Vitamin aisles at pharmacies typically contain a daunting amount of options. There are standard multivitamins, multivitamins with multiminerals, men’s multivitamins, women’s multivitamins, prenatal vitamins, children’s vitamins, silver multivitamins, various specialty vitamins, and so on. To make matters more confusing, these are all also available in multiple brands with differing ingredient combinations.
There’s no singular definition of what a “typical” adult multivitamin contains. However, many adult multivitamins contain some combination of vitamin A (retinol), vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B5 (pantothenic acid), vitamin B6 (pyridoxine), vitamin B7 (biotin), vitamin B9 (folic acid), vitamin B12 (cobalamin), vitamin C (ascorbic acid), vitamin D, vitamin E, vitamin K, calcium, iron, phosphorus, iodine, magnesium, zinc, selenium, copper, chromium, manganese, and/or potassium.
Multivitamins that are intended for use in individuals aged 50 years and older are commonly referred to as “silver” multivitamins. Silver multivitamins are similar to standard adult multivitamins, but they typically have higher doses of certain components and/or a few additional ingredients.
As adults become more advanced in age, certain body functions begin to decline. Silver multivitamins contain additional components or higher doses of certain ingredients compared to standard adult multivitamins that help to promote the health of body functions commonly impacted by age.
Specifically, silver multivitamins have additional ingredients that may aid the overall health of eyes, bones, the brain, and the heart. Similarly, some silver multivitamins have a special coating that aids in swallowing and/or digestion of the vitamin. Of note, the exact components of a silver multivitamin vary by brand and formulation. This discussion entails common trends among silver multivitamins.
Eye Health: Vitamin A, Vitamin C, Vitamin E, Lutein, and Lycopene
According to the American Optometric Association, in the years after an individual turns 60, a number of eye conditions may develop. Multivitamins with additional ocular-focused ingredients can be beneficial for eye health over time.
Vitamin A, vitamin C, and vitamin E are common ingredients in standard adult multivitamins. Vitamin A and beta carotene go hand-in-hand, and that is because the human body converts beta carotene into vitamin A. Vitamin A acts as an antioxidant, it helps to produce pigments for the retina, and it aids with proper eye lubrication. Vitamin C is noted to help the health of blood vessels in the eye. Vitamin E is an antioxidant with support that it may reduce the progression of age-related macular degeneration and cataract formation.
Lutein and lycopene are not ingredients typically found in many standard adult multivitamins, but they are found in most silver multivitamins. Lutein and lycopene are carotenoids that act as antioxidants that are noted to be beneficial for eye health. There is support that lutein and lycopene may reduce the risk for the progression of age-related macular degeneration and cataract formation.
Using Centrum Adult vitamins versus Centrum Silver vitamins as a comparative example, there are the following key differences between the two formulations:
- Vitamin A: Centrum Adult has a dose of 3,500 IU (29% beta carotene) vitamin A whereas Centrum Silver has a dose of 2,500 IU (40% beta carotene) vitamin A. Note the higher concentration of beta carotene in Centrum Silver.
- Vitamin C: both Centrum Adult and Centrum Silver contain a dose of 50 IU vitamin C. Other silver multivitamins from different brands may contain a slightly higher dose of vitamin C than a comparator standard adult multivitamin.
- Vitamin E: Centrum Adult has a dose of 30 IU vitamin E whereas Centrum Silver has a dose of 50 IU vitamin E. Note the higher concentration of vitamin E in Centrum Silver.
- Lutein: Centrum Adult does not contain lutein whereas Centrum Silver contains 250 mcg lutein.
- Lycopene: Centrum Adult does not contain lycopene whereas Centrum Silver contains 300 mcg lycopene.
Bone Health: Vitamin D and Calcium
Bone cells undergo a constant process of being broken down and being reproduced. As individuals become more advanced in age, these bone cells tend to be broken down at a higher rate than they are reproduced. Because of this, bone health can decline with age and it can lead to conditions such as osteopenia and osteoporosis.
Two key nutrients to help aid bone health are calcium and vitamin D. These two ingredients are commonly seen together as vitamin D helps the body absorb calcium. Calcium is essential for bone health, but supplemental calcium isn’t helpful if there isn’t enough vitamin D to allow bones to absorb it.
Again using Centrum Adult vitamins versus Centrum Silver vitamins as a comparative example, there are the following key differences between the two formulations:
- Vitamin D: Centrum Adult and Centrum Silver both have a dose of 1,000 IU vitamin D. It is common to have Vitamin D dosing be consistent between the different vitamin formulations, but occasionally silver multivitamins may have a higher dose of vitamin D than a comparator standard multivitamin.
- Calcium: Centrum Adult has a dose of 200 mg of calcium whereas Centrum Silver has a dose of 220 mg calcium. As women are at an increased risk of developing osteoporosis compared to men, Centrum Silver Women has a dose of 300 mg calcium whereas Centrum Silver Men has a dose of 210 mg calcium.
Brain Health: Zinc and B Vitamins
Of all of the body functions that are affected by age, brain health is often the first one that comes to mind. Simply put, as adults age, brain function declines for a variety of reasons.
As neurology and psychiatric research has progressed, the role of zinc in neuropsychiatric disorders has been increasingly studied. Although its specific role is still being studied, it is noted that a zinc deficiency may play a role in various neuropsychiatric disorders and memory deficits. Similarly, it is thought that certain B vitamins may help to break down homocysteine. Homocysteine accumulation has been linked to an increased risk of dementia and stroke. However, this association is not proven.
Again using Centrum Adult vitamins versus Centrum Silver vitamins as a comparative example, there are the following key differences between the two formulations:
- Zinc: both Centrum Adult and Centrum Silver contain 11 mg zinc. Other silver multivitamins from different brands may contain a slightly higher dose of zinc than a comparator standard adult multivitamin.
- B Vitamins: see the below listing for a breakdown of various B vitamins in the Centrum formulations.
Heart Health: B Vitamins and Omega-3 Fatty Acids
As individuals age, the heart may become more rigid, not as efficient, and different electrical impulses within the heart may become altered. Thus, people of advanced age are more at risk to suffer a heart attack, coronary heart disease, or heart failure compared to younger individuals.
Similarly to the section above, B vitamins are thought to have a role in decreasing homocysteine levels in the body. Relative to the heart, it is thought that homocysteine accumulation may slightly increase the risk of heart attacks, coronary heart disease, and heart failure.
Even though a few observational studies signify a slight cardiac benefit with B vitamins, one meta-analysis found that B vitamin supplementation is not associated with a reduction in major adverse cardiovascular events, cardiac death, heart attack, or stroke. However, because there is a proposed association, many vitamin producers still place slightly higher doses of B vitamins into their silver multivitamins compared to their standard adult multivitamins.
Separately, the three primary omega-3 fatty acids are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). The human body does not produce omega-3 fatty acids naturally. Instead, they are consumed in the diet or via nutritional supplements.
Omega-3 fatty acids are included in some silver multivitamins because they are thought to slightly reduce triglyceride levels, slow the buildup of plaque in arteries, and reduce the risk of developing arrhythmias (irregular heart beats).
Again using Centrum Adult vitamins versus Centrum Silver vitamins as a comparative example, there are the following key differences between the two formulations:
- Vitamin B1 (thiamine): both Centrum Adult and Centrum Silver contain 1.5 mg thiamine. Other silver multivitamins from different brands may contain a slightly higher dose of thiamine than a comparator standard adult multivitamin.
- Vitamin B2 (riboflavin): both Centrum Adult and Centrum Silver contain 1.7 mg riboflavin. Other silver multivitamins from different brands may contain a slightly higher dose of riboflavin than a comparator standard adult multivitamin.
- Vitamin B3 (niacin): both Centrum Adult and Centrum Silver contain 20 mg niacin. Other silver multivitamins from different brands may contain a slightly higher dose of niacin than a comparator standard adult multivitamin.
- Vitamin B5 (pantothenic acid): both Centrum Adult and Centrum Silver contain 10 mg pantothenic acid. Other silver multivitamins from different brands may contain a slightly higher dose of pantothenic acid than a comparator standard adult multivitamin.
- Vitamin B6 (pyridoxine): Centrum Adult contains 2 mg pyridoxine whereas Centrum Silver contains 3 mg pyridoxine.
- Vitamin B7 (biotin): both Centrum Adult and Centrum Silver contain 30 mcg biotin. Other silver multivitamins from different brands may contain a slightly higher dose of biotin than a comparator standard adult multivitamin.
- Vitamin B9 (folic acid): both Centrum Adult and Centrum Silver contain 400 mcg folic acid. Other silver multivitamins from different brands may contain a slightly higher dose of folic acid than a comparator standard adult multivitamin.
- Vitamin B12 (cobalamin): Centrum Adult contains 6 mcg cobalamin whereas Centrum Silver contains 25 mcg cobalamin.
- Omega-3 Fatty Acids: neither Centrum Adult nor Centrum Silver contain omega-3 fatty acids. However, many other silver multivitamins contain omega-3 fatty acids.
Pill Coating Considerations
As individuals age, it may become harder to physically consume pills. Because of this, some vitamin producers place a smooth coating onto their silver multivitamins for the sake of easier swallowing and digestion. Typically, this smooth coating is a synonym for the multivitamin having an enteric-coated or film-coated surface.
Like the name implies, these types of tablets have a very thin coating placed over the tablet that consists of polymer(s), plasticizing agent(s), glidant(s), colorant(s), and flavor(s).
Polymers compose the backbone and stability of the coating. Examples of polymers are hydroxypropyl methylcellulose (HPMC) and hydroxypropyl cellulose (HPC). Plasticizing agents improve the elasticity of the coating. Examples of plasticizing agents are polyethylene glycol (PEG), acetylated monoglycerides, mineral oil, and vegetable oil. Glidants make the coating smooth in texture. Examples of glidants are carnauba wax, talc, and stearates.
Overall, silver multivitamins are recommended for most individuals over 50 years of age. However, taking a multivitamin of any type does not serve as a replacement for having a well-balanced diet.
Future Pharmacist Consult articles will discuss the differences between other types of specialty multivitamins.
References:
- Dietary Supplement Fact Sheets. Office of Dietary Supplements. National Institutes for Health. Accessed 26 April 2020.
- Pharmaceutical Excipients. American Pharmaceutical Review. Accessed 26 April 2020.
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