I am an unabashed vitamin snob. My supplement shelf has labels that read like Maserati and Ferrari to car buffs. How many patients have I advised to ditch their mass-produced multivitamin and replace it with a better quality choice? Don't you know that common vitamins are made from petrochemicals? From coal tar? Why would you ever consider a mass produced vitamin, often owned by a pharmaceutical giant like Pfizer, versus a boutique producer? The distinction between synthetic drug store vitamins and high-end vitamins is black and white.
Or so I thought.
When I develop a strong opinion—from postings I read, and from conversations with colleagues and teachers I respect—I will eventually search for support in the scientific literature so that I can deliver the academic karate chop and claim victory, case closed.
I am humbled on this topic to say that I may have overstepped my bounds.
What scientific literature can tell us about vitamins
When you go to the National Library of Medicine, which contains over 22 million medical articles often spanning back 60 years, you realize it's difficult to take a strong opinion on which vitamins are truly the best.
Are there legitimate concerns about the type and source of supplement you take? Absolutely. One example is a 2012 study of 121 natural health products evaluated independently for toxins like mercury, lead, cadmium and arsenic. Not exactly ingredients you find on the bottle label.
Turns out that roughly 75% of products sampled had these toxins at detectable levels. (The silver lining, if we can call it that, is that fewer than 10% of them had levels that were deemed highly unsafe. Sort of reassuring.) The worst offenders were supplements produced in China.
Another example is the overwhelming predominance of multivitamins to have only one form of Vitamin E, from a synthetic source. (There are actually 8 types of Vitamin E in nature, found in seeds, nuts, greens and avocados.) The risk of prostate cancer is actually higher if you take racemic alpha-tocopherol acetate, a version of Vitamin E that is found in many inexpensive preparations. I would never permit this form of Vitamin E in my body! A better choice is a supplement with mixed Vitamin E preparations, including tocopherols and tocotrienols from natural sources like annattto, rice or palm oils.
Beyond these observations, a tour of the National Library of Medicine doesn't clarify too many purchasing decisions. The Linus Pauling Institute advises that the Vitamin C in synthetic and inexpensive supplements is identical chemically to that in fruits and vegetables and that Dr. Pauling himself, a two-time Nobel Prize winner, favored the benefits of inexpensive C supplements. The same institution did recommend natural not synthetic Vitamin E for the reasons I've already mentioned.
The Pauling Institute also advised against magnesium oxide supplementation, the most common form in inexpensive vitamins, because it is poorly absorbed, and favored the chloride, citrate and malate versions. I generally use magnesium malate or glycinate as they are better tolerated in terms of GI tract symptoms and are so helpful for cardiac conditions like extra heart beats and high blood pressure.
There are actually studies in humans with Centrum vitamins, a brand I have railed against to patients, showing benefit for delaying cataracts and boosting antioxidant levels.
Are there any large and long term studies comparing a potent "synthetic" multivitamin versus a "natural"version on markers of inflammation, antioxidant levels, or clinical endpoints?
I cannot find any.
There is clearly a need for even a small study evaluating chemical and blood vessel responses to drugstore and boutique manufacturers.
Do I have recommendations?
The basis of all nutrition remains a plate loaded with colorful and organic vegetables and fruits. Nuts, seeds, and beans round out the main choices. Processed foods, artificial sweeteners, and partially hydrogenated vegetable oils are best avoided.
Due to a deterioration in the nutritional value of our soil and the produce it supports and the infiltration of genetically modified produce deficient in vitamin levels, supplementation remains a reasonable choice and one that I practice daily.
The Buddha said that "To keep the body in good health is a duty, for otherwise we shall not be able to trim the lamp of wisdom and keep our mind strong and clear." I suspect that vegetarian and plant-based supplements are part of that duty even if the data is not fully in.