When most people look at a list of ingredients on a supplement bottle, they can understand words like "vitamin B2, zinc, iron etc".
But did you know there is a massive difference in the forms used in supplements? Remember you get what you pay for and if it's cheap then there's probably a reason why.
Why you may need a supplement in addition to a good diet
Most people have a perception that they are 'healthy' and have a 'nutritious diet'. On closer inspection, their diet and lifestyle history may not be as healthy as they originally thought. Recommended daily intakes (RDI's) of nutrients are usually easily met with a healthy diet.
However, these are only the amounts required each day to prevent serious deficiencies. These include diseases such as scurvy (vitamin C deficiency) or rickets (vitamin D deficiency).
RDI's aren't the amounts most people require for optimum wellness. This is analogous to having a full service of your car using top quality products for optimum performance.
What happens if as a child you were an extremely fussy eater who often didn't meet your nutritional requirements and ended up with a few nutrient deficiencies?
- Then you become a teenager who thinks it's ok to drink soft drinks or eat junk food (sugar and refined foods deplete nutrients).
- Later in early adulthood, you start to binge drink on weekends (depletes nutrients and is toxic).
- Perhaps you even take up smoking for a while (depletes nutrients and is also toxic).
- You consume caffeine (depletes nutrients and stresses the body).
- You start to experience high stress through work (depletes nutrients and impairs absorption of nutrients).
You can see how by the time a woman is in her late 20s or 30s she might not meet the nutritional demands pregnancy places on her body. Let alone meet the needs of her unborn baby from diet alone.
That aside, any dietician, naturopath or obstetrician will be able to tell you that it is almost impossible to meet the RDI for iron through diet, particularly in your third trimester.
So you might say "why not just take an iron supplement?"
Every vitamin and mineral has an antagonist. Taking a high dose of one vitamin or mineral in isolation, e.g. folate in your first trimester and iron in your third trimester will cause a depletion of other nutrients. In the case of iron; zinc and calcium will be depleted and vice versa.
Taking more than 1000mcg of folate can mask a B12 deficiency. The upper limit for folate supplementation is 1000mcg unless you are homozygous for the MTHFR gene C677T, but more on that later.
Hopefully, you can now see that taking extra nutrients in the form of a multivitamin is necessary, especially during pregnancy.
A lot of prospective parents are testing for MTHFR gene mutations C677T and A1298C. 45% of white Australians are either heterozygous (inherited from one parent) or homozygous (inherited from both parents) for C677T.
What this means is that you have either a 40% (heterozygous) or 70% (homozygous) reduction in your ability to metabolise the cheaper, synthetic form of folate, folic acid.
Choosing the best prenatal multi for you
With so many brands on the market, it can be hard to choose the right one for you. Here are some tips for choosing a good quality multivitamin and mineral supplement:
Choose a prenatal multi with activated B vitamins. Activated B vitamins are the same form as found in food (i.e. they don't have to go through the many biochemical steps to become "usable" in the body like the cheaper, synthetic forms). An example of this is folate - the cheap form is folic acid which goes through many steps to finally become 5-methyltetrahydrofolate (5-MTHF).
Alternatively, you can take a better quality form, 5-MTHF which is essential for those who are heterozygous or homozygous for C677T. Please seek advice from your health professional if you are homozygous as you will probably need to take a higher dose.
Vitamin B12 comes in many forms - cyanocobalamin is the cheap form found in the majority of retail supplements. It is cyanide attached to cobalamin and must be converted into active forms.
Methylcobalamin and adenosylcobalamin are active forms.
Hydroxocobalamin is the natural form found in foods. It is easily converted to both of the active forms as the body requires it. Hydroxocobalamin is the type used in B12 injections and has been found to have equivalent absorption when taken orally.
Iron comes in many different forms. The cheap forms which aren't absorbed well and more likely to cause side effects such as nausea and constipation are as follows:
- Ferrous sulfate
- Ferrous fumarate
- Iron oxide
High-quality forms of iron include the following:
- Iron bisglycinate
- Iron phosphate
- Iron amino acid chelate
- Iron picolinate
- Iron citrate
When it comes to supplementing with iron it is best to ask your lead maternity carer for a ferritin test at the end of each trimester. This is a measure of iron stores in the body. Ideally, you should try to keep it above 50 for optimum energy levels. Also, good stores help prepare your body for the loss of blood during labour.
Supplementing with iron during the first trimester can aggravate the symptoms of morning sickness. It is best to build iron stores prior to pregnancy and avoiding iron supplementation during the first trimester.
Supplementing with zinc is also associated with causing nausea whether pregnant or not. It is best to go for a supplement which contains the RDI of zinc in your first trimester.
Cheap, poor quality forms of zinc include the following:
- Zinc oxide
- Zinc gluconate
- Zinc sulphate
Good quality forms of zinc include:
- Zinc citrate (ideal during pregnancy because it is gentle on the stomach)
- Zinc amino acid chelate
- Zinc glycinate
- Zinc picolinate
Magnesium is an essential mineral which is easily depleted through consumption of alcohol, caffeine and stress.
Magnesium oxide is commonly found in supplements but is very poor quality and has poor absorption. In fact, it is commonly prescribed by naturopaths as a laxative.
Good quality forms of magnesium include:
- Magnesium glycinate
- Magnesium citrate
Copper levels naturally rise rapidly during pregnancy as the level of oestrogen increases. It would seem unnecessary to supplement with copper during pregnancy. Until further research is done, it would be best to avoid copper containing supplements during pregnancy.
One case study showed that high levels of copper in the mother's blood during pregnancy was associated with autism in the baby. This is not surprising because studies have shown a high level of copper in the blood of children with autism spectrum disorders.
Iodine is essential during pregnancy. It supports thyroid function (zinc and selenium are essential here too) and healthy development of the baby's brain. During the first trimester, the pregnancy hormone hcg stimulates the thyroid. This has been associated with worsening the symptoms of morning sickness. The least amount of iodine taken per day during pregnancy should be 150mcg. In the second trimester, it is best to ensure you meet the RDI of 220mcg per day.
The Royal Australian College of Obstetricians and Gynaecologists recommends avoiding supplementing with some fat-soluble vitamins.
Fat-soluble vitamins such as vitamins A and K are stored in the liver and can become toxic in overdose.
These vitamins are easily obtained in the diet. A good example would be to eat the following:
- A few servings of green leafy vegetables and brightly coloured fruit and vegetables per day
- A handful of nuts and seeds
- 3 servings of full-fat organic dairy products (a great source of vitamin A)
There is no doubt that antioxidants are highly beneficial to you and baby during pregnancy.
Alpha lipoic acid is an antioxidant which regenerates vitamins C and E and glutathione in the body. It has also been shown in a study to reduce the risk of premature labour when combined with magnesium.
You can learn more about how to supplement according to blood test results in my Becoming Supplement Savvy course.
If you care about you and your baby's health, then your choice of prenatal supplement should be about quality rather than price.