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Prenatal Vitamins

One thing that people always ask me is about their prenatal vitamin. Is there a difference between the prescription brands and other brands and if what they are taking will be good for them and the growing baby. I found there is a large amount of variance between these vitamins and, believe it or not, ones that patients think would be best and acquired by prescription are often some of the worst. I want to discuss this issue in detail so that you can look at the ingredients of your vitamin and know exactly what you are getting.

Variety of Vitamins

As with all vitamins, there are generally four categories: prescription brands, drug store brands, health food store brands and professional brands. Most of my patients know to stay away from the drug store brands as they use very cheap raw materials leading to very low nutrient content, poor absorption and potential toxic buildup due to fillers and binders they contain.

What many people do not realize however, is that many of the prescription brands are actually not much better.
When I started looking further into this, I was shocked to find what was inside.

What is important in a Prenatal Vitamin?

Studies show that the minimal nutrients crucial for a healthy pregnancy and growing baby are:

Essential Vitamin/Mineral: Why You Need It:
Vitamin A 5000 IU Helps bones and teeth grow
Vitamin D 400 IU Helps body use calcium and phosphorus; promotes strong teeth and bones
Vitamin E (50IU) Helps body form and use red blood cells and muscles
Vitamin C (120 mg) An antioxidant that protects tissues from damage and helps body absorb iron; builds healthy immune system
Thiamin/B1 (1.4 mg) Raises energy level and regulates nervous system
Riboflavin/B2 (1.4 mg) Maintains energy, good eyesight, healthy skin
Niacin/B3 (18 mg) Promotes healthy skin, nerves and digestion
Pyridoxine/B6 (1.9 mg) Helps form red blood cells; helps with morning sickness
Folic Acid/Folate (600-800 mcg) Helps support the placenta, and prevents spina bifida and other neural tube defects
Calcium (500-1,000 mg) Creates strong bones and teeth, helps prevent blood clots, helps muscles and nerves function
Iron (27 mg) Helps in the production of hemoglobin; prevents anemia, low birth weight, and premature delivery
Zinc (12 mg) Helps produce insulin and enzymes
Essential Fatty Acids EPA/DHA (300mg) These essential fats, particularly the Omega 3′s, are key for the proper development of the baby’s brain and immune system.  EFAs are also believed to lower the likelihood of post-partum depression.  The optimal dietary balance is best achieved by consuming omega-3 fat from at least two different sources, thereby mixing and matching, in order to achieve a net daily consumption of 1,000 mg of combined EPA/DHA with at least 300 mg coming from DHA.

There are of course many other nutrients that act as synergistic components to the above vitamins and minerals, but since these have been thoroughly studied, most prescription vitamins concentrate on including only these.

Potential Problems with Rx Prenatal Vitamins

Dosage

Many Rx brands are formulated with a one a day dose. While this is very convenient, please know that your body can only absorb a little at a time, so if you take a big dose of everything at once, you would only be absorbing a portion, wasting the rest. It is much better to have a 2 or 3 a day nutrient so you can have a little at a time.

Types of Nutrients

I also find the many Rx brands only have a few ingredients, specifically the folate and iron, but much less of everything else. Many do not even have calcium or the very important essential fatty acids which would then need to be taken separately.

Quality

Another big issue is the quality of the actual vitamins and minerals in these formulations. They often use synthetic ingredients and cheaper forms of vitamins and minerals which require much more processing in the body to actually absorb and use them. Many brands also contain fillers, binders and artificial colorings which is toxic to both the mom’s and baby’s body.

EPA/DHA quality is extremely important. You may have heard about the study that came out last weekend testing several brands of EFA’s such as CVS and Costco brands and found they contained toxic PCB’s. Because Omega 3′s come from fish, it is very important that they are purified to remove harmful mercury and other toxins found in the oceans. The problem however is that fats in general, but especially Omega 3′s are extremely fragile and can become rancid very easily. Once rancid, these fats create very harmful free radicals that destroy your cells and can mutate DNA. Many companies purify their fish oils but they do it through the use of heat which denatures the oil and makes is more dangerous for you. Thus, it is imperative that you know where the oil is derived, how pure it is and how it was cleaned to preserve its purity.

Let’s See What is Inside Popular Rx Brands

Let’s take a look at an example of a popular Rx brand and go through exactly what it contains and what it is potentially missing.

Each softgel contains

Vitamin C (ascorbic acid) ……………………………………………………..85 mg

Vitamin D3 (cholecalciferol) …………………………………………………200 IU

Vitamin E (d-alpha tocopherol) …………………………………………….10 IU

Vitamin B6 (pyridoxine HCl) …………………………………………………25 mg

Folate…………………………………………………………………………………….1 mg

(L-methylfolate as Metafolin® 600 mcg, folic acid USP 400 mcg)

Vitamin B12 (cyanocobalamin) ……………………………………………. 12 mcg

Calcium (calcium carbonat.e…)…………………………………………….140 mg

Iron (ferrous fumarate) ……………………………………………………….27 mg

Magnesium (magnesium oxide) ……………………………………………45 mg

Docosahexaenoic Acid (DHA)………………………………………………..300 mg

(from 330 mg omega-3 fatty acids)

The above vitamin has sufficient C. The vitamin D is in the natural form which is great, but there is only 200IU compared to the minimum of 400-600IU. Remember that if you live in the northern hemisphere, you can only get vitamin D from the sun during summer months.

The vitamin E is in the natural form indicated by d-alpha tocopherol, but there is only a small amount included. (The synthetic form of vitamin E is labeled as dl-alpha tocopherol, so be on a look out for that).

B6 and Folic acid look good, but B12 is a bit low. Also the B12 is in the cyanocobalamin form which is not the active form of B12. Methylcobalamin is the coenzyme or active form and can be used by the body immediately where as several conversions need to take place for cyanocobalamin to be absorbed and used.

The calcium amount is very low, only at 140mg and the calcium carbonate form is the cheapest and least absorbable form of calcium. Best are combinations of citrate, malate and glycinate in their chelate forms.

The iron dosage looks great, however it is not in the chelate form and may cause constipation in sensitive individuals.

Magnesium is very low. It is best to have a 2:1 or even a 1:1 calcium to magnesium ratio for proper balance but here the ratio would be 3.5:1 which is too low.

This one does have 300mg of DHA, but contains no EPA which is also essential. Furthermore, they do not list how the fish oil was extracted and purified so its quality is unknown.

As you can see, there are various problems with this vitamin, but wait, we are not yet done. Right below all the nutrient facts, we have “other ingredients”. Many people forget to read this part but it is also crucial as it contains everything else not listed above.

Other Ingredients: Soy lecithin, beeswax, fish oil, hydrogenated vegetable oil, gelatin, sorbitol, glycerin, propylene glycol, titanium dioxide, vanillin, FD&C blue No.1, hypromellose.

I highlighted each of the ingredients that pose a problem. First is hydrogenated vegetable oil. As many of my patients know, hydrogenated oils are another name for trans fats which are very toxic to the body. If you try so hard to avoid these in the diet, why take a vitamin on a daily basis that contains them?

The second problem here is FD&C Blue No 1. This is an artificial coloring agent. Many patients have sensitivities and allergies due to colorings thus taking them on a daily basis can cause problems. You may think a little coloring won’t hurt you but I encourage you to think about your size in relation to the size of the fetus.  Even if you are not sensitive to the colorings and it’s only a small amount, it can very easily affect a baby which is a fraction of your size.

Let’s look at another popular brand.  This one is actually suitable for vegetarians and vegans because it uses a plant form of essentially fatty acids.

Each Softgel capsule contains

Vitamin C (ascorbic acid, USP)………………………………………………………………………..28 mg

Calcium (tribasic calcium phosphate, NF)……………………………………………………..160 mg

Iron (ferrous fumarate, USP)………………………………………………………………………..26 mg

Vitamin D3 (cholecalciferol, USP)………………………………………………………………….400 IU

Vitamin E (d-alpha tocopherol, USP)…………………………………………………………….30 IU

Vitamin B6 (pyridoxine Hydrochloride, USP)……………………………………………….25 mg

Folic Acid, USP…………………………………………………………………………………………….1.2 mg

DHA (docosahexaenoic acid, contained in the oil derived from microalgae)….300 mg

Docusate Sodium, USP………………………………………………………………………………….55 mg

Inactive Ingredients: Ethyl vanillin, FD&C #1, FD&C red #40, FD&C yellow #6, gelatin, glycerin, lecithin, palm kernel oil, sodium benzoate, soybean oil, sunflower oil, titanium dioxide, yellow beeswax, water and white ink (ammonium hydroxide, isopropyl alcohol, n-butyl alcohol, propylene glycol, shellac glaze in SD-45 alcohol, simethicone, titanium dioxide). Contains Soy.

In this vitamin, the C and calcium are low. Iron is same as the previous one and vitamin D looks a little better. Vitamin E is natural which is good, but still low. B6 and folic acid look good. The DHA is from a plant source, but studies show it may not absorb as well and may not provide the same benefits as omegas from fish. This brand is also missing EPA.

The last ingredient is a stool softener, however if the proper chelate form of iron was used, the stool softener would not even be necessary.

Looking at the “Inactive Ingredients” you can see that this contains 3 artificial coloring agents. Since they are first on the list, they are the highest percentages. Also, this vitamin contains other oils like soybean and sunflower and while they are not hydrogenated as the previous vitamin, they are used here as fillers for the missing EPA essential oils.

Both of the above vitamins are also missing many other essential nutrients such as Zinc, Copper, Selenium and Chromium just to name a few.

As you can see from the above, these vitamins are far from superior. Take a look at your brand using the discussion above and see how it measures up.

 

What We Are Doing About This

I am excited to offer several great option for great prental care. For those interested in the most convenient option, the Prenatal Pro Essential Packets are here!

There are many advantages to our prenatals over both prescription and other store brands.

  • They contain the highest quality nutrients from several raw material suppliers that I whole-heartedly trust.

 

  • It is complete to include not only the needed folates and iron, but all the essential vitamins and minerals, the purest form of fish oil (DHA) and plenty of calcium which lacks in other vitamins.

 

  • They contain natural folates and free of synthetic folic acid. For more information about the problems with synthetic folic acid, please read the full article on the folic acid controversy.

 

  • They are designed to promote the best possible absorption. I used capsules with powder inside which is easier to digest than tablets. The pills are split up into 2 packets, morning and evening for easier compliance and each dose has nutrients that absorb better at that time of day. Calcium is known to hinder iron absorption, therefore the iron is in the morning packet and calcium is in the evening one to bypass that problem.

 

  • There are absolutely no additives, colorings, allergens or toxins of any kind as opposed to many prescription brands that contain these fillers. I get the certificates of analysis on every batch to back up this claim no matter of when they were manufactured.

 

While it is more than just one pill, patients report they are very easy to take. They are extremely gentle on the stomach and the fish oil will never repeat on you as with other brands.

Another great option for those who are not interested in packets is a combination of Prenatal Pro which supplies all the essential vitamins and minerals and OmegAvail Ultra for the essential fatty acids.

If you have any questions about our prenatals, please do not hesitate to contact us.

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