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Multivitamins – to use or not to use

Multivitamins – to use or not to use
0 15 January 2014

At Cenegenics, we bring you perspective on current medical issues as part of our commitment to high quality service. Below is some much needed perspective.

A series of recent articles published in The Annals of Internal Medicine received a lot of press because of an editorial entitled “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.”

  • Authors of the editorial stated – “supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful.”
  • The USPTF study that was referenced in the editorial actually concluded that there was limited evidence for benefit of multivitamin/mineral supplementation on heart disease and cancer. However, 2 large trials included in the USPTF study that were greater than 10 years did show a lower risk of cancer in men taking multivitamins.

The authors of the editorial went far beyond what the USPTF study stated, saying that multivitamins are useless, potentially harmful and their use should be discouraged, even though the 2 studies mentioned above did indeed show benefit. They also made misleading statements about antioxidants, folic acid, B-vitamins and even vitamin D in the editorial.

The USPTF study itself had multiple limitations making its conclusions nearly useless to begin with. These limitations include:

  • Only 2 endpoints were measured, heart disease and cancer. This ignores every other endpoint such as osteoporosis (fractures), cognitive function, etc.
  • Vitamins used were common, over the counter multiple vitamins generally of poor quality.
  • More expensive and effective forms of vitamins were not used, such as mixed tocopherols vs. d-alpha tocopherol (vitamin E) found in most vitamins.
  • Doses of individual vitamins were usually not high enough to be effective.
  • Optimal vs. sufficient vitamin levels were not assessed.
  • Medication use, which can cause nutrient depletion, was not taken into account.
  • Most of the studies included were less than 10 years, probably not long enough to assess outcome differences between those taking vitamins and those who did not.

Commentary: Perhaps the most erroneous assumption the authors of the editorial made was that the majority of adults are “well nourished.” Most people simply do not eat a well balanced diet and can benefit from vitamin and mineral supplements. While it is clearly preferable to get our nutrients from whole foods, multiple factors make this unrealistic for most people. It can be time consuming and expensive to buy and prepare healthy foods. Even if one tries to eat a healthy diet, modern farming practices and the use of genetically modified crops has left much of our food supply stripped of essential nutrients, sabotaging even the best efforts at getting complete nutrition through whole foods.

The authors clearly had an axe to grind, but are they “throwing out the baby with the bathwater?” We at Cenegenics would agree that low quality multiple vitamins with poor absorption, using less than optimal dosages and often the wrong vitamin form, probably have minimal impact on overall health. It’s another thing altogether to imply that vitamin supplements are useless, potentially harmful and that their use should be discouraged.

If the authors of the editorial don’t want to take multivitamins, that is their choice. Personally, I will continue to take high quality vitamin and mineral supplements that are well absorbed, use the correct vitamin form and take them in proper dosages.

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Posted in Dr. McCallen's Blog by Cenegenics Denver