By Scott Gavura
Vitamin supplementation is unnecessary for the vast majority of people. You wouldn’t know this walking through a drug store, where you’ll usually find an entire aisle packed with supplements. Alternative health providers like naturopaths tend to be strong supporters of supplementation, but this advice seems to be based mainly on the belief that “vitamins are magic” rather than good science. The best research hasn’t established a strong evidence base for taking supplements. We definitely need vitamins in our diet to live. But that’s where we should be getting those vitamins – from our food, instead of from pills. If you eat a reasonable and balanced diet, and have no medical conditions that require special consideration, vitamin supplementation won’t offer meaningful health benefits. In the absence of any deficiency, vitamin supplements seem to be useless at best and harmful at worst.
That doesn’t mean vitamins are always useless or unnecessary. They can also have important science-based roles. Vitamin deficiencies can occur, and sometimes the consequences can be significant. Pregnancy is one example. Pregnant women may not obtain adequate amounts of nutrients like folate in their diet. Deficiencies are linked to major birth abnormalities: neural tube defects (NTDs). It is well-established that folic acid supplementation around the time of conception, and continued through pregnancy, can significantly reduce the risk of NTDs, and may reduce the risk of some other abnormalities as well. There are now widespread recommendations for folic acid supplementation in pregnancy. Because many pregnancies are unplanned, public health strategies have included fortifying food with folic acid, and this approach also seems to reduce birth defects in populations.
Folate is not the only deficiency possible in pregnancy. Pregnant women have higher requirements for calcium and iron. There’s also the need to ensure adequate amounts of vitamins A, the Bs, C, D, E and zinc. While these needs can potentially be met through diet, some guidelines recommend a multivitamin (and not just folic acid) because of the consequences of a deficiency and a lack of any real risks. And supplementation works. The most common maternal multivitamin (at least here in Canada) is Materna, though there are many competitors and lots of generics. Costs can be as low as $4-8 per month. Prenatal vitamins will usually contain 0.4mg to 1mg of folic acid – it’s the most essential ingredient. Most contain slightly higher amounts of calcium and iron than a typical daily multivitamin, along with modest amounts of other micronutrients. This formula helps pregnant women’s diets meet their nutritional requirements, reduces the risk of birth defects, and is a practice aligned with the best evidence.
Choosing a prenatal vitamin is normally a fairly straightforward matter: pick one, and take it daily, starting from when you begin to contemplate having a baby. I could find no guidelines that have established one brand of prenatal vitamin as superior, though some may be better tolerated than others. I usually suggest Materna (as it’s been used in clinical trials) but it’s expensive, so if cost is an issue, a store-brand product should be fine. (In Canada a prescription-only vitamin called PregVit is also popular.) With the exception of occasional reports of nausea and vomiting, most women have no problems finding a product they can tolerate and also afford. Beyond the basic prenatal vitamin brands, you’ll find other brands that are advertised as being superior for you and your baby’s growth. That’s why I read a recent blog post from a naturopath with interest, as she listed her preferred prenatal vitamins, and why.
What do naturopaths think of prenatal vitamins?
I first learned about naturopathy when I was a retail pharmacist in Toronto – Toronto has one of a handful of naturopathy schools in North America, so it’s not uncommon to meet patients that consult with them. I spent some of my time in that pharmacy helping patients source strange supplements, which sometimes cost hundreds of dollars per month. It was good for that pharmacy’s sales, but I was curious how naturopaths could always find conditions like food “intolerance”, pH “imbalances”, adrenal “fatigue”, and hormone “depletion” in their patients. I’d never heard of these conditions, and there was nothing in the medical literature that established they were real. It seemed the likelihood of being diagnosed with a condition like “candida overgrowth” was highly correlated with visiting a naturopath, as nearly every client was taking purgatives and avoiding bread, believing they were fighting some sort of a whole-body colonization of yeast that was widespread yet not detectable by medical science. The treatment, of course, was more supplements, sometimes combined with different forms of “detox” kits and some homeopathy.