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Product Review: Multivitamin and Multimineral Supplements Review
 

Posted: 11/22/15  Updated 2/22/17
Sections: Jump to a section by clicking on its name.
Summary:
  • If you eat a well-balanced diet (including fruits, vegetables, grains, and dairy) and have no special nutritional needs (such as when pregnant), you may not need a multivitamin/multimineral. If you're not sure about your diet, a multi can help provide required vitamins and minerals. Taking a modest daily multi is safe and may slightly reduce the risk of certain cancers. In women, it may also reduce the risk of death from cardiovascular disease and, in men, it may reduce the risk of cataracts.
  • When selecting a multi, be sure it...
    • Lists enough of each essential vitamin and mineral. Check your own requirements using our RDA table or the detailed information for each nutrient below.
    • Doesn't contain too much of any nutrient, as this can negate the benefits. This is not indicated on the label but is noted by ConsumerLab.com for each of the reviewed products in the 2nd column of the table below.
    • Is of high-quality, delivering its listed nutrients without unacceptable contamination. Check that it has been Approved by ConsumerLab.com in the results table below. Thirty-two percent of the multis selected for review failed to be Approved.
  • See our top picks by category based on high quality at low cost among the products reviewed:
Multivitamin/Multimineral Supplements Reviewed by ConsumerLab.com  
Important Update About Folic Acid and Changes to the Daily Values for Nutrients — You May Be Taking Too Much or Too Little! 

Several months after publication of this Review, the FDA announced changes in the daily requirements (the "Daily Values" or "DVs") for many vitamins and minerals. Some DVs increased and others decreased. However, supplement manufacturers are not required to apply these new values to their product labels until mid-2018 or later. In the meantime, the "%Daily Value" information on labels can, unfortunately, be misleading. Use the link above to see the latest Daily Values and you can compare those to the amounts in products in this Review.

The FDA also changed the way in which folate and its synthetic forms (such as folic acid and methylfolate) are to be labeled, recognizing that synthetic forms are much more bioavailable than folate naturally found in foods. In fact, every 100 mcg of folic acid or methylfolate you get from a supplement or fortified food is now considered equivalent of 170 mcg of folate -- 70% more than most labels show. With the new labeling, a product which previously listed 400 mcg of folic acid and 100% of the adult DV (which is 400 mcg of folate) will, more accurately, be labeled as providing 680 mcg DFE (dietary folate equivalents) and 170% of the DV.  It will be more apparent to the consumer that many products provide more folate than normally required from all sources (food and supplements) combined.

The new labeling for folate will also make it more apparent that many supplements exceed the tolerable upper intake level (or "UL") for folate, which is 1,000 mcg DFE for adults. Potential risks associated with getting high amounts of folate include masking signs of B-12 deficiency, kidney toxicity, peripheral neuropathy, promotion of cancer, and autism in offspring.

Supplements for adults which provide 589 mcg or more of folic acid exceed the UL for adults because they really provide over 1,000 mcg DFE. Although pregnant women are advised to get 400 mcg of folic acid from a supplement daily in addition to 400 mcg of folate from their diets, many if not most prenatal supplements contain 800 mcg of folic acid and exceed the UL by actually providing 1,360 mcg DFE. Some children's and teens' multivitamins also exceed the lower UL's for children -- particularly when given at their maximum suggested serving size.  

Each of the following products in this Review exceeds the UL when taken within its suggested daily serving size. Unless you are deficient in folate or have a known problem absorbing folate, these products are likely to provide more folate than you need — particularly considering that most Americans already get the Daily Value for folate from naturally occuring folate in foods and folic acid fortification of cereal products. 

Supplements in This Review Which Exceed Tolerable Upper Intake Level for Folate (1,000 mcg DFE for Adults)

General (Adult):
  • Nutrilite® Double X (800 mcg = 1,360 mcg DFE)
  • USANA Essentials, Mega Antioxidant (1,000 mcg = 1,700 mcg DFE)
Bariatric:
  • Bariatric Advantage Chewable Multi Formula (800 to 1,200 mcg DFE = 1,360 to 2,040 mcg DFE)
Women's:
  • Nature Made Multi For Her (600 mcg = 1,020 mcg DFE)
  • Nature's Way Alive! Whole Food Energizer Women's Multi Max Potency (800 mcg = 1,360 mcg DFE)
Women 50+:
  • Nature's Way Alive! Once Daily Women's 50+ Ultra Potency (800 mcg = 1,360 mcg DFE)
Prenatal:
  • Enfamil Expecta Prenatal (800 mcg = 1,360 mcg DFE)
  • NOW Prenatal Gels + DHA (800 mcg = 1,360 mcg DFE)
  • USANA BabyCare, Prenatal Mega Antioxidant (1,000 mcg = 1,700 mcg DFE)
  • VitaFusion PreNatal (800 mcg DFE = 1,360 DFE)
Men's:
  • Melaleuca Vitality Multivitamin & Mineral - Men (600 mcg =1,020 mcg DFE)
  • Thorne Research Al's Formula (1,000 mcg at max serving size = 1,700 mcg DFE)
Men's 50+:
  • Natural Factors Men's 50+ MultiStart - Dr. Michael Murray Formulated (800 mcg at max serving size = 1,360 mcg DFE)
50+ General:
  • Country Life Seniority Multivitamin (800 mcg = 1,360 mcg DFE)
  • Dr. Whitaker Forward Gold Daily Regimen Daily Regimen For Adults 65+ (800 mcg = 1,360 mcg DFE)
Children's: Upper limits by age: 1-3: 300 mcg DFE; 4-8: 400 mcg DFE; 9-13: 600 mcg DFE
  • USANA Usanimals™ (200 to 400 mcg = 340 to 680 mcg DFE)
Teens': Upper limit for ages 14-18 is 800 mcg DFE
  • USANA Body Rox™ (500 mcg = 850 mcg DFE)

Background:
Multivitamins/multiminerals (or "multis") are the most popular supplements among the general population in America. While they can help make up for shortcomings in your diet, the benefits for most people are uncertain. In 2013, the U.S. Preventive Services Task Force reported that there is inadequate evidence regarding a benefit or risk of harm with multivitamins in healthy adults without nutritional deficiencies (excluding women who are or may become pregnant) (USPSTF 2013, based on studies reviewed in Fortmann, Ann Int Med 2013).

There is some evidence that taking multivitamins is associated with a reduced incidence of some types of cancers in certain populations. For example, a major study of male physicians 50 years of age or older found an 8% lower incidence of cancers among those taking a relatively modest-dose daily multivitamin compared to men taking placebo -- although there was no reduction in the mortality rate during the study period of approximately 11 years (Gaziano, JAMA 2012). The greatest reductions in cancer were among men with a prior diagnosis of cancer (27% fewer new cancers) and men with no family history of cancer (14% fewer cancers). There was no significant reduction in prostate cancer -- the most common type of cancer in the study, however, there was a 12% reduction in all other cancers combined. The supplement used in the study was Centrum Silver, which is similar to the Centrum Silver (and several similar store brands) reviewed below, although the formula in the study dated from 1997 and contained 400 IU of vitamin D3 (now 500 IU), 5,000 IU of vitamin A with 50% beta-carotene (now 2,500 IU with 40% beta-carotene), and did not include the small amounts of lutein and lycopene in the current formula. In the opinion of ConsumerLab.com staff, the recent changes to the formula would seem unlikely to have negatively affected outcomes and the new formula may be beneficial.

This same study of Centrum Silver found no significant effect on the risk of cardiovascular disease, including no significant reductions in heart attack, stroke, or death from cardiovascular disease, among men taking the multivitamin versus placebo (Sesso, JAMA 2012). Researchers found that taking the multivitamin was not associated with any gastrointestinal side effects, fatigue, drowsiness, skin discoloration, or migraine, but there was a 7% increased risk of skin rashes. Additional analyses of this long-term study using Centrum Silver among male physicians found no benefits on cognition or verbal memory, although the researchers noted that the population studied may have been too well-nourished to benefit from a multivitamin (Grodstein, Ann Int Med 2013). A 9% decrease in the risk of cataract was found among those taking Centrum Silver in this study, compared to those taking placebo, although there was no decrease in the risk of developing visually significant age-related macular degeneration (AMD) (Christen, Am Acad Opthal 2013). However, among participants who were randomized to also take a separate, daily, high-dose vitamin C supplement (500 mg synthetic ascorbic acid -- about 6 times the RDA), there was no reduction in cataract risk, while the risk of cataract decreased by 18% among those taking Centrum Silver (which contains 60 mg of vitamin C) without the additional vitamin C supplement.

A study in adults who previously suffered heart attacks found that giving them high-dose vitamins and minerals did not result in a statistically significant reduction in further cardiovascular events compared to those receiving placebo (Lamas, Ann Int Med 2013). The supplement consisted of 28 vitamins and minerals given as 6 large caplets daily and was designed by complementary and alternative medicine practitioners. It included amounts of vitamins A, C, and E and most B vitamins at several times the Daily Value, and up to three times the Daily Value for folate, selenium, chromium, and molybdenum. Patients took the supplement regimen for one to five years (median was 31 months) and were followed for two to five years (median was 55 months). Many people dropped out of the study due to the complexity of the regimen, although there was no evidence of harm.

There is little evidence from clinical trials showing that a specific multi can reduce the risk of dying from cardiovascular disease, cancer, or any other cause (Park, Am J Epidem 2011).
However, a U.S. study found that people who had used multivitamin/multimineral supplements for at least 3 years were 35% less likely to have died of cardiovascular disease over the following 20 or so years, compared to those who had not taken a multi. This positive finding was largely driven by results for women in the study, who were 44% less likely to have had a cardiovascular-related death. None of the subjects had cardiovascular disease at the start of the study and the results were adjusted to avoid potentially confounding variables including race, education, aspirin use and blood pressure. Interestingly, the apparent benefit did not occur for people who had used multivitamins which lacked minerals, nor among people who had taken multis for less than 3 years at the beginning of the study (Bailey, J Nutr 2015). In addition, a study of women aged 50 to 79 years with invasive breast cancer found that those who used multivitamins were 30% less likely to have died from the disease, compared non-users, over an average period of 7 years (Wassertheil-Smoller, Breast Canc Res Treat 2013). Adjusting for factors such as age, race, and the use of other supplements did not substantially change this estimate. Unfortunately, the study did not evaluate the specific multivitamin formulas used, so it is impossible to say which formula, if any, was associated with the lowest mortality.

There's no standard formula for multis, so the ingredients will vary dramatically from one brand to another. It would be impossible to make a one-size-fits-all multi anyway because nutritional needs depend on age, gender, health status, and several other factors.

Multivitamins also differ greatly in terms of quality. The large number of ingredients in these products opens the possibility for more things to go wrong. One potential problem is that the ingredients and amounts of ingredients in the bottle may not match those listed on the label. And, as with many mineral and herbal products, there's also a risk that a multi could be contaminated with lead or other toxins.

What CL Tested For:
No U.S. agency routinely tests multis or other dietary supplements for their contents or quality. That's where we come in. As part of our mission to independently evaluate products that affect health and nutrition, ConsumerLab.com recently purchased 45 of the leading multivitamin/multimineral products sold in the U.S. and Canada (including seven multis intended for pets) and put them to the test in the laboratory. 

We couldn't test every ingredient in every product, so we chose to focus on several standard nutrients including folate (folic acid), calcium, and vitamin A (retinol and beta-carotene). We made some substitutions as needed. If a product didn't contain folate, for example, we tested for vitamin C instead. If it didn't contain significant calcium, we checked the levels of iron or zinc. The amount of iodine was also checked in every prenatal vitamin claiming to contain it. We also tested tablets for disintegration (how long it takes to break apart in liquid); if tablets can't break apart fast enough, less ingredient may be available for absorption by the body.

In any product claiming to contain whole herbs or more than 250 mg of minerals per daily serving, we also tested for potential contamination with arsenic, cadmium, and lead.

Any product claiming to be gluten-free was tested to be sure it met this claim. Products had to pass testing for all of these criteria, as well as meet FDA labeling requirements, to earn our APPROVED rating in the table below (see Testing Methods and Passing Score).

Update:
Several months after release of this Review, the FDA released changes to the Daily Values for vitamins and minerals and labeling rules which will make it easier for consumers to know when they are getting too much or too little of these nutrients. The changes highlight the fact that many multivitamins provide much more folic acid than required -- often above the tolerable upper intake levels. For more about this, see the Update near the top of the full Review.
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