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With IRON and Copper. Each bottle Added Protection 3 Multivitamin, by Douglas Labs, has 180 tabs, a 30 day supply.
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Beta-carotene gives the tablets their pink color. Added Protection III is extremely bioavailable since it can be taken in up to six separate doses per day if one desires, and the tablets are documented to disintegrate within 30 minutes following digestion. In addition, the minerals found in this multivitamin are obtained from Albion Labs, which produces chelated forms that are the most bioavailable (easily absorbed) in the industry, according to some studies. Chelation means that the mineral is embedded in amino acids, in this case, between two glycine molecules.
The dosages of the minerals are also designed to provide optimal quantities but not too much, since too much can be toxic. In addition, the chelated (and other forms) are designed to limit side effects experienced by sensitive individuals. If you experience any stomach problems, nausea, diarrhea or constipation once starting this regimen, you may be experiencing a reaction to this formulation and should stop to see if the problem clears up. Recommended dose: 6 tabs/day (2-3x/day--or more often--with food). Store in a cool, dry place away from light.See: AP3
In addition to this excellent formula with iron, the exceptional forms and a well engineered delivery system, this MV is made by Douglas Labs who has also been a choice supplier for NYBC and a mainstay since the days of DAAIR, although they have undergone some changes on the corporate front, having been bought by Atrium Labs in Canada. They provide high quality ingredients for their multi-vitamins that include the best and most absorbable forms of micronutrients as well as a range of important nutrients and dosages.
Take six tablets per day with meals or as directed by your qualified health consultant. For best results, take two with each meal (this tends to level out your bioavailability), as these tablets dissolve within 30 minutes of ingestion. Most multivitamins have lower amounts of D3 than you may really want, so folks often supplement with D3 (after checking vitamin D blood levels). Store in a cool, dry place. DANGER: Keep out of reach of children (this multi contains IRON!).
A good nutritional supplement program should always have as its base an excellent, high-potency multivitamin (containing multiple vitamins and minerals) that will supply a basic level of all the micronutrients most important to human function, and are best in a form likely to be "taken up" (best utilized by the body - or "bio-available") by those suffering from the absorption and digestive problems of HIV infection.
This sort of "multiple" can help to make up for overall dietary deficiencies, while also helping to maintain nutritional balance when you are taking other nutrients separately. Normally, this type of supplement will provide a balanced supply of nutrients in appropriate ratios for normal function.
However, please remember that with HIV disease you are not dealing with normal function. With all the factors that result in the advanced deficiencies that have been found in most of those living with HIV and/or hepatitis C, it is almost always necessary to add to the multiple a number of additional supplements both to increase dosage levels and to include those things often not found in multiples.**See: NYBC MULTIVITAMINS FACT SHEET
NYBC has several great resources on Multi's.
NYBC publishes an excellent newsletter resource called the SUPPLEMENT, which is available in print form (sent to members with their orders) and via email Subscribe to the Supplement Email Newsletter. We have numerous NYBC Blog entries NYBC has a series of Supplement Fact Sheets including this Multivitamin Fact Sheet. Below are some of these articles, fact-sheets and entries on multi's:
The Journal of the American Medical Association has published a new study showing that a multivitamin and selenium combination supplement significantly reduced immune decline and morbidity in people with HIV who were treatment naïve (=not on antiretroviral/ARV therapy). This was a two year study with individuals who had CD4 counts above the recommended threshold for beginning ARV treatment. Over the two-year period, the combination of a daily multivitamin plus the mineral selenium cut by about half the risk of reaching the point where ARV therapy would be recommended (CD4 count of 200-250).
This study shows the importance of daily multivitamin + selenium supplementation for HIV+ people who are recently infected and/or have relatively high CD4 counts. It also provides further confirmation of the value of multivitamin, multi-mineral supplement strategies like the one included in the NYBC MAC-Pack.
Aside from the recent Times article that once again spread a message of fear and misinformation, three articles were published in the Annals of Internal Medicine that were accompanied by an editorial verging on hysteria that proclaimed in stentorious tones: DON’T TAKE THEM!
Is that a justifiable conclusion? Well, when you look at the studies undertaken, I don’t believe the answer is that clearcut. However, there also may be evidence here that clarifies who may and may not benefit from a simple micronutrient supplement. At the end of the article are links to other analyses that rebut the claims made.
Let’s take a little closer look at each of these three negative studies. First, one relatively large study, using a low dose combination of often synthetic vitamin constituents (Centrum Silver) among older individuals (1). Using these modest doses, the upshot of the study, which was otherwise well-controlled and randomized, found no benefit of the use of the supplement in offsetting or mitigating cognitive decline over about 10-14 years. This was part of the large physician’s study and the study was limited by the potential that the doses may have been too low for an otherwise well-nourished population. Is this generalizable to older individuals who are well-nourished?
Perhaps so and taking a Centrum is therefore quite probably a waste of money if maintaining cognitive function is the goal. However, this is the same study that had previously reported that even this simple intervention modestly reduced the risk of cancer. Is that a useful endpoint? And indeed, the authors note that the study may need to be up to 20 years or longer to adequately detect any significant differences.
The third study was a meta-analysis or review of the literature that has pre-specified criteria for the selection of studies to be reviewed and then applies statistical analytic techniques to combine the results into a conclusion (3). They sought to assess the use of multivitamins in the primary prevention of cancer or cardiovascular disease. (Drug studies indeed more commonly look at the use of a drug in preventing a second heart attack, for example: secondary prevention.) Having done these, I know there is a certain degree of judgment in what gets selected and the method used for analysis. In this case, the authors note that the primary limitations are as they note is 1) they only assessed four RCTs and one cohort study that used radically different multivitamin/mineral formulas; one of these was a study that used a multi with only 5 ingredients another only 3 vitamins; 2) these were ONLY among otherwise healthy adults (not secondary prevention studies). The PHS-II study, discussed above, and another the SU.VI.MAX study were the two largest studies. So what can we conclude from this? That the extant data do not robustly support the use of a multi for these indications? Possibly, though they also note that the large PHS-II study that found a benefit for reducing cancer risk also detected a benefit for fatal myocardial infarction (adjusted hazard ratio, 0.61 [95% CI, 0.38 to 0.995]; P < 0.048). It may again be that these interventions are not up to the rather daunting task of achieving the endpoint of primary prevention—such studies probably need to be larger and a lot longer to come up with definitive conclusions.
They also reviewed single and paired studies. They noted that calcium alone is ineffective overall and possibly dangerous as a single supplement, but you throw in vitamin D, and gosh–lower mortality, though just barely (unadjusted RR 0.94, 95%? CI 0.87,1.01). It begins to beggar the imagination however to think these extremely disparate trials can be combined in any meaningful way when the populations, interventions and even primary outcomes were so significantly different.
The third study, however, did assess the effects of chelation therapy, with or without a multivitamin/mineral combination as secondary prevention for a heart attack (myocardial infarction) (3). It was a relatively short study with a median follow-up of 31 months in the vitamin group. The article notes that there was a huge dropout rate. Of the 853 in the vitamin arm and the 855 in the placebo arm, 584 and 547 were lost to follow up, respectively but the analysis was done “intent-to-treat” and all were included in the final analysis. Further, the study was not powered to see a difference with the few that were finally enrolled and completed the study—i.e., the initial proposal was to enroll 2,372 patients. And there was a small difference: while the primary and secondary outcomes did not achieve statistical significance, one can see in the Kaplan-Meier curves that there is a lower rate of events in the multi arm compared to the control by about 11% and that appears to improve as the study progresses: had it lasted longer or been better powered, might this trend have improved over time? We don’t know. The effect is relatively modest but the study wasn’t powered to detect this difference.
It seems to me that the latter study reflects reality and should calm the anxieties about people using supplements expressed by the editors (4). The upshot: Most people don’t want to take vitamins as suggested by the Lamas study. If THAT conclusion is generalizable, they have little to fear—but is that wise public policy?
The other important fact to note was that all the studies showed no evidence of adverse events. For the most part, side effects of the use of supplements are exceedingly rare and generally arise with the use of single agents (e.g., vitamin E or beta-carotene alone). Probably not the wisest way to use interventions designed to work in a biological way or in a system that is severely oxidatively stressed.
I would suggest several caveats. First, this is irrelevant to people living with HIV. Even a fairly simple formula can have a significant impact in slowing disease progression and reducing mortality (modestly) with the use of a multivitamin/mineral. The results of our meta-analysis will, we hope, be published soon. (This of course does NOT mean they are a replacement for antiretroviral therapy! Absolutely not.)
Second, these are SUPPLEMENTS – diet and access to clean water need to be the first consideration and far too many people have limited access to these basics while millions of others are forced to consume what is available on the market, which is often poor quality, processed, loaded with chemicals, preservatives, antibiotics, hormones and potentially dangerously genetically modified.
And finally, supplements are NOT drugs in key ways. They are supporting the body’s ability to fight disease while retaining an optimal level of health, especially when we are discussing the use of vitamins and minerals (as opposed to botanicals). Whether the optimal dosages have been determined, whether the findings are generalizable to everyone, whether there are groups, like people with HIV, for whom they are demonstrably beneficial—these are questions hardly answered to the point of declaring no one should ever use them as these editors have done.
We were interested to see a short Q and A today in our hometown newspaper, The New York Times. The subject was “micronutrients,” and the question was specifically about multivitamins:
Q. A doctor told me that you don’t need daily vitamin supplements if you eat right, and that they don’t dissolve anyway. Is he correct?
The NYT answer: The doctor is probably not correct. The reality is, very many people do not have the varied smorgasbord of optimum nutrients in their diet that represents the nutritional ideal. One example cited in the reply: carotenoids, important in preventing vision-destroying macular degeneration, are found in sufficient quantities only in a few leafy green vegetables like spinach and collards that most Americans do not consume with sufficient regularity.
As for whether multivitamins dissolve: current standards of quality control testing for multivitamins do generally insure that micronutrients reach the small intestine, where they can be effectively absorbed.
We would add that factors like age and health status may also affect the absorption of nutrients. See our blog posts about gastrointestinal health for tips on subjects such as additional B vitamin requirements as you get older; or use of supplements like glutamine for poor absorption of nutrients in the gut.
B vitamins, Omega-3 fatty acids, acetylcarnitine, Antioxidants, Acetylcholine, Resveratrol, Ginkgo biloba: Supplements for the Brain (and Nerves)
The Canadian AIDS Treatment Information Exchange (CATIE): Why Vitamins B12 and D3 Are Especially Important to People with HIV
NYBC recommendations taking multi's 4 hours apart from raltegravir (brand name, Isentress): Raltegrivir (Isentress) and Antacids/Minerals
HIV and cardiovascular disease: Care for your Heart
K-PAX Alternative uses SuperNutrition's Opti-Pack: Opti-MAC Pack
Things you may have heard, or not: Five Things To Know About Multivitamins
On complementary therapies (CT) and their perceived benefits: Complementary Therapy use in HIV-positive People: an Online Community Survey
Helping people with diabetes maintain good health and reduce infections: "Supplements and Diabetes" and "Diabetes Facts & Figures"
K-PAX formula trials: K-PAX Canadian Trial
Supplements that have been studied for diabetes or insulin resistance: Info sheet on "Supplements studied for diabetes/insulin resistance"
Guide to managing and preventing HIV medication side effects: NEW! Managing and Preventing HIV Med Side-Effects
MAC Pack (for Multivitamin Antioxidant Combination): Micronutrients for people with HIV: a low-cost equivalent to K-Pax
Important supplements that have been studied for diabetes: Supplements studied for diabetes: multivitamins, fish oil, lipoic acid, chromium and biotin
Choose a good diet to stay healthy, but don’t throw out the supplements: Time to throw out the supplements? Comments on The New York Times article: “Vitamin Pills: A False Hope?”
Fix Your Broken Brain by Healing Your Body First: Supplement recommendations in “The Ultramind Solution” by Dr. Mark Hyman
Extended interview: Supplement recommendations from Fred Walters / Houston Buyers’ Club
Close equivalent to the double-strength K-PAX: The MAC-Pack: a K-PAX alternative from NYBC
From our friends at FIAR: Reports from CROI
Standard of care: Multi helps prevent TB Relapse in HIV+
Centre in Harare, Zimbabwe: Super Nutrition Helps Our Friends in Nepal and Zimbabwe!
Canadian AIDS Treatment Information Exchange (CATIE): Taking Vitamins and Minerals When You’re HIV+ Some Advice from the Canadians
Healthy Years newsletter: UCLA Division of Geriatrics/David Geffen Medical School on “Four Supplements Seniors Should Take”
What? Why? Medicine? Safe? Identity, Purity and Potency? CAM?: FAQ on nutritional supplements
Our friends at the Canadian AIDS Treatment Information Exchange: Practical Guide to Nutrition for People Living With HIV – a new publication from CATIE
We be JAMA! Report: Multivitamin + selenium slows progression of early-stage HIV
We’re tempted to file this story under the heading of “news that we already knew,” but it’s still good to get a stamp of approval in the form of publication in Journal of the American Medical Association (JAMA), one of the top medical journals in the U.S., if not the world.
At NYBC and at our predecessor DAAIR we have long recognized the development of vitamin and mineral deficiencies in HIV, and have long recommended multivitamin/mineral supplements to counter those health-threatening deficiencies. We have also followed for years the work of Marianna Baum, lead author of the JAMA study, who has focused attention on the mineral selenium, which may have an important role in preventing replication of HIV. So, while this story doesn’t come as a complete surprise, it’s great to have further support for some long-held practices.
The combination of a daily multivitamin plus the mineral selenium proved to be an effective regimen, cutting by about half the risk of reaching the point where ARV therapy would be recommended
Baum’s study was conducted in Botswana, where nearly one in four adults is infected with HIV. The trial followed about 900 newly infected adults who were not yet taking any HIV medications. These participants were divided into groups that randomly received different combinations of vitamins, the mineral selenium, or a placebo. Over the study’s two-year period, the combination of a daily multivitamin plus the mineral selenium proved to be the effective regimen, cutting by about half the risk of reaching the point where ARV therapy would be recommended in Botswana (CD4 count of 200-250).
Baum’s findings are especially relevant for early-stage HIV infection, where the multivitamin + selenium combination proved its value in cutting risk of progression, and actually decreased the likelihood that participants would reach the point where antiretroviral meds would be recommended. Other research, such as Dr. Jon Kaiser’s study of a multivitamin + antioxidants, has been directed at those who are using antiretroviral meds, and may have developed some symptoms or side effects such as peripheral neuropathy. Kaiser’s finding that the multivitamin + antioxidants combination could increase CD4 counts led to the development of K-PAX, and also motivated NYBC to offer its MAC Pack, a close equivalent of K-PAX, assembled from hand-picked products from NYBC’s catalog.
Taken together, the Baum and Kaiser studies suggest to us the value of long-term supplementation strategies that can slow progression of HIV, oppose the known, damaging deficiencies that are likely to develop with HIV, and help stabilize and even improve health for people with HIV, whether they are taking antiretroviral meds or not.
If you’d like to get started with NYBC’s MAC-Pack, or if you’d like to find a multivitamin + selenium combination, please visit our website. You can also call our toll-free number at (800) 650-4983 for further information and advice about supplement strategies for HIV.
Baum, M. et al. Effect of Micronutrient Supplementation on Disease Progression in Asymptomatic, Antiretroviral-Naive, HIV-Infected Adults in Botswana: : A Randomized Clinical Trial. JAMA. 2013;310(20):2154-2163. doi:10.1001/jama.2013.280923.
Kaiser, J. Micronutrient Supplementation Increases CD4 Count in HIV-infected Individuals on Highly Active Antiretroviral Therapy: A Prospective, Double-Blinded, Placebo-Controlled Trial. Kaiser JK, et al. JAIDS 2006;42: 523-528.
When Multivitamins Attack! Recent Controversy Sparks Debate: Could Vitamins & Minerals Be Bad for You?
The short answer is: yes. ANYTHING can be toxic. Even water! If you drink too much water, you can wipe out your electrolytes. This can cause brain swelling and even death (as happened to some soldiers and reported in the J. of Military Medicine).
The question comes up because some physicians and community members have expressed alarm at the possibility that micronutrients can be toxic, particularly to the liver. Yes, it’s true that vitamins and minerals can be toxic. Nonetheless, we’re obliged to balance legitimate concerns in this department with the many decades of publications showing so much benefit from supplementing with vitamins and minerals. Please don’t throw out your multivitamin (or other supplements) just yet!
Happily, there is independent science to help answer the question “HOW MUCH IS TOO MUCH?” One way to look at it is the no-observed-adverse-effect-level (NOAEL), defined as the “greatest concentration or amount of a substance, found by experiment or observation, which causes no detectable adverse alteration of morphology, functional capacity, growth, development, or life span of the target organism under defined conditions of exposure.” Got that?
Many studies have found that the vitamins and minerals in quite potent multi formulas are very safe, with little likelihood of causing side effects. The biggest concerns are the fat-soluble vitamins (A, D, E and K), as these may have an impact on liver function. So for people on liver-toxic meds and/or with chronic hepatitis, high doses of these may be worrisome.
The good news is that vitamins D and E are not so troublesome, with fairly high levels required to cause a problem. Perhaps the biggest worry is Vitamin A. While most of the stuff in the NYBC Custom Multi is in the water-soluble beta-carotene form, a hefty 7500 IUs of A (IU= international unit, a standard measure) is also included. Is this too much?
By some measures, it may be, since there is a published NOAEL of 3,000mg per day for Vitamin A. To keep under that safety limit, you should take only about four Custom Multi pills per day (not the suggested nine). However, given that HIV is often associated with Vitamin A deficiency, six to seven tablets would probably be fine. Indeed, many of us feel the Custom Multi Vitamin A dosage, even for people with liver disease or on liver-toxic meds, is fine, because it’s provided together with all the other nutrients needed to keep it in balance. (Of course, we’d love to have more clinical data to explore this widely-held view!)
For now, to address concerns about Vitamin A toxicity, observe this caution: stop taking the multi immediately if you experience nausea and vomiting, blurred vision, or bone pain. (These may be symptoms of many other conditions, but one way to know if they’re linked to the multi—is to stop taking the multi!)
The good news is that a lot of people have been using these multis and Added Protection for years with no liver trouble that we’ve heard reported at either NYBC or our predecessor, DAAIR. That’s not definitive proof of course which is partly why we feel it is important to raise the issue: forewarned is forearmed!
We know that iron can be hard on the liver, which is why NYBC offers a formula without iron. Too much selenium is very toxic, but the level at which concern arises is much above that in the Custom Multi (400 mcg). While this amount is higher than is sometimes seen even in potent formulas, it is there for a reason: people with HIV tend to have significant selenium deficiency.
Indeed, NYBC’s Custom Multi was designed around known nutrient deficiencies associated with HIV infection. It’s hoped that levels provided in the multi can help offset the damage done by HIV to gut function, absorption, and blood levels of these nutrients, which are critical for health and survival.
For more information, please see these AIDS Community Research Initiative of America (ACRIA) web pages: The Role of Dietary Supplements in HIV and a breakdown of Vitamins and Minerals as related to those with HIV/AIDS.--NYBC SUPPLEMENT Issue #2 (PDF)
Gotta have HAART? Here's Hopeful News
Old news, you might say, reading the title above…but in science, “old” news is always being updated, questioned, revised. For many years, NYBC and its predecessor DAAIR have been putting out news and views on the use of antioxidants and other micronutrients to counter drug toxicities related to HAART (Highly Active Anti-Retroviral Therapy). So we thought you’d like to hear about two sources from the past year that assess where the HIV research community now stands on this subject.
First, we’ll mention researchers from Tufts University, who have reviewed a long list of studies and concluded that micronutrients, especially antioxidants, can play a significant role in helping people with HIV manage the toxicities associated with drug therapy. (“Micronutrients: Current Issues for HIV Care Providers,” from June, 2005, can be found online at the National AIDS Treatment Advocacy Project's site – a good web resource for HIV treatment info.) In particular, the authors advocate focusing more research energy on supplements that can benefit people co-infected with HIV and hepatitis; supplements to combat cardiovascular disease (a big concern as people with HIV continue on drugs for years); and supplements to help counter cognitive problems in people with HIV. To date, these investigators find the strongest evidence for the usefulness of Vitamins C and E, selenium, and a good multivitamin in combating drug toxicities and maintaining health over the long haul. (Also cited: Vitamin D for bone health. See “Close to the Bone” in this issue of SUPPLEMENT.)
Secondly, we recommend an interview with Dr. Jon Kaiser, conducted by NYBC’s George Carter at the 2005 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston. Dr. Kaiser, who has a large HIV+ practice in San Francisco, has been investigating and writing about nutritional supplements and HIV for over ten years. One of his main conclusions is that antioxidants (chiefly, alpha lipoic acid, NAC, and acetyl l-carnitine) may be useful not only in dampening HAART side effects, but also in promoting “immune reconstitution.” Doing repair work on the immune system, boosting CD4 counts—this remains an essential goal as people stay on HAART for longer periods of time and the potential for health problems due to side effects escalates.
Speaking of clinical trials he has recently conducted, Dr. Kaiser stated, “When I added the Alpha Lipoic Acid and the Acetyl L-Carnitine to the NAC, in the background of a good potent multivitamin, I saw really an astounding difference in freedom from HAART side effects and increase in CD4 count.”
Well, we warned you not to expect anything earth-shatteringly “new.” But isn’t it good to have a little confirmation now and then that you’ve been heading in the right direction all along?--NYBC SUPPLEMENT Issue #3
Aside from these claims, nothing else here has been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
|Sources in Daily Life||
Iron deficiency is a common problem for premenopausal women and generally, they should select a multi with iron, like this one. Men and postmenopausal women usually should not take an iron containing supplement, so take an iron-free version instead. Before taking any iron supplement, you should consult your qualified healthcare practitioner and have your blood work monitored, even though the 20 mg of iron supplied here (by taking six tablets) is only 111% of the US RDA (Recommended Daily Allowance).
Children can also be iron deficient, but extreme caution should be taken when giving any multivitamin, especially those with iron, to children. ONLY under the direction of and with the continued supervision of a doctor (who understands the supplement--bring the bottle to the doctor to remind them of the formula) should children or adolescents be given THIS or ANY supplement. DANGER: Accidental overdose of iron is the leading cause of fatal poisoning in children under six years old. Keep all supplements--and especially secure those with iron--out of the reach of children.
|FDA Statement||** These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.|
|Added Protection 3 Multivitamin WITH Iron 180 Tabs||Amount Per Serving:||% Daily Value:|
|Vitamin A (as palmitate)||
|Beta Carotene (natural, vitamin A activity)||
|Vitamin C (as calcium and magnesium ascorbate/ascorbic acid complex)||
|Vitamin D3 (cholecalciferol)||
|Vitamin E (as d-alpha tocopheryl succinate)||
|Vitamin K1 (as phytonadione)||
|Vitamin B1 (as thiamine mononitrate)||
|Vitamin B2 (as riboflavin)||
|Vitamin B3 (as niacin/niacinamide)||
|Pantothenic Acid, Vitamin B5 (as d-calcium pantothenate)||
|Vitamin B6 (as pyridoxine HCl)||
|Biotin, Vitamin B7||
|Inositol, Vitamin B8||
|Folic Acid, Vitamin B9||
|Vitamin B12 (as cyanocobalamin on ion exchange resin)||
|PABA, Vitamin Bx (para-aminobenzoic acid)||
|Choline (as choline bitartrate)||
|Calcium (as calcium citrate and calcium ascorbate)||
|Iodine (from kelp)||
|Iron (as iron carbonyl)||
|Magnesium (as magnesium aspartate/ascorbate/oxide complex)||
|Zinc (as zinc amino acid chelate)||
|Copper (as copper amino acid chelate)||
|Selenium (as selenium amino acid complex)||
|Manganese (as manganese amino acid chelate)||
|Chromium (as chromium polynicotinate)||
|Molybdenum (as molybdenum amino acid chelate)||
|Potassium (as potassium aspartate/chloride complex)||
|Boron (as boron aspartate/citrate complex)||
|Vanadium (as vanadyl sulfate)||
|Cysteine (as L-cysteine HCl, L-form, amino acid)||
|D,L-Methionine (DL-form, amino acid)||
|Citrus Bioflavonoid complex||
|*Daily value not established.|
|Other Ingredients: Modified cellulose gum, methylcellulose, silica, vegetable stearine, cellulose, titanium dioxide, magnesium stearate, gum ghatti, natural tangerine flavor and canthaxanthin (carotene color).|
|Purity: Yeast-free, wheat-free, gluten-free, soy-protein-free, dairy-free, corn-free, sodium-free, sugar-free, starch-free, no artificial coloring, no artificial preservatives and no artificial flavoring.|
RDA variance and advice: the RDA can vary based on age, and whether women are a pregnant or breastfeeding, in which cases the above RDA is based on men and women ages 1-70 years and for women that are not breastfeeding or pregnant. A variety of factors such as what medications you are taking and what chronic conditions you may have can significantly contribute to altered nutrient blood-levels and bioavailability. Additionally, it should be noted that the RDA is often the minimal figure of a range (of conservative general population figures). Due to these factors, it is, therefore, recommended that you consider expert advice as these general recommendations are not intended to take the place of medical advice. You are encouraged to talk to a knowledgable consultant, practitioner or doctor to get advice based on your unique circumstances and needs. Unfortunately, not all experts have a time allotment long enough or the care, consideration or training to be able to answer your questions or to test for blood levels when necessary. So, consider whether your provider is giving you the attention you want--as a specialist may be required.
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