Dr. Michael Roizen knows your secret. You're not eating enough fruits and veggies. That's why most Baby Boomers need a multivitamin, said the chairman of the Wellness Institute at the Cleveland Clinic.
When it comes to opinions about the need for multivitamins, there seems to be, ahem, one a day.
Mount Sinai School of Medicine's Dr. Victor Herbert famously fell on the side of the skeptics, declaring, "supplements help some, harm some, and do nothing for most, so the bottom line is a wash," in the book Total Nutrition: The Only Guide You'll Ever Need, first published in the mid 1990s.
Until recently many doctors sided with Herbert, telling their patients that spending money on vitamins amounted to creating expensive urine.
But as Boomers have aged, nutrition science has advanced as well.
Studies are increasingly showing large gaps between optimal nutrition and what typical Americans are taking in from food, gaps that are easily surmounted with vitamins.
Roizen has data to prove it.
Co-author of You: The Owners Manual, Roizen is also the co-creator of the Web site RealAge.com . On that Web site, people report on their health status, including diet, to learn whether their "real age" is younger or older than it should be, and to glean wellness tips.
Based on users' responses, Roizen says he's certain about most adults' need for a multivitamin.
"We've had 27 million people take the RealAge program," Roison says. "A little less than 1 percent can get the right vitamins and minerals from their diet alone. It's possible, but it isn't done commonly in America. We just don't eat right."
For once, Boomers are following their doctors' advice.
According to Nutrition Business Journal estimates, U.S. consumer sales of dietary supplements reached $25.2 billion in 2008 on 6.2 percent growth. The multivitamin category accounted for $4.7 billion of these sales in 2008, on 4.3 percent growth.
But it's not necessary to go broke buying fancy brand-name vitamins, Roisen said. He tells patients at the Cleveland Clinic that a low-cost multivitamin will meet their basic needs. Grocery store brands are usually fine, he said. They're often manufactured by the same companies as the expensive vitamins, using the same basic ingredients.
But there are some other vitamins he suggests adding to the multivitamin.
His tips:
"You want to look for a multivitamin that has less than 3,500 international units of vitamin A," he said.
Buy a pill splitter, and take part in the morning, part at night, to improve absorption, he said.
Most Boomers need extra vitamin D, in the form of D3, as well, he said. Those under age 50 need around 1,000 IUs, while those over age 50 should get 1,200 IUs.
Two hours after taking their multivitamin and extra D, he recommends taking 600 mg of calcium two times a day, plus 200 mg of magnesium two times a day.
Last, he wants most of his adult patients to take fish oil, for the omega 3 fatty acids which benefit heart, brain and vascular health. Look for ones that offer 600 mg of DHA, he said. In his books, Roizen cautions patients to stay within his guidelines, and not fall for the "if a little is good, a lot must be better" mentality.
"There is toxicity from too much of some of the vitamins and minerals, so you want to make sure you stay within the guidelines of what we write," he said.
In Boynton Beach, internist Dr. Stacey Shinder has her patients bring in their vitamins, to ensure they're taking the right amounts, and not taking anything that might interfere with their prescription drugs.
Niacin, for example, can affect liver function, she said, and high doses of that and selenium can pose problems. Fish oil and blood-thinning drugs may be a bad combination.
Shinder, part of the MD VIP concierge group, charges members $1,500 a year for the extra attention. But she doesn't just go over vitamins with her patients. She orders blood tests to assess their levels of vitamin D, iron and other nutrients.
And she wants to hear about their diet.
"I often will have patients keep food diaries for me. Especially when we have weight management issues."
While she prefers good diet to vitamins, she's realistic.
"I am more of a believer in getting people to eat more fruits and vegetables, more colors, more varieties," she said. "No vitamin is a magic pill."
Rich or poor, the advice is similar.
Sue Grammond, registered dietitian at the Palm Beach County Health Department, also encourages clients to take a multivitamin. But she tells them if money is short, it's most important to eat a variety of colorful fruits and vegetables, and go for frozen veggies if fresh are difficult to keep, she tells them.
"One of the mantras in nutrition is food first," Grammond said. "It comes with the vitamins, the fiber, the whole package when you eat the whole thing."
Dr. Roizen's vitamin advice for Boomers:
1. Take a multivitamin that contains no more than 3,500 IUs of vitamin A. Buy a pill splitter, and take half the multivitamin in the morning, half at night.
2. Take additional vitamin D3. Those under age 50 need around 1,000 IUs a day, while those over age 50 should get 1,200 IUs a day.
3. Add calcium two hours after your multivitamin. Aim for 600 mg of calcium two times a day, plus 200 mg of magnesium two times a day.
4. After checking with your doctor, take a fish oil capsule with 600 mg of DHA per day.
5. Beware mega doses of vitamins. Too much vitamin A, niacin, vitamin E, and other nutrients can cause health problems, so talk to your doctor about what you're taking.
The buzz word is phytonutrients. The claim is that hundreds of plant compounds are still unknown, and benefit the immune system, the vascular system and general health.
But can they be turned into juice, freeze-dried, pressed into a capsule, and still offer health benefits? Top brands promising whole-food benefits include Juice Plus+, Nutrilite, Dr. Mercola's Whole Food Multivitamin and GNC's Maximum Greens, among others. These supplements can be much more expensive than a multivitamin.
A 31-day supply of Nutrilite's Double X multivitamin/mineral and phytonutrient pack costs a whopping $71.41. A month's supply of Juice Plus+ is $41.75. And a month's supply of GNC's Maximum Greens Ultra Mega Green Vitapak costs $35.99.
But are they worth it?
Nutrition Professor Susan Percival thinks it's likely.
At the University of Florida's Department of Food Science and Human Nutrition, in Gainesville, she is studying the effect of several natural food compounds on immune system cells called gamma delta T cells.
The cells play a dual role, first by attacking germ invaders, then by dialing down the inflammatory response after infection has passed.
Mounting an immune attack requires just about every nutrient there is to produce armies of these immune cells, she said. Several plant compounds that are not found in multivitamins play an important role in priming the immune cells, she said.
Those compounds include catechins, found in green tea, cocoa and grapes, and anthocyanins, found in blueberries, Concord grapes and cranberries.
For research published in 2006, she enrolled 59 UF law school students in a study on Juice Plus+ capsules. She found those who got the real capsules and not the placebo had increased blood levels of nutrients and antioxidants, fewer DNA strand breaks, and an increase in circulating gamma delta T cells.
Many of the beneficial food compounds are in their pigments, the chemicals that make them colorful. Eating colorful fruits and vegetables is best, because you get the fiber, she said. But the capsules she studied had definite benefits.
"I cannot generalize to all whole food capsules except to say the ones I know take very good care to preserve much of the nutritional value that the whole fruit and vegetable had," Percival said.
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