Multivitamins: Wise or Wasteful?

By G. Douglas Andersen, DC, DACBSP, CCN

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

The following are quotes from 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 multiminerals did not statistically significantly reduce cardiovascular events in patients after MI who received standard medications. However, this conclusion is tempered by the nonadherence rate."³

In turn, this provoked a blisteringcommentary titled, "Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements,"⁴ that made national news. The piece focused on multivitamin-multimineral use, even though the title indicated otherwise. After reviewing the findings of the three 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 went 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:

• Vitamin and mineral supplements, including multivitamins (an umbrella term for multivitamin and multivitamin multimineral) 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 health care 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, who is more likely to take a supplement and who is more likely to need a 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?
• The "diet" part of dietary supplement is overlooked so often, I could repeat the concept for the next 20 years. Ask five DCs how much calcium a woman should take or what the best multi is. All five should reply by asking what the woman eats (an individual, not a general group). But they won't, which is why one woman takes 1,000 mg of calcium and has a heart attack, and the next woman benefits.
• 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 three-quarters 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, etc.
• 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 health care pros do (or should be doing) prior to advising a patient to take any dietary supplement, including a multivitamin.

References

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;159(12):824-834.
2. Grodstein F, O'Brien J, Kang JH, et al. Long-term multivitamin supplementation and cognitive function in men: a randomized trial. Ann Intern Med, 2013;159(12):806-814.
3. Lamas GA, Boineau R, Goertz C, et al. Oral high-dose multivitamins and minerals after myocardial infarction: a randomized trial. Ann Intern Med, 2013;159(12):797-805.
4. Guallar E Saverio Stranges S, Mulrow C, et al. "Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements." (Editorial) Ann Intern Med, Dec. 17, 2013;159(12):850-51.