Vitamins: How to Shop Wisely

Momma said, “Eat your vegetables.” She was right, of course, but we often ignored her as kids, and we are failing to listen as adults. Very few of us eat the recommended five to nine servings daily of fruits and vegetables, and many are eating three or fewer servings. And that’s why many scientists and medical researchers believe most Americans could benefit from taking a vitamin pill.

Consumers need to know what vitamins and minerals they need every day, and the cheapest way to get them. A single daily pill, called a multivitamin, is the best way to get your supplemental nutrition, especially if you don’t regularly consume the recommended amounts of fruits, vegetables and other vitamin-rich foods. But you’ve got to know how to shop wisely.

Unlike prescription drugs, vitamins (and other dietary supplements, such as herbal products) aren’t regulated for safety and efficacy by the Food and Drug Administration. The government does not assure you that a bottle of vitamins is safe, that the pills inside work to give you the nutrients you need or that the product is manufactured under strict standards. Typically, the government steps in only when something goes wrong--for example, when consumers who have used a particular product get sick or die.

So you have to be your own inspector. First, check the label on the bottle to be sure the contents are what you need. There are FDA-approved daily values, which tell you what a healthy adult needs in a typical day. The vitamin is never a substitute for eating properly. But it can assure that you get the basic things you need. The multivitamin should contain 100% of the daily values of vitamins A, B-6, B-12, C, D and E, as well as riboflavin, niacin and folic acid. The pill also should contain calcium, copper, magnesium, zinc, iron and iodine. Next, you have to be sure the product will dissolve in your bloodstream, so that you actually get the benefit of the vitamins. If the pill is compacted too tightly when it is manufactured, or if the coating is too thick, it will pass through your system without dissolving.

Here is an easy home test. Drop the multivitamin in a glass of vinegar, which represents the acid content of your stomach in this experiment. The pill should dissolve within 45 minutes. If it doesn’t, look for another product. Or you can look for the USP label on the bottle. This means the vitamin product has been approved by the U.S. Pharmacopoeia, an independent organization that performs laboratory tests on the pills.

And don’t be impressed by any extravagant language on the bottle that goes beyond a simple listing of the basic vitamins inside and their percentage of recommended daily value. The UC Berkeley Wellness Letter gives a selection of “words you don’t need to see listed” on a vitamin bottle. These include “stress formula,” “sugar-free,” “starch-free,” “natural,” “super-potency,” “senior formula,” “slow-release,” “enzymes” and “amino acids,” as well as the addition of herbal ingredients such as ginseng. These serve no purpose and add to the price, according to the newsletter. If you want to buy an herbal supplement, purchase it separately. Talk to your doctor because herbs sometimes counteract the medicines you might be taking. And the quality and quantity of herbs in a given bottle of supplement is uncertain, some health professionals caution.

While virtually all adults can benefit from a multivitamin, for some groups it may be essential. Women of childbearing age need folic acid because it prevents birth defects. It is needed in the first trimester of pregnancy, often before a woman may discover she is pregnant. But 70% of women between 18 and 45 aren’t taking a multivitamin with folic acid, according to a series of public opinion surveys for the March of Dimes.

Others at high risk of vitamin deficiency are those who consume at least one or two alcoholic drinks daily; persons over 65; and poor people, who may be unable to afford adequate supplies of fresh vegetables and fruits. Vegans--individuals who eat no animal products--also are at risk of suffering vitamin deficiencies. Also, many women nearing menopause don’t have enough iron in their diets, and a multivitamin can help.

How much should you pay for vitamins? A 2001 report in the New England Journal of Medicine said adults can get a multivitamin at a typical cost of $20 to $40 a year. Because the price is so reasonable, it makes sense to give a general endorsement to the idea of vitamins for most people, rather than spending the money for blood tests to determine who has vitamin deficiencies, according to the Harvard School of Public Health researchers who wrote the article.

Prices may range from about $3 for a monthly supply to as much as $30, but the expensive brands don’t necessarily offer anything worth paying extra for. The key is the contents of the bottle in terms of the daily values of vitamins. “You can spend 10 cents a day and get a good vitamin, or spend $1 a day and get one that is no better,” said David Schardt, senior nutritionist at the Center for Science in the Public Interest, a consumer health advocacy group.

Major supermarket and drugstore chains can offer high-quality, low-cost house brands, and these big retail chains have enough clout with the manufacturers to insist on quality and uniformity. This is an important issue. The independent testing organization Consumer Lab purchased 27 brands, examined them for content and discovered that nine of the 27 did not live up to the claims on the label. They had too much or too little vitamin A, or too little folic acid.

Consumer Lab said the products that passed its tests included Geritol Complete High Potency Multi-Vitamin; One a Day Maximum MultiVitamin; Theragran-M Advanced Multivitamin; Vita-Smart High Potency Vitamins; and Walgreens Multiple Vitamins.

Once you’ve decided what brand to buy, there are a few more things to remember. Don’t buy any product without an expiration date on the label. The pills can lose their potency quickly.

Take your vitamins with your meals. They are easier for the body to absorb. Talk to your doctor before buying multivitamins, especially if you are taking medication. Vitamins sometimes clash with the efficient absorption of medications. Vitamins E and K, for example, can interfere with blood-thinning medications such as Coumadin and its generic version, warfarin.

Don’t overdo a good thing. Consuming 200% of the daily recommended amount of a vitamin won’t make you twice as healthy or give you a double dose of protection against disease. Instead, it can make you sick. Too much vitamin A, for example, can cause headaches, blurred vision and diarrhea.

More information is available from the American Dietetic Assn. Web site at www.eatright.org; the Mayo Clinic at www.mayoclinic.com; Consumer Lab at www.consumerlab.com; and the Center for Science in the Public Interest at www.cspinet.org (look for the article titled “Multivitamins: How to Pick a Multi” in the April 2000 issue of the Nutrition Action Healthletter).

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Bob Rosenblatt welcomes your questions, suggestions and tips about coping with the changing world of health care. He can be reached by e-mail at bobblatt@aol.com. Dollars & Sense runs the fourth Monday of each month.