What is the recommended regimen for a basic multi-vitamin (multivitamin) supplement?

From the Guidelines

A daily multivitamin supplement in amounts equivalent to 100% of the Daily Value is a good choice for anyone who cannot eat a healthful diet. When selecting a multivitamin, consider a formula that contains vitamins A, C, D, E, K, B vitamins (including B12, B6, thiamin, riboflavin, niacin, and folate), and minerals like calcium, magnesium, zinc, and iron 1. The supplement should provide approximately 600-800 IU of vitamin D, as recommended by general guidelines, although specific recommendations may vary based on individual needs and conditions, such as pregnancy or post-bariatric surgery 1.

For specific populations like pregnant women or those after bariatric surgery, more detailed recommendations are available, emphasizing the importance of folic acid, iron, calcium, and vitamin D, among others 1. For example, pregnant women may require higher doses of folic acid (4-5 mg daily) and iron (45-60 mg elemental iron), and should ensure their multivitamin contains sufficient amounts of these nutrients 1.

Key considerations when choosing a multivitamin include:

• Ensuring the supplement contains 100% of the Daily Value for most essential vitamins and minerals
• Selecting a formula appropriate for the individual's life stage (e.g., pregnancy, postmenopausal)
• Being mindful of potential interactions with other medications or health conditions
• Recognizing that while multivitamins can fill nutritional gaps, they are not a substitute for a healthy, balanced diet 1.

Given the most recent and highest quality evidence, the best approach is to follow the guidelines that recommend a daily multivitamin with 100% of the Daily Value for essential nutrients, tailored to the individual's specific needs and health status 1.

From the FDA Drug Label

Doses of folic acid exceeding the Recommended Dietary Allowance (RDA) should not be included in multivitamin preparations; if therapeutic amounts are necessary, folic acid should be given separately. The recommended regimen for a basic multi-vitamin supplement is not directly stated in the provided drug label. Key points:

• The label discusses the dosage of folic acid, not the regimen for a multi-vitamin supplement.
• It advises against exceeding the Recommended Dietary Allowance (RDA) for folic acid in multivitamin preparations. The FDA drug label does not answer the question.

From the Research

Multi-Vitamin Drug Class

The recommended regimen for a basic multi-vitamin supplement is not strictly defined, but several studies provide guidelines for evaluating prenatal vitamin-mineral supplements and addressing nutritional gaps with multivitamin and mineral supplements.

• A daily antepartum supplementation of 0.4-0.8 mg of folic acid and 30-60 mg of elemental iron is currently recommended 2.
• Prenatal supplements should probably contain other nutrients such as pyridoxine hydrochloride, cholecalciferol, vitamin E, pantothenic acid, calcium, magnesium, zinc, copper, and possibly selenium 2.
• A balanced and varied diet is the best source of essential vitamins and minerals, but nutrient deficiencies can occur, and multivitamin and mineral (MVM) supplements can help fill nutritional gaps 3.
• MVM supplements are generally well tolerated and do not appear to increase the risk of mortality, cerebrovascular disease, or heart failure 3, 4.
• The potential benefits of MVM supplements likely outweigh any risk in the general population and may be particularly beneficial for older people 3.
• A daily supplemental dose of 400 μg/day of folate is recommended when planning pregnancy 5.
• Supplementation with vitamin D in the third trimester in vitamin D deficient women seems to be beneficial 5.
• The use of vitamins E, although generally considered "healthy", may be harmful to the pregnancy outcome by disrupting a physiologic oxidative gestational state and is consequently not recommended to prevent pre-eclampsia 5.

Nutrient Intake

• The average intake of vitamin D, folic acid, vitamin B2, vitamin C, iron, iodine, and zinc from supplements was above recommended values 6.
• The average intake of vitamin B1, B12, and B6 from supplements was about 95-105% of RDA 6.
• The lowest average consumption was noted for vitamin A, as well as calcium and magnesium 6.

Safety of Long-Term Use

• Multivitamin/mineral supplements (MVMs) can be safe for long-term use (>10 y) when used within the range of the Dietary Reference Intake 4.
• MVM use does not result in excess intake, even when including the effect of food and fortified food, and does not increase mortality 4.