Are multivitamins Worth the Price?

Some individuals may be wondering if multivitamins are worth the cost and the effort. Not surprising when one considers all the bad press multivitamins are getting lately. For instance, in the Harvard Men’s Health Watch, published March of 2008, readers may have gotten the impression that most of the ingredients in multivitamins were not worth buying or ingesting. In the Nutrition Action Health Letter of June 2008, it was suggested that individuals only take multivitamins every two days and not everyday. What brought about this concerned buzz? Folic acid. Or to be more precise, the concern that people were getting too much folic acid because of the use of multivitamins.

So, what to do? Here is a good suggestion. Take a multivitamin on a daily basis, but cut down, or eliminate, consumption of fortified foods that can deliver a lot of folic acid to the body.

The Difference Between Folic Acid and Folate

Folic acid and folate are both in the family of B vitamins. The names they carry come from the Latin word for leaf—folium. Folate can be found naturally in vegetables, fruits, many types of grains, and several other foods. It is in a natural form at this phase. On the other hand, folic acid is the synthetic form. It is only available when it is added to different types of foods or when added to vitamin supplements. The important thing to remember is that folic acid will absorb more quickly but the body will still need to convert it to folate before it actually does any work.

Folate is essential in healthy cell function. It has the job of moving carbon atoms (along with the attached hydrogen and oxygen atoms) from one chemical compound to the next. This transfer is crucial to cell functions and that is why folate is so important. Folate is also crucial for making and repairing DNA. It also assists in the conversion process of amino acids, which are the foundation for proteins. Some of the best ways to get folate is to eat beans, sunflower seeds, various types of greens, fruits, and vegetables.

Starting the late 1990’s, folic acid was added to just about all enriched breads sold in the US. It was also added to rice, pasta, flour, grain products and cornmeal. It was added to these food products as a means of preventing spina bifida as well as anencephaly. These are birth defects caused (in part) when there is not enough folate in the mother at the time of conception. By adding folic acid to food products, folic acid was increased, on average, by 100 micrograms per day. This helped to reduce the number of US children who were born with a neural tube defect by an estimated 25 to 50 percent. Controlled studies also showed that folic acid helps to protect people from strokes. Some studies have also suggested folic acid may reduce the risk of heart disease as well.

The IMO (Institute of Medicine) has recommended that adults receive 400 micrograms of folate or folic acid per day. They recommend that pregnant women get 600 micrograms per day. The IMO often sets guidelines for both vitamins and other nutrients. It should be noted that the IMO also suggested that individuals NOT take more than 1,000 micrograms of folic acid a day if it comes from vitamin supplements or if it comes from fortified food. This limit does not apply to folate that is eaten via food intake.

While it may sound contrary, it has been shown that taking too much folic acid can actually hide B12 vitamin deficiency signs. Older individuals often suffer from this at the rate of about one in six. This is often because the elderly do not get the level of B12 that they need or it is not absorbed efficiently. It has also been shown that excessive folic acid levels can mask the signs of anemia. This is another of the early warning signals of vitamin B12 deficiency. If not treated in a timely manner, it could lead to health issues such as dementia, confusion, and severe damage to the person’s nervous system; some of which may be irreversible.

The above are just a few of the health issues associated with excessive folic acid levels. It is also known that normal levels will often help prevent early tumors, but too much folic acid can actually help tumors grow faster. Some other studies have reported that too much folic acid may be linked to an increased risk for various types of cancer such as breast, colorectal, and prostate cancer. It should be noted, however, that these reports and studies are somewhat limited and many other studies have not found a link between excessive folic acid and cancer.

It is not surprising that many consumers are confused over folic acid. In one major study, it was reported that fortifying with folic acid may cause a minor increase in colon cancer. Another equally major study, suggested that other causes may be at the root of colon cancer. And others debate that more effective detection methods for finding colon cancer are the reasons more cases were noted. It could be argued that since doctors are now more effective in locating colon cancer earlier, it is their work that has brought about the increase in colon cancer reporting and that folic acid has nothing to do with it. In fact, studies have shown that there is a lowered chance of colon cancer, as well as breast cancer, when folic acid or folate levels are increased.

It is known that with higher intakes of folic acid the body cannot convert it all into folate. How this may or may not affect the person’s overall health is not clear at this time.

When is Enough?

It is important that readers understand that getting too much of the folate form is not a problem. This form is found in foods and it is naturally balanced within that food. The body can easily take care of its absorption. Now, folic acid, on the other hand, can become a problem. Here is how that problem occurs:

Many of the foods that we eat everyday such as nutrition bars, breakfast cereals, and forms of fortified foods, can contain as much as 800 micrograms of folic acid. This is more than double what most people need on a day-to-day basis. Consider this: if a person consumes an average size bowl of the breakfast cereal Special K, they will get about 390 micrograms of folic acid. If that same person ingests a Nitro-Tech nutrition bar later in the day, they have addd another 800 micrograms of folic acid. And if they eat just one half cup of pasta later on, they can add another 85 micrograms to the total. As you can see, it doesn’t take much to get to and exceed the daily recommended upper limit of 1000 micrograms. And this is the upper limit as set by the IMO.

It is important to know when enough is enough when it comes to vitamin intake. And this applies to all vitamins and minerals. For instance, too much vitamin A can lead to a weakening of bones which can lead to bone fractures. Likewise, too much folic acid can lead to health issues as well.

On the other hand, it is also important to remember that we often do not get the needed amount of vitamins and folic acid that we require through food alone. Eating foods that are fortified with folic acid is one way to increase intake, but it must be done with common sense. Nothing is better than healthy food, but multivitamins and supplements can play an important role as well. This can be especially true for certain groups of people such as pregnant women, elderly individuals, those who do not have access to healthy food on a regular basis and others.

A sensible idea is to take a multivitamin every day and make it a habit to limit or eliminate foods that have been fortified above 100 to 200 micrograms of folic acid. This is one of the best ways to get the vitamins you need without going overboard.

Folate and Cancer

Focus on Folate

One of the biggest breakthroughs in vitamin research was when researchers discovered that a woman with a deficiency in folate, a B vitamin, was at an increased risk of having a child with a neural tube defect such as spina bifida or anencephaly. In the past, it was unknown what caused these birth defects. Now it is understood that these neural tube defects occur in the very early stages of pregnancy, often before a woman even knows she is pregnant. This is because spinal cord development is one of the very early stages of fetal development.

Over 30 years ago, researchers in the UK discovered that women who had borne children with spina bifida had lower-than-normal levels of certain vitamins, including folate. During the course of two large trial studies in which women were given either folate or a placebo it was discovered that those who had been given the placebo had a higher incidence of having a child with a neural tube defect. Inversely, the studies showed that the women who had been given adequate levels of folate were less likely to have a baby with a neural tube defect.

For folate to effectively lessen the risk of having a child with a neural tube defect, proper timing is essential. For optimal effectiveness, the vitamin must be taken regularly during the first few weeks following conception, with neural tube development occurs. The problem with this is that many women do not even know they are pregnant until after this stage passes by, making it difficult to time taking the requisite amount of folate. To ensure that enough folate is taken, women of childbearing age who could become pregnant should take folate regularly, either on its own or as part of a multivitamin.

Women of childbearing age who themselves were born with a neural tube defect need to take particular caution. These women are at a higher risk of having a child with a neural tube defect and they will need to take a much higher dose of folate prior to and during the early stages of pregnancy. Although most women can take an over-the-counter folic acid supplement, women who have spina bifida or another neural tube defect will need a prescription-strength supplement that can only be obtained by way of a doctor’s prescription.

It may be tempting to assume that adequate levels of folate can be achieved through a healthy diet, but this isn’t always an easy task. Women should take at least 400 micrograms daily, which can be extremely difficult to get from the average diet. Fortunately, the United States Food and Drug Administration has mandated that folic acid (a form of folate) be added to products such as breads, pasta, rice and other enriched products. Since the government has mandated the fortification of products with folate, there has been a dramatic decrease in the incidence of babies born with neural tube defects, somewhere in the neighborhood of 25 percent.

Folate and cancer

Folate plays an important role in the building of DNA. These complex substances are what form the basis of our genetic blueprint, or one-of-a-kind (excepting identical twins) genetic makeup. Studies have shown that those who receive adequate amounts of folic acid from their diets and/or supplements for more than 15 years exhibit a lesser chance of getting colon cancer or breast cancer. Those who drink alcohol must be particularly careful, as alcohol in the system interferes with the proper metabolism of folate by the body. The protection offered by folate against breast cancer seems to be mitigated by those who have more than one alcoholic drink daily, moreover. A Swedish study supports these findings: That study indicates that the protection offered against breast cancer by folate is only applicable to those women who consume one alcoholic drink or less daily.

It is difficult to ascertain the true relationship between folate and certain kinds of cancer, however. It is a complicated relationship, particularly for those who are already at a higher risk for colon cancer. This is because those people who already have colorectal adenomas (polyps) are not further helped by the taking of folate. In fact, one study’s finding suggests that taking folate may actually increase the risk of those with polyps developing further growths that may be cancerous. However, it is very important to note that the participants in this study were taking a much higher than normal amount of folate than what is typically found in a standard multivitamin – about twice as much, in fact. This could be another instance wherein the timing of taking folate is the key. It may be that folate may prevent the development of polyps in those who don’t already have them, but that it also may speed up the development of polyp growth in those who already do have them.

The key in ascertaining any potential causal relationship between a vitamin supplement and cancer is understanding what cancer cells actually are. They are our own cells gone awry, not a foreign invader like a virus or bacteria. Cancer results from our own cells growing and dividing too rapidly. Because they are on “overdrive,” cancer cells require more nutrients than the rest of our cells do, which is why it seems that certain levels of various nutrients in the body can actually accelerate the growth of already-present cancer cells. This is why chemotherapy often contains nutrient antagonists (including folate antagonists) which are designed to combat the “feeding” of cancer cells by these nutrients.

As always, before taking any vitamin supplements for any reason, it is wise to consult your doctor. They will advise you what to take and how, and what to possibly avoid given your particular situation. Depending on your health needs and current situation, you may be instructed to bump up your intake of certain things or to avoid taking other things. The important thing is to get educated, to be open and honest with your health care professional and to be proactive about your health.

B Vitamins and Heart Disease

Can B vitamins keep your heart healthy?

Sadly, the death of two young children who had died of massive strokes were the catalyst for a 1968 investigation. The Boston pathologist who investigated the death of the children found that they had extraordinarily high levels of a protein breakdown product in their blood. Both children’s arteries were blocked by cholesterol as well, resembling more closely the arteries of a middle-aged unhealthy person than those of a young child. These discoveries led to the hypothesis that elevated levels of this breakdown product (know as homocysteine) had contributed to the process of hardening of the arteries. This condition is called atherosclerosis. So, what is the connection between B vitamins and heart health?

Folate, vitamin B6 and vitamin B12 are instrumental in the body’s ability to convert homocysteine into methionine. Methionine is one of the 20 substances that help the body to build new proteins. Insufficient levels of any or all of these B vitamins can hamper the conversion process, driving homocysteine levels up. Sufficient levels of these vitamisn, on the other hand, can help to keep homocysteine at a safe level.

Many studies over the last few decades have shown that high levels of homocysteine can be associated with an increase in the risk of heart disease and stroke. Some studies have also shown that there is a causal relationship between high intakes of folate and the lower incidence of cardiovascular disease, hypertension and strokes. There cannot be a direct link made, however, between higher homocysteine levels and lower folate levels to an increased risk of heart disease. In other words, it cannot be definitely stated that lower homocysteine levels by taking more folic acid and other B vitamins will lower one’s risk of having a heart attack, stroke or other heart-related condition.

There have been several randomized trials involving B vitamins and heart health, but they have not conclusively shown any relationship between the two. In the studies adutl participants who had a history of heart conditions or who were in the upper risk categories for heart disease were given either a placebo or a pill that contained high doses of vitamins B6, B12 and folic acid. The result of the study was that taking the high doses of the three B vitamins did lower the levels of homocysteine present in the body, but that that reduction did not lead to a reduction in the number of cardiac events in the participants. There is some suggestion that the participants in this study were already too far gone in terms of heart health for the B vitamins to have an effect.

Recently, analysis of several studies seems to suggest that taking folic acid supplements can reduce the likelihood of a stroke in a person who had never before suffered a stroke. The risk reduction does not occur, however, in people who have already had a stroke. Further, folic acid was most effective in promoting heart health when combined with vitamins B6 and B12 as opposed to when it is consumed in isolation.

In the United States and in Canada, since the governments in those countries have mandated that certain products such as bread and pasta be fortified with folic acid, the rate of death from stroke has fallen dramatically. In the UK, where folic acid fortification is not yet mandated, there has been no significant change in the rate of death from strokes.

The long and the short of it is this: Folic acid supplementation may reduce the risk of heart disease in people who have lower levels of folate in their systems. This will typically include those people living in countries where folic acid fortification of food is not yet the rule. In countries where people already get adequate levels of folic acid from their food, further supplementation, even levels that are much higher than can be found in a standard multivitamin, has not been sufficiently shown to be of any significant benefit and, actually, may cause harm.

Currently, what constitutes a sufficient daily intake of B vitamins isn’t clearly defined. The definition would likely change over time anyway, as more data are collected from randomized trials. Currently in the United States, folic acid fortification of food has led to an increase in the percentage of adults who have adequate levels of folate in their systems. Still, only a small percentage of American adults currently get the recommended daily intake of all B vitamins derived just from their diets alone.

New Insight Into Cardiovascular Disease

A seldom-measured amino acid that is circulating in your blood may be an indication of cardiovascular disease. It is called homocysteine, and an increasing number of physicians and researchers are acknowledging that high levels of the chemical are associated with heart disease and stroke.

A summary of 15 studies revealed that elevated homocysteine levels produced a 70 percent increase in the risk of coronary artery disease and a greater risk for stroke. Previous studies have shown connections with schizophrenia, Alzheimer’s disease, hypothyroidism and anemia.

However, the evidence is not conclusive. “Five other studies found no link between homocysteine and cardiovascular disease,” says Oklahoma City internist Dr. E. Randy Eichner, a member of the Editorial Board of The Physician and Sportsmedicine, “but six studies did find a relationship. I think the balance of scientific evidence favors a homocysteine/CAD link.”

Atlanta cardiologist Dr. John Cantwell agrees with Eichner. “I recognize it as a possible risk factor, but the only time I measure it is when a person has a family history of heart disease without the more obvious risk factors.”

Dr. M. Rene Malinow, professor of medicine at the Oregon Health Sciences University and one of the nation’s leading homocysteine researchers, says we don’t yet know for sure that it is a cause of atherosclerosis. “We will have to wait for the results of clinical trials, and that could take several years.” Adds Malinow, “Although it is a relatively new risk factor by itself, it is possible that a high homocysteine level combined with traditional risks, such as hypertension or smoking, is even more significant.

Even those who think homocysteine is related to heart disease are not sure why it may have a harmful effect. One theory is that, in elevated amounts, it irritates the inner lining of the arteries and could cause blood clots to form. There is even a possibility that homocysteine levels increase after a stroke, not before.


The good news is that a high homocysteine count can be prevented or treated by getting adequate amounts of folic acid (folate). Cantwell tells patients who have high levels to take 0.4 mg of folic acid per day, as well as a multivitamin supplement that includes B6 and B12. A high intake of folate by itself can mask other medical conditions, including a type of anemia.

The U.S. Food and Drug Administration has mandated that all enriched grain products be fortified with folate. Check the labels on cereal boxes. Most of them provide 25 percent of the daily folate requirement and many contain 25-35 percent of daily vitamin B6 and B12 needs. If you are eating a well-balanced diet, you probably don’t need the supplements.


Homocysteine screening is not very common. The American Heart Association is taking a very conservative position on the issue, saying that it’s too early to recommend general screening. Cantwell points out that the one-year cost of a folate and multivitamin supplement is approximately equal to the cost of a screening test.

Americans are well informed of the risk factors associated with heart disease. Sooner or later, a new one — elevated homocysteine levels — may be added to that list.

Folate is also good for unborn babies.

Vitamin B9 Folic Acid (Folate)

The terms folate and folic acid are used interchangeably when referring to vitamin B9. Folic acid is the most stable of the two forms and is often found in supplements and fortified foods. Folate occurs naturally in food sources such as spinach and other green leafy vegetables. Like other B vitamins, folic acid is necessary for a variety of functions and body processes, from cellular maintenance to the prevention of birth defects in developing fetuses.

Folic Acid and DNA and RNA Synthesis

Folic acid is essential for the synthesis of DNA, the genetic blueprint that allows cells to properly develop and divide. Doctors recommend that pregnant women take folic acid supplements, a practice that has significantly reduced the incidence of certain birth defects. Researchers at the University of California, Berkeley, have found that even mild folic acid deficiency can greatly increase the incidence of damaged DNA. Other studies have linked folic acid deficiencies to the development of dysplasia (abnormal cell development often linked to cancer) in the colon, the lungs and the cervix.

Folic Acid and Homocysteine

Recent studies indicate that folic acid, taken alone or with other B vitamins, can effectively lower homocysteine levels. Homocysteine is associated with atherosclerosis and myocardial infarction, as well inflammation associated with rheumatoid arthritis. In addition, excess homocysteine can significantly add to the amount of stress a person experiences. B vitamin supplements can help bring homocysteine levels down and may reduce stress.

How Much Folic Acid Do We Need?

Research shows that most of us aren’t getting enough folic acid in our diets. Most people consume about 200 micrograms of folic acid each day. This is only half of the daily recommendation, and many experts believe the daily recommendation is inadequate. Good food sources of folic acid include green leafy vegetables, lentils, pinto, navy, lima and kidney beans, tuna, oranges, strawberries, wheat germ, asparagus, bananas, and cantaloupe. Eat these foods as fresh as possible, because heat and long storage times can destroy folic acid content.

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