Most of us have some idea that we are not getting the nutrients we need from our diet. Maybe it’s because life is stressful right now and you don’t have time to cook. Or perhaps you have some digestive issues and you are afraid you aren’t absorbing things well. Or maybe you just like the idea of an insurance policy for nutrients. And so you want to take a multivitamin to cover your bases and make sure you are getting the nutrients your body needs.

Picking a multivitamin is actually very challenging. There are so many to choose from and many have subpopulations they are designed for, like a multivitamin for women over the age of 50. Some are tablets, some are capsules, and others are gummies. Some have iron, some don’t, and then there is a whole separate section for prenatal multivitamins. When choosing a multivitamin, you need to determine if you have any specific nutritional needs, you need to consider the form of the supplement, and you need to read the label for certain ingredients.

First of all, what are your specific nutritional needs? Are you anemic or pregnant? If not, then you do not need and should not get a multivitamin with iron. Too much iron will cause health issues. If you are vegan or most vegan you will need B12 in a substantial amount and may want to consider an active B-complex instead. Do you sweat a lot, get muscle cramps, or have weak nails? A multi-mineral may be a better choice for you.

Secondly, consider the form your multivitamin comes in. Anything in tablet form will likely not be absorbed and is essentially worthless. In fact, there are instances where the tablets just build up in the stomach and create what is called a bezoar, a clump of stuff stuck in the stomach. 

Liquid multivitamins present a stability issue. Many chemical reactions work better in water than in air, and so when you put vitamins into water they are going to be more reactive and therefore more likely to degrade than if they were not in water. Liquid vitamins should have sort of technology to stabilize the ingredients and a guarantee about amounts otherwise your multivitamin might not have any vitamins in it.

Now that you’ve ruled out all the liquid and tablet multivitamins, it’s time to start reading labels. Most multivitamins cheap out on either the B-vitamins or on the minerals. B-vitamins have long been fortified in our processed bread products. However, these B-vitamins are synthesized in a lab and are not bio-indentical to actual B-vitamins. They are poor imitations. These imitation B-vitamins may actually do more harm than good according to more recent research.

The bad forms of B-vitamins that are most common are folic acid instead of folate, and cyanocobalamin instead of active B12. The good or active forms are called methyltetrahydrofolate and methylcobalamin or hydroxycobalamin, respectively (brand names Mecobalactive® or Quatrefolic®). Just seeing folate or B12 listed as such isn’t good enough. If they won't tell you what form the vitamin is, don’t buy the product.

With minerals the issue is bioavailablity, or how readily your body can absorb that mineral from the intestines. The cheap form of a mineral is the oxide form, for instance, zinc oxide or magnesium oxide. Unfortunately, these are also the completely worthless forms of the mineral as they are not bioavailable. In fact, magnesium oxide is used as a laxative because it stays in the intestines and pulls in water. Citrate is the next cheapest form and it is only marginally better than the oxide form.

Minerals are all absorbed more readily when they are attached to an amino acid or a bigger molecule. This is called a chelate. Zinc bisglycinate or zinc chelate is far superior to zinc oxide. The most absorbable of the chelates are from Albion labs and you will see them on the label of decent supplements as “traacs”. They actually test the percentage of the mineral that is bound to amino acids, whereas other supplies do not.

Some multi-vitamins have omega 3s added. This should not sway your decision because the amount of omega 3s in a multivitamin are generally inconsequential. Some multivitamins have anti-oxidants added or whole food powders. Again, this should not really sway your decision since the amount is so inconsequential. 

Gummy vitamins are just silly, as much as we all wish eating candy could be good for our health. Even if they aren’t made with artificial coloring or sugar, they often have to cut corners on vitamins and minerals to make up for more expensive ingredients to make the gummy portion. 

Here is an example label of a bad multivitamin. This is a very common gummy multi found at stores like Costco and Target. It is one of the better multivitamins of the bad options.

Here’s what an amazing multivitamin looks like. This one is a physician brand that I carry in my clinic.

Very few multivitamins have both active B-vitamins and bioavailable minerals. Even fewer have trace minerals, those nutrients you hardly ever hear about but that are very important like molybdenum, vanadium, and boron. It’s very hard to cram everything into one dose and have it be in meaningful amounts, cost effective, and not require you to take 6 pills to get the dose. Full disclosure: I rarely recommend a multivitamin (unless it’s a prenatal for a pregnant woman or breastfeeding mom) because I think targeted nutrients in clinical doses are more effective. However, if you are determined to take a multivitamin, hopefully this will help steer you towards your best options.