March 2022 Issue
Supplements: Women’s Multivitamins
By Joanna Foley, RD, CLT
Vol. 24, No. 3, P. 16
The Most Important Nutrients for Every Life Stage Plus Product Recommendations
Supplements continue to be a hot topic in the health care industry. About 50% of adults regularly take supplements, with multivitamins being the most popular type.1 According to the Centers for Disease Control and Prevention, dietary supplement use is more common among women than men, and the likelihood of use increases with age.2
With hundreds of options on store shelves and online, choosing a multivitamin can be confusing for many people. For women, choosing the right multivitamin can be even more challenging due to the distinct nutrient needs throughout their different life stages and changes that go on in a woman’s body.
Should All Women Take Multivitamins?
Most dietitians promote a food-first approach to getting nutrients in the body. While dietitians should continue to encourage this, there are many situations in which taking a multivitamin may be indicated for women.
These circumstances may include preconception; pregnancy and lactation; postmenopausal aging; having rigid dietary restrictions; health conditions, such as cancer, bariatric surgery, or gastrointestinal disorders that may impair nutrient digestion and absorption from the diet; inadequate nutrient intake from the diet; genetic variants that increase the need for certain nutrients; taking certain medications that interfere with the usability of nutrients; and desires to achieve a specific health goal.
Overall, multivitamins help fill nutrient gaps in the diet. However, not all are created equally. The type of multivitamin selected should be specific to age group and health needs.
There are three general age groups women fall into that dictate what type of multivitamin they may need: premenopausal, menstruating adolescents and women; pregnant and lactating women; and postmenopausal women.
Nutrients for Premenopausal, Menstruating Women
The nutrients premenopausal, menstruating women should look for in a multivitamin include the following:
• Iron. Since iron is lost during menstruation, this is one of the most important nutrients for this life stage. Iron is a crucial component of hemoglobin, which transports oxygen to all of the tissues in our bodies. Not getting the recommended 18 mg per day can mean less oxygen delivery, which interferes with normal organ functioning.3
• Vitamin D3. Vitamin D plays many important roles in the body, including building and maintaining strong bones and protecting against certain cancers and other diseases.4,5 The American Cancer Society doesn’t recommend relying on sun exposure to meet daily needs.6
• Folate or folic acid. As with iron, folate helps form red blood cells and protects against anemia. Folic acid is the synthetic form of this vitamin, while folate is naturally occurring. Folic acid isn’t as readily absorbed in the body for some people, specifically those with the MTHFR gene mutation, which affects about 25% of Hispanics and 10% to 15% of white Americans.7 Thus, women may benefit from choosing supplements that contain the methylated form of folate, indicated by the word “methyl” in front of folate (ie, methylfolate) on the ingredients label.
Some good multivitamin options for premenopausal, menstruating women include the following:
• Pill version. Nature Made Women’s Multi is inexpensive, readily available in stores and online, and third-party tested, and requires only one capsule per dose. Another good option is Bayer’s One A Day Women’s Complete Multivitamin, which is recommended by ConsumerLab.com, a company that provides independent test results, reviews, ratings, and comparisons of vitamins, supplements, and herbal and nutrition products to consumers and health care providers.
• Gummy version. Nature Made Multi for Her Gummies contain most essential nutrients, require only two gummies per serving, and have just 3 g added sugars. The Multi for Her + Omega-3s Gummies provide small amounts of beneficial omega-3 fatty acids. However, neither of these products has iron, so a separate iron supplement may be needed if a client is iron deficient or is unable to get enough from diet.
Nutrients for Pregnant, Lactating Women
Nutrition plays a huge role in the health of both mother and baby during pregnancy and breast-feeding. Increased amounts of nutrients are needed to build the placenta, nourish the developing child, and make sure the mother continues to receive the nutrition she needs to stay strong and healthy. This is why the American Pregnancy Association recommends all women take a prenatal vitamin.8
Nutrients to look for in a prenatal and lactating multivitamin include the following:
• Folate or folic acid. This is the most important nutrient during pregnancy due to its role in supporting proper brain and nervous system development in the baby and helping prevent neural tube defects. According to the Centers for Disease Control and Prevention, prenatal supplements should provide a minimum of 400 mcg of folic acid. However, as mentioned before, methylated folate may be the better form for some women.9
• Choline. Research is discovering that choline is a critical nutrient during pregnancy for processes such as brain and tissue development.10 Most pregnant women in the United States aren’t getting enough choline and would benefit from boosting their intake through diet and supplementation to get the recommended 450 mg per day.
• Magnesium. Magnesium assists with hundreds of reactions and processes in the body, and is needed in higher amounts during pregnancy, about 360 mg per day.
• Vitamin K. This vitamin comes in two forms. Ryann Kipping, MPH, RDN, author and founder of The Prenatal Nutritionist, says, “Vitamin K2, different from vitamin K1, works alongside other key nutrients like calcium, vitamin D, and vitamin A. It’s necessary to activate the use of calcium in our bodies in the right places like our bones.” Vitamin K also plays an important role in blood clotting. Research shows vitamin K deficiency during pregnancy may lead to vitamin K deficiency bleeding, a bleeding disorder in young infants that manifests in hemorrhaging inside the brain soon after birth.11
• Vitamin D3 and calcium. Beyond calcium and bone metabolism, vitamin D plays a role on the health status of both the mother and fetus.12 A pregnant and lactating woman provides the main source of vitamin D for her infant, so having enough to give is crucial. The National Institutes of Health recommends a minimum of 15 mcg (600 IU) for vitamin D and 1,000 mg calcium per day during these life stages.
• Iron. Iron needs increase from 18 to 27 mg per day during pregnancy to provide for mother and baby.
• Iodine. Iodine is important for proper thyroid function. Kipping says, “Iodine is needed to produce adequate thyroid hormones. Because the thyroid is producing hormones for two in the first part of pregnancy, iodine needs go up by almost 50%.” Pregnant women need at least 220 mcg per day and 290 mcg per day during lactation.
• Selenium. As with iodine, selenium is required to activate thyroid hormones. According to the American Thyroid Association, selenium supplementation during pregnancy may reduce the risk of thyroid function abnormalities in the mother after birth.13
• Zinc. Pregnancy causes rapid cell growth in mother and baby, which requires zinc and increases daily needs.14 Zinc deficiency during pregnancy can lead to complications, including difficulties during labor, low birth weight, and premature delivery, so getting the recommended 11 mg per day for pregnancy and 12 mg per day for lactation is essential.15
In addition to these nutrients, pregnant and lactating women should consider taking supplemental DHA, a type of omega-3 fatty acid that research shows is critical for brain, eye, immune, and nervous system development in a growing fetus.16 Fetal DHA demand increases exponentially with gestational age, especially in the third trimester, due to fetal development. Most prenatal vitamins don’t contain DHA, so it’s a good idea to take it separately in addition to eating food sources such as low-mercury fish. Research shows lactating women need 1,000 mg of DHA per day to reach the recommended concentration in their breastmilk to best support their infant. The requirements during pregnancy haven’t been established but likely exceed that of a nonpregnant woman.
Some of the best prenatal vitamin options include the following:
• Pill version. Klaire Labs’ Prenatal and Nursing Formula is a professional-grade brand that provides all of the essential nutrients mentioned to support reproductive health in pregnant and nursing women and women wanting to become pregnant. Another option is Deva Vegan Prenatal Multivitamin & Mineral One Daily, which comes highly recommended by ConsumerLab.com.
• Gummy version. Garden of Life mykind Organics Prenatal Multi is whole food based and organic with no synthetic ingredients. However, it contains no iron, so a separate iron supplement may be necessary. As with all gummy vitamins, this brand contains a small amount of added sugars from fruit, and it also requires four gummies per serving.
Nutrients for Postmenopausal (50+) Women
Like other life stages, increased amounts of specific nutrients are needed for older women to protect against age-related diseases. Older adults also tend to have smaller appetites and decreased nutrient absorption, further warranting supplementation.
Nutrients to look for in a multivitamin for women over age 50 include the following:
• Calcium. Calcium absorption declines with age, which, in part, is why calcium needs increase by 200 mg per day for a total of 1,200 mg per day for women over age 50.17,18
• Vitamin D3. “Vitamin D is essential for bone health and immune health. While aging doesn’t affect vitamin D absorption in the gut, older adults typically have low vitamin D levels, as they spend most of their time indoors and have decreased intake of foods high in vitamin D due to decreased appetites and decreased variety of foods in their diets,” says Tricia Perry, MPH, RD, who works with older adults in multiple skilled nursing facilities across southern California. Postmenopausal women should get 600 IU of vitamin D per day.
• Vitamin B12. Vitamin B12 absorption also decreases with age, so older adults need a minimum of 2.4 mcg per day.19
• Vitamin E. This is an antioxidant that helps with skin conditions that can occur with aging, such as adult acne, eczema, and rosacea. Adult women need a minimum of 15 mg per day.20
• Vitamin A. Vitamin A works with vitamin E for skin health. It also supports eye health and can help prevent and treat macular degeneration and other age-related eye diseases. Adult women need at least 700 mcg of retinol activity equivalents per day.
• Zinc. This mineral supports strong immune function, which is essential since older adults may be more prone to illness from weakened immune systems. Zinc also supports skin health. Adult women need at least 8 mg per day.21
Some of the best multivitamins for woman over 50 include the following:
• Pill version. According to ConsumerLab.com, Bayer One A Day Women’s 50+ Complete Multivitamin is a top choice. It’s inexpensive but high in quality.
• Gummy version. Smarty Pants Masters Formula Women 50+ contains essential vitamins and minerals in an easy-to-consume form. It also provides fish oil to help combat inflammation, lutein and zeaxanthin for eye health, and coenzyme Q10 for heart health. However, like many gummy vitamins, it doesn’t contain calcium, so a separate supplement may be necessary.
Considerations When Choosing Multivitamins
Unfortunately, the FDA doesn’t regulate the US supplement industry sufficiently; supplements have no standardized definition or formula, such as what nutrients they must contain or in what amounts.22,23 This means there are significant disparities among brands and products.
RDs should advise clients and patients to purchase brands that use third-party testing. Some labels to look for on supplement bottles that indicate voluntary third-party testing include US Pharmacopeia, NSF International, ConsumerLab.com, and GMP. Says Kipping, “a third-party testing stamp will be directly on the bottle, or it will be apparent on their website without much digging.” Third-party testing ensures high-quality supplements that have the right potency, contain no contaminants, and include forms of the nutrients the body can effectively absorb. Individuals also should look for supplements that are free from any substances they’re allergic to, such as milk, fish, and shellfish.
What’s more, before clients choose supplement types, recommend they consider what form they’re more likely to best tolerate, such as capsules, gummies, or chewables. They also should pay attention to the serving size and consider the number of pills they’ll need to take, since some brands require one pill and others three or more per serving.
— Joanna Foley, RD, CLT, is a freelance health and nutrition writer, cookbook author, and health coach based in southern California. She has worked in several health care settings, including hospital, outpatient dialysis centers, and private practice. Visit her at joannafoleynutrition.com.
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