Q: I’ve read a lot of conflicting advice on multivitamins. Some doctors say never skip them, others say a good diet is enough. Should I be taking them? If so, what should I look for (or avoid) in a multivitamin?

-Diego T.

A: Hi Diego,

Supplements cannot replace a diet rich in nutrient-dense organic foods. They’re called “supplements” for a reason!

To get the most benefit from any supplement, including multivitamins, you should keep your diet as clean as possible. This means avoiding processed foods, soft drinks, added sugars, and refined carbohydrates. Replace these with fresh organic fruits and vegetables, wild-caught fish, grass-fed beef, clean water, and pastured poultry.

Once you’ve done this, you’re ready to think about adding a multivitamin. But don’t just buy the first one you see at your local drugstore. There are a few very important things to keep in mind…

Look for a broad range of ingredients. It should include more than just vitamins and minerals. The ideal multivitamin will also contain probiotics, digestive enzymes, and amino acids.

Go organic when you can. Many products derive their vitamin and mineral content from powdered whole foods. This is desirable. But it’s even better if they’re organically sourced. It means they’re free of pesticides and other chemicals you don’t want.

If you can’t get organic, look for verified non-GMO. In many instances, it’s only one or two ingredients that don’t carry an organic certification.

Avoid additives. Most products contain fillers… These include binders, gums, titanium oxide, and silica. But some take it a step further and include artificial flavors and/or colors and hydrogenated oils. These are usually listed under “other ingredients” on the label. The shorter this list, the better.

Get the right form. Avoid cheap ingredients that do not absorb well. One good rule to follow is to stay away products that use the “oxide” form of its ingredients. These tend to be the cheapest and least beneficial versions of nutrients. Chelated minerals, on the other hand, use amino acids to enhance absorption. Look for the word “chelate” (pronounced key-late) after nutrients like magnesium and zinc.

Check the seals. The USP Verified Mark is a seal that indicates the product meets the strict standards of the U.S. Pharmacopeial Convention.

This means it contains the listed ingredients in the proper amounts…does not contain harmful levels of contaminants (like mercury, pesticides, and lead)…will break down properly in the body…and has been made according to the FDA’s current Good Manufacturing Practices (GMP) criteria.

If your multivitamin doesn’t have this mark, look for a GMP-certified seal.

Pay attention to expiration dates. The fresher your vitamins, the more potent they are. Look for “use by,” “expiration,” and/or “manufactured” dates on your vitamins. Many quality products include this to emphasize their potency. If your multivitamins don’t include a date on them, you might want to find a new brand.

Ignore marketing ploys. The term “pharmaceutical grade” is misleading. It has nothing to do with the purity or quality of ingredients. This term doesn’t mean a supplement is better than those without this term on the label.

Another thing to watch out for is liquid multivitamins. While they claim to be better and more quickly absorbed, they often contain artificial preservatives (like sodium benzoate), flavors, and other additives you should avoid.

(Note: I used to think that specialty vitamins—like women and senior formulas—were a gimmick. In most cases, this is not true... But use the criteria I’ve given here to identify quality specialty products.)

Another important consideration for multivitamins, Diego… Pay attention to the “% DV” of each nutrient on the label.

This “daily value” usually corresponds to the “recommended daily allowance,” or RDA, of a particular nutrient. But this isn’t the ideal amount. That number is simply the minimum you need in a day to prevent a deficiency. In other words, it’s good to get more than 100% in most cases.

For instance, look at vitamin D3. The current RDA is 600 IU for most adults and 800 IU for seniors. But I recommend you get between 2,000-5,000 IU a day for optimal health.

If you need a good place to start when looking for a quality multivitamin, I suggest you look at Labdoor.com’s rankings, here. They independently test and rank supplements based on quality and value to consumers. I wouldn’t stray outside of the top 10 on their list...

In fact, one brand I like when it comes to multivitamins—Garden of Life—took the top two spots on Labdoor’s most recent rankings. I have no affiliation with the company. But in my experience, they make quality products. My family and I use them.

Like many of their supplements, Garden of Life’s men’s multivitamin is sourced from whole (i.e. real) foods. It also contains probiotic and enzymatic support. You can get more details here.

Best,

Dr. Wayne J. Broth

Q: My wife has been plagued for years by restless legs syndrome (RLS). The medication she takes when she feels the onset of symptoms makes her drowsy. We have been unable to find natural remedies. Do you know of any that can ease her RLS?

-Ken J.

A: Hi Ken,

I'm glad you asked this question—I've long been concerned about the conventional treatments for restless leg syndrome (RLS). We don't fully understand RLS. But we have some ideas about the mechanism of action.

RLS affects women twice as often as men. The prevalence in the population is somewhere between 5% and 25%. Not everyone consults their doctor about the problem. This makes exact numbers difficult to know. It is more common in those with kidney disease, during pregnancy, or in association with any condition leading to iron deficiency.

Symptoms of RLS are typically worse in the evening. As you likely know, RLS is a significant cause of sleep disturbance. Moving the leg may relieve symptoms temporarily, but they often recur soon after.

The evening period of aggravation corresponds with low levels of dopamine in a part of the brain known as the substantia nigra. This leads to two of the primary treatment options. Dopamine synthesis requires iron, which is why RLS symptoms can be mitigated by taking iron supplements… Even when blood tests show no evidence of iron deficiency.

I recommend a whole food-based iron supplement, taken with vitamin C. Or simply add iron-rich foods as a first step. These include dark leafy greens (like spinach), wild-caught shellfish, and grass-fed beef.

The other line of treatment is RLS drugs used for Parkinson's disease. (This may be what your wife takes now.) Some aspects of the two conditions are similar. Unfortunately, it appears that treatment with such medications may ultimately aggravate RLS symptoms in the long term… Both in severity and frequency. Not a good outcome!

Let’s back up a minute, though, and think a bit more about the cause of RLS. In many cases there is an underlying cause that can be addressed to relieve RLS symptoms. (This may be true in your wife’s case.) In addition to iron deficiency, I always consider several other conditions.

If someone has an underlying chronic illness, auto-immune or other inflammation throughout their body (reflected in blood tests), or a neurological illness like Parkinson’s, RLS can be one manifestation of that illness.

Further, a condition that is increasingly common with age is Small Intestinal Bacterial Overgrowth, or SIBO. It is often overlooked as “weak digestion.” SIBO can manifest as burping and bloating, constipation or diarrhea, and also seems to generate an auto-immune component.

Identifying and addressing the underlying condition can remedy RLS symptoms. SIBO with RLS in particular has been treated with specific antibiotics, dietary modifications, and a drug called naltrexone taken in very low doses.

Most of the conditions mentioned above require a similar approach: a combination of targeted therapy and lifestyle modifications. Resolution or reduction of systemic inflammation can help with RLS.

Vitamin D deficiency can contribute to RLS severity as well as factor into many of the inflammatory conditions linked with RLS. I like to test blood levels of vitamin D and aim for a value between 40-65 ng/ml on standard testing.

The best way to get vitamin D is through sun exposure (without burning). I also recommend supplementation when sun access is limited. I prefer a preservative-free liquid vitamin D3, taken in doses of 1,000-6,000 IU daily as needed to maintain that optimal level of vitamin D in the blood.

So what else is there?

In terms of supplements, folate is helpful for some—particularly pregnant women. I counsel my patients to avoid supplements that use the “folic acid” form of the nutrient. Instead, take those containing either folinic acid or methyl folate.

Start with about 1 mg daily. People's response to folate varies widely, though the majority of people take it without a problem. It helps some—not all—patients with RLS.

Magnesium is always a good supplement to consider whenever there is any neurological or muscular irritability. It has a soothing effect on many aspects of our physiology. Here again, the form of magnesium is very important.

Magnesium oxide is only useful as a laxative. It fails to build any significant stores of magnesium in the body. Better forms include magnesium glycinate, lactate, or taurate.

The best application is topical. You can apply magnesium oil directly to the affected area. Or take an Epsom salt bath. Look for the salts in a form that would be suitable for taking by mouth. (The ones that are labeled “safe for oral ingestion” will be the highest quality.)

Medications or lifestyle factors can trigger RLS. In some cases, avoidance relieves the symptoms. Triggers include caffeine, nicotine, and alcohol. Medications such as antihistamines or antidepressants may also cause flare-ups.

Finally, there are many who report relief from vigorous exercise earlier in the day. I don't know whether the exercise helps boost dopamine in the brain or improves circulation and delivery of nutrients to the affected muscles… Perhaps both.

To Your Health,

Dr. Deborah Gordon
 

Q: Is it better to take coconut oil as a supplement or eat a spoonful of it straight from the jar?

-Eileen R.

A: Hi Eileen,

As long as you are getting the same amount of oil in a capsule as you would by the spoonful…and you are getting unfiltered, extra virgin coconut oil…there should not be much of a difference medicinally. The main difference is likely in the cost.

You are paying for the capsule, processing, and packaging… And you don’t need to!

My motto is always “eat your medicine” when you can. And make sure it is minimally processed and as close to the source as possible.

For instance, there’s a good chance that capsulized coconut oil has lost some of its beneficial properties during processing. The additional step of encapsulating may expose the oil to additional heat, light, and oxygen. All of these can diminish its nutrients.

I say forget the pill—go for the spoonful! Just be sure to get organic, extra-virgin coconut oil.

The best quality products are cold-pressed. This means the extraction process uses the lowest heats possible—usually not above 120 degrees. It also allows the coconuts to be minimally processed. This preserves nutrients and offers you the most health benefits.

Best Wishes,

Dr. Shannon Amori

Q: I’m a man in my 60s and like most people my age, my near vision has gotten worse over the years. I work on a computer all day, and sometimes well into the night. Has this contributed to my poor near vision?

Also, I tend to enlarge the type size on my computer screen to compensate for my bad reading vision. Is this a good strategy, or should I wear my reading glasses instead?

-Stewart P.

A: Hi Stewart,

When you hit 45-50 years old, presbyopia sets in. This is farsightedness cause by loss of elasticity in the lens. That’s normal.

After the age of about 25, you’re not going to make your near vision worse by reading or doing work that requires you to look at near objects. But when you are using screen devices, you should use the tools available to you to protect your vision and to help you perform better: 

• Use reading glasses. You don’t need to get expensive prescription ones. The cheap ones that you can buy at any drug store are fine. They will decrease eye strain.
• Enlarge the type on your screen. This is an excellent strategy, which you’ve already adopted. Your eyes won’t have to work so hard.  
• Follow the 20/20/20 rule. Every 20 minutes while you’re on your computer look away at something at least 20 feet away for at least 20 seconds.
• Nourish your eyes. Lutein and zeaxanthin are two powerful, natural antioxidants that my research shows is important to eye health. Leafy greens contain high amounts of these carotenoids. You need about two bowls of spinach or kale a day to get a therapeutic dose. Eat it with some kind of fat such as olive oil dressing to make the lipid-soluble nutrients more absorbable. Another option is a supplement that includes about 20 mg of lutein and 5 mg of zeaxanthin. 

If you do these things, you’ll lessen the strain on your eyes, you’ll likely feel better, and you’ll be protecting your vision over the long term.

Best,

Dr. James Stringham

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