of chronic disease and improve pregnancy outcomes. However, you need to take care in examining the contents of any multivitamin you select.

Who Should Take a Multivitamin?

There is very good evidence supporting the use of prenatal vitamins. There are much better outcomes for a growing foetus if the mother has had a multivitamin on board for at least three months prior to conception. For example, when taken before and during pregnancy, prenatal multivitamins can decrease the risk of neural tube defects, cleft lip and palate, some childhood cancers (leukemia, brain tumors, neuroblastoma), and preterm births. Prenatal multivitamins taken for three months prior to pregnancy have also been found to eliminate the increased risk of birth defects in children born to diabetic mothers.

Women in their childbearing years should be sure to take a multivitamin, and one that has at least four hundred micrograms of folate. Pregnant women should be taking a specially designed prenatal vitamin that has extra iron in it. 

When it comes to our children, the American Academy of Pediatrics has concluded that a great many children would benefit from taking a multivitamin, or at the very least taking vitamin D during the winter months.

Others who should take a multivitamin include those over 50 years of age, and anybody who might have some nutritional gaps in their diet. Also, anyone who suffers from a chronic illness. Some patients on specific medications will also require a multivitamin.

In selecting a good multivitamin, it is wise to get advice from a qualified health provider.

What to Look for When Choosing an Adult Multivitamin

When choosing a multivitamin, you’ll want to look for some beta carotene and a little preformed vitamin A. You’ll want to make sure all eight of the B vitamins are there, but not in excessive amounts (thiamine, riboflavin, niacinamide, pyridoxine, folic acid, B12, biotin, and pantothenic acid). You will want vitamin C and your required daily amount for vitamin D. 

The multivitamin you select can have vitamin E in it, as long as it is down at a modest dose. You ideally want to see micro minerals like zinc, copper, selenium, chromium, and iodine. Be sure the zinc and copper are in a roughly ten to one ratio. 

Importantly, you will want to keep in mind the Recommended Dietary Allowance (RDA) level for each nutrient in the multivitamin that is appropriate for your gender and age. The RDA is the average daily dietary intake level that is sufficient to meet the nutrient requirement of nearly all (97 to 98%) healthy individuals in a particular life stage and gender group. Be sure the doses in the multivitamin you select are not excessive, but that they meet your RDA requirements. Your health care provider can assist you.

Also look at whether the multivitamin you are examining contains iron, because only certain people should take multivitamins with iron. For women who are menstruating, iron should be included in the supplement. As mentioned above, pregnant women should be taking a specially designed prenatal supplement with additional iron. In contrast, men and postmenopausal women, only need a very small amount of iron every day, and in most circumstances should not be taking a multivitamin that contains any iron.

Once you have selected a good multivitamin, be sure to take it with a meal to get good absorption of your fat-soluble nutrients. 

In general, avoid single high dose nutrient supplements. Instead, look for balanced, lower dose products.
It is also important to keep in mind what a multivitamin won’t provide. Multivitamins almost never have essential fatty acids, protein, fibre, and all the naturally occurring forms of vitamin E in them. 

Getting Enough Vitamin D

Vitamin D is a very unusual nutrient in that it doesn’t come in high amounts in food. It is present in fatty fish, egg yolks, sun-exposed mushrooms, and milk, but at quite low levels. Babies need 400 international units (IU) of vitamin D per day and most of us need 700 IU.

Humans have evolved to obtain most of the vitamin D we need from sun exposure. However, in Saskatchewan the angle of the sun is too low from October to March to get adequate vitamin D. Vitamin D insufficiency has become common. That is why if someone is only going to take one tiny, very inexpensive supplement, I would suggest it should be vitamin D. Take it with meals since it is fat soluble.

The material in this article was prepared by Dr. Louise Gagné. Louise practiced medicine in Saskatoon for over 35 years and completed a Fellowship in Integrative Medicine at the University of Arizona with Dr. Andrew Weil. She taught nutrition and integrative medicine at the University of Saskatchewan for 15 years. This article was sourced from both her spoken and written words in a presentation she made at the University of Saskatchewan. Dr. Gagné passed away in 2023, but her exceptional knowledge continues to be shared.