Our Top Nutritional Insurance Policies
AKA What to do if you Diet is lacking in Nutrient Density
Consuming fruits and vegetables offers health benefits that are greater than the sum of their parts, underscoring the fact that vitamins and minerals should be primarily obtained from a healthful diet high in fruits, vegetables, nuts, seeds, high-quality protein, unsaturated fats, and whole grains. Whole foods contain a plethora of nutrients, such as phytochemicals (flavonoids, anthocyanins, carotenoids), antioxidants, insoluble fiber, hundreds of various probiotic strains, and more, which are not found in supplements alone.
So why are supplements so popular and how can they be useful?
I live a pretty chaotic lifestyle-48 yo, 2 yo son, busy medical practice, going back to graduate school – so my diet is not always the ideal. Some form of multivitamin is my own nutritional “insurance policy” to make up for the key nutrients I am probably missing.
Some vitamin and mineral deficiencies have been associated with certain conditions. For example, insulin resistance is linked to a deficiency in Magnesium1. Vitamin B12 deficiency is linked to megoblastic anemia. Zinc deficiency is linked to depressed immune function. Even if you don’t have a deficiency, if you are looking to enhance your healthful diet, manufactured supplements may be able to help. According to the Dietary Supplement Health and Education Act of 1994 (DSHEA), almost 50% of the U.S. population consumes dietary supplements.2 If you follow a restrictive diet, such as vegetarian or vegan, have certain health conditions, or have food insecurity, then you may require supplementation. If you have physical or biochemical signs or symptoms of a vitamin or mineral deficiency, then your doctor will likely suggest you take a specific vitamin or mineral supplement and recommend follow-up care. The National Institutes of Health (NIH) Office of Dietary Supplements offers some guidelines in what nutrients to focus on: “Nutrients of special public health concern in American diets are Calcium, Potassium, dietary fiber, and Vitamin D in both adults and children…”3. Medical guidelines vary depending on the specific nutritional need and are specific from person to person.
Most multivitamins don’t contain Calcium or Magnesium because the amounts needed to fulfill 100% of the daily value are too large to fit into a capsule, which is unfortunate because these two minerals are among the most common deficiencies4.
How do I choose a multivitamin supplement?
When picking out a multivitamin, consider your specific needs. For the purposes of this article, I’ll be focusing on men aged 31-50 years old. The Recommended Dietary Allowance (RDA)5 indicates the average daily dietary intake level sufficient to meet the nutrient requirements of about 97-98% of healthy individuals. Men require a slightly higher amount of Vitamin A (900ug versus 700ug for women), Vitamin K (120ug versus 90ug for women), Vitamin C (90mg versus 75mg for women), Niacin (16mg versus 14mg for women), as well as other nutrients, such as Thiamin and Riboflavin. Men who have not been diagnosed with Iron deficiency anemia should not seek additional Iron from supplements. A fraction of men has a genetic variant for hemochromatosis and Iron overload, and since they don’t have menstruation, pregnancy, or lactation to get rid of excess Iron, supplementation should be avoided.
Third-party testing organizations are your best bet for evaluating a supplement’s safety and honesty of labeling.Supplements that have the United States Pharmacopeial (USP) Verified Mark indicate that the manufacturer has met certain quality standards6. Other third-party approval organizations include the National Sanitation Foundation (NSF) and Informed Choice.
A randomized, double-blinded placebo-controlled study published in 2014 found that healthy men aged 50+ taking a Centrum Silver multivitamin once per day had a significant decreased risk of total cancer.7 One in nine men will be diagnosed with prostate cancer.8 The American Cancer Society reports that while Vitamin E and Selenium supplementation had been thought to help lower prostate cancer risk, a large study called SELECT found no beneficial effects of Vitamin E and Selenium on prostate cancer risk.9 Per the American Cancer Society, “…Vitamin E supplements actually were found to have a slightly higher risk of prostate cancer” 9.
In this article, I’ll be comparing different multivitamin supplements for men ages of 31-50 years old. I’ll be comparing three multivitamins from different nutrition supplement companies, such as Thorne, PureEncapsulations, and Takecareof, as well as a capsule from Juice Plus.
Thorne is a nutritional supplement company that has products in clinical trials and partners with the NIH, Cleveland Clinic, Johns Hopkins, Columbia University, the Mayo Clinic, and other institutions. Thorne partners with 11 U.S. National Teams as their exclusive provider of nutritional supplements.
As with most nutritional supplement companies, none of the health claims on the Thorne website have been evaluated by the FDA, such as, “Al’s Formula …supports the metabolic functions of a mature man”. Their “Al’s Formula” complete multivitamin contains a plethora of nutrients. Four to eight capsules per day is a serving size, which may be difficult to swallow. The efficacy of some of the compounds have not yet been sufficiently proven in clinical trials. This would include Saw Palmetto, which has been shown to be no more effective than a placebo in relieving urinary tract symptoms caused by prostate enlargement.10 There are risks of taking compounds that are not only shown to not be beneficial, but for which there is conflicted evidence of their safety. For example, Hawthorne extract may interact with some heart condition medications,11 so it’s probably best to stay away from this if you’re taking those medications.
PureEncapsulations is a nutrition supplement company that produces hypoallergenic multivitamins that are free from artificial ingredients and contaminants. As with the Thorne products, none of the health claims have been evaluated by the FDA. They have a multivitamin for men over 40 years old that is gluten-free, GMO-free, and vegetarian. It contains various, manufactured blends of nutrients, such as the MacularSynergy Complex, ProstaProtect Plus, Cardio Polyphenol Complex, and EnduraBoost Blend, some of which contain herbs such as pygeum and astragalus, which have not been thoroughly studied. This multivitamin has many components that may be unnecessary for some people, such as 20mg Choline (one egg has 293mg Choline)12. It also only contains 100mg Calcium; the RDA for calcium is 1000mg for men ages 31-50 years old5.
Another option is to take a quiz on Takecareof.com and have them recommend a pack of vitamins. The products evaluated on the website are tested three times in the United States and Takecareof.com claims that the vitamins/minerals tested are highly bioavailable. The research displayed on their website is relevant and up-to-date (usually dated no later than 2010). Some of the research is not fully accessible without journal access, so the consumer will have to trust that TakeCareOf is providing an accurate description of the outcomes described in the research articles. TakeCareof is backed by doctors from respected institutions, such as Tufts and Harvard, which may give you ease-of-mind.
I took the quiz as a 45 year-old male who is interested in health and fitness who regularly engages in resistance training. They recommended that I take 600mg of dried, encapsulated Ashwaganda supplement and a Vitamin D supplement. Ashwaganda has not had conclusive evidence to support any health outcomes, but is known as a supplement that helps the body deal with stress.
TakeCareof has a general multivitamin (with no Iron) that has a good amount of each nutrient, except Calcium. So if this multivitamin is chosen, an additional Calcium supplement or adequate intake of dairy products may be recommended. It also does not contain Potassium. But, if you’re looking for a potassium source, an orange alone has 181mg Potassium13!
Juice Plus is a nutrition supplement company that offers a capsule that doesn’t claim to be a multivitamin, but more of an enhancement to your fruit and vegetable intake. Their capsules have been NSF approved and they have a variety of fruits and vegetables that have been juiced and dried into them. This company is one of the few that have invested their money back into research for their products. There have been over 30 research studies done on Juice Plus that support certain heart health, immune system, oxidative stress, skin, systemic inflammation, quality of life, lung health, and obesity benefits. Some of these claims, such as that Juice Plus significantly decreases three biomarkers of inflammation, are based on just one study and should be taken with a grain of salt (the studies were funded by Juice Plus).
Green Juices and Powders
If you’re not interested in taking pills or capsules, green juices were created to make the daunting task of getting fruit and vegetable nutrients attainable and convenient. It’s a great alternative to 100% fruit juice, which is high in sugar (and added sugar depending on how it’s prepared), but many companies increase the sodium content to improve palatability. A half cup of fruit or vegetable juice counts as one serving of fruits or vegetables, but it’s not recommended to drink more than 1 cup of fruit or vegetable juice per day.
The bioavailability of the product must be considered as the high temperatures of pasteurization can reduce the number of available ingredients. Some manufacturing methods have shown to help preserve the nutrient content of the product, such as cold-pressed (also known as High Pressure Processing or HPP). If something is labelled as “raw,” use caution because this product has not been treated for pathogens, has a short shelf-life, and usually needs to be refrigerated.
Juices have been criticized for their lack of fiber and therefore companies have added prebiotics, probiotics, and soluble fiber to their products so that they can advertise that their products are good for gastrointestinal health. Many health benefits of probiotics are strain-specific, so it may be helpful to do some research on the specific bacteria strain that is in the product.
Some supplement companies claim their product has a specific number of antioxidants. Oxygen radical absorbance capacity (ORAC) measures the antioxidant activity in food14. There used to be an ORAC database publicly available via the U.S. Department of Agriculture, but it has since been retracted since the limited research has only been shown in vitro and the results cannot be extrapolated to in vivo effects15. The results were misused by manufacturing companies to sell products and unfortunately, this still happens today. Beware of companies that say that a product has “X” number of antioxidants, because there is no official standardized method to measure its ability to impact health in humans16.
Here is a comparison of a few green juice/powder companies that are widely available, including Athletic Greens, Organifi, Super Green Juice, and Suja Juice.
Athletic Greens sells nutrient-rich powder made in New Zealand that is paleo, keto, and vegan-friendly, gluten and dairy-free, and has less than 1g of sugar per serving. It has 75 vitamins, minerals, probiotics, digestive enzymes, and other whole food-sourced ingredients. The product website claims to have many kinds of benefits, including clearer skin, stronger hair and nails, improved mood/concentration, more balanced digestion and gut health, and feeling more energy. The website is lacking the scientific evidence to support these claims, so whether these outcomes are from customer reports (and placebo effect?) or not is unclear. One tablespoon (12g) of the powder contains just as many micronutrients as a normal multivitamin supplement would. The green tint of the product is likely solely because of the most prevalent ingredient, Spirulina. Although it may seem as though the amount of Vitamin C and Vitamin E levels are excessive, the Tolerable Upper Intake Levels (UL) are 2000mg and 1000mg, respectively. Vitamin B12 does not even have a UL because there have been no adverse effects associated with excess intake in healthy individuals17.
Organifi makes powder that is organic, vegan, keto-friendly, and gluten-, dairy-, and soy-free. This powder claims to “detox” and “burn fat.” The company suggests drinking this product on an empty stomach to “encourage alkalization,”. Any “alkalizing” your drink is supposedly doing does not affect your blood pH and there has been no conclusive evidence that drinking these products will make your body more alkaline. Organifi contains several ingredients that have not been adequately scientifically studied to support any health claims, such as moringa powder. The enticing color of the powder comes from the wheatgrass, chorella, and spirulina ingredients. The third-party study18 they refer to on their website is an unpublished, short-term (90 days) study conducted on 34 subjects based on self-reported product consumption compliance. The participants could mix the powder into their liquid of choice, which could significantly alter the results depending on the different types of liquid they chose. As with any health claims that have not yet been evaluated by the FDA, take these with a grain of salt.
Super Green Juice makes a green powder that is organic, vegan, and non-GMO, and it can be mixed into a beverage of your choice. This product has no scientific evidence to support their claims or the bioavailability of the product, and it is not endorsed by any physicians or registered dietitians. It uses the phrases, “Alkalize to reset your metabolism” and “Detox the body”, both of which do not have scientific backing. Some of the ingredients are unnecessary; for example, if you don’t have a lactase deficiency, then adding lactase into your diet isn’t going to help you in any way.
Suja Juice offers a variety of ready-made green juices, such as Green Delight, Mighty Dozen, Uber Greens, Green Supreme, and Cucumber Ginger. The Green Supreme is USDA Certified Organic, vegan, and dairy-, soy-, and gluten-free, and has no added sweeteners. The company only tests for Calcium and Potassium due to the nutrition labelling requirements, so other micronutrient values are not available. The ingredients in the Green Supreme juice are limited to apple juice, kale juice, and lemon juice, so it may not have as many micronutrients as one would anticipate. This would be a rare situation where it may be beneficial to choose the product with the most ingredients (as opposed to the least) in order to get the most out of your purchase. I would choose the Twelve Essentials juice that has – yes, you guessed it – twelve nutrient-dense ingredients.
To summarize on green juices, if a person who normally has unhealthy diet habits drinks a lower-calorie, nutrient-dense green juice in place of their usual high-calorie, nutrient-lacking food, they will likely have metabolic changes, including improved blood lipid levels and decreased weight and fat mass, as well as self-reported improved mood and energy. For supplements in general, it’s important to look for products that don’t claim to do-it-all. If you have the time and energy, it may be best to just spend that $80 on fruit and vegetables from a grocery store and bake them into a casserole or eat them whole. But, yeah, I don’t have that kind of time presently.
Hopefully this article gave you a good idea of what to look out for when choosing an appropriate supplement, whether in the form of a multivitamin or a nutrient-dense juice. These products can be supplemental to a wholesome diet, especially when it’s not feasible to obtain the adequate amount of every nutrient every day.
If you want to know more about how training, nutrition, supplementation, and recovery all fit together into a complete system visit the Dynamorphic Training System site.
This article is for informational purposes only and does not intend to treat, diagnose, or give medical advice. Affiliate links earn revenue that supports military combat trauma research.
Lanny Littlejohn, MD