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Special Reports September 2015 Issue

Should You Take a Multivitamin?

Four Tufts experts tackle the multi-billion-dollar question.

Since the early 1940s, when multivitamin/mineral supplements first became available, Americans have popped countless such pills in hopes of “nutritional insurance” and making up for any dietary shortfalls. Today, more than one-third of all Americans take a multivitamin, and multivitamins alone account for more than 40% of all vitamin and mineral supplement sales—an estimated $5.4 billion annually. Yet the scientific evidence for the benefits of multivitamins is mixed at best, with large recent studies reporting no association between usage and better cardiovascular or cognitive health and only modest cancer protection.

What do the experts say? Tufts’ Julie Flaherty sat down with four of the university’s nutrition scientists (see box) for a roundtable discussion about the science of multivitamins and to answer a simple question: Should healthy adults take them?

Flaherty: I am a fairly healthy adult, and I think I eat a slightly better-than-average diet. My doctor says I should take a multivitamin—she recommends it for all women my age. Should I take one?

Jeffrey Blumberg: There is no harm in taking a multivitamin and, importantly, doing so will help fill in the substantial gaps that are consistently apparent in national surveys of intake. Over two-thirds of Americans fail to meet the Estimated Average Requirement (EAR) for vitamins D, E, and K and for the minerals magnesium and potassium; about 40% fall short of the EAR for vitamins A and C. In large part, these nutrient inadequacies are due to common dietary patterns that continue to fall short of the recommended consumption of fruits, vegetables and whole grains. So, while we try get people to change their eating behavior, taking a multivitamin seems a prudent action.

Alice H. Lichtenstein: Your physician’s recommendation is not consistent with current clinical guidelines. There was a very extensive systematic review sponsored by the federal government that was done by the Johns Hopkins Evidence-Based Practice Center that showed no benefit to the general population from taking a multivitamin. It may be useful in certain select groups, but we know that in the US, those individuals who need a multivitamin most—those who are nutrient-insufficient—are less likely to use supplements. We’re not even sure whether falling a little bit below the Recommended Dietary Allowances (RDAs) will cause a problem because, in general, clinical manifestations of nutrient deficiencies are rare.

One of the problems is that when you put an emphasis on something like whether people should take a multivitamin, you shift the focus off what is really important: that they are eating too many calories, too much saturated fat and trans fat, too much sodium, not enough fiber, and they are not exercising enough. There is no quick fix. You can’t just pop a pill and make everything better.

Blumberg: I agree. If you want to take a multivitamin because you love to eat at fast-food restaurants five times a week, and you hate fruit and vegetables and you think you can compensate for that, my answer is no, you can’t. Multivitamins are supplements, not substitutes for a healthy diet.

And I agree that the people who need a multivitamin most are the ones who aren’t taking them. Who is taking a multivitamin? The more affluent, the more highly educated, the people who are actually eating better diets, who exercise, don’t smoke. The people who really need to be listening to their doctor’s advice to take a multivitamin are not.

But I don’t agree with the converse: that people who need them the least don’t need them at all, because they are not meeting their RDAs either. Maybe some of the RDAs are not perfect, but they are a goal that reflects the current scientific consensus, and we know that most people aren’t meeting it.

Johanna Dwyer: Speaking for myself, I don’t think that a multivitamin is going to cause any particular good, nor do I think it is going to cause any particular harm. It’s a personal choice. It’s like whether people should be avoiding every animal food or everything that has added sugar. A lot of these blanket statements about absolutely consuming or not consuming foods or multivitamins are oversimplified, inconsequential, yuppie-related food faddism. Some examples where a multivitamin-mineral dietary supplement at RDA or DV levels may be useful are with the very old and frail who eat very little, and with chronically ill children whose appetite fluctuates widely. Some examples where they are not are people who are taking three or four pills a day in the hope that their sports performance will improve. They’d be better off training more.

Flaherty: When I asked a few people why they take multivitamins, they said things like, “I’m a little anemic, so I need the iron,” or “That’s how I get my vitamin D.” It seems to be one-stop shopping for a variety of concerns.

Joel Mason: I think the mindless approach that many Americans (and, for that matter, many American physicians) take—that it might help, and it can’t hurt—is not a very rational perspective, nor is it very appropriate. It simply ignores the fact that taking supplements should be tailored to each individual’s particular needs. For instance, a young woman might not be getting enough vitamin D and calcium to support her bone health. A multivitamin might not be the right approach since most multivitamins—even if they include minerals as well—have a trivial amount of calcium and often inadequate amounts of vitamin D to optimize bone health. Nevertheless, this young woman and her physician might be dissuaded from thinking about the issue further because they have been lulled into complacency by the false reassurance that a multivitamin provides. If you really think carefully about what you as an individual need, most often you are going to end up with a more intelligent strategy.

Lichtenstein: If your physician finds that you need more calcium, I would ask, have you tried non-fat Greek yogurt? Do you think there is a way of increasing your dairy intake? There are so many food-based ways of getting your nutrients. And a benefit is other nutrients come along with the one of concern when you take the food-based approach.

Dwyer: Years ago I was studying vegetarians, and some of them told me they took a vitamin supplement because they weren’t getting enough calcium and iron. If you looked at the vitamins they were taking, they were indeed vitamins, but the calcium and iron they needed were minerals.

Indiscriminate vitamin use is sort of like the use of holy water in the Middle Ages: People thought if you sprinkled it on things, it would ward off all evil. Some people really believe that. If you look at their reasons, they are not more sophisticated than beliefs in the Middle Ages. And I worry about self-diagnosis of what could be concerning health conditions that are developing. On the other hand, there are some supplements that I think are worth taking such as vitamin D and calcium in postmenopausal women. I take them, and I am sure many others do as well.

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