Dispelling nutrition myths, ranting, and occasionally, raving


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Are prenatal vitamins a waste of money?

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Last week the news that pregnant women don’t need vitamin supplements seemed to be all over social media. The articles were based on this review article published in the Drug and Therapeutics Bulletin. The authors concluded that based on the evidence, much of which was from research in developing nations, that women (in Britain) do not need to take prenatal vitamins.

They reached this conclusion based on examining studies of the effects of folic acid, vitamin D, iron, vitamin C, vitamin E, and vitamin A supplementation on birth outcomes. While they concluded that multivitamin supplements are unnecessary for women during pregnancy, they stated that there was strong evidence to support women taking folic acid supplements and vitamin D supplements during pregnancy.

The message that came across most strongly (from the news articles) to me was that women are being shamed into purchasing vitamins that they can ill-afford, and don’t need, under the guise of wanting the best for their baby. The implications of these news articles concern me.

Firstly, women should be aware that many pharmacies (in Canada at least) have prenatal programs through which pregnant women can receive free multivitamin supplements, amongst other things. An inability to afford multivitamins should not prevent women from receiving them. Let’s not make this about drug companies trying to make money from poor women desperate to do the best for their unborn children. This should be about doing the best for women and their unborn children.

Okay, now that, that’s out of the way… I worry that the message that women should still be taking folic acid supplements and vitamin D supplements (and not just pregnant women I should add as most women of childbearing age should be taking folic acid supplements and most women in North America at least, should be taking vitamin D during the winter months) will be lost amid the cry that multivitamins are unnecessary. The message is not that all vitamin supplements are unnecessary for most Western women during pregnancy, just that the current evidence doesn’t support the use of multivitamins.

I’d also like to note that the researchers were focussing on birth outcomes. The conclusion that multivitamins are unnecessary was based on whether or not mums gave birth to healthy full-term babies. The authors did not take into consideration any potential long-term benefits maternal supplementation might have on their children. The authors did not take into consideration benefits that multivitamin supplementation might provide to mums. They did note that multivitamins can lower the mums risk of anemia, but as that didn’t seem to affect birth outcomes iron supplementation was deemed unnecessary. There are many other vitamins and minerals in multivitamins that the authors didn’t look at. Quite likely there’s not enough research on them to make a call either way. Regardless, the needs of pregnant women, not just their babies, should be taken into consideration when determining whether or not supplements are needed. Not all mums are going to get all the nutrients they need from food. Especially if they’re suffering from “morning” sickness. Perhaps not all mums will benefit from taking multivitamins. However, some very well may, and I think it would be a shame to tell them that they’re “wasting their money”.

Finally, as my friend Mark (who asked me to write about this topic) mentioned, taking two pills is more effort than taking just one. If it’s still being recommended that women take folic acid and vitamin D during pregnancy then they may as well just get those nutrients from a prenatal multivitamin rather than buying separate bottles of two supplements and having to remember to take both pills. It may be ever so slightly less expensive to buy vitamin D and folic acid instead of a multivitamin but I can’t even be certain of this because there was no folic acid for sale at my local grocery store when I went to price them all out. Which raises the issue of availability as well.

Women shouldn’t be made to feel guilty about not being able to afford a prenatal multivitamin. They also shouldn’t be made to feel like they’re wasting their money by buying them.

 


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Vitamin supplements: deadly or life saving?

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Last week everyone was getting worked up because an editorial in the Annals of Internal Medicine advised against taking vitamin supplements. I wish that I could unequivocally state that they were correct (or incorrect) in this assessment. Unfortunately, this is a complicated issue and I don’t think that we have all of the answers yet.

We know that there are problems with the supplement industry. It’s not well-regulated. Some herbal supplements were recently found to contain ingredients other than those stated on the label, some even contained none of the sole ingredient they claimed to contain. It’s not a stretch to presume that this issue extends to supplements beyond the herbal variety. Last year researchers found that vitamin D supplement often contained hugely variable quantities of vitamin D, even within the same bottle.

An issue unique to multivitamins is that some minerals impede absorption of other minerals when consumed together (for example, zinc and copper). Other vitamins and minerals actually work better together (think calcium, magnesium, and vitamin D). When we’re taking a multivitamin we’re almost certainly not absorbing many of the vitamins and minerals listed on the label (assuming the label is correct in the first place). Does this mean that we should give up on supplements altogether? Possibly not.

The editorial refers to three specific studies. The important thing to note if that these studies looked at people who were not nutrient deficient. The problem with this is that many of us are nutrient deficient. Canadians have difficulty meeting their nutrient needs for calcium, magnesium, and vitamin D through food alone. We also tend to fall short in consumption of potassium as well as EPA and DHA (essential omega-3 fatty acids). There is also the fact that individual nutrient needs vary and that increased nutrients are needed during specific life stages. For example, folic acid is needed early in pregnancy to prevent neural tube defects in infants (1) and many nutrient needs are increased during pregnancy and lactation. Smokers have increased vitamin C needs and athletes have increased needs for nearly everything. Infants require vitamin D supplementation to avoid rickets. Vegans and seniors need vitamin B12 supplements. Etc.

Another problem with the basis on which the authors of the anti-supplement editorial made their recommendation is that they were looking at extremes. They asked: Do multivitamins prevent cancer? Cognitive decline? Heart attacks? Just because vitamin supplements don’t seem to prevent these conditions doesn’t mean that there aren’t other potential benefits to supplementation. More “minor” aliments may be ameliorated by consumption of supplements. We also may have been simply too late to see benefit from supplementation in those involved in those studies. As with osteoporosis which is a pediatric disease with geriatric consequences, these diseases are likely a result of exposures and lifestyles starting in utero.

So, should we take vitamin and mineral supplements or not? I think that it’s a bit of a gamble either way. On one hand you may not be getting what you bargained for in a supplement. On the other hand, you might be risking nutrient deficiency by avoiding all supplements.

Obviously it’s best to try to meet your nutrient needs through food. Realistically, most of us do not do this. If you’re able to determine what specific nutrients you’re lacking in your diet then it’s best to supplement with only those nutrients. Try to select supplements that have an NHP number on them to ensure a minimal level of regulation. And, of course, too much of anything can be a bad thing. Unless advised by your MD or nurse practitioner to take a high dose (and even then, you might want to question them) of any supplement avoid reaching or surpassing the upper limit.


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Gummy vitamins: more candy, less nutrition

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It’s terrible, I know, but I always assumed that multivitamins were fairly similar. I’ve always advised people who wish to take them to choose one based on their age and sex as nutrient needs vary throughout our lifespans and are different for men and women. Personally, I always read the label to ensure the nutrients I’m most concerned about are included in reasonable amounts. However, I never thought that there would be much of a difference between the traditional tablets and the newer gummies. Turns out I was wrong.

I was catching-up on my reading of Nutrition Action magazine when I saw a blurb about the One A Day Fruiti-ssentials gummy multivitamins. The blurb pointed out that these “complete adult multivitamins” are not all that complete at all. In fact, they only contain 7 vitamins and no minerals. Compare that to a “traditional” multivitamin and mineral supplement which has 13 vitamins and 9 minerals. It’s also worth noting that the dose for the One A Day gummies is two pieces yet the amounts of vitamins provided is still less than the amounts provided by the tablets. And don’t forget about the added sugar (as if we need anymore of that in our diets) as well as the importance of cleaning your teeth after consuming gummy candy. Really, when it comes down to it these are basically fortified candy.

As a woman, and a runner, and an infrequent meat-eater, I tend to be concerned about iron and calcium. If you took these gummy vitamins you wouldn’t be obtaining any of these nutrients.

I know that some people have difficulty swallowing pills, and tablets aren’t an option. Make sure that you read the labels carefully and that your multivitamin supplement is providing you with all of the nutrients you’re concerned about. There are a number of chewable and some liquid options on the market as well. Even if you’re buying a traditional tablet variety you should still take the time to read the label.