• Taylor Leahy - Dietitian

Are Liquid Vitamins Better for POTS?

Do you find yourself struggling to get your nutrient requirements, or do you worry that you may be deficient in certain vitamins? For individuals with Postural Orthostatic Tachycardia Syndrome and gastroparesis, this may be an all too common struggle. Gastroparesis (or delayed stomach emptying) is one of the most common conditions associated with POTS, and is thought to be due to autonomic denervation with possible links to other comorbid conditions. In addition to gastroparesis, individuals may suffer from diarrhea, vomiting, nausea, or other gastrointestinal abnormalities. Gastroparesis – whether presenting with other GI abnormalities or not – can severely influence the stomach's capacity for food and can often lead to severe malnutrition and weight loss. This is understandable, and if you’ve ever been forced to take a second or third helping of food by your well-meaning Grandma, you’ll know that once you feel full, even the thought of food makes you feel queasy.

Once you understand gastroparesis, it’ll come as no surprise that many individuals turn to supplements as a way of ensuring they stay up to par with their nutrient needs. Supplements are very popular among consumers, with many brands offering a unique combination of vitamins and minerals – so much so that shopping for supplements has become overwhelming. So which supplements work well with gastroparesis and POTS?

Before we take a look at specific brands, let’s first understand which specific nutrients should be prioritized for someone with gastroparesis. The most common nutrient deficiencies for someone with gastroparesis is iron, vitamin D, calcium, and vitamin B12. These nutrients are typically found in meats, leafy vegetables, and fortified milk – all food groups known to exacerbate gastroparesis symptoms. Their absorption can also be impacted by taking acid reducing medication which are common when having chronic vomiting. When choosing a supplement, look for these four primary nutrients. Often, calcium and iron will not be found in the same supplement as calcium inhibits the absorption of iron. For supplements with iron, taking it on an empty stomach can enhance absorption, however if GI intolerance occurs, take it with food; specifically higher acidic foods such as citrus or tomatoes which help iron have higher absorption.


Pills or Liquid?

Normally this might be based on personal preference, but for those with gastroparesis, liquid supplements can be better tolerated. Liquid supplements also have better bioavailability – meaning they don’t need to be broken down, so they are easier to absorb. For those with gastroparesis this is a big component to consider. Liquid supplements can also be added to juice, water, or smoothies, making them easier to consume than a large chalky pill.



Liquid Multivitamin Options

Source: Amazon.com

Nature’s Way Alive! Multivitamin Max Potency seems like an almost all-in-one option for individuals with gastroparesis. Many vitamin supplements contain upwards of 1000% of your daily vitamin needs, and despite what this seems, this isn’t exactly a good thing. Since the body can only absorb small amounts of vitamins at a time, bombarding the body with high amounts is wasteful – as most of the excess will be excreted in the urine or feces.

This multivitamin for the most part does not have astronomically high percentages of vitamins, meaning it’s a relatively good bang for your buck. It provides over 100% Daily Value for calcium, and B12, while providing 50% Daily Value for Vitamin D. This supplement has no iron, and it’s not verified by USP or NSF, although the company has been analyzed by Labdoor, an independent lab that determines product quality. They ranked Nature’s Way Alive as the second best multivitamin in 2014. You can snag this multivitamin on Amazon for $27.43 per 30oz bottle, and it comes in a citrus or berry flavor.


Source: Amazon.com

Mega Premium Liquid Multivitamin seems like another good option for individuals with gastroparesis. Unlike Nature’s Way, this multivitamin contains 33% Daily Value for iron, while also providing Vitamin D and B12. Be wary though, this supplement claims to provide 3333% of the Daily Value for Vitamin B12, and you will definitely not absorb all of that. This product provides excess amounts of several other vitamins seen throughout the nutrition label on this product.

Mega Premium has a similar serving size as Nature’s Way (2 tbsp) and is roughly the same price at $29.95 per 32oz bottle on Amazon. Unlike Nature’s Way, this supplement is verified by GMP -- meaning the company uses good manufacturing practices – but is not certified by USP. Mega Premium comes in a citrus flavor.


Source: Amazon.com

Garden of Life Vitamin Code Raw Liquid Multivitamin is a unique supplement as it provides many of its vitamin and minerals through the inclusion of probiotics, and while other multivitamins contain processed ingredients, the ingredients for this supplement seem to be derived from common household foods such as apple cider vinegar and lemon juice. This supplement contains over 100% Daily Value for Vitamin D, and B12, while also providing 33% Daily Value of calcium, and a very small amount of iron. Given that calcium is present this can inhibit the absorption of iron.

Garden of Life has the same serving size as the supplements analyzed above, but is slightly more expensive at $35.39 for 30 oz. The company offers several flavors including orange mango, and fruit punch. It is not verified by USP, NSF, or GMP.




Source: Amazon.com

Centrum Liquid Multivitamin is a great alternative for someone who may not be able to tolerate the 2 tbsp serving size of the supplements reviewed above, as Centrum’s serving size is 1 tbsp. That being said, it only provides 50% Daily Value for Vitamin D and iron, while also providing over 100% Daily Value for Vitamin B12. This supplement does not contain calcium, nor has it been verified by USP, NSF, or GMP. It’s also the only liquid multivitamin reviewed that contains 6% alcohol per bottle. It comes in a citrus flavor and you can buy it on Amazon for around $13.00.








Other Options?

It’s important to note that at the time this article was written, no liquid multivitamins on the market have a USP seal. A USP seal indicates that a product has been verified by an outside company, and it has been tested to confirm the safety of the product and the supplement ingredients. In the United States, supplements are considered food and do not require FDA approval before being sold to customers. This means that the supplement manufacturer is responsible for ensuring the product is safe to consume and contains everything it advertises. Although some manufacturers maintain safe practices, others don’t. If a supplement has a USP seal, it has gone through rigorous testing to ensure that it is safe and meets USP standards.


Softgels and Gummies

It’s understandable then, that many consumers may want to stick with a supplement that ensures safety and reliability. For those with gastroparesis, multivitamin gummies and softgels are a good alternative to liquid. Gummies and softgels require more digestion than their liquid counterparts, so they may not have as high of an absorption rate especially for those with GI disruptions.


Advantages of Softgels and Gummies

Softgels and gummies are more shelf stable compared to liquid multivitamins. Since they’re sold in a solid form, the ingredients stay fresher for longer whereas liquid multivitamins have a shorter shelf life once opened. Softgels and gummies may also be better tolerated in terms of flavor, as liquid multivitamins can have intense flavors that may not be tolerable for some.


Gummies tend to be sweeter mainly due to the lack of metallic tasting minerals (such as iron) and the addition of sugar. Many gummy multivitamins are incomplete due to the limitation of minerals that can be added without altering the taste. Softgels tend to have no flavor, as they’re usually taken like a regular pill.


Softgels and Gummy Options


Source: Amazon.com

Nature Made Multi Complete Softgels

Nature Made is a trusted brand of supplements that has consistent USP verification, and this specific supplement is no different. Nature Made Multi Complete softgels contain 22 key nutrients, including over 100% the Daily Value for Iron, B12 and Vitamin D. This supplement also contains 8% the Daily Value for calcium, although iron is present in the same supplement so it is unclear how well the calcium would be absorbed. The serving size is 1 softgel, and one bottle is $8.99 for 60 capsules. You can snag this great option from Amazon.


This brand also provides gender specific multivitamin soft gels with the same USP certification. Note that the Nature Made Multi For Him does not contain iron, while the Nature Made Multi For Her does. These multivitamins have a similar composition to the multi complete, with some small variations in nutrient content. The same brand has Multi For Her 50+ and Multi For Him 50+ that are also USP certified and have higher concentrations of B12 to improve absorption in older adults. Gender specific supplements are not necessary but may be beneficial for older adults and those with a doctor’s recommendation. You can find all of these Nature Made options on Amazon.


Source: Amazon.com

Kirkland Adult Multi Gummies

Kirkland is another trusted brand that many individuals are familiar with. These Kirkland Adult Multi Gummies are USP verified, contain 100% of the Daily Value for Vitamin D, and over 100% of the Daily Value for Vitamin B12. The downside to this gummy is the lack of iron and calcium, which were probably excluded due to their characteristic taste. These gummies come in a bottle of 160 gummies with flavors like mixed berry, tropical fruit, and strawberry. The serving size is 2 gummies, and each serving has 15 calories and 2g added sugar. You can buy them from Amazon in a 2 pack for $19.00, or from Costco in a 2 pack for $14.99.



Vitafusion Adult Gummies

These Vitafusion Adult Gummies are very similar to the Kirkland Adult Multi in that they lack iron and calcium. Vitafusion gummies provide over 100% of the Daily Value for vitamin D and vitamin B12. It appears as though the overall makeup of these supplements are extremely similar, with an overall similar composition of nutrients. Vitafusion Adult Gummies are also USP verified. Vitafusion has a 2 gummy serving size, and each serving has 15 calories with 3g of added sugar, which is 1 more gram added sugar compared to the Kirkland Adult Multi. Vitafusion also contains tree nuts, while the Kirkland brand does not. You can buy Vitafusion Adult Gummies from Costco for $16.99 a bottle.



Summary- What is Best for Me?

  • There are many options of multivitamin supplements, including liquid, gummy, and soft gel options. Liquid is quickest to absorb, but some gummy and soft gel options are USP certified and have had additional testing to ensure safety and quality.

  • To find the one that is right for you, do your research. Compare brands and prioritize specific nutrients; for those with gastroparesis prioritize vitamin D, vitamin B12, calcium, and iron.

  • Iron and calcium may not be found in the same supplement, you may need to consider several different types of supplements if you are concerned about vitamin deficiencies.

  • Choose a supplement that you will be able to tolerate taking every day.

Sources

  1. Dietary Intake and Nutritional Deficiencies in Patients with Diabetic or Idiopathic Gastroparesis. (2011). Gastroenterology, 141(2), 486-498.e7. https://doi.org/10.1053/j.gastro.2011.04.045

  2. Parrish, C. R., & Yoshida, C. M. (n.d.). Nutrition Intervention for the Patient with Gastroparesis: An Update. 19.

  3. R, J., & Nurse, all R. (n.d.). 5 of the Best Liquid Vitamins. LoveToKnow. Retrieved October 5, 2020, from https://vitamins.lovetoknow.com/Best_Liquid_Vitamins

  4. USP Verified Products Listing (n.d.). Quality Supplements. Retrieved October 13, 2020, from https://www.quality-supplements.org/verified-products/verified-products-listings

  5. How to Evaluate Vitamins and Supplements. (n.d.). WebMD. Retrieved October 13, 2020, from https://www.webmd.com/diet/how-to-evaluate-vitamins-supplements

  6. The 9 Best Gummy Vitamins of 2020, According to a Dietitian. (n.d.). Verywell Fit. Retrieved October 13, 2020, from https://www.verywellfit.com/best-gummy-vitamins-4174259

  7. What is the absorption rate (or bioavailability) of supplements? (n.d.). Ask The Scientists. Retrieved October 13, 2020, from https://askthescientists.com/qa/what-is-the-absorption-rate-or-bioavailability-of-usanas-products/

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