The Problem isn’t Using Multivitamin Supplements, it is Nutrient Inadequacy
Yesterday Chris van Tullekin advised readers that they were wasting their time, and potentially even harming themselves by taking vitamin supplements via BBC News Magazine. Chris started with an example of vitamin A toxicity from eating dog liver. It is true. Eating a bear liver can be toxic because it can contain 18,000 IU per gram (Rodahl & Moore, 1942). But I am digressing, as was Chris, into a discussion of nutrient toxicity from natural overdoses and away from the topic at hand – the wisdom of using dietary supplements to help meet nutrient requirements.
It is wrong to say that if one is healthy and living in a country like the UK that taking multivitamins may shorten your life. The value of using a multivitamin supplement depends upon many factors – the quality of your diet, your health, your age, the environment where you live and work, and your genetics. Many people in developed countries are not consuming recommended amounts of nutrients (Troesch et al, 2012). Multivitamin supplements help people obtain the vitamins and minerals their bodies need (Fulgoni et al, 2011). This is not a recommendation for mega-doses. If your diet is nutritionally adequate, it isn’t necessary to use dietary supplements. But there isn’t any evidence of harm with vitamin intakes below the Tolerable Upper Limit (UL), a concept endorsed by the World Health Organization (WHO) and endorsed by governments in Europe and North America.
Because nutrients are essential for health, supplementation is more important for those with poorer nutrient status. Although Gaziano and colleagues report that physicians - smart, health-savvy men - taking a multivitamin daily had a lower risk of cancer, it isn’t realistic to expect nutrients to act like drugs. Drugs are used to treat, prevent and mitigate disease. Nutrients are needed for cell metabolism. Better nutrition benefits cellular function.
As Dr Wassertheil-Smoller, Professor of epidemiology and population health at Albert Einstein College of Medicine is quoted in the Sioux City Journal with regards to a study of women with invasive breast cancer and the potential role of multivitamin supplements on mortality rates, “Almost all of these women took a multivitamin before they developed breast cancer. So it’s not like we’re saying that once you get breast cancer, you should take multivitamins.” Exactly. Nutrition needs to be part of a life plan, every day, every month, every year.
Nutrient deficiency is the worst. Nutrient inadequacy isn’t optimal. More is not better. If your diet is lacking, then a multivitamin supplement to fill the gap is wise.
When it comes to choosing a multivitamin supplement, the choices can be overwhelming. One suggestion is to choose products from member companies of the Council for Responsible Nutrition (CRN). In addition to following regulations set out by the Food and Drug Administration (FDA) and Food and Trade Commission (FTC) in the US, CRN member companies voluntarily adhere to a strong code of ethics, dosage recommendations and manufacturing standards.
CRN also provides consumers with information on how to read a Dietary Supplement Label.
Rodahl K, Moore T. The vitamin A content and toxicity of bear and seal liver. 1942 Biochem J 37: 166
Troesch B, Hoeft B, McBurney M, Eggersdorfer M, Weber P. Dietary surveys indicate vitamin intakes below recommendations are common in representative Western countries. 2012 Br J Nutr doi:10.1017/S0007114512001801
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Foods, fortificants, and supplements: where do Americans get their nutrients? 2011 J Nutr doi: 10.3945/jn.111.142257
Gaziano JM, Sesso HD, Christen WG, Bubes V, Smith JP, MacFayden J, Schwartz M, Manson JE, Glynn RJ, Buring JE. Multivitamins in the prevention of cancer in men: The Physicians’ Health Study II randomized controlled trial. 2012 JAMA doi:10.1001/jama.2012.14641
Wassertheil-Smoller S, McGinn AP, Budrys N, Chlebowski R, Ho GY, Johnson KC, Lane DS, Li W, Neuhouser ML, Saquib J, Shikany JM, Song Y, Thomson C. Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the women’s health initiative. 2013 Breast Cancer Res. Oct 9 Epub ahead of print.