Choosing Vitamins and Supplements

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Here are my tips for choosing high quality supplements:

  1. Do your research before you get to the store.  The federal govt has useful information on the office of dietary supplements website.  Health professionals find Natural Medicine Comprehensive Database (requires a subscription) incredibly useful.
  2. Look for the USP or NSF label
  3. Purchase a membership in consumerlab.com
  4. Use the products that were used in research studies
  5. want more information?  This recent NY times article can help

The Center for Disease Control (CDC) data shows that 75 percent of the U.S. population is not meeting the daily requirement for folate; 34 percent do not get enough iron; 42 percent don’t get enough zinc; and 73 percent are deficient in calcium. This is because our Western, largely processed-food diet is low in vegetables and fruits, which contain many of the nutrients we need. As a nation, we have become overweight and undernourished. Ideally, I ask my patients to address this by eating a healthy diet. To be totally explicit: supplements cannot replace the value of a nutritious diet. Still, there are times, conception being one of the most critical, when supplements—and especially multivitamins—are advisable.

Men and women preparing for pregnancy are wise to take a multivitamin. Exposure to oxidative stress from diet, stress, exercise, and environmental chemicals create reactive oxygen molecules. In women, these reactive oxygen species (ROS), can affect how well the egg matures, how easily it is fertilized, and how well the embryo develops. ROS may also contribute to the age-related decline in fertility, and oxidative stress also has a significant impact on spermatogenesis; taking a multi can enhance a man’s fertility. And, in male mice, folic acid is critical for DNA methylation – a key factor in epigenetics – the science of what the genes actually express.

Scientific studies suggest that there are four major reasons to take a multivitamin:

1. Taking a multivitamin may help you to conceive.

2. Taking a multivitamin reduces the risk of birth defects in your baby.

3. Taking a vitamin lowers the risk of miscarriage.

4. Taking a multivitamin reduces the risk of pediatric cancer in your child.

Preliminary research provides a fifth  reason to take multivitamins before you become pregnant.  Three studies suggest that preconceptual vitamins may reduce the risk of autism and other learning disabilities. The CHARGE group (Childhood Autism Risks from Genetics and Environment) revealed that women who took prenatal vitamins beginning 3 months before conception were 38% less likely to have a child with autism.

I recommend to my patients that they take a multivitamin every single day. Begin taking them the moment you start thinking about conceiving—and because half of all pregnancies are not planned, it is wise for all adults of child-bearing age to take them. It may well help you to conceive, and it will ensure that when you do conceive, you lower the risk of birth defects and miscarriage.

Some find that multivitamins are difficult to swallow, or that they cause nausea. First thing in the morning, on an empty stomach, can be especially difficult. Instead, take them with the largest meal of the day (usually lunch or dinner). I find swallowing my supplements between bites of food helps. If you suffer “fish burps,” freeze your omega-3 and take it with dinner.

Women:

Look for the following ingredients in your pre-conception multivitamin:

  • Vitamin A: 2300 IU
  • Iron 18 mg
  • Iodine 150 mcg
  • Folic acid 400 or more mcg***
  • Vitamin D 1000 IU
  • Vitamin B12 2.4 mcg
  • Vitamin E 22.4 IU (mixed tocopherols are best)
  • Calcium 1000 mg (calculate needs after estimating how much is in your diet and supplement if needed for the balance)
  • Trace minerals: small amounts of copper, zinc, magnesium, and potassium

*** Some women benefit from taking higher doses of folic acid.  Discuss using a higher dose or a methylfolate supplement with your doctor if you have a personal or family history of giving birth to a child with a neural tube defect, have inflammatory bowel disease, obesity with BMI >35, or diabetes.  Higher doses are also indicated for women who take antiepileptic drugs, folate antagonists (eg, methotrexate, sulfonamides) smoke cigarettes, or belong to higher-risk ethnic groups (Sikh, Celtic, Northern Chinese.)

Supplementing with fish oil is something I recommend as well. Look for a molecularly distilled omega 3 with 300-400 mg of DHA and 500-600 mg of EPA, and take it with your largest meal of the day.

Free prenatal vitamins are available at these stores with a prescription:

  • Basha’s
  • Giant Eagle
  • HEB
  • Meijer
  • Price Chopper
  • Schnuck
  • Shop-Rite
  • United Supermarkets

Men:

Although women tend to think much more about their own health when it comes to conception, it is a team effort, meaning the health of your partner is just as important as yours.

Male sperm counts have been declining for decades. While the exact cause is unknown, it is likely to be multifactorial, including environmental exposures to pesticides, endogenous estrogens, and heavy metals. Since antioxidants mitigate the effects of toxins, men who are thinking about becoming fathers should take a multivitamin.

Sperm are exquisitely sensitive to oxidative stress. In the final stages of sperm formation, cytoplasm is extracted, creating a lean, fast swimmer. The cost is that with the removal of cytoplasm, some of their protection from free radicals is lost as well.

A 2010 meta-analysis reviewed thirty-four studies of more than 2,800 couples undergoing fertility treatment. When men took antioxidants, they were four times more likely to impregnate their partner, and the rate of live birth was five times higher. A wide range of antioxidants was used in the studies and included vitamins C and E, zinc, folic acid, and selenium.

Men who were treated with a combination of folic acid and zinc sulphate showed a 74 percent increase in normal sperm count. Other studies indicate that L-arginine increases sperm count and motility; some show that zinc alone improves the sperm’s motility, and there have been studies of the antioxidants vitamins C, E, and CoQ10.

Considering that sperm contains rich amounts of essential fatty acids, omega-3 has been looked at in men. One study compared the sperm of eighty-two infertile men with reduced sperm count to the sperm of seventy-eight fertile men. Fertile men had higher blood and spermatozoa levels of omega-3 fatty acids, compared with the infertile men. This provides presumptive evidence of the importance of omega-3. Some animal studies show that when omega-3s are given to males, they are concentrated in the sperm. Omega-3s contribute to the sperm’s fluidity necessary for it to penetrate and fertilize the egg.

Vitamin D is also important for men. There is preliminary evidence that a vitamin D deficiency corresponds to an increased risk of autism in the child. Vitamin D is important in repairing DNA damage and protecting against oxidative stress, so men, too, should be sure their levels are normal.