Designing the ultimate multivitamin

by Dr. Joseph Debé

The notion that nutrient supplementation is not necessary if one eats a "well balanced diet" is a myth. A cursory review of modern agricultural and food processing techniques should make anyone concerned with health want to take supplements. Even a whole food, fresh "organic" diet falls short in supplying nutrient requirements when one understands the magnitude of the load of environmental pollutants that the body is exposed to, regardless of where one lives. Nutrient supplementation is a necessity for optimal health. 

As unfounded as the "well balanced diet" belief, however, is the confidence of the "one a day" vitamin consumers. When you give it some thought, does it really make sense that if you and I take the same multivitamin-mineral supplement we will both be meeting all our micronutrient needs? 

To begin to answer that question, let's first examine why we need vitamins and minerals at all. Vitamins and minerals are substances that play many vital roles in the body but cannot be produced by the body. They have to be obtained from outside sources (food and supplements). One important role of these nutrients is to function as coenzymes in spurring chemical reactions within the body. For example, selenium (a commonly deficient nutrient) is necessary for the activity of the antioxidant enzyme glutathione peroxidase. Glutathione peroxidase is instrumental in helping to neutralize highly reactive molecules called free radicals, which cause damage to subcellular structures throughout the body. The cumulative effects of free radicals are implicated in the development of arthritis, cataracts, Parkinson's disease, heart disease, cancer, accelerated aging and more. Not surprisingly, a recent study found that supplementation of selenium was associated with a dramatically reduced risk of both developing and dying from several different types of cancer. 

Undeniably, vitamins and minerals are of critical importance to good health. So why not just take a multivitamin-mineral supplement for "insurance?" The answer lies in the concept of biochemical individuality. The first consideration in this regard is genetic uniqueness. Not only does each of us have a distinct fingerprint, but the rest of our anatomy and physiology are also unique. For example, individuals who inherit the biochemical condition known as homocysteinemia develop very high blood levels of the toxic amino acid known as homocysteine. High levels of homocysteine are associated with the development of vascular disease, dementia, osteoporosis, arthritis, and probably cancer. The body normally disposes of homocysteine by way of chemical reactions that are dependent upon the vitamins B6, B12 and folic acid. A person with homocysteinemia (high levels of homocysteine in the blood) may require 100X the RDA of vitamin B12 to keep homocysteine levels low and prolong life expectancy. 

There are many other factors in addition to genetics that contribute to individual nutritional requirements. Our food and beverage choices are an important consideration. For example, a diet high in refined carbohydrates increases the need for additional B vitamins, chromium, and magnesium, to name a few. Caffeine and alcohol consumption influence nutritional status. Our stress levels, pollution exposure and exercise habits play roles as well. Drug use, prescription or otherwise, alters nutrient requirements, as does the existence of metabolic dysfunction (such as malabsorption) and various disease states. Understandably, the amount of a given nutrient required for optimal metabolic performance can vary tremendously from one individual to the next; by a factor of 100 fold or more! Taking a multivitamin-mineral supplement is better than not taking any supplement at all, but will, in almost every case, fall short in meeting requirements for optimal nutrition. 

An individual’s unique nutritional requirements can be assessed with laboratory testing. Analysis of blood samples can pick up most vitamin deficiencies. There are several different tests that can be performed on blood to determine vitamin status and some are much more meaningful and accurate than others are. I recommend performing functional tests as much as this is possible. Specifically, the activity of enzymes requiring the activation of a particular vitamin can be measured. For example, an enzyme called transketolase can be isolated from red blood cells. Transketolase requires vitamin B1 as its coenzyme in order to function. This enzyme can be measured as a test of vitamin B1 status. The laboratory measures the activity of the isolated transketolase enzyme. If it is low, vitamin B1 insufficiency is present. Additionally, a second test is performed which picks up more subtle insufficiencies. Vitamin B1 is added to the transketolase enzyme and the activity of this enzyme is measured again. A large increase in transketolase activity after addition of vitamin B1 shows that the enzyme’s activity had been limited by a functional lack of the vitamin. Adequacy of levels of several vitamins can be evaluated by measuring activities of different enzymes. Other vitamins are assessed simply by measuring their concentration within blood or blood cells. 

Whereas vitamins are best evaluated from blood samples, most minerals are best measured from hair specimens. The body deposits minerals in the hair, nails, teeth and other tissues. For obvious reasons, hair is the preferred tissue to use. Although pubic hair can be used, scalp hair gives more accurate results. A hair specimen shows the levels of minerals in the body over the past two months. Hair analysis is accurate for evaluating most minerals. I have yet to see an individual not lacking in at least one mineral on hair analysis. 

Most people, including those who take supplements, are found to be lacking in multiple nutrients on blood and on hair analysis. Taking a separate pill to correct each nutrient insufficiency can sometimes be rather inconvenient. Fortunately, there is an alternative. 

Custom compounding pharmacies can personalize nutritional formulas based on the results of these laboratory tests. As an example, it is no problem for the pharmacist to put vitamins B3 and B6, zinc, molybdenum, and chromium together into one supplement when these are found to be lacking. This way you can take only what you need, and you can take it all from one bottle. 

Modern technology has disturbed the natural order of things, producing a need for nutritional supplementation. On the other hand, it is also technology that is now enabling us to be more precise in restoring optimal nutritional status.

Sample Lab test report with a customized vitamin formulation