Multivitamins: Wise or Wasteful?

Multivitamins: Wise or Wasteful?

Recently multivitamin use was (depending on your nutritional politics) questioned, criticized or attacked. The news was based on a blistering commentary three new studies showing that using multivitamins had little effect or no effect on cancer, heart disease and dementia. The following are quotes are the conclusions from each study:

- Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on CVD. (1)

- In male physicians aged 65 years or older, long-term use of a daily multivitamin did not provide cognitive benefits. (2)

- High-dose oral multivitamins and multi-minerals did not statistically significantly reduce cardiovascular events in patients after MI who received standard medications. However, this conclusion is tempered by the non adherence rate. (3)

In turn this provoked a blistering commentary titled Enough is Enough: Stop wasting money on vitamin and mineral supplements (4) that made national news. The piece focused on multivitamin-multi-mineral use even though the title indicated otherwise. After reviewing the findings of the 3 studies above the authors stated:

“Other reviews and guidelines that have appraised the role of vitamin and mineral supplements in primary or secondary prevention of chronic disease have consistently found null results or possible harms.” They go on to say “Despite sobering evidence of no benefit or possible harm, use of multivitamin supplements increased among U.S. adults from 30% between 1988 to 1994 to 39% between 2003 to 2006, while overall use of dietary supplements increased from 42% to 53%.” (4)

The following is what I told family, friends and patients who contacted me after this story broke over the 2013/2014 holiday break.
Vitamin and mineral supplements, including multivitamins* are dietary supplements designed to provide micronutrients that a person’s diet alone does not provide in adequate amounts.

Dietary supplements are also used by healthcare professionals to treat various conditions.
It is no surprise that when people who get enough vitamins and minerals take more anyway, researchers see no change in their overall health status. In those cases, I would agree that taking more is an unnecessary expense.

I have noticed that the people who need multivitamins and minerals to supplement their diets the most take them the least. For example, which example below is more likely to take a supplement and which is more likely to need supplement?
A. The person who has frosted cereal or donuts for breakfast, hot dogs and chips for lunch and a cheeseburger, fries and soda for dinner or
B. The person who has Greek yogurt and an apple for breakfast, a veggie burger and smoothie for lunch and a large salad with chicken for dinner.

There are a lot of things in life that are harmful. Is it possible that a multivitamin could be harmful to selected individuals? Of course, but if you asked me where I would put a multivitamin on a ‘possible harm’ list, it would be far behind half, if not 3/4 of the food and drinks found in any supermarket, fast food restaurant or convenience store. It would also trail many household cleaners, bug spray, fumes at the gas station and many more.
Is it possible that some people waste their money on supplements? Of course. Are all supplements a waste? Of course not. Finally, making blanket recommendations to a population at large in a research paper is not intended to replace the history, examination and analysis healthcare pro’s do (or should be doing) prior to advising a patient to take a dietary supplement, including a multivitamin.

*An umbrella term used to for multi vitamin and multivitamin multi-mineral

1. Frotmann SP, et al. Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013, Vol. 159. No. 12. 824 – 834
2. Francine Grodstein, ScD; Jacqueline O’Brien, ScD; Jae Hee Kang, ScD et al. Long-Term Multivitamin Supplementation and Cognitive Function in Men: A Randomized Trial. Ann Intern Med. 2013, Vol. 159. No. 12. 806 – 814
3. Gervasio A. Lamas, MD; Robin Boineau, MD, MA; Christine Goertz, DC, PhD; et al. Oral High-Dose Multivitamins and Minerals After Myocardial Infarction: A Randomized Trial. Ann Intern Med. 2013, Vol 159, No. 12. 797 – 805.
4. Guallar E, et al. Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Annals of Internal Medicine. Ann Intern Med. 2013, Vol. 159. No. 12. 850 - 851.

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