Your Prenatal Vitamin Needs a Check-up

Hi this is Dr Tod Cooperman of ConsumerLab

com and I'm happy to be here live on Facebook tonight talking about prenatal vitamins because there's been a lot of change in terms of what really should be in a prenatal vitamin and the fact that many of the prenatal vitamins on the market today don't contain what has been lately really recommended to be in a prenatal vitamin So what we're going to do tonight is really go over a few things First of all, should you even take a prenatal vitamin — do you need one? So really I want to talk about three critical ingredients in a prenatal vitamin We'll talk about some others as well, how to look for these in a prenatal vitamin, how you can get them if they're not in a prenatal, and you are pregnant or about to become pregnant, and we'll talk a little bit about women who are breastfeeding, so during lactation, and how you can get these ingredients from products on the market if it's not already in the prenatal you're taking So really the first thing to know is that do you need to take a prenatal? The answer is yes

You do need to take a prenatal vitamin I'll get into really why that's so important to you if you are pregnant or as I said about to become pregnant, because really the time around preconception can be just as important as during pregnancy itself And during pregnancy you're not only feeding the fetus but you're also going to be losing a lot of those nutrients from yourself which makes it twice as important to make sure you're getting enough of critical nutrients Now the first one to talk about, in the first nutrient, is folic acid Probably everyone's heard folic acid is critical

It prevents, reduces the risk of neural tube defects, spina bifida, which is the leading cause of paralysis in childhood The folic acid that's in most supplements is actually a synthetic form of folate Folate is found in green leafy vegetables, but what's interesting about folic acid and why it's in so many supplements is that it's actually absorbed much better than natural folate, because you have to actually extract that natural folate from these leafy vegetables If you take folic acid and you take a food that has folate in it I'm just looking at a question here: "I read too much folic acid causes harm" That's true and I'm going to get to that as well, so thank you Mike for asking that question So basically when you take a synthetic form of folate, such as folic acid or methylfolate, which is just as good and for some people might even be a little better, you actually absorb more You absorb almost twice as much

In fact if you take it on an empty stomach, you're absorbing twice as much folate from folic acid as you would from natural forms On average you're getting about 70 percent more of folate from folic acid And so the reason why it's recommended that pregnant women take folic acid, it's a really guarantee that they're going to get that folate, and the requirement for folate increases with pregnancy from the normal 400 micrograms per day to 600 micrograms per day And what is recommended is that still get your folate from your green leafy vegetables and other natural sources but you're also getting an additional 400 micrograms every day from a supplement Now a problem, and as Mike pointed out in one of the comments, is that nearly all the products on the market as far as we've seen contain too much folic acid

They contain 800 micrograms of folic acid even though 400 microgramsis the recommended amount I believe the basis for that is really just "more is better" philosophy, and frankly many marketing people feel also — people gravitate toward higher levels — but that's really more than you need In fact since you're absorbing more of the folic acid when you get it from a supplement rather than from a food, that 800 micrograms is actually becoming something more like 1,400 or 1,500 micrograms On top of that, most manufacturers are putting in an overage I'm just going to read a comment, as noted there you can actually read more about everything I'm talking about on ConsumerLabcom, which I failed to mention at the beginning I am the president of ConsumerLabcom all this information is published on the website

It is a membership-based website, you need to subscribe It's currently 39 dollars per year and there are reports on multivitamins, including prenatals, there are reports on B vitamins including folic acid, and the other things that I'll be talking about So getting back to folic acid, manufacturers actually put in more than is on the label, typically 25 – 30% is not unusual as an overage, and that's to make sure that the product contains a hundred percent of what it claims all the way through its life, while sitting there on the shelf So if you're buying a folic acid product, a prenatal, early on, it just kind of came out of the factory, and hit the shelves and it says 800 micrograms of folic acid you're probably getting over 1,000 micrograms of folic acid, which really translates to over 1,700 micrograms of folate Now the upper limit for folate is just a thousand micrograms

Above that it can interfere with diagnosis of certain types of anemia and in fact, there was a small and it's a preliminary study that was done in Baltimore among pregnant women there by researchers at Johns Hopkins, who actually founded a doubling in the risk of autism in the children of women who had particularly high levels of folate in their blood, probably due to taking high potency prenatal vitamins In fact the risk was double when folate levels were high and the risk was seventeen and a half times as high when levels of B12 were also high in conjunction with the folate being high So you don't want to overdo it on folic acid At the same time you absolutely want to get folic acid in a supplement because you will reduce your risk of autism in children and spinal cord defects and other potential birth defects etc, by getting at least the 400 micrograms of folic acid, but just don't overdo it

That's enough on folic acid We're going to move on now to iodine Iodine is also important to the development of the fetus The problem though is that although we have been putting iodine into salt — we iodize table salt in America — the salt that's used in creating prepared foods is not iodized You don't get iodine from from the salt in prepared foods, you don't get iodine from the specialty salts that have become popular, Himalayan salt etc

So what is happening is that about a third of the women in America who are pregnant are probably are not getting enough iodine And this is a problem around the world So it's been recommended just in 2014 that prenatal vitamins also include iodine, 150 micrograms per day of iodine, and that's typically in the form of potassium iodide And so you're getting about 197 micrograms of potassium iodide to give you this 150 micrograms of the iodine So you absolutely want to make sure that you're getting iodine

I see another question: "Are prenatal vitamins really necessary? Can't my wife get the necessary folic acid and iodine with multivitamins? It seems like prenatal ones are overkill" That's an excellent point and that's really my feeling as well Mike, is that some of the prenatals are overkill, in fact, some and at the same time they're underkill , as I'll be getting into And a combination of using a good general multivitamin and supplementing it with some other ingredients may be the best way to go at this point, especially since the products on the market have not yet caught up to the science Now the third thing that you want to look for in a prenatal vitamin, or right now they're really not in them but you want to get them in the future, and you want to get them now through some other source, is choline And it was just last month there was a vote at the annual conference for the American Medical Association

It was recognized that all prenatal vitamins should contain choline Choline is also required for proper brain development It's found in phosphatidylcholine which is part of the cell walls, the cell membrane in every cell in your body, so you need to get choline And it's been recognized that many Americans are not getting enough choline, and this is particularly important for pregnant women The average young woman gets about 280 milligrams of choline from their diet per day – and you can get this from meats and egg etc

– but you really need about 400 to 450 milligrams per day if you're pregnant, and 550 milligrams if you're lactating Just going to check and as noted there you can read more about iodine and choline and all this on ConsumerLabcom So choline is very important Now the American Medical Association didn't mention yet how much choline should be in prenatal vitamins but if you do the math basically you want to get what's missing from the diet

So if the average American diet has about 280 milligrams of choline and you need 450 milligrams you know you need about 200 milligrams, 250 milligrams of choline if you're pregnant and you want to bump that up to almost 300 milligrams if you're lactating So those are really three very, very important ingredients that you probably are not going to find in totality in the prenatal vitamins on the market today In fact, one of the products that we've tested,this is from a product called VitaFusion prenatal vitamins, which are commonly available This was actually a product that we tested two years ago We're currently testing multivitamins again today and we'll be putting out a new report on multivitamins in about two months, so sometime toward the end of this summer

Let me show you what is in this prenatal vitamin And hopefully you can see this, well I will read this to you but basically the amount of folic acid as I mentioned if you can see this, is 800 micrograms, so that's twice as much folic acid as you want to see in a prenatal vitamin Second of all, choline which we just talked about, and where I said you probably want roughly 200 milligrams of choline, well this product to its credit, does have some choline but it's only 10 milligrams So you need to get more choline than that to come close to the recommended daily intake for choline for pregnant women In addition iodine is something which we mentioned earlier, you need to get 150 micrograms of iodine per day from a supplement and on top of that you need to get some from your diet as well

Nowhere on here is iodine> So here's a prenatal vitamin that's on the market that really is not going to give you the iodine, it's not going to give you the choline, and it's going to give you more folic acid then you need So just some other ingredients that you need to keep in mind in terms of what you need in a prenatal vitamin is iron — the need for iron increases during pregnancy — normally it's about 18 milligrams of iron per day You want to increase that to about 27 milligrams of iron during pregnancy You can do that by eating more meat — red meat is a good way — you can take an iron supplement — we have a whole review on ConsumerLab of iron I'm just going to get another question: "If the supplement has folate, 5-MTHF (L-5-Methylfolate) how much would the recommended dosage be?" Good question

So L-5- Methylfolate is another form of folate It's another synthetic form of folate It's also absorbed very well just like folic acidThere may be some benefits to it but the dosage is exactly the same as what I said when you're dealing with folic acid You want 400 micrograms of methylfolate from that supplement

So good question — methylfolate and folic acid both synthetic forms, both absorbed much better than folate from food So sorry getting back to iron, you need iron, you need an increased amount of iron as well Other things that increase, your needs for other B vitamins, thiamin, riboflavin B6, they go up by about 50% You can get that from more typically again, green leafy vegetables from your diet or from a good general daily multivitamin In terms of other ingredients that you want in a multivitamin

we'll talk about omega-3s next because that was really the other common question is "Omega-3s — do I need more fish oil, EPA and DHA during pregnancy?" Well it's interesting, you do need DHA in building the brain, that's a known fact However, and studies have not shown an increase in mental ability and functioning in infants or children of mothers who have taken fish oil and DHA supplements However, at the same time, some studies have shown a decrease in the incidence of preterm births and there's somewhat of a reduction in allergies and colds in offspring of women who have taken fish oil supplements

So there may be some benefit It's not it's not going to make your child a genius, taking fish oil supplements, but if you don't eat fish and if you're going to eat fish while you're pregnant — obviously you want to go for the fish with lower levels of metals in them, of mercury in them — fish oil supplements don't have any mercury in them We've tested hundreds of them and the reason is that mercury binds to protein, protein is the same as muscle in fish There's no protein or muscle in fish oil supplements It's all the oil, so they're very clean and very safe

So it's perfectly fine to take a fish oil supplement or prenatal that has fish oil in it, and we have tested some if you look at our fish oil review, you'll find regular fish oil supplements, plus prenatals that contain fish oil, but again, it's not essential It can't hurt and there might be some slight benefit to taking omega-3s The last thing actually is vitamin C Vitamin C, the need for it, increases slightly during pregnancy, but it increases greatly during lactation, during breastfeeding So if you are breastfeeding you should bump up your vitamin C

You can certainly get that from citrus fruits or a vitamin C supplement You don't need mega amounts because there is a downside to that as well So just to sum up — do you need to take a prenatal? I would highly recommend that you take a prenatal vitamin if you're about to conceive or you are pregnant, that you take either a prenatal or some other type of supplement that will provide 150 micrograms of iodine, at least about 200 milligrams of choline, as well as 400 micrograms of folic acid, and then bump up your intake of iron and your intake of B vitamins as well So that pretty much wraps up what I wanted to talk about this evening in terms of prenatal vitamins If you have any questions, you can always post them below this video which we will put up on Facebook, on our site, as well as on YouTube, where you can comment there as well

And feel free to share this with with any friends who may be interested Excuse me, one other question: "Please could you suggest some brands which contain the best amounts as discussed?" Unfortunately I would love to recommend a product that contains all these qualities, the right amounts of all these ingredients — it doesn't exist as far as we have found at the moment We're going to be putting out a report in about two months toward the end of the summer that summarizes what's in all the current major prenatal vitamins and you can see there what comes closest and what you need to still supplement with in order to get where you want to be And again, it might require just taking a good general prenatal, a good general multivitamin — and you can look at our multivitamin report there — even like a women's one-a-day will contain many of the ingredients I believe it contains the iodine and the folic acid, but probably not the choline, which you'll need to get elsewhere

One more thing on choline, if you are going to take choline — and they do suggest it — you don't want to take it forever There is some evidence coming up suggesting that there might be a negative cardiovascular effect from taking choline chronically over the years It increases something called TMAO, which may increase atherogenicity of the blood, basically, a possibility that it might actually stimulate atherosclerosis, but I wouldn't worry about that I think it's much more important that you get the choline for the benefit of your infant during pregnancy and lactation One other question: "My daughter takes Usanimals while pregnant

" I don't recall if we've looked at Usanimals or not but what I would recommend is that you do look at our report in terms of multivitamins, look at our free page we have a whole free beautiful table of the RDAs (recommended daily intakes) for everyone based on age and gender, pregnancy, lactation, and you can see I'll get to Mike's other question there about over-the-counter versus prescription, I believe in any event, on our site if you go to wwwconsumerlab

com/RDAs/ you can actually find out exactly what you need at different stages in your life and then compare that to what's in Usanimals or whatever product you're taking So that's just a free service that we offer, please take advantage of that as well Now: "What was the difference between over-the-counter vs prenatals that need an Rx (prescription)?" We have also looked at some of the prescription vitamins I am not sure that at this point they provide choline, or at least at the level that they should be

I believe that's something that's going to come down the line But some of the over-the-counter products do contain what they claim The quality can be just as good as a prescription product, you don't have to get a prescription product The most important thing is making sure that the product contains the key ingredients So again this is Dr

Tod Cooperman, president of ConsumerLabcom, on Facebook live And again, feel free to post comments questions — we'll try to respond — and feel free to share this with others Thank you

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