After writing my first article on multivitamins titled The Best and Worst Multivitamins, I received requests for both an article on multivitamins for seniors and for prenatal vitamins. Neither of these are an easy feat because it is impossible to get everything you need in one pill. But I am also up to a challenge to help people simplify their search by knowing what to look for.

If you are interested in learning more details about multivitamins, I recommend reading my first article on multivitamins. Or if you just want to know the best and worst multivitamins for seniors, scroll right to the bottom. But for this article, I’m going to give you a roadmap for understanding what you need to know to prevent many of the disorders linked to aging, and how you can make informed decisions about your diet and supplementation.

The Baby Boomers

You may be surprised to learn that a senior citizen starts at age 60. I think the perception of this age has changed quite a bit in one generation, and 60 is starting to seem much younger. So with respect to my parents (who are 77 and 79) who hate the term “senior citizens,” I will refer to the group as the “older generations.”

Many of the people in this generation grew up with parents that smoked, drank too much, embraced margarine/vegetable oils, white bread, and sugar, and experienced a lot of cardiovascular diseases. The baby boomers learned from their parent’s mistakes, for the most part. By simply dropping the smoking and margarine habit alone from the previous generation, they dropped the risk of cardiovascular disease considerably.

You hear a lot of negative statistics about the rates of disease as we age. The fact of the matter is that many of these diseases are not destined by fate or genetics, but actions. According to the CDC, heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis are the most common and costly and preventable of all health problems. What isn’t on this list is Alzheimer’s and dementia, which I believe can also be explained as a preventable.

Prescription Drugs Contributing to Cognitive Decline

According to the Harvard Center of Ethics, prescription drugs are the 4th leading cause of death, tied with a stroke. Alzheimer’s disease is the fifth-leading cause of death for those age 65 and older. I find it interesting that we focus a lot of attention of finding a cure to Alzheimer’s and dementia, yet very little attention is focused on the drugs that may be majorly contributing to cognitive decline in the first place.

In the book Drug Muggers and Supplement Your Prescription, you can look up what nutrients your drugs are depleting. In certain cases, your medications may be causing memory and other health disorders due to these depletions and toxicities.

• According to WebMD, possible drugs that can cause memory loss include antidepressants, antihistamines, anti-anxiety medications, muscle relaxants, tranquilizers, sleeping pills, and pain medications given after surgery.
• According to the CDC, the most frequently prescribed therapeutic classes include analgesics (pain killers), antihyperlipidemic agents (Statins) and antidepressants.

Interesting yes? Let’s not forget Statins which should also be on this memory list.

1. Anticholinergic drugs

These include nighttime pain relievers, antihistamines, sleep aids, antidepressants, incontinence drugs and narcotic pain relievers. They block the neurotransmitter acetylcholine, the one that requires choline.

One study from the British Medical Journal looked at the use of anticholinergic drugs (nighttime pain relievers, antihistamines, sleep aids, antidepressants, incontinence drugs, and narcotic pain relievers) and tested 372 people over 60 years old without dementia.

A total of 9.2% of the subjects continually used anticholinergic drugs during the year before cognitive assessment. Compared with non-users, they had poorer performance on reaction time, attention, delayed non-verbal memory, narrative recall, visuospatial construction, and language tasks. Eighty percent of the continuous users were classified as having mild cognitive impairment. Another study found a significantly higher rate of falls in elderly patients using anticholinergic drugs as well.

A French study looking at 4,128 women and 2,784 men that reported taking anticholinergic drugs showed a greater decline over four years in verbal fluency scores and in global cognitive functioning than women not using anticholinergic drugs.

In men, an association was found with a decline in visual memory and to a lesser extent in executive function. Significant interactions was observed in women between anticholinergic use and age, ApoE, or hormone replacement therapy. A significantly 1.4–2 fold higher risk of cognitive decline was observed for continuous anticholinergic users.

One study bred mice to have dementia and poor memories with low brain acetylcholine concentration. The administration of phosphatidylcholine to mice with dementia improved memory, showing the link to acetylcholine.

Approximately 90 percent of Americans do not get enough choline. Now imagine you are 65 or older, taking a PPI, sleep aid, and a Statin. That spells trouble.

Choline can also be supplemented and I recommend using phosphatidylcholine, not choline bitartrate. For some people, choline supplementation can affect sleep.

2. Proton Pump Inhibitors

Deficiencies in vitamin B1 and B12 specifically can affect memory. How is this related to PPI’s? PPI’s block 99% of stomach acid, which is needed for B12 absorption, calcium, magnesium and numerous other vitamins and minerals. These drugs also increase the risk of disturbing valuable gut flora. So it shouldn’t be a surprise that German researchers looking at participants 75 years of age or older and free of dementia receiving regular PPI medication had a significantly increased risk of incident dementia compared with the patients not receiving PPI medication.

A study published in 2010 found that people with Alzheimer’s have low levels of SAMe in their brains. B12 in the form of methylcobalamin (not cyanocobalamin), helps produce more SAMe along with magnesium.

3. Benzodiazepines (Valium, Xanax, Lexomil, Ativan, Klonopin, Restoril)

Benzodiazepines are in the class of anti-anxiety, insomnia and seizure disorder medications and deplete biotin, folate, vitamin D and vitamin K. These are actually intended to only be used for a short time however some people may use them long term.

In a study from the British Medical Journal, benzodiazepine use is associated with an increased risk of Alzheimer’s disease. The stronger association observed for long-term exposures reinforces the suspicion of a possible direct association. According to researchers “unwarranted long-term use of these drugs should be considered as a public health concern.”

As of August 31st, 2016, the FDA sent out a press announcement issuing boxed warnings (the highest strongest warning) to combining prescription opioid analgesics, opioid-containing cough products and benzodiazepines due to the risk of death. According to the FDA Commissioner Robert Califf M.D., “It is nothing short of a public health crisis when you see a substantial increase of avoidable overdose and death related to two widely used drug classes being taken together.”

4. Statin Drugs

Crestor is the second-highest prescribed drug at 21.4 million per month. As men and women age, cholesterol naturally goes up. This isn’t necessarily a bad thing. Your digestive system requires cholesterol to prevent infection, your hormones requires cholesterol as starting material, and your memory requires cholesterol to function. The reduction of cholesterol and the increase of blood sugar by Statin drugs is most likely the reason the memory is affected, as reported by the FDA.

We know that with diabetes, the cells become resistant to insulin causing the pancreas to increase the amount of insulin released. What people may not know, is that in Alzheimer’s the part of the brain that is responsible for memory and personality also becomes resistant to insulin.

Insulin is made in the brain in a similar way that it is made in the pancreas. In fact, insulin is responsible for helping build neurotransmitters and the tasks involved with learning and memory. Some researchers are now referring to Alzheimer’s disease as “type 3 diabetes.” Diabetics actually have up to a 65% higher risk of developing Alzheimer’s disease.

A study published in the Archives of Internal Medicine found a nearly 50 percent increase in diabetes among longtime statin users. A 2011 analysis in the Journal of the American Medical Association and a 2010 analysis in The Lancet also found a higher risk of diabetes among those taking cholesterol-lowering drugs. According to the American Heart Association, adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes.

So essentially the impression is that cholesterol is a bigger risk factor than diabetes for heart disease, which is wrong. I highly recommend reading the article How to Interpret Your Cardiovascular Blood Work in 5 Easy Steps to learn about cholesterol numbers and more significant risk factors.

5. Lithium Deficiency

While lithium is a natural element and not a prescription drug, I think the research on lithium is worth noting in this section. Patients with mood disorders have been shown to have rates of dementia higher than those of the general population. Researchers found that continued lithium treatment was associated with a reduction of the rate of dementia to the same level as that for the general population and can actually be neuroprotective or even enhance the growth of neurons. Lithium is also a B12 carrier, so a combined deficiency of lithium and B12 would really affect brain health.

According to Dr. Nassir Ghaemi, a professor of psychiatry at Tufts University School of Medicine, “Lithium is, by far, the most proven drug to keep neurons alive, in animals and in humans, consistently and with many replicated studies. If lithium prevents dementia, then we may have overlooked a very simple means of preventing a major public health problem.”

What’s an easy way to get lithium? Add DayLyte liquid minerals to your water to get 1mg of lithium per serving.

Addressing the Nutritional Needs of the Older Generations

Hippocrates once said, “all diseases begin in the gut.” According to the Journal of Clinical Nutrition “elderly persons who malabsorb macronutrients do so because of disease, not because of age.”

The malabsorption of micronutrients like B12 in the elderly is actually due to the high prevalence of atrophic gastritis, related to H. Pylori and low stomach acid. How many older people are on acid blockers for acid reflux! Acid reflux occurs from low stomach acid, not too much. Chronic gut inflammation is also due to nonsteroidal anti-inflammatory drugs (Aspirin, Tylenol, etc.) accounting for the large majority of peptic ulcer disease. Nutrients whose absorption has been shown to be affected by low acid conditions in the stomach include folate, vitamin B-12, calcium, iron, and beta-carotene.

It has been shown that elderly persons (excuse me, older generation) with atrophic gastritis severely malabsorb folate, and can be corrected by administering folate along with hydrochloric acid. B12 supplementation is also superior for absorption over food for those with low stomach acid. B12 deficiency is even more pronounced in those with digestive disorders, gene variants in FUT2, or those taking medications like proton pump inhibitors and Metformin.

Decreased skin synthesis of vitamin D, vitamin D absorption, vitamin D receptors in the intestinal epithelial cell and conversion to the active form of vitamin D have all been observed in the elderly. Vitamin A absorption actually increases, lowering the requirement for vitamin A. This could explain the osteoporosis study I explored here and why high vitamin A intake was correlated to osteoporosis.

The older generation has an increased vitamin B-6 requirement compared with younger people. A study done in 1990 found that in the United States that of 11,658 people, 91% of women and 71% percent of men were deficient in vitamin B-6 using the RDA, and 1 in 10 of the elderly in the US and Europe have been defined as deficient.

CoQ10 is the antioxidant energy molecule of the mitochondria, protects cell membranes and the oxidation of LDL. Production has been found to peak at age 20 and decreases as we age. Low CoQ10 causes low energy and accelerated aging. Statin drugs inhibit CoQ10 production. However, the production of CoQ10 can be encouraged. It can be boosted with exercise and vitamin B1, 2, 3, 4 5, 6, folate, vitamin B12, vitamin C, manganese, and magnesium.

Approximately 2/3’s of Alzheimer’s patients are women. Estrogen levels drop in post-menopausal women, affecting memory and choline production. Only 15% of women get enough choline. Choline plays a major role in memory. If you are female, eat your eggs daily, include many phytoestrogen-rich foods like flax seeds in your diet, and think twice about anticholinergic drugs.

Determining Your Nutritional Needs with Genetic Testing

One of the most beneficial tests for understanding higher needs for vitamins, minerals, and compounds is through Nutrition Genome. Nutrigenomic testing allows you to find your genetic weaknesses and turn them into strengths by understanding which nutrients you need to target the most for optimal health.

I spent years designing this software while in clinical practice, and it has been by far the most useful testing I’ve done on people to help determine the best dietary and supplemental approach.

The Worst Multivitamins for Seniors

1. Centrum Silver

The #1 Doctor recommended multivitamin makes my #1 for the worst multivitamin. Made by the pharmaceutical company Pfizer, it brings in close to 1 billion in sales. Centrum uses synthetic vitamin E (dl-alpha-tocopherol) and potentially synthetic beta-carotene (source not listed).

Synthetic versions of beta-carotene have been shown to increase the risk of cancer in heavy smokers and drinkers, and accelerated the death and shortened the life span of rats exposed to radiation. But the natural form of beta-carotene decreased the death rate and significantly increased the life span of exposed rats.

Synthetic vitamin E has been shown to have little or no anticancer effectiveness, and may even increase prostate cancer. Centrum uses the oxide form of magnesium, which only 4% is absorbed. The poor form of B6 (pyridoxine hydrochloride), folate (folic acid) and B12 (cyanocobalamin) are also used.

Folic acid appears to be potentially problematic as I explained here. The formula is missing K2 (important for heart and bone health) and boron (important for testosterone for men and bone density for women).

Centrum contains hydrogenated palm oil, a trans-fat highly correlated to heart disease, not to mention bushels of corn additives and all the horrible artificial colors including FD#C Blue #2, Yellow #6 and Red #40 found to disrupt mitochondrial function (the power house of a cell that is important for keeping you young).

A study published in the Journal of Food and Chemical Toxicology found that the dyes actually enter the bloodstream through the skin or digestive system, debunking previous expertise that the skin blocked it and the digestive system destroyed it first. This is alarming because these dyes have already been linked to ADHD, allergies, and asthma, but due to the dye’s ability to inhibit cellular respiration, a whole cascade of health effects.

2. Men’s One a Day and Women’s One a Day 50+

In another popular choice, you will find a similar formula. This one contains artificial flavor, potentially synthetic beta-carotene, magnesium oxide, cupric oxide (found to exhibit high toxicity in vitro), synthetic vitamin E, yellow dye #5, FD&C yellow 36 lake, soybean oil and zinc oxide. The poor form of B6 (pyridoxine hydrochloride), folate (folic acid) and B12 (cyanocobalamin) are also used.

The women’s formula contains 500mg of calcium carbonate and only 50mg of magnesium oxide. This is from the erroneous notion that higher calcium automatically means better bone density. Poor bone density in females is not due to low calcium intake only; it is due to estrogen levels that are too low, coupled with low vitamin D, calcium, magnesium, boron, inositol, vitamin C, silicone and K2 deficiencies.

Like B12, vitamin D synthesis goes down as we age. Along with the wrong calcium/magnesium ratio, this formula does not contain boron, inositol or K2.

3. Kirkland Adults 50+ Mature Multi

I always overheard my mom use the phrase, “don’t buy a discount parachute.” This applies to your vitamin choices. Kirkland’s multivitamin for seniors sells for $9.99. at Costco. I’m all for trying to find deals and not overspend, but this has to throw up a red flag. You have to imagine how cheap a product has to be made to retail for $9.99.

Further inspection shows similar shortcuts as Centrum. Magnesium oxide, synthetic vitamin E as dl-alpha tocopheryl acetate, zinc oxide, folic acid, and cyanocobalamin. This formula contains 222mg of calcium to 50mg of magnesium oxide (only 4% absorption rate), which is the wrong ratio. Magnesium should be in a 1:1 to 2:1 ratio, being the same or higher than calcium. Kirkland does make a point to show that they do not use food dyes.

The Best Multivitamins for Seniors

I don’t want to admit how many hours I spent analyzing multivitamins to find a product that would fit at least most of the guidelines, but let’s just say that this was my hardest task. I have added two additional multivitamins based on the need for formulas without beta-carotene or vitamin K.

What you decide to add to this base will depend on where you need to focus. For the older generations, this includes mainly digestive health, cognitive function, bone health, eye health and heart health.  Below I have outlined how to customize your program.Below I have outlined how to customize your program.

Remember to take your multivitamin with food so that you absorb the carotenoids and fat-soluble vitamins A, D, E and K.

1. Primitive Scientific 2/Day Essentials for Adults and Seniors

Cost: $34.99 for 30 servings

Primitive Scientific has proven to be a company willing to go the extra mile for the highest quality ingredients and intelligently sourced and dosed blends. It has taken the top spot for seniors by casting a wider net with appropriate doses of various vitamins and minerals, and including incredible blends targeting the eyes, muscles, brain and gut. They have also gone above and beyond with testing that goes beyond organic, NSF and Non-GMO testing.

This formula has been updated:

• Removed DHA because Primitive Scientific now offers a standalone fish roe oil.
• Removed a few ingredients and adjusted some minor quantities related to supply chain constraints
• Calcium now from natural bone matrix
• Removed proprietary blends to list each ingredient with amount

Highlights:

– Contains the correct forms of all vitamins and minerals
– Vitamin E as d-alpha tocopherol plus mixed tocopherols and mixed tocotrienols
– Comprehensive eye and heart support that contains wild alaskan blueberry, CoQ10, lutein, astaxanthin, zeaxanthin
– Unique brain and gut support that contains a high quality form of choline, uridine and lithium (read more about how this combo can heal the brain and gut)
– Unique muscle and cell support that includes tri-creatine malate, alpha-lipoic acid, and PQQ
– methylated folate
– Choline from the superior AlphaGPC and not inferior forms like bitartrate
– B12 in from MecobalActive (Spain) methylcobalamin
– 100 mcg K2 from B. Lichenformis MK-7 form and MK-4 form
– 250 mcg of Lithium for neuroprotection, mood and brain health
– Does not contain iron
– Non-GMO, gluten-free, preservative-free, vegetarian-friendly and proudly made in the USA in a cGMP and NSF certified facility

2. Adapt Naturals Bio Avail (20% off with this link)

Adapt Naturals comes from Chris Kresser, well known in the clinical functional medicine scene. This company has quickly ascended to gaining a reputation for high-quality ingredients and formulation, and a unique catalog that keeps growing. 

Highlights 

• Uses correct forms of B-vitamins
• Includes lutein, zeaxanthin and lycopene
• Includes MK-4 and MK-7 vitamin K2
• Uses chromium, inositol and benfotiamine for those requiring blood sugar support
• Includes elderberry for immune support
• Includes broccoli sprout extract and quercetin
• Includes betaine, which supports the methylation cycle
• I’ve witnessed great results in people using this product, including turning my 82-year-old dad’s grey hair dark again 

Formulation Improvement and/or Additional Nutrition Needed

• This formulation uses high doses of biotin and B12, however, some may require higher doses of B12
• Vitamin E is missing mixed tocopherols and tocotrienols
• Iodine is missing, however, this is on purpose so those that have Hashimoto’s disease can use it

3. Momentous Essential Multi

Momentous is a company that kept coming across my desk and recently had a change to explore their products. They have built a reputation on strict quality control and carefully selected ingredients, choosing NSF certification for each product. 

Highlights

4. Seeking Health Optimal Multivitamin

Highlights

• This formula is uses high-quality forms of vitamins and minerals, and includes many impressive blends.
• Uses methylfolate, methylcobalamin and B6 in the active form P-5-P
• This formula stands out due to its blends, which are all well-formulated and a reason for the higher price
• Ashwangandha, Siberian ginseng, gotu kola, bacopa, ginkgo, spirulina, chlorella, citrus fiber, milk thistle, turmeric, bilberry, CoQ10, and pine bark extract are some of the main highlights.

Improvements

• Requires 8 capsules with unnecessarily high doses for most people, but only includes 200mg of magnesium and 100mg of calcium, requiring more supplemental calcium and magnesium
• Uses choline bitartrate, which has been shown to increase TMAO levels
• Contains ginkgo, which means you need to check your medications before using this supplement

5. Basic Nutrients 2/Day by Thorne Research

Cost: $27.99 for 60 capsules

The Basic Nutrients 2/Day provides the best bang for your buck if you are taking medications, helping offset nutrient depletions with only 2 capsules per day.

Highlights

– Contains the right form of B12, B6, and folate for everyone including MTHFR variants
– Contains 15mg of highly absorbable zinc bisglycinate chelate
– Contains the right doses of manganese, copper and boron
– Uses the correct dosage of vitamin E in the mixed tocopherol form, not dl-alpha tocopherol or isolated alpha-tocopherol
– Uses natural mixed carotenes (including beta-carotene) from the marigold flower
– Uses K2 instead of just K1
– Contains selenium as selenomethionine, not selenate and selenite
– Contains iodine
– Contains a higher dose of vitamin C (250mg) from L-ascorbate
– Contains 2,000IU of vitamin D instead of 800IU or less
– A small amount of copper (750mcg)
– It requires 2 capsules instead of the 6-8 capsules often required of higher quality multivitamins
– It is affordable. A higher cost doesn’t always mean higher quality, and I try to seek these out for people.
– It does not contain any harmful fillers or food dyes. I have also found some clients to be sensitive to citrate forms, and this formula does not contain any.
– They are conducting double-blind, placebo-controlled clinical trials.
– Certified by GMP, TGA from the Government of Australia (Australia’s FDA), as well as by the prestigious NSF International for quality control, purity and manufacturing.

6. Thorne Research Advanced Nutrients

Price: $60.00 for 30 servings

Highlights

– Higher dosage of vitamins and minerals in the right forms for those who need it
– Contains vitamin K2 as MK-7
– 250mg of magnesium malate and 250mg of calcium malate
– 850mg of vitamin C
– 225mcg of iodine
– 3mg of boron, which is excellent for bone and hormone health
– 80mg of bilberry for eye health
– Lutein, zeaxanthin, astaxanthin, and lycopene
– Nicotinamide Riboside (Niagin), which is found in small amounts of milk, beer, and yeast. It has been found in research to support healthy aging, neurological support, brain/cognitive support, metabolic/weight support, and liver support and muscle support.

Improvements 

– B12 and biotin are excessively high, even for this formula
– 200mcg of selenium may be too high for some people

7. O.N.E Multivitamin

Cost: $33.00 for 60 capsules

If you need to avoid vitamin K due to blood thinners, this is a good choice.

Highlights

– Does not contain vitamin K for those on blood thinners
– Beta carotene is from D. Salina
– Contains lutein, lycopene, and zeaxanthin for eye support
– Contains a higher amount of zinc for eye support (25mg)
– Contains CoQ10 for mitochondrial support
– Contains alpha lipoic acid for cell membrane support
– Contains small amounts of choline and inositol
– Methylated forms of B12 and folate
– Does not contain copper
– Contains 2,000IU vitamin D

Notes: If you have low copper levels, this may not be a good fit due to the higher levels of zinc and omission of copper.

8. MegaFood Multi for Men 55+ (No Vitamin K) and MegaFood Multi for Women 55+ (No Vitamin K)

Cost: $24.91 for 60 capsules (2 a day)

As of June 2016, MegaFood has created a new formula to include methylfolate, methylcobalamin, and active B6 P-5-P. This formula is a blend of organic whole foods, USP vitamin and mineral-fed yeast and synthesized nutrients. I have chosen to add this as a lower potency multivitamin alternative that represents a blend of all the current processing technology. Be aware that yeast-bound vitamins and minerals still remain untested for absorption and people with yeast sensitivities may not do well with this formula.

Highlights

– Contains 200mg of choline
– Uses methylfolate, methylcobalamin and B6 in the active form P-5-P
– Does not contain vitamin A and only uses beta-carotene from carrots which could be beneficial for certain older populations with bone density issues
– Contains 1,000IU of vitamin D3
– Contains 15mg of zinc
– Small amount of copper (200mcg)
– Does not contain vitamin K, important for those on blood thinners
– MegaFoods is GMP registered with NSF, soy free, dairy free, gluten free, pesticide and herbicide free and GMO-free.

For those with low stomach acid or gastritis and may have trouble absorbing B12, you may require sublingual B12 from Seeking Health in addition to this supplement due to the low B12 content.

The folate level is also 200mcg, which made need to be higher based on your MTHFR enzyme function.

If you are a female concerned about bone health, make sure to be getting sufficient boron, K2, calcium and magnesium outside of this formula.

9. Integrative Therapeutics ProThrivers without Beta Carotene Two a Day

Cost: $45.00 for 60 capsules

If you have been instructed to avoid beta carotene, alpha-tocopherol, copper or boron by your doctor, this is the only formula I know of that also uses methylated B-vitamins. You should be aware that this formula does not contain any calcium or magnesium, you may require more folate, iodine, and zinc and the B6 dose is larger than normal.

Highlights

– Does not contain beta-carotene, alpha-tocopherol, copper or boron
– Methylated folate, B12 and the right form of B6
– 500mg of vitamin C
– 100mcg of vitamin K2
– 1,000IU of vitamin D
– 25 mg of tocotrienols
– 7mg of zinc
– Does not contain copper
– Betaine HCL (good for those with low stomach acid)

Relevant Research for these Formulas

In a randomized controlled study on elderly subjects with increased dementia risk, researchers showed that high-dose B-vitamin treatment (folate 0.8 mg, vitamin B6 20 mg, vitamin B12 0.5 mg) slowed shrinkage of the whole brain volume over 2 years. B- vitamins lower homocysteine, which directly leads to a decrease in gray matter atrophy, thereby slowing cognitive decline.

Macular degeneration is the leading cause of vision loss in the United States and Europe in people over fifty-five years old. The Rotterdam Study performed in the Netherlands suggests that atherosclerosis (hardening of the arteries) may be involved in the etiology of age-related macular degeneration. One study followed 3,600 people ages 55-80 years old for six years and found that those that took antioxidants plus zinc were less likely than those who took only antioxidants or only zinc to lose their vision. Lutein and zeaxanthin are crucial to eye health.

As we age, melatonin production decreases rapidly, getting to its low point around 70. In the United States, only about one-third of the population (37%) reported getting 8 hours of sleep per night, and 31% reported 6 hours or less. Sleep deprivation increases the risk of hypertension, coronary heart disease, and type 2 diabetes. Melatonin is produced by the pineal gland as it gets dark and makes you sleepy. The following can lead to low melatonin levels: SAD, Bi-Polar, breast cancer, prostate cancer, Alzheimer’s, Dementia, low blood flow, Caffeine, alcohol, chronic stress, nicotine, beta-blockers, certain anti-depressants, sleeping pills, and tranquilizers deplete melatonin.

To optimize melatonin production nutritionally, you need to look at the dopamine/adrenaline pathway (vitamin C and magnesium), the serotonin and melatonin pathway (B2, folate, B6 and B12), and glutamate/GABA pathway (probiotics, vitamin C, zinc, B6, magnesium, choline) to see where biochemical issues may need to be addressed. Then you have to look at stress, lifestyle, environment, medications, brain injuries, and diet.

Additional Supplementation

1. Adapt Naturals Luminous Mind (20% off with this link)

This is one of the most impressive products for cognitive health. It is designed to enhance focus, memory and processing speed, promote healthy levels of dopamine and acetylcholine, protect against neural toxicity, and enhance blow flow and oxygen to the brain. The ingredients include: Bacop monnieri, Lion’s Mane, uridine monophosphate, alpinia galanga, citicholine, ginkgo biloba, and phosphatidylserine. 

Bacopa is an Ayurvedic herb that has been used for centuries to enhance memory and cognition. Lion’s Mane stimulates Nerve Growth Factor (NGF) production in the brain. Uridine has been shown to increase synaptic plasticity and formation of new synapses. It also enhances some of the cognitive benefits of DHA and choline. Alpinia galanga improves alertness and focus in as little as one hour and boosts energy and mood. It works by modulating dopamine, serotonin, GABA, and glutamate. Citicoline supplies choline for acetylcholine synthesis and cytidine for uridine synthesis in the brain. Ginkgo contains flavone glycosides that increase dopamine levels and enhance attention, motivation, and mental energy (check your medications if you can take Ginkgo). Phosphatidylserine (PS) is a type of fat that is a major building block of brain cell membranes.

For those concerned about memory, the dosage of Lion’s Mane in research is 2-3 grams per day, whereas this formula contains only 200mg. I recommend Real Mushrooms Lion’s Mane.

2. Real Mushrooms RealClarity

This product combines Lion’s Mane mushroom with ashwagandha, rhodiola and bacopa extracts.

Compounds in Lion’s Mane are able to stimulate the production of nerve growth factor (NGF), which promotes the repair and regeneration of neurons. There is growing clinical evidence that Lion’s Mane in beneficial in mild forms of dementia. See more research under NeuroEffect. The dosage of Lion’s Mane in the following studies is 2-3g per day. Additional Lion’s Mane can be taken with the Real Mushrooms Lion’s Mane.

One study took 7 patients with different types of dementia were given 5g a day of Lion’s Mane in soup. Six months all seven demonstrated improvement in their Functional Independence Measure score (eating, dressing, walking etc.), while six out of seven demonstrated improvements in their perceptual capacities (understanding, communication, memory, etc). A different study found that neuronal excitability from glutamic acid (one of the causes of Alzheimer’s and dementia) appears to be attenuated in the presence of Lion’s Mane.

Anxiety and depression was reduced in a human study with a dosage of 2 grams per day after 4 weeks, with a significant difference between groups on the measurements of concentration and irritability.

The other fascinating characteristic of Lion’s Mane is the gastro-protective effect on the digestive system. This is a major secondary benefit since gastritis is one of the main reasons the older generations start to decline in health.

Lion’s Mane has been found to promote ulcer protection and significant protection activity against gastric mucosal injury by preventing the depletion of antioxidant enzymes. Treatment with a hot water extract of Lion’s Mane decreased lipid peroxidation and increased superoxide dismutase (SOD) and catalase (CAT) activities, quenching free radicals in the gastric tissue of the ethanol-induced rats to exhibit gastroprotective activity.

Ashwagandha is also known as Indian Ginseng. Alzheimer’s disease is characterized by progressive dysfunction of memory and higher cognitive functions with abnormal accumulation of extracellular amyloid plaques and intracellular neurofibrillary tangles throughout cortical and limbic brain regions. Researchers have demonstrated that when ashwagandha was added to beta-amyloid treated samples, the toxic effects were neutralized and ashwagandha root extract was neuroprotective against beta-amyloid induced neuropathogenesis.

The buildup of amyloid plaque appears to do special damage to the default network of the brain. The default network is the place your brain clicks over to in the resting state known for creativity. The complexity of the default network is also responsible for self-awareness, memory, future planning, empathy and moral judgment.

Canadian researchers using big data revealed that a decline in the brain’s blood flow is the earliest symptom of Alzheimer’s. It would appear then that increasing oxygen and blood flow would help prevent this decline and protect the default network. Ashwagandha has been found to increase oxygen capacity and protect against amyloid plaque. Combining ashwagandha with deep breathing exercises (meditation, yoga, tai chi, Qi Gong) and regular exercise would be a prudent approach to help increase oxygen transport to the brain.

Rhodiola rosea is used to stimulate the nervous system, extenuate anxiety, enhance work performance, relieve fatigue, and prevent high altitude sickness. In thirty six animal studies, Rhodiola rosea has been proven to improve learning and memory function.

Bacopa has been shown in many clinical studies to improve verbal learning, delayed word recall, memory acquisition, and anxiety reduction. The triterpenoid saponins are believed to be responsible for most of the herb’s pharmacological actions.

3. NeuroEffect by PaleoValley (15% off with this link)

This supplement contains 2,100mg total of Lion’s mane, cordyceps, reishi, chaga, turkey tail, shiitake, maitake, tremella, and coffee fruit berry. It has been tested to contain over 26% beta-glucans. The coffee fruit is added to add increased focus without the caffeine by increasing BDNF. While this product is marketed for enhanced cognition, it contains many strong anti-cancer compounds as well.

4. Lifeforce Magnesium 

This product on the market that uses Magnesium L-threonate, bisglycinate, acetyltaurinate, and malate. Typically, supplements only contain one type of magnesium. This makes it one of the most comprehensive single magnesium products on the market for memory, cardiovascular health and muscle health.

Magnesium required for the removal of DNA damage generated by environmental toxins, endogenous processes, and DNA replication. Deficiency increases the susceptibility to oxidative stress, cardiovascular heart diseases as well as accelerated aging. Approximately 40-60% of sudden deaths from heart attacks occur in the complete absence of any prior artery blockage, clot formation or heart rhythm abnormalities. They are most likely occurring from spasms in the arteries with magnesium being a natural antispasmodic.

The US government study often cited shows 68% of Americans are deficient in magnesium based on dietary intake (which is high to begin with) is incredibly inaccurate based on the percentage of those with the numerous habits that deplete magnesium like medications, excess coffee, sugar, flour-based food, and excess alcohol. Magnesium deficiency induces heart arrhythmias, impairs glucose homeostasis, and alters cholesterol and oxidative metabolism in post-menopausal women. One study found that centenarians (those living over 100) have higher total body magnesium and lower calcium levels than most elderly people.

Researchers from MIT formulated this type of magnesium to concentrate more in the brain, increasing neurotransmitter sites, synapse density and brain cell signaling. Magnesium L-Threonate has been shown in rat studies to enhance learning abilities, working memory, and short and long-term memory by 15% for short-term memory and 54% for long-term memory compared to magnesium citrate. It improved in both young and old, with the older rats getting the most benefit.

Magnesium has been found to have a positive impact on both neural plasticity and synaptic density, and this formula has the potential for those with Alzheimers, dementia or those simply wanting to improve memory.

Magnesium Citrate is the best form for constipation. Malate is the best form for muscle pain or cramps.  If acid reflux is an issue, you need to build bone health or digestion is suboptimal, use the calcium/magnesium product. Read more about magnesium in my article here.

5. Primitive Scientific Nordic Pure Fish Roe Oil Complex

After doing extensive research on the APOE gene, one revelation is that people who have the e4 allele do not benefit from regular fish oil like those without the e4 allele. They require a phospholipid carrier (found naturally in fish but not fish oil) for successful delivery into the brain. This isn’t to say that only people with the e4 allele will benefit, everyone will. But people with the e4 should especially seek this type of fish oil supplement.

This fish oil supplement combines fish roe and fish oil supplement, providing a superior delivery system more in tune with how omega-3’s are packaged in fish and absorbed by the body. I’ve always had issues with the fishy aftertaste and burps, and this is the first fish oil supplement that hasn’t caused that. The addition of vanilla to the capsule was a great idea as well, making it very easy for anyone to take. This is my new staple fish oil product.

Alzheimer’s disease and dementia have been called “type 3 diabetes” due to the role of high blood sugar and brain deterioration. However, there are other factors including hormone function and nutrient deficiencies in the glutamate/GABA pathway.

In many ways, DHA is a miracle nutrient for the human body. DHA protects the brain from elevated blood sugar and lowers the risk of diabetes, lowers triglycerides, helps prevents cognitive decline and Alzheimer’s disease, reduces sudden death from heart attack by 50% with 200mg, prevents cardiac arrhythmias and lowers depression, lowers blood pressure, prevents tumor formation and arthritis.

Eating fish one to three times a week has been associated with a 40 to 75 percent reduction in macular degeneration. A study concluded that elder people with poor diets, especially with low antioxidants and omega-3 fatty acids, are more prone to developing macular degeneration and benefit from supplementation. “Micronutrient supplementation enhances antioxidant defense and healthy eyes and might prevent/retard/modify macular degeneration” with the use of omega-3 fatty acids, lutein/zeaxanthin, vitamins C, E, and zinc/copper.

Further Reading

To read more about bone health, see Best Calcium, Magnesium, Vitamin D and K2 Supplements.

For understanding more about mental health including anxiety and depression, read the article Mental Health Starts in the Gut, Not the Brain.

For heart health, check out How to Read Your Cardiovascular Blood Work in 5 Steps. This will also tell you how to adjust your diet and supplement program based on your results.

Have kids or grandchildren? The Best Children’s Multivitamins

The Best and Worst Prenatal Vitamin article has been the most requested article that I have written so far. I didn’t want to disappoint with this article, so I put extensive time and research to outline everything needed for healthy development, the optimal amounts of every nutrient based on research, and the correct forms of the nutrients for building healthy babies worldwide.

By taking these steps, I believe we can begin to reduce the disease statistics dramatically in one generation.

The Importance of Prenatal Nutrition

Our risk factors for heart disease, high blood pressure, cancer, diabetes, allergies, asthma, mental illness, PCOS, and obesity have been consistently linked in research studies to prenatal nutrition during the first 9 months of pregnancy.

Women who take multivitamins may be less likely to experience ovulatory infertility; women who take six or more tablets had the lowest relative risk for infertility. This shows you the importance of supplementation from the beginning of conception.

At Nutrition Genome, we recommend nutrigenomic testing for couples before conception to outline the most beneficial diet for future parents based on their unique genetics and biochemistry. This preparation has the potential to shape the gene expression of the child during pregnancy and even extend to the grandchildren. It also gives the mother sufficient reserves so that her health isn’t dramatically altered.

Epigenetics is the study of how this expression occurs from our diet, environment, relationships, and stress. What you eat has an epigenetic effect on your genes. According to David Williams, principal investigator for the Linus Pauling Institute at Oregon State University, “DNA expression can be altered at any age, but the fetus is especially susceptible because these pathways are very active as tissues grow and differentiate.”

In other words, a mother’s eating habits, exercise regime, stress levels, and environment actually have the power to shape the gene expression passed down.

Prenatal Vitamin and Mineral Research

According to the 2009 statistics from the U.S Department of Agriculture, here is the list of nutrients that women are commonly low in:

Vitamin E: 86%
Folate: 75%
Calcium: 73%
Magnesium: 68%
Zinc: 42%
Vitamin B6: 35%
Iron: 34%
Vitamin B12: 30%

I have created a chart for the optimal levels of vitamins and minerals during pregnancy. You will not find a supplement that hits all of these perfectly, but it will allow you see what you might be missing. Below this chart is a very detailed summary of the research used to come to reach these conclusions.

You can treat this like a mini prenatal vitamin and mineral guide. You can also scroll right to the bottom if you just want to know my prenatal recommendations.

Vitamin A as Retinol (3,000-10,000IU from your diet)

There has been a major scare over the past few years regarding vitamin A and teratogenic (birth defects) effects on the fetus, lowering vitamin A recommendations for pregnant women and leading to multiple supplement companies to keep lowering their vitamin A content, or completely switching to beta carotene. Read this section carefully and educate yourself, because it will be challenged by your doctor. 

The American Pediatrics Association cites vitamin A as one of the most critical vitamins during pregnancy and the breastfeeding period, especially in terms of lung function and maturation. According to the European Journal of Nutrition, The German Nutrition Society (DGE) recommends a 40% increase in vitamin A intake for pregnant women and a 90% increase for breastfeeding women.

They also state that “pregnant women or those considering becoming pregnant are generally advised to avoid the intake of vitamin A rich liver and liver foods, based upon unsupported scientific findings.”

Up until the 1950s, a relatively large number of studies showed that laboratory animals (pigs, rabbits, chickens, rats, and mice) fed vitamin A–deficient diets gave birth to malformed offspring and spontaneous abortion. A 2000 study on pregnant mice found that high (100 mg/kg) and moderate (50 and 25 mg/kg) doses of vitamin A as retinyl acetate resulted in significant facial, heart, and thymus abnormalities.

Finally, neural defects and craniofacial malformations were found in children born in regions where glyphosate-based herbicides (sprayed on GMO crops) are used due to glyphosate-induced endogenous retinoic acid activity.

The truth is, that both vitamin A deficiency and toxicity can cause birth defects.

Studies that Found Safety

#1 A 1997 study found that women consuming doses of vitamin A between 8,000 and 25,000 IU from supplements and fortified cereals were no greater in the major malformations group or the group with neural tube defects than in the normal control group.

The researchers concluded, “If vitamin A is a teratogen, the minimum teratogenic dose appears to be well above the level consumed by most women during organogenesis.”

#2 A study found that human epidemiologic studies do not establish at what level vitamin A becomes teratogenic; however, pharmacokinetic data presented in this paper indicate that blood levels of retinoids from women taking 30,000 IU/d of preformed vitamin A are not greater than retinoid blood levels in pregnant women during the first trimester who delivered healthy babies.

#3 A clinical trial was carried out in Hungary in which a supplement of 6000 IU of vitamin A did not increase the incidence of fetal malformations.

#4 According to the American Journal of Clinical Nutrition, up to 20 case reports of the relationship between a high vitamin A intake and an adverse pregnancy outcome in humans were published in the past 30 years. These reports are of limited use for establishing a quantitative link between vitamin A intake and teratogenic events, however.

Furthermore, the pattern of the observed malformations is not always consistent with the retinoic acid syndrome, thus calling into question the origin of these malformations.

Studies that Raised Caution

Teratogenesis of high vitamin A intake has been reported in several animal species. The pattern of birth defects sometimes called “retinoic acid syndrome” includes the central nervous system, craniofacial, cardiovascular, and thymus malformations.

Similar abnormalities were observed in humans when pregnancies occurred during therapeutic treatment with retinoic acid, especially isotretinoin (Accutane). This synthetic form of vitamin A used for acne is well known to cause birth defects.

This study concluded that among the babies born to women who took more than 10,000 IU of preformed vitamin A per day in the form of supplements, an estimated 1 infant in 57 had a malformation attributable to the supplement.

According to the American Journal of Clinical Nutrition:

The teratogenicity of high vitamin A intakes during pregnancy remains unclear and it is unlikely that new findings will shed light on this issue over the next few years. Human clinical trials are not ethically possible, so we must rely on those already performed, on forthcoming epidemiologic trials, and on our knowledge of vitamin A metabolism and functions, which is largely derived from animal studies. This information clearly shows that the teratogenicity of vitamin A is biologically and physiologically possible, yet its real occurrence in humans seems limited.

One drawback in all human studies is that the specific effects of vitamin A intake cannot be determined. Most of the information comes from the use of supplements or, at best, supplemented foods, that are taken on a regular basis and in moderate doses. However, data from animal studies clearly show that one single, high dose of vitamin A can be teratogenic, provided it is given at a critical period of embryonic development.

Beta Carotene is Not Vitamin A

If you look at the label on prenatal vitamins you will see vitamin A listed, but next to vitamin A you will find (as beta-carotene). This is true of many regular multivitamins as well.

Assuming a vitamin A conversion rate for beta-carotene for juice is 4:1, and for fruit and vegetables between 12:1 and 26:1; the total vitamin A contribution from beta-carotene intake represents 10-15% of the RDA. This does not take into genetic variants of BCMO1 that decrease the conversion another 57%, dietary fat intake (the conversion requires fat), and thyroid disorders.

If the vitamin A supply of the mother is inadequate, her supply to the fetus will also be inadequate, as will later be her milk. The major problem is that post-natal supplementation will not correct this issue.

A clinical study in pregnant women with short birth intervals or multiple births showed that almost 1/3 of the women had plasma retinol levels below 1.4 micromol/l corresponding to a borderline deficiency. Vitamin A deficiency is the western world should no longer be ignored.

That being said, I believe prenatal vitamins should use D. Salina or vegetable-sourced beta-carotene and mixed carotenoids and vitamin A is best from the diet.

Conclusion for Vitamin A

From my research, it appears that vitamin A in the form of supplements given at a large dose or a high intake of glyphosate from processed food during a time of key embryonic development is the key understanding of toxicity. Natural vitamin A from food – or even from supplements less than 10,000 IU in relationship to vitamin D intake does not appear to have any evidence that proves causation of toxicity.

Vitamin A helps protect against the toxicity of vitamin D, and vitamin D helps prevent against toxicity of vitamin A. The absence of this understanding is also a major omission in these studies.

For numerous generations, liver was recommended once a week during pregnancy. I know my mom ate liver once a week, took vitamin A supplements, and ate a lot of eggs while she was pregnant with me. Approximately 3.5 oz. of liver has 52,000 IU of vitamin A. Since vitamin A is fat-soluble and stored in the liver, once a week would give you your weekly dose of vitamin A.

If you didn’t like liver, taking 1 tsp. cod liver daily would be equivalent to approximately 21,000-35,000IU per week. Even three bright orange pastured eggs per day (vitamin A is higher in pastured eggs) could give you up to 3,000IU per day, or 21,000IU per week.

The optimal dosage of vitamin A would be very hard to determine since it also probably changes from person to person. However, a dose of 3,000-10,000IU daily and 3.5 oz. of grass-fed liver once a week does not appear to pose any toxicity risk while appearing to supply optimal vitamin A. In my opinion, this is a more responsible recommendation than wrongly thinking you can get all the vitamin A you need from beta-carotene.

Vitamin C (400mg-500mg 1-2x a day)

According to data from the US National Health and Nutrition Examination Survey (NHANES), 31% of US adults do not meet the estimated average requirement for vitamin C, and this is for an RDA that has been drastically reduced over the years. If you read studies on our Paleolithic ancestors, they obtained approximately 400mg per day. Today, the RDA is only 60mg and is wrong.

Having a low intake of vitamin C during pregnancy may be associated with high blood pressure, swelling of the hands, feet, and face, upper respiratory infections, pre-eclampsia, anemia, and low birth weight. Large quantities of ascorbic acid are utilized by the female during conception and are necessary to the formation and integrity of the fetal membranes. Vitamin C also reduces blood lead levels, important due to today’s water and air quality.

During pregnancy, plasma levels of vitamin C normally fall approximately 10 to 15%. A combination of vitamin C from a prenatal and from the diet should hit 400-500mg daily. This need may be higher for those prone to respiratory infections, low immunity, and high stress.

If you are experiencing infertility, one study showed that the rate of pregnancy was significantly higher in the vitamin C supplementation group of 750mg: 25% within six months, while only 11% of the untreated women became pregnant in the same time period.

Vitamin D3 (Vitamin D level between 35-50ng/ml, 2,000IU-4,000IU or 50-100mcg)

A randomized controlled trial to date from the Medical University of South Carolina took 256 pregnant women and separated the group into two groups, 2,000 and 4,000 IU daily starting 3-4 months of pregnancy. A control group of 400IU was not allowed because the ethics committee felt that this would endanger the women and their newborns. This is the amount women have taken with just a prenatal vitamin! 

The results showed that the 4,000 IU group had 2.4 times higher of having an infant in the 50th percentile of birth weight compared to the 2,000 IU group. Lower vitamin D levels were predictive of preterm delivery, infections, and other complications.

In this posthoc analysis, achieving a 25(OH)D serum concentration ≥40 ng/mL significantly decreased the risk of preterm birth compared to ≤20 ng/mL.

In a very recent 2016 study, pregnant women with low vitamin D levels at 20 weeks are more likely to have a child with autistic traits.

Get your vitamin D levels tested early. 

Vitamin E (22-30mg as d-alpha tocopherol and mixed tocopherols)

One study concluded that “consumption of high doses of Vitamin E (over 400IU) during the first trimester of pregnancy does not appear to be associated with an increased risk for major malformations, but may be associated with a decrease in birth weight.”

What is interesting about this is that research has associated low birth weights with an increased risk of heart disease later in life, something vitamin E is associated with preventing in the right dosage.

Another study found that supplemental vitamin E (400IU) from the second trimester of pregnancy did not appear to affect the risk of pregnancy outcomes and the occurrence of preeclampsia.

While vitamin E shares an antioxidant commonality with vitamin C, it does not appear to warrant the same use of higher doses. Low dietary intake of vitamin C was associated with a trend towards an increased incidence of either severe pre-eclampsia or eclampsia. A small increase in the incidence of severe disease was also seen in the group of women with a high intake of vitamin E from supplements and dietary sources.

Based on the available evidence, I think 22-30mg is the correct amount, not 400IU or higher.

Vitamin K1 and K2

Vitamin K is essential for the formation of at least three proteins involved in blood clotting as well as of other proteins found in plasma, bone, and kidney. Vitamin K deficiency primarily affects the blood clotting process.

Newborn infants are at high risk of deficiency because breast milk contains inadequate concentrations of vitamin K and their intestines are not yet colonized with vitamin K-producing bacteria.

Studies have found that the blood thinning drug Warfarin – which depletes vitamin K – has been shown to cause birth defects. This shows the importance of vitamin K which hasn’t been fully elucidated yet. Vitamin K2 is believed to be instrumental in teeth and bone formation.

Vitamin K is provided by the diet and gut bacteria. There is no known toxicity for K2 and therefore an upper limit hasn’t been established. The optimal amount is still being determined for pregnancy, but a conservative amount of vitamin K2 from supplementation is currently in the 65 mcg-100mcg range, depending on your diet.

B1 Thiamin (1.4mg to 2mg)

Conventional treatment for gestational diabetes increases the proportion of infants born with low birth weight, a risk factor for cardiovascular disease and diabetes in later life.

During pregnancy, approximately 50% of the women develop a biochemical thiamine deficiency. The need for thiamine goes up in the third trimester. Causes of thiamine deficiency include a milled grain-based diet, high alcohol intake, gastrointestinal disorders, and prolonged cooking of foods.

Thiamine is essential for glucose oxidation, insulin production by pancreatic beta-cells, and cell growth. Research has stated that thiamine supplementation is a good preventative and treatment of gestational diabetes because it improves glucose tolerance and stimulates intra-uterine growth, thereby preventing a low birth weight to ensue from conventional therapy which only improves glucose tolerance.

B2: Riboflavin (1.4mg to 2.4mg)

Riboflavin deficiency has been implicated in preeclampsia.

Riboflavin plays a special role in MTHFR 677 where it has been found to stabilize the enzyme. Studies have shown that the MTHFR 677 TT genotype is associated with high homocysteine when riboflavin (B2) status is low.

Many doctors will see a homozygous MTHFR 677 and automatically give high amounts of methylfolate (1-5mg) without looking at riboflavin, B6, B12 or choline status. Often, 400-800mcg of methylfolate is sufficient, and more than this can cause anxiety issues depending on variants in other genes.

B6 (2.2mg to 10mg as Pyridoxal-5-Phosphate)

Pyridoxal phosphate (PLP) is the physiologically active form of vitamin B6 and is a coenzyme in over 100 known reactions. In multivitamins, B6 is often labeled as pyridoxal hydrochloride, which is not absorbed as well as PLP. PLP is expensive, and many companies do not use it because it increases the price of their product. PLP is worth the money.

An epidemiological study done at Tufts University in 2008 found that a substantial percentage of the population had inadequate B6 status. Studies have also consistently shown that in comparison with nonpregnant controls, pregnant women have lower plasma levels of vitamin B6.

It has been suggested that low B6 is associated with gestational diabetes and ”pregnancy depression”—described as pessimism, crying tension without sleep, or appetite disorders. Vitamin B6 plays a very important role in mental health, needed in the formation of histamine, serotonin, and dopamine.

All forms of vitamin B6, especially PLP, cross the placenta into the fetal blood where its concentrations are two to five times higher than those in maternal blood. The most substantial decrease in plasma PLP levels is found between the fourth and eighth months of pregnancy, paralleling the period of most intensive growth of the fetus.

B6 is higher in organ meats than muscle meats and is needed for amino acid metabolism. Therefore a high lean protein intake low in B6 increases the need for B6. This is also true of vitamin A. The elevation of estrogen during pregnancy also increases the need for B6. The deficiency of B6 leads to nausea, which can be treated successfully with B6 supplementation.

If you have been on birth control for a long period of time, B6 needs may be higher. Long-term use (>30 months) of oral contraceptives containing high levels of estrogen was associated with significantly lower maternal and umbilical cord serum vitamin B6 levels than those in women who took no oral contraceptives, and evidence indicates that their vitamin B6 reserves may be decreased in early pregnancy.

B7 Biotin (30mcg)

The need for biotin increases with pregnancy and deficiency has been linked to birth defects. At least one-third of women develop a marginal biotin deficiency during pregnancy, and there are prenatal vitamins that do not contain any biotin. The highest levels of biotin are actually found in pastured egg yolks.

B9 (600-800mcg as Methylfolate)

Folate is one of the most well-known nutrients during pregnancy for preventing spinal bifida. Due to its role in DNA synthesis, a deficiency has widespread consequences in fetal development. Folate and choline are methyl donors, and the addition of a single methyl group can change an individual’s epigenome.

Folic acid is a synthetic version of folate that does not exist in nature. In a study titled Is Folic Acid Good for Everyone?, the author argues that folic acid could interfere with the metabolism, cellular transport, and regulatory functions of the natural folates that occur in the body by competing with the reduced forms for binding with enzymes, carrier proteins, and binding proteins.

The folate receptor has a higher affinity for folic acid than for methyl-THF—the main form of folate that occurs in the blood and might inhibit the transport of methyl-THF into the brain.

A new study from Johns Hopkins University looked at 1,391 mother-child pairs in the Boston Birth Cohort, a predominantly low-income minority population. The researchers found that very high circulating folic acid doubled the risk of autism, and B12 levels that were very high tripled the risk of autism. If both levels are extremely high, the risk that a child develops the disorder increases 17.6 times.

Homozygous variants in MTHFR 677 or a combination of a heterozygous MTHFR 677 and 1298 may put you at a higher need for folate. These variants also require B2 (riboflavin), B12, B6, and choline to normalize the methylation cycle. You want to choose folate as methylfolate and B12 as methylcobalamin.

If you were advised to take a high amount of methylfolate (1-5mg) and had a bad reaction, niacin is actually given due to niacin’s ability to quench excess methyl groups. It makes much more sense to give methylfolate as part of a B-complex because it includes niacin and other B-vitamins that provide balance.

B12 (2-10mcg as Methylcobalamin)

Cyanocobalamin is the synthetic B12 form found in cheap multivitamins and fortified foods. Cyanocobalamin must be converted to methylcobalamin and requires the split of a cyanide (the toxin) molecule from cobalamin. Like folic acid, the ability to make this conversion is impaired in many people.

As mentioned above, one study found that very high circulating folic acid doubled the risk of autism, and B12 levels that were very high tripled the risk of autism. If both levels are extremely high, the risk that a child develops the disorder increases 17.6 times.

As I explored in my Best and Worst Multivitamins article, this study was done in a predominately low-income minority population and was most likely due to a diet high in processed fortified foods along with supplements containing folic acid and cyanocobalamin.

I will give you my theory on why this may have occurred, which I haven’t seen explored yet. One, synthetic folic acid can bottleneck and block folate receptors, creating high circulating levels.

Two, cyanide is one of the air toxins found to have a statistical significance on autism risk and high oxidative stress is found in children with autism.

Three, a study found that young US children with autism and their mothers had unusually low levels of lithium compared to neurotypical children and their mothers. I will explain how this relates to excessive cyanocobalamin.

Cyanocobalamin is composed of cyanide and cobalamin and splits off cyanide, which can block the electron transport chain of the mitochondria (powerhouse of the cell and sensitive to oxidative stress).

Lithium is a carrier of B12 into the mitochondria. Excessive cyanocobalamin could theoretically both disrupt the electron transport chain into the mitochondria, deplete methyl groups for methylation, increase mitochondrial oxidative stress, and cause very low lithium levels trying to keep up with the high circulating blood levels of B12 that are struggling to make it into the mitochondria.

Mitochondrial dysfunction is one of the medical disorders that has been consistently associated with Autism Spectrum Disorders.

Zinc (15mg)

Studies have estimated that 82% of pregnant women in the world may have inadequate intake of dietary zinc! Why is this happening? Drop in liver and shellfish consumption, zinc from plants is poorly absorbed, grains high in phytic acid will actually block zinc uptake, and very high amounts of copper or iron in the diet will compete with zinc at absorption sites.

Zinc deficiency can lead to congenital abnormalities, poor immunity, abortions, intrauterine growth retardation, premature birth, and preeclampsia. Oxide forms of zinc should be avoided.

Copper (1mg)

Copper plays a role in the brain, tendons, and skin development, increasing iron absorption, and processing oxygen. Too much can cause preeclampsia and intrauterine growth retardation while low serum levels have been linked to pathological pregnancies and miscarriage. Serum copper increases during pregnancy and is doubled at full term with peaks at the 22nd, 27th, and 35th gestational week.

There is a balance between zinc and copper levels that is very important (approximately 15mg of zinc to 1mg of copper). Adequate zinc will push down excess copper, but too much zinc will push it too low. Conversely, insufficient zinc will lead to elevated copper levels.

A form of copper called “cupric oxide” in prenatal vitamins should be avoided. If the type of copper is not listed, ask the company if it is cupric oxide.

Iron (18-30mg)

Iron requirements are reduced during the first trimester, increase for the second and third trimester of pregnancy due to oxygen requirements and infant storage during the breastfeeding phase, and are especially high after delivery. Iron deficiency can lead to postpartum depression, fatigue, and poor breast milk production or quality.

It is recommended to enter pregnancy with higher levels of iron and ferritin levels to meet your requirements fully. Approximately 40% of women entering pregnancy with insufficient iron reserves and unfavorable iron status, and 25% get iron deficiency anemia.

Women suffering from iron deficiency anemia during the first two trimesters are twice as likely to deliver early and three times the risk of having a low birth weight. Iron deficiency during the third trimester also affects the hippocampus; involved in learning, memory, and cognition, leading to cognitive dysfunction that could continue to adulthood.

Research has stated that “the amounts that can be absorbed from even an optimal diet, however, are less than the iron requirements in later pregnancy.” I wonder if this would be true if women ate liver once a week? In 3.5 oz. of liver, there is 17.7mg of iron. In 3.5 oz. of beef, there is 2.6mg.

Nevertheless, many women would rather have another option, and supplementing is recommended. You want the right dosage for your levels. Remember that too much iron can be constipating, taking vitamin C at the same time helps iron absorption, copper increases iron absorption, and vitamin A helps mobilize iron storage.

The main forms of iron you want to avoid are gluconate and sulfate, which are constipating. I recommend Iron Bisglycinate. A 2014 double-blind study found that 25mg of Iron Bisglycinate was as effective as 50mg of ferrous sulfate for pregnant women. They also experienced lower gastrointestinal complaints and their babies had slightly higher birth weights.

Choline (450mg to 930mg)

As of June 17th, 2017, the American Medical Association voted to support evidence-based amounts of choline in all prenatal vitamins, noting that most prenatals currently contain little if any choline.

Choline plays an important role in the liver, and gallbladder, vulnerability to toxins, preventing spinal cord and brain defects, and the future mental health of the child.

Genetic polymorphisms in PEMT may alter the dietary requirement for choline and increase the likelihood of developing signs of deficiency (fatty liver, gallbladder issues during pregnancy) when choline intake is inadequate.

The choline pathway is actually enriched with DHA, which of course also plays a prominent role in brain development.

One analysis found that a higher choline intake (930 compared with 480 mg/d) augmented the rise in choline/DHA in nonpregnant women and choline needs are increased during the third trimester of pregnancy. The researchers found that a higher choline intake along with supplementary DHA acted synergistically to produce the greatest enrichment of choline and DHA in red blood cells. This is a major find for mental health. 

An article from NPR came out this month that explored whether or not supplementing with choline could enhance brain growth in the developing fetus and prevent mental illness.

One group of moms-to-be was given phosphatidylcholine and the other group was given a placebo. The dosage was large; 900mg total. However, this is also close to the amount recommended during the 3rd trimester of pregnancy.

After birth, infants were given either 100 milligrams of liquid phosphatidylcholine or a placebo once a day for approximately three months. A test was administered at 5 weeks old testing simultaneous clicking sounds while measuring brain activity.

The results published in 2013 in the American Journal of Psychiatry by Freedman’s group show that 76 percent of newborns whose mothers received choline supplements had normal inhibition to the sound stimuli, while 43 percent of the newborns did not. Those who do not have a normal inhibition to the sound stimuli have been found to have an increased risk for attention problems, social withdrawal, and, later in life, schizophrenia.

The results show that choline might steer the infant brain away from a developmental course that predicted mental health problems.

Omega-3 Fatty Acids (100-400mg of EPA and 200mg to 600mg of DHA)

NIH has set a minimum of 200mg of DHA per day as the recommendation for pregnancy. Based on the current research, the optimal daily amount may be in the 300-400mg range.

Omega-3 fatty acids are vitally important during pregnancy as they are critical building blocks of the fetal brain and eyes, but are also crucial for preventing postpartum depression.

DHA is transferred from the mother to the fetus at a high rate during pregnancy, thereby depleting maternal stores. EPA also assists in transporting DHA into fetal cells. This is a very important point to understand for all vitamins and minerals transferred from the mom to the fetus. If an expecting mom does not have sufficient reserves, this can drastically affect her pregnancy.

A recent study found that an estimated 106,000 high-risk preterm births could be avoided in the US and 1,100 in Australia alone every year if women supplemented with DHA.

The studies demonstrating the greatest efficacy have used doses in the range of 1–2 g/day of fish oil. One study found that Mexican women supplemented with 400mg of DHA delivered babies who weighed more and had larger head circumferences.

The lowest concentrations of DHA were found in North America and Canadian breast milk. Levels of DHA averaged only 0.17% of total fatty acids in contrast to the highest levels found in Japan where DHA represented 0.99% of the total milk fatty acids.

I believe fish oil should be supplemented separately if adequate EPA and DHA is not obtained in the prenatal.

Iodine (150-300mcg)

Data from the National Health and Nutrition Examination Survey suggest that more than half of pregnant women have urinary iodine concentrations below 150 mg/dL. Inadequate iodine intake during pregnancy result in fetal loss, stillbirths, cretinism, and mental retardation of the newborn infant.

As of 2015, The US Council for Responsible Nutrition’s new guidelines calls for all dietary supplement manufacturers and marketers to begin including at least 150mcg of iodine in all daily multivitamin/mineral supplements intended for pregnant and lactating women in the United States.

The optimal dose may be 200-300mcg. If you have suffered from hypothyroidism, this makes sufficient iodine along with selenium, zinc, vitamin C, vitamin A, and vitamin D that much more important.

A study in 2009 found that 51% of US prenatal multivitamin brands did not contain any iodine and, in a number of randomly selected brands, the actual dose of iodine contained in the supplements did not match the values on the label.

Fluoridated water displaces iodine, creating a higher need for this crucial mineral and filtering fluoride.

Selenium (60-70mcg, 200mcg for infertility)

Selenium is a primary mineral needed by glutathione, our master antioxidant system. It also blocks the uptake of mercury and plays a significant role in the reproductive system. Selenium deficiencies may lead to gestational complications, miscarriages, and the damaging to the nervous and immune systems of the fetus.

As you will see in the study below, 200mcg of selenium was used along with magnesium to resolve infertility. Selenium has also been found to resolve infertility in men.

Magnesium (400-600mg)

Magnesium plays a special role in regulating blood sugar, preventing muscle spasms, increasing energy, and preventing preterm contractions and fertility.

In one study, six women with a history of unexplained infertility or early miscarriage and who had failed to normalize their red cell magnesium (RBC-Mg) levels after four months of oral magnesium supplementation (600 mg/day) were investigated for red cell glutathione peroxidase activity.

They were compared with six age-matched women with a history of unexplained infertility or miscarriage who did normalize their RBC-Mg levels on magnesium supplementation. The six non-normalizers had significantly lower glutathione levels than the six normalizers.

After a further two months of 200 micrograms daily oral selenium as selenomethionine and oral magnesium supplements, all six women normalized their magnesium and RBC-selenium levels. All 12 previously infertile women have produced normal healthy babies all conceiving within eight months of normalizing their RBC-Magnesium levels.

Calcium (1000mg)

During pregnancy, a woman’s body provides daily doses between 50 and 330 mg to support the developing fetal skeleton. A recommendation in the US and Europe has continually been 1,000mg, while the average intake is 800mg in young women. Vegetables high in calcium, calcium-rich mineral water like Gerolsteiner, and dairy can reach your daily calcium targets. Since calcium blocks lead uptake, getting adequate calcium is crucial.

Calcium absorption and utilization are tightly regulated. For example, many foods that contain oxalic acid bind to calcium; often found in foods that contain calcium. Too much calcium affects the absorption of magnesium, while higher amounts of magnesium increase the absorption of calcium.

Calcium deficiency is rare in pregnancy but appears in cases of hypoparathyroidism, severe dietary inadequacy, and in individuals who are unable to eat foods high in calcium.

Calcium needs go up in the third trimester and during labor. For this reason, I recommend Gerolsteiner Mineral Water (let it go flat) as an electrolyte drink during labor.

Best and Worst Prenatal Vitamins

In 2024, we launched a new ranking system for all supplements to allow a longer list of choices and a faster way for you to make an informed choice. You can find our list of the best and worst prenatal vitamins on our new Supplement Ranking page, giving in-depth feedback, scores and 3rd party testing. As usual, if you have questions about a prenatal, leave a comment below and we will add it to the ranking list.

Prenatal Vitamin Ranking
Prenatal Omega-3 Ranking

Other Articles of Interest

The Best Children’s Multivitamins
The Best Probiotic and Prebiotic Supplements (contains info on probiotics during pregnancy)