Should I take a daily multi-vitamin? Are multivitamins necessary? Will multivitamins help me live longer? Are multivitamins harmful?
The good news is that 79% of nurses and 82% of physicians recommend supplements including vitamins. But are vitamins helpful? There has been a lot of good research done on the subject. Let’s take a look at two recent large studies.
The Study of Supplemental Vitamins and Minerals for CVD Prevention and Treatment
Firstly, This study was done in 2018 and included 175,000 people. It was a meta-analysis (a combination of multiple studies) trying to answer 2 questions.
- 1. Do vitamins and supplements prevent cardiovascular disease?
- 2. Do vitamins and supplements prevent death?
They focused on Multi-vitamins, Calcium, Vitamin D and Vitamin C. But also included studies looking at : Vitamin A, E, B1, B2, B3 (niacin), B6, B9 (folic acid), B-12, and B complex (combination of B vitamins), Beta-carotene, Iron, Zinc, Magnesium, Selenium, and Antioxidant combos: a combination of ≥2 of the following: vitamins A, C, E, β-carotene, selenium, zinc.
They found, drumroll please…… Multivitamins (MVI’s), Calcium, and Vitamin C and D, had NO effect on Cardiovascular disease or preventing death. (I’m a huge fan of Vitamin D! Let’s get this out in the open. I’m shamelessly biased. In defense of Vitamin D, and the many ways it does help us, I will say that the studied dose was 1000 IU where I think 2000 IU would be a more reasonable dose.
Both Antioxidant combinations and Niacin increased mortality risk!
The surprising findings here were the following antioxidants increased all-cause death risk 7%. Yes, the same antioxidants that we at first thought would help us live forever. The antioxidants studied include: Vitamin A, C, E, Beta-carotene and zinc in different combinations. In addition, this study found that extended-release niacin increased all-cause death by 10%. Niacin was prescribed to almost everyone with elevated triglycerides when I first started practicing 10 years ago. Yikes! That’s the pendulum of medicine again.
United States Preventative Services Task Force
Secondly, let’s look at The US Preventative Services Task Force (USPSTF) study. It included around 100,000 participants in 2013. The study was designed to address 4 questions:
- Are Multivitamins effective?
- Are they safe?
- Is nutrient supplementation and nutrient pairs effective?
- Is nutrient supplementation safe?
Vitamins A and Folic Acid Associated with Risks
This study also had some surprising results:
- An increased risk of hip fracture with Vitamin A supplements.
- A very rare, but increased risk of prostate cancer with folic acid.
- Increased lung cancer risk with Beta-Carotene
Their summary recommendation was to recommend against Beta -carotene or Vitamins A, C, and E supplements.
In summary, they report insufficient evidence for recommending Multi-vitamins. But they do recommend additional studies be done looking specifically at Multivitamins to prevent Cardiovascular disease and cancer.
Multivitamins can Increase Mortality Risk?
Lastly, a study published in UptoDate, my very favorite clinical resource, had different results. Uptodate is an evidenced-based resource many healthcare providers and clinicians use. I use it daily to check research or learn new things. The study size here was smaller but still significant. 38,000 older women were followed for over 20 years. They found a small INCREASE in total mortality. That’s right an increased risk of death in those that took a daily multivitamin.
In addition, three smaller studies found that MVI’s did help reduce the length of time with infections but did not decrease how many you got.
My Personal Recommendations
My thoughts: I will not take or recommend a daily MVI with Beta -carotene or Vitamins A, C, and E . Nor will I recommend an MVI with folic acid to a patient with a personal history or family history of prostate cancer. I could not find a multi-vitamin on the market that did not include these ingredients. Generally, I recommend specific supplements or dietary changes to correct deficiencies instead. I do recommend 3 daily supplements for everyone. Read about them here: https://nurseandnature.com/top-3-daily-supplements-for-adults/
In another article, we’ll discuss specific nutrient needs for different populations of people ages, gender, vegetarian, etc. In the meantime, vitamins and supplements need to be individualized, there is no one size fits all. Discuss your needs with your healthcare provider. We love Preventative Care!
Fortmann, S. P., Burda, B. U., Senger, C. A., Lin, J. S., Beil, T. L., O’Connor, E., & Whitlock, E. P. (2013). Vitamin Supplementation to Prevent Cancer and CVD: Preventive Medication. : Agency for Healthcare Research and Quality (US);
Jenkins, D. J. A., Spence, J. D., Giovannucci, E. L., Kim, Y.-I., Josse, R. Vieth, R. & et al (2018). Supplemental Vitamins and Minerals for CVD Prevention and Treatment. Journal of the American College of Cardiology, 71(22), 2570–2584. doi: https://doi.org/10.1016/j.jacc.2018.04.020
Ritchie, C. (2019, June 7). Geriatric nutrition: Nutritional issues in older adults. Retrieved October 11, 2019, from Retrieved from https://www.uptodate.com/contents/geriatric-nutrition-nutritional-issues-in-older-adults.
