Dr. Tori Hudson, N.D.

As the saying goes, you usually get what you pay for. But just so you know what you’re paying for, multivitamin-mineral supplements vary in four basic ways:

1. ingredients
2. potency
3. quality
4. manufacturing process

In general, however, basic mass-market multiples are often sold at a lower price because they are inferior in one or more of those four basic ways. Typically, they omit mixed carotenoids, bioflavonoids and smaller minerals and nutrients such as vitamin K, boron and iodine. Because they contain fewer ingredients, and often not some of the premier more costly ingredients such as CoQ10, they are less expensive. One of the most striking differences is the amount of individual ingredients. For instance, vitamin D may range from 100 IU to 400 IU; calcium may vary from 200 mg to 500 mg. Taking one capsule/tablet per day may be what is written on the label, but serving sizes may be 2 or 3 capsules in order to get the total on the label. The point is, read the label carefully so you are taking the number of capsules you need to take, in order to get the dose on the label. Many of the vitamins and minerals are available in more than one form and some are more bioavailable than others. Bioavailability is determined by absorption or more efficient use by the body. For instance, calcium carbonate is usually less expensive, but for some people it is constipating and they do better with calcium citrate – this is not necessarily more expensive, but it is a bulkier form of calcium with less elemental calcium per pill, so you have to take more pills to get the dose you have targeted. Many vitamins are synthetic and aren’t available in natural forms. Beta carotene for example comes in a natural or synthetic form and better yet, some multiples contain natural mixed carotenoids and the natural form of other vitamins, which provide additional more potent antioxidant effects. Processing methods also vary, and some of those methods expose the nutrients to greater heat less stable conditions, and use additives and dyes which can render them with less nutritional value.

One capsule/tablet per day mass market multis are usually very low potency, contain the less desired form of the nutrient, omit some important ingredients that would be optimal for a daily vitamin, and contain unnecessary additives. Look for multis where the serving size is 2 or 3 capsules per day, have mixed natural carotenoids, have some of the extras such as bioflavonoids, vitamin K, boron, iodine and then you have to be a bit studious in order to learn about the more bio-available forms of nutrients. The book, Encyclopedia of Nutritional Supplements by Michael Murray, N.D. is an excellent resource for this.

Thirty-two hirsute women with polycystic ovary syndrome (PCOS) were studied in an open-label clinical trial. All the women were given 100 mg of spironolactone per day while sixteen of them also received 3.5 g/day of a licorice root extract standardized to 7.6% glycyrrhetinic acid. Study duration was two months. Systolic blood pressure significantly decreasd at 30 and 60 days in the women taking spironolactone (SP), but not in the SP plus licorice group. Diastolic blood pressure did not change in either group. Twenty percent of the women in the SP only group had fatigue, orthostatic symptoms and polyuria. These were most significant in the first two weeks of treatment but diminished over the course of the study. Women in the SP and licorice group did not report any of these side effects. Plasma rennin activity and aldosterone were more increased in the SP only group compared with the other group. There were no changes in SHBG in either the SP only group or the SP plus licorice. Plasma cortisol increased in both groups after 30 and 60 days.

Armanini D, Castello R. Scaroni C, et al. Treatment of polycystic ovary syndrome with spironolactone plus licorice. Eur J Obstet Gynecol 2007;131:61-67.

Commentary: It’s very useful to find a second study on licorice and it’s role in PCOS. Glycyrrhetinic acid has been shown to reduce serum testosterone and induce regular ovulation. (Yaginuma T, Izumi R, Yasui H, et al. Effect of traditional herbal medicine on serum testosterone levels and its inductions of regular ovulation in hyperandrogenic and oligomenorrheic women. Nippon Sanka Fujinka Gakkai Zasshi 1982;34:939-944) ( Takahashi K, Yoshino K, Shirai T, et al. Effect of a traditional herbal medicine on testosterone secretion in patients with polycystic ovary syndrome detected by ultrasound. Nippon Sanka Fujinka Gakkai Zasshi 1988;789-92.)

Spironolactone is often used as part of a treatment plan in PCOS women with bothersome hirsutism. While Spironolactone can be helpful, fatigue and polyuria are a frequent side effect. It may be that licorice and glycyrrhetinic acid have a potential synergistic effect on the androgen receptors, reduce the side effects associated with Spironolactone, as well as reducing serum testosterone and inducing regular ovulation. Licorice extract along with a lower carbohydrate/higher protein diet, therapies that increase SHBG such as nettles root, green tea, flax seeds and soy and insulin sensitizing strategies such as daily aerobic exercise, fenugreek powder, cinnamon extract, d-pinitol, chromium (and possibly glucophage) offer a comprehensive approach for women with PCOS.

In order to evaluate the efficacy of a topical green tea extract, researchers conducted a randomized, double-blind, vehicle (placebo)-controlled trial involving 502 men and women aged 18 and older. Participants were clinically diagnosed with 2 to 30 external genital and perianal warts and were randomly assigned to receive sinecatechins ointment 15%, sinecatechins ointment 10% or vehicle (placebo). The duration of treatment was a maximum of 16 weeks or until there was complete clearance of all baseline and new warts, whichever occurred first, followed by a 12 week treatment free phase at which time wart recurrence was assessed.

Seven patients were excluded from analysis and the results were based on 495 patients (254 men and 241 women). Baseline warts were mainly on the vulva (41.2% of women), and penile shaft (36.9% men), followed by the perianal area (18.1% total), perineal area (15.3% total) and glans penis (11.8% men).

Complete clearance of all baseline and newly occurring warts occurred in 57.2% and 56.3% of patients treated with both 15% and 10% sinecatechins ointment compared with 33.7% for the vehicle (both P

Tatti S, Swinehart J, Thielert C, et al. Sinecatechins, a defined green tea extract, in the treatment of external anogenital warts. ObGyn 2008;111:1371-1379.

Commentary: External genital warts are one of the most common sexually transmitted infections, yet no single treatment has emerged as delivering the best outcomes. Options include herbal topical applications of thuja, licorice root and vitamin A, homeopathic medicines, and conventional treatments including podofilox solution or gels, imiquimod cream, trichloroacetic acid, cryotherapy, curettage, electrosurgery, excision, laser therapy, interferon and 5-fluorouracil gel.

This study is one of two independent phase III studies to establish efficacy and safety of sinecatechins ointment. Overall, patients in both the 15% and 10% ointment group had a significantly higher number of complete clearances of baseline warts and a lower number of recurrent lesions during the 12 week treatment free follow-up period. The results were better in women than in men, likely due to the greater keratinization of the skin on the penile shaft. Based on clearance rates of all warts, a 50% success was achieved in almost 80% of patients in both sinecatechins ointment strengths. Recurrence rates are higher in cryotherapy, imiquimod and podofilox. The results of the current study indicate that a green tea extract ointment standardized to 15% or 10% sinecatechins is a very effective topical treatment to clear warts, inhibit new external anogenital warts and keep patients wart free.