Do I really need a multinutrient?

‘Why do I need a multinutrient, don’t I get everything from my diet?’ ‘Aren’t they just making me produce expensive urine?’

These are the questions sometimes posed when querying multinutrients. It is these questions that often lead to confusion, deferring people away from supplementation. However, choosing the right multinutrient can be an incredibly powerful tool to support many aspects of life, from stress and relaxation, to immunity, blood sugar balancing and detoxification. When a vitamin and mineral complex is carefully formulated, with great doses and active nutrients, it is so much more than just a bog standard supplement. You can synergistically support many body systems, helping us to adapt more comprehensively to our environment.

The truth is, most individuals nowadays have an inadequate intake of vitamins and minerals. The most obvious reason is a diet high in processed food and low in fruits and vegetables. However, even those who do manage a high plant intake may also be at risk due to the detrimental impact of intensive agriculture on the nutrient density of soils around the world which can go to reduce the micronutrient content of crops yielded, especially if non-organic.

Digestive health is also crucial to our overall nutrient status. Having low stomach acid or low levels of pancreatic enzymes can significantly affect our ability to digest food and absorb nutrients. Certain nutrients such as vitamin B12 and zinc require sufficient stomach acid for absorption. Many other aspects can also have an impact, such as the presence of inflammatory bowel conditions like Crohn’s disease and ulcerative colitis. This can affect the absorptive function of our digestive tract, further contributing to low nutrient status.

So, if you think you are eating everything you need – are you actually absorbing it?

Additionally, is your diet matching your lifestyle? With busy work and personal lives, stress is common for most individuals on a daily basis. Many nutrients are required to mount a stress response, and help us calm and recover afterwards. With more stressful stimulation, this can result in us using up these nutrients faster than we are replenishing them, potentially resulting in suboptimal levels.

We are all individual, with differing diets, lifestyles, and requirements, but dietary intake research is suggesting that most of us, in some way, may be lacking or deficient in certain nutrients. Of course, the first thing that needs addressing by most individuals is their diet. A multinutrient is by no means a replacement for a healthy diet and lifestyle, but rather a complementary addition to it, and a great foundation to build upon. Even if the diet is addressed, it still might not be enough.

Here are examples of key nutrients we may require more of:

• Vitamin C – This antioxidant has several functions such as supporting our immune system, iron absorption, and connective tissue. Due to its many functions, symptoms of suboptimal intake can be vast. Scurvy, a vitamin C deficiency, was first recorded in the 18th century in sailors on long-distance excursions, where fresh fruit and vegetables were scarce.¹ Symptoms include low immunity, weakness and fatigue, and easy bruising.² Now, in the 21st century, shockingly it is back on the rise. Based on hospital admissions alone, there has been a 27% increase in scurvy since 2009.³ This signifies just how poor the dietary intake of the UK population is today, with reports showing that only 30% of adults and 10% of children are consuming their government recommended 5 portions of fruit and vegetables per day.⁴ Vitamin C at 1 gram per day may decrease the duration of cold symptoms by 1-1.5 days.⁵ Higher doses can also support histamine clearance, so further beneficial for those with allergies.⁶
• Vitamin D – Up to 56% of children and 29% of adults may be deficient in vitamin D in the UK.⁷ This is mainly due to a lack of sunlight exposure, along with low dietary intake. Other contributing factors include age, pregnancy, breastfeeding, and dark or covered skin. So supplementation for these groups, as well as the general population, could be crucial. Vitamin D plays a role in immunity, bone health and mental health, so deficiency symptoms can range from increased susceptibility to infections, to low mood and joint/bone pain. In 2017, over 500 individuals were admitted into hospital with rickets, a deficiency which causes soft, weak bones and deformations.⁸
• Magnesium – This mineral is one of the most important elements in our body, involved in over 300 enzymatic reactions.⁹ In the UK, 1 in 5 adults have magnesium intake levels significantly below the recommendations, putting them at risk of deficiency.¹⁰ If you suffer from headaches, cramps, high blood pressure, anxiety, constipation, fatigue, memory problems, or hyperactivity, you could be deficient. Additionally, when stressed, magnesium is rapidly used up during hormone production, as well as through increased excretion. This clinically calls for increased magnesium intake.
• Vitamin B12 – In 2014, approximately 6% of adults under 60, and 20% of adults over 60 were deficient in vitamin B12.¹¹ However, since 2014, the number of vegans in the UK has quadrupled, potentially increasing these statistics.¹² One study reported that 92% of vegans and 77% of vegetarians had blood test results indicating B12 deficiency.¹³ A vegan or vegetarian diet is commonly associated with low vitamin B12, as it is primarily found in animal sources. Vitamin B12 is essential for the key cellular process, methylation, which is involved in hundreds of reactions throughout the body, including detoxification and sex hormone regulation. It is becoming increasingly prevalent for individuals to have issues with methylation, either due to poor diet, genetic mutations on the enzymes involved, or both. Therefore, when investigating multinutrient formulations, it is key to look out for the active form of nutrients. For B12, this is methyl- or adenosylcobalamin
• Folate – Up to 60% of children, 56% of adults under 64 and 36% of adults over 65 are at risk of folate insufficiency. Some folate found in foods, as well as folic acid from supplements, needs to be converted into active forms in the body. Some individuals may struggle with the conversion, affecting their methylation capacity. One mutation linked to poor folate conversion is the MTHFR (methylenetetrahydrofolate reductase) gene, which codes for an enzyme that synthesises methylfolate. You can overcome poor conversion by supplementing with methylfolate directly. The Quatrefolic® form of methylfolate has been shown to be 3 times more bioavailable than folic acid.¹⁴
• Zinc – An estimated 2 billion individuals,¹⁵ or around 20% of the world’s population,¹⁶ are at risk of zinc deficiency. Zinc can support many areas, such as our immune defences, stress response, and mood.^17,18 When we are under chronic stress, whether emotional or physical, we are at further risk of using up zinc more quickly, leaving us prone to a sub-optimal zinc status and increasing risk of infections and poor mental health.

Multinutrients come in different forms – capsules, tablets, and powders. Capsules can be really convenient to take, for example if out and about or travelling. However, to make supplementation more interesting and enjoyable, powders are a great choice. They can be mixed into morning smoothies or shakes, to give you a boost to start off your day. Another benefit to powdered supplementation is the dose, especially when it comes to minerals. With powders, there are no confinements due to capsule shell or tablet size, so it’s easier to get higher dosages in your daily serving without having to swallow large capsules or tablets.

Nutritional requirements vary from person-to-person, day-by-day, and even hour-by-hour. Our bodies will use what they need, and we need to trust the supplement formulation to include therapeutic, but safe levels. Surely it’s worth consuming more than you need and potentially excreting the excess, than not consuming enough and increasing the risk of deficiency?

A comprehensive multinutrient is a great and effective way of ensuring you are getting everything you need. They are a safety net for when our diet cannot quite match up to our lifestyle and overall requirements.

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References

¹ Velandia, B. et al. Scurvy is still present in developed countries. Journal of general internal medicine. 2008; 23(8): 1281–1284.

² National Health Service. Scurvy, 2017. https://www.nhs.uk/conditions/scurvy/

^{3/sup> National Health Service Digital. Patients treated for scurvy, rickets and malnutrition 2007- 2017. 2018. https://digital.nhs.uk/data-and-information/find-d...}

⁴ British Nutrition Foundation, NDNS: time trend and income analyses for Years 1 to 9. 2019. https://www.nutrition.org.uk/nutritioninthenews/ne...

⁵ Douglas et al. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev 2000;(2):CD000980.

⁶ Johnston et al. Antihistamine effect of supplemental ascorbic acid and neutrophil chemotaxis. J Am Coll Nutr. 1992; 11 (2): 172-6.

⁷ British Nutrition Foundation, NDNS: time trend and income analyses for Years 1 to 9. 2019. https://www.nutrition.org.uk/nutritioninthenews/ne...

⁸ National Health Service Digital. Patients treated for scurvy, rickets and malnutrition 2007- 2017. 2018. https://digital.nhs.uk/data-and-information/find-d...

⁹ DiNicolantonio JJ et al. Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. Open heart, 2018;5(1): e000668.

¹⁰ Derbyshire E. Micronutrient Intakes of British Adults Across Mid-Life: A Secondary Analysis of the UK National Diet and Nutrition Survey. Frontiers in nutrition, 2018; 5, 55.

¹¹ National Institute for Health Care Excellence. Active B12 assay for diagnosing vitamin B12 deficiency. 2015 https://www.nice.org.uk/advice/mib40

¹² The Vegan Society. Statistics. 2019. https://www.vegansociety.com/news/media/statistics

¹³ Herrmann W et al. Vitamin B-12 status, particularly holotranscobalamin II and methylmalonic acid concentrations, and hyperhomocysteinemia in vegetarians. Am J Clin Nutr. 2003;78(1):131-6.

¹⁴ Miraglia N et al. Enhanced oral bioavailability of a novel folate salt: comparison with folic acid and a calcium folate salt in a pharmacokinetic study in rats. Minerva Ginecol. 2016;68(2): 99-105.

¹⁵ Prasad AS. Discovery of human zinc deficiency: its impact on human health and disease. Adv Nutr. 2013; 4 (2): 176-190.

¹⁶ Wuehler SE et al. Use of national food balance data to estimate the adequacy of zinc in national food supplies: methodology and regional estimates. Public Health Nutr. 2005; 8 (7): 812-9.

¹⁷ Encyclopedia of Human Nutrition. Caballero B, Allen L, Prentice A (eds.). Academic Press, San Diego, 447-454

¹⁸ Wessels I et al. Zinc as a gatekeeper of immune function. Nutrients. 2017; 9 (12): 1286.