Laura Schoenfeld: This is a really good question, and as Chris Kresser tends to say in everything that he does, it depends. I do think multis can be useful for some clients. I don’t particularly like using them because a lot of times they have certain amounts of nutrients that are either excessive or not enough. There are a lot that contain certain types of the nutrients that are not optimal.
Some examples of nutrients that I am looking for as far as whether I think something is appropriate or not are, for example, vitamin A. Certainly higher doses of vitamin A, like 10,000 IU per day in a supplement form, aren’t a problem. I’m not worried about that amount, but a lot of multis contain beta carotene as vitamin A, and I don’t feel comfortable supplementing with high doses of beta carotene. There’s a lot of evidence that that can potentially increase the risk of cancer. Also it’s really not as effective as preformed vitamin A, so that’s an example of a nutrient that if I see someone taking a multi that is all beta carotene, there’s really not many people that I think all beta carotene is appropriate for, so I’ll usually switch them to something that also contains preformed vitamin A, like retinol or vitamin A as palmitate. Basically you’ll see a certain percentage as beta carotene and a certain percentage as one of the retinols.
Then also folic acid is in a lot of supplements, especially multis. I don’t like to have supplements that contain folic acid, so I’m always looking for either methylated folate or … really it’s any of the methylated versions of folic I’m looking for, and B12, for example, in a lot of multis comes as cyanocobalamin. That’s another nutrient I don’t like people supplementing with, so I’ll look for either methylcobalamin or adenosylcobalamin or hydroxocobalamin as the options there. I also look for the balance between vitamin A and D. I look for certain minerals and see if there are any minerals in there that are not good. I don’t want most of my male clients taking something that has a lot of iron in it, and even my postmenopausal clients, it’s questionable whether supplementing with iron is necessary. There are a lot of prenatals that I think have too much iron in them. I’m trying to think of some other things. There are some multis out there that are really good. Personally, one of the ones that I like the best for most of my clients, especially if I don’t know what their methylation profile is, I really like the Pure Encapsulations PureGenomics multi. The reason I like that one is because it kind of covers all those different issues that we talked about. It has some retinol as part of the vitamin A. It has methylfolate. It actually has a combination hydroxy- and adenosylcobalamin, so it doesn’t have methylcobalamin in it. There’s nothing inherently wrong with methylcobalamin, but if you don’t know what somebody’s methylation profile is, like if they’re MTHFR or if they have COMT mutations, then sometimes too much methylcobalamin, I’ve found, can cause some anxiety or those kinds of symptoms in my patients. So if I don’t know what someone’s methylation status is or what their methylation profile is, I try to err on the side of caution and do the adenosyl- or hydroxocobalamin. It’s not a huge deal, but I like that this product has that in there. And like I said, it provides a lot of the nutrients that I like and doesn’t have excessive amounts of nutrients and still has a good amount of some other ones that I like. So that’s one that I really like.
Designs for Health makes a couple that are good, but with multis, it’s really hard to find a multi that fits each person’s needs perfectly. A lot of times what I’ll try to do is focus on certain single nutrients that I think are either universally helpful, like A, D, and K2 and magnesium and maybe some vitamin C, things like that that most people can benefit from unless they’re super-high in vitamin D or something. There may be a couple of things, depending on the person’s symptoms, that I think are important. Maybe I think zinc would be helpful, or those B vitamins can come in specific separate forms, so maybe I’ll think, OK, they need a little bit of methylfolate, and I’ll do hydroxocobalamin on top of that because they have a COMT mutation, or something like that.
Really, my preference is to do single nutrients when possible. The biggest downside to using single nutrients is that it ends up being 10 different pills that people are taking, and that’s really difficult for compliance, and obviously compliance is an important part of your recommendations to people. You don’t want to be recommending things that they literally just can’t do, and that’ll depend on the person. That’ll depend on how busy they are. You can kind of judge whether or not someone’s going to be able to deal with a bunch of different supplements. If I have someone come to me that’s on no supplements, then I might be really limited as far as the ones that I recommend, or I’ll ask them if they’re OK with taking a couple of different supplements. If somebody comes to me and they’re on 20, really I’m looking to kind of minimize how many they’re taking, and I’ll maybe take some out that aren’t necessary.
The multis can come in handy when you have someone that isn’t going to be compliant with taking more than two or three different pills a day. Like I said, with finding a good brand, I’m really looking for a balanced amount of nutrients, not excessive amounts of certain ones, and the right forms of the ones that I like to see in the supplement, not random things in there that could potentially be a problem for certain people. Sometimes they’ll have herbs or different nutrients that really aren’t necessary to be in a multi, and I like to kind of minimize how many things that somebody is supplementing with, especially if they’re eating a Paleo diet and getting a lot of nutrients from their food.
Then if there’s something that I’m a little concerned that the multi has too much in it, but the person maybe doesn’t have a super-nutrient-dense diet, sometimes I’ll even cut the multi dose in half. For example, Designs for Health has a multi that provides six pills a day for their total dose, and for that one, if somebody’s eating pretty well but not amazing, I’ll end up cutting that in half or something and saying to just take three a day. That way they’re getting a little bit of a boost, almost like a safety net, and then the rest of their nutrition is coming from the food.
I know it can get a little complicated. With supplementation, oftentimes I’m looking at what the person’s major symptoms are. We’re going to talk about this in a few … I want to say, like, in a couple of months. We’re actually creating the content right now for the nutrients to supplement with and the nutrients to avoid supplementing with, and so you’ll get a lot more information about this in a couple of months. That is going to cover where all the nutrients come from in people’s diets, and if somebody’s not eating certain things, then how much to supplement with, what form of the vitamin to supplement with. So hold tight! We’re going to give you more information about that, and hopefully this answer was at least a good starting place for you.