How to Select the Best Multi

By Joel Fuhrman, M.D.

The most convenient and reliable way to ensure nutritional sufficiency is to take a multivitamin/ multimineral supplement (multi). As I mention elsewhere in this newsletter, some people—even those eating my nutritionally excellent Eat To Live diet (vegan version)— may find it difficult to obtain sufficient levels of iodine, zinc, vitamin B12, and vitamin D without supplementation.

That said, I am not suggesting that you visit the local vitamin shop and randomly pick a multi off the shelf. Care must be taken in selecting one. Not all multis are created equal, and some can cause much more harm than good.

Problems Of Excess

The downside of taking a multivitamin/multimineral is the possibility of taking in too much of certain micronutrients. It is very tempting to think that if a small amount of something is good, a larger amount will be better. In medicine and health, this belief is never true; even water can be harmful when consumed in excess.

The body needs vitamins in comparatively small amounts, and to exceed those amounts is harmful. The problem is that many multivitamins on the market contain excessive amounts of certain micronutrients, and consuming these large amounts may not be health-supporting. When choosing a multivitamin, choose one that has extra B12, but watch to make sure you do not consume excess levels of other nutrients. When it comes to certain vitamins, such as beta-carotene and vitamin A, you are better off not supplementing at all.

Let’s look at a few nutrients that illustrate the pitfalls of vitamin and mineral supplementation.

Vitamin A

The most foolish substance to ingest in supplemental form is vitamin A. Vitamin A, also called retinol palmitate (RP) or acetyl palmitate (AP), is found mostly in animal products and supplements.

A review of 20 clinical studies on vitamin A showed that the levels of intake—whether from diet or supplements— were associated with a graded increase in hip fractures and low bone mineral density or osteoporosis. 4 The most surprising fact is that adverse effects occur at the levels found in most multivitamins used today. That means that any amount of supplementation of vitamin A may weaken bones. It appears wise to let your own body make the amount of vitamin A it needs. Eat a diet high in plant-derived carotenoids, and do not ingest pre-formed vitamin A at all.

Beta-Carotene & Vitamin E

A new meta-analysis reported in the Lancet reveals that taking beta-carotene has been shown to lead to a small but significant increase in all causes of death and an increase in the risk of dying of heart disease.5

While vitamin E supplementation is not associated with such risk, it does not exhibit clinically beneficial effects.

Beta-carotene use was examined in approximately 140,000 patients, among whom the rate of all-cause mortality was 7.4% in the active treatment group and 7.0% in the control group (p = 0.003). In the six trials that evaluated cardiovascular death specifically, rates of death were 3.4% in the treatment group and 3.1% in the control group.

By contrast, when you eat foods that are high in beta-carotene, you get the benefits of scores of other carotenoids at the same time. Having a high blood level of beta-carotene from food, not supplements, actually has been associated with a significantly longer life.6

Copper And Iron

Copper is another nutrient that should not be taken as a supplement. Copper (found plentifully in animal products) is sometimes considered a marker for a high-protein diet. Higher intake of copper is linked to increased cancer and overall mortality and increased risk of Alzheimer’s dementia. In fact, one recent study showed that high copper values (highest quartile) in the blood were associated with a 50% increased risk of all-cause mortality, and the combination of low zinc with high copper was even more risky.7 Another recent study confirmed a higher risk of colorectal cancer with higher dietary intake of iron or copper.8 Furthermore, blood levels of trace minerals link higher levels of both aluminum and copper to higher risk of dementia.9

Dementia is one of the most pressing public health problems, with significant social and economic implications, and it is now found to be of dietary origin. The same dietary factors that promote heart disease (a diet low in dietary antioxidants and micronutrients and high in animal products) promote dementia. You can protect yourself through excellent nutrition.

It also seems wise not to take supplemental iron, unless needed. The iron present in meat, called heme iron, is more absorbable than vegetable-derived iron; it also is more risky. There is considerable evidence that dietary heme iron increases cancer and heart disease risk. For example, in studies of 54,500 men and 16,000 women, those with the higher intake of heme iron had over 50% increased risk of heart disease.10 Meat-derived iron also has been shown to be a factor in increasing risk of colon cancer.11 Interestingly, higher zinc intake decreased incidence of colon cancer in this same study. This association between heme iron intake and disease does not mean a little supplemental iron will cause heart disease or cancer. It merely means that meat-derived (heme) iron is not favorable.

Vitamin D And Calcium

Recently, it has become public knowledge that the amount of vitamin D (400 IU = RDI) contained in the typical multi is insufficient for most indoor-living people who do not get sunshine regularly. Since calcium and vitamin D can take up a lot of room in a multi, a separate supplement for these few nutrients make sense, rather than trying to get them from a multi.

The Ideal Multi

When I began looking for multis that I could give to patients with confidence, I was disappointed. The multis on the market all had too much of some things and too little of others. As a result, I designed my own line of vitamins. One of the key features that make the multivitamin/multimineral that I designed so unique is the absence of copper, beta-carotene, iron, and vitamin A. My goal in designing them was, first, “do no harm,” and, second, create a multi that would top off a good diet to make it the ideal diet. Of course, I also wanted it to be easy and convenient. There is no reason to fear using a multivitamin/multimineral that is well designed.


1. Crandall C. “Vitamin A intake and osteoporosis: a clinical review.” Women’s Health (Larchmt) 2004; 13(8):939-53.

2. Vivekananthan DP, Penn MS, Sapp SK, et al. “Use of antioxidant vitamins for the prevention of cardiovascular disease: Meta-analysis of randomized trials.” Lancet 2003; Jun 14; 361:2017-23. Bjelakovic G, Nikolova D, Gluud LL, et al.“Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis.” JAMA 2007; 297(8):842-57.

3. Huerta JM, González S, Fernández S, et al. “Lipid peroxidation, antioxidant status and survival in institutionalised elderly: a five-year longitudinal study.” Free Radic Res 2006; 40(6): 571-8. Buijsse B, Feskens EJ, Schlettwein- Gsell D, et al.“Plasma carotene and alphatocopherol in relation to 10-year all-cause and cause-specific mortality in European elderly: the Survey in Europe on Nutrition and the Elderly, a Concerted Action (SENECA).” Am J Clin Nutr 2005; 82(4):879-86.

4. Leone N, Courbon D, Ducimetiere P, et al. “Zinc, copper, and magnesium and risks for all-cause, cancer, and cardiovascular mortality.” Epidemiology 2006; 17(3):308-14.

5. Senesse P, Meance S, Cottet V, et al.“High dietary iron and copper and risk of colorectal cancer: a case-control study in Burgundy, France.” Nutr Cancer 2004; 49(1):66-71.

6. Smorgon C, Mari E, Atti AR, et al.“Trace elements and cognitive impairment: an elderly cohort study.” Arch Gerontol Geriatr Suppl 2004; (9):393-402.

7. Qi L, van Dam RM, Rexrode K, Hu FB. “Heme iron from diet as a risk factor for coronary heart disease in women with type 2 diabetes.” Diabetes Care 2007; 30(1):101-6. Van Der A DL, Peeters PH, Grobbee DE, et al. “Dietary heme iron and coronary heart disease in women.” Eur Heart J 2005; 26(3):257-62.

8. Lee DH, Anderson KE, Harnack LJ, et al. “Heme iron, zinc, alcohol consumption, and colon cancer: Iowa Women’s Health Study.” J Natl Cancer Inst 2004; 96(5):403-7.

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