Multivitamins a waste of money?

[Pythagorean]

So I guess cod liver oil supplements wouldn't be lumped in with the derogatory term "vitamins" since it's technically a whole food in pill form?

 

[Johninch]

Post the studies that say taking vitamin supplements is of "High" benefit. I haven't seen any.

I have spent some time searching the internet without success and come to the conclusion that there are NO serious studies on multivitamins taken at the recommended daily allowance. What you find everywhere are studies on individual vitamins, usually at higher dosages than the RDA. But we are discussing the probability of correcting a small dietary deficiency in one or more of about 20 vitamins and minerals. If you have a serious deficiency, this will not be corrected with multivits and it is not meant to. Multivits could even cover up a major dietary deficiency by undertreating it.

I have also searched for data on the number of healthy people who consume an RDA of multivitamin preparations. No luck. There are industry estimates. The Lewin Group for example does surveys of health issues by picking data out of selected studies, for industry clients, which the industry then uses for marketing purposes. Lewin evaluates the data and comes up with billions of potential health care savings from administering high doses of certain supplements in specific cases, such as the elderly with serious health problems or pregnant women. But the supplements are very specific and are not the OTC multivits we are talking about here.

In my case, I have no health issues and I take a half daily allowance of 21 vitamins and minerals every day. Nobody can tell me what is the likelihood of my being otherwise deficient in one of those ingredients. But if I were, then the multivits could be a high benefit. That’s why I do it. I don't detect a benefit of course, because I remain apparently healthy.

.

 

[Monstrous Math]

I have spent some time searching the internet without success and come to the conclusion that there are NO serious studies on multivitamins taken at the recommended daily allowance.

Multivitamin Use and Mortality in a Large Prospective Study:

http://aje.oxfordjournals.org/content/152/2/149.short (American Journal of Epidemiology - Johns Hopkins University)

Multivitamin Use and Risk of Prostate Cancer in the National Institutes of Health:

http://jnci.oxfordjournals.org/content/99/10/754.short (JNCI - National Cancer Institute)

Multivitamin Use, Folate, and Colon Cancer in Women in the Nurses' Health Study (Annals of Internal Medicine - American College of Physicians)

http://annals.org/article.aspx?articleid=711703

Periconceptional Use of Multivitamins and the Occurrence of Neural Tube Defects (Journal of the American Medical Association):

http://jama.jamanetwork.com/article.aspx?articleid=375357

 

[Office_Shredder]

Let's see what the results of those studies are.

http://aje.oxfordjournals.org/content/152/2/149.short (American Journal of Epidemiology - Johns Hopkins University)

However, adjustment of the relative risk estimates for potential risk factors besides age consistently narrowed the difference between people who did and those who did not use vitamin supplements, suggesting that vitamin use itself accounts for, at most, only part of the survival benefit associated with these products

There was no consistent gradient of decreasing risk with more prolonged (table 3) or more frequent (data not shown) use of supplements for either ischemic heart disease or stroke

Sounds like a ringing endorsement for vitamins.

http://jnci.oxfordjournals.org/content/99/10/754.short (JNCI - National Cancer Institute)

No association was observed between multivitamin use and risk of localized prostate cancer. However, we found an increased risk of advanced and fatal prostate cancers (RR = 1.32, 95% CI = 1.04 to 1.67 and RR = 1.98, 95% CI = 1.07 to 3.66, respectively) among men reporting excessive use of multivitamins (more than seven times per week) when compared with never users

Taking multivitamins won't help, but it might kill you (oops).

http://annals.org/article.aspx?articleid=711703

This is the only one that appears to support vitamin use

http://jama.jamanetwork.com/article.aspx?articleid=375357

At this time, it is not possible to determine whether this apparently lower risk is the direct result of multivitamin use or the result of other characteristics of women who use multivitamins.

All of the studies observe that people taking vitamins are generally healthier and take better care of themselves, so if a study is unable to rule out those effects it doesn't have a whole lot of sway.

At the end of the day one study says vitamins are good, and one study says they're bad out of the ones you posted.

 

[Ivan Seeking]

Why do you think you need additional iron? Did your doctor do a blood test and find that you have an iron deficiency? It's not a common deficiency in men. I actually suffer from too much iron and it's killing me. Literally killing me, I have to give blood to try to reduce the iron in my body. Too much iron destroys the organs in the body, resulting in death. My doctor says it probably killed my father and other relatives because it wasn't diagnosed. I can't undo the damage the iron has already done, I can only try to rid myself of iron for the rest of my life to try to prevent further damage.

I am looking at the RDA for iron and the amount in the foods I eat. Most people apparently get their iron from breakfast cereal, which I don't eat. Beyond that red meat is the best source. But I try to limit my intake of red meat.

Anyone who eats common breakfast cereal is effectively taking an iron supplement.

 

[Monstrous Math]

(oops)

I posted these studies in response to someone saying there was NO RESEARCH. How is that an oops? I posted research. I never made the point that all of this research supported taking multivitamins. You assumed something I never said. What ever happened to the civility in the site's codes?

Secondly, your final quote is somewhat without context:

We found an overall apparent protective effect of periconceptional multivitamin use on the occurrence of neural tube defects, with a crude estimated relative risk of 0.40 (95% confidence interval, 0.25 to 0.63). At this time, it is not possible to determine whether this apparently lower risk is the direct result of multivitamin use or the result of other characteristics of women who use multivitamins.

Their last caveat applies to all research in human studies. Because there can always be another factor associated with people, since we cannot control them as strictly as we can mice or roundworms. It doesn't invalidate the entire research.

As for the first study, if I were to cherry pick information as you did:

Men and women who used both multivitamins and vitamin A, C, or E had lower all-cause death rates, and their risk was inversely associated with duration of use

Compared with men and women who took no vitamin supplements, users, in general, tended to be more educated, less overweight, and more likely to eat more vegetables and drink wine or liquor.

But the first study, taking place over seven years has quite a bit of information, and it's not meant to be read at a glance. The fact that you only chose to post certain items without letting people read these journals on their own, is evidence of bias.

If you are referring to my response to Evo, I already gave her one. This had nothing to do with that.

 

[Evo]

I am looking at the RDA for iron and the amount in the foods I eat. Most people apparently get their iron from breakfast cereal, which I don't eat. Beyond that red meat is the best source. But I try to limit my intake of red meat.

Anyone who eats common breakfast cereal is effectively taking an iron supplement.

But what were the results of your blood tests? Do you need iron? The body doesn't really excrete iron, and very little is used.

 

[Johninch]

Multivitamin Use and Mortality in a Large Prospective Study:

Thanks.

All of the studies observe that people taking vitamins are generally healthier and take better care of themselves, so if a study is unable to rule out those effects it doesn't have a whole lot of sway.

That's what I think too. I am healthy and take good care of myself. This certainly causes me to take multivits. Whether multivits makes a contribution to my wellbeing is not known, because it is not known whether my diet is deficient in any of these substances. It is however known that a large proportion of the population have dietary deficiencies.

I have never thought that multivits would extend my lifespan or protect me, even partially, from heart disease or cancer. I don't think that the purveyors of multivits are claiming this either. The claims of both multivit purveyors and multivit consumers circle around vague and unproven general health benefits, so I don't think that there is any deception here. It is also necessary to emphasize that the discussion is not about people with special health needs or about people who for any reason take more than the RDA.

At the end of the day, if one doesn't want to spend a few cents a day to pop a pill at breakfast, because the benefit has not been proven, that's a personal preference. I have the feeling, which is not contradicted by the studies, that a small additional intake of substances, which one should take anyway in the diet, is not going to do any harm.

If taking a precaution is followed by the desired condition, continue taking the precaution. However, if the desired condition does not occur, it may not be correct to strengthen the precaution. This is a common mistake.

.

 

[Evo]

Multivitamin Use and Mortality in a Large Prospective Study:

http://aje.oxfordjournals.org/content/152/2/149.short (American Journal of Epidemiology - Johns Hopkins University)

Multivitamin Use and Risk of Prostate Cancer in the National Institutes of Health:

http://jnci.oxfordjournals.org/content/99/10/754.short (JNCI - National Cancer Institute)

Multivitamin Use, Folate, and Colon Cancer in Women in the Nurses' Health Study (Annals of Internal Medicine - American College of Physicians)

http://annals.org/article.aspx?articleid=711703

Periconceptional Use of Multivitamins and the Occurrence of Neural Tube Defects (Journal of the American Medical Association):

http://jama.jamanetwork.com/article.aspx?articleid=375357

Thank you MM for looking those up.

I think all of them may be included in the article below, the article has links to all of the studies they discuss.

Multivitamin researchers say "case is closed" after studies find no health benefits

http://www.cbsnews.com/news/multivi...case-is-closed-supplements-dont-boost-health/

Johnnich, thank you also for your input. Basically, people need to be aware of what they are taking and what they may or may not need. Due to my condition, I cannot take multi-vitamins that contain iron, and most do. Due to the fact that I can't exercise, I eat very little, ~600 calories a day on average, so I have started taking a low dose multi-vitamin without iron. Based on research that has been posted previously in the forum, it seems to be unknown if the isolated supplements work the same as they do when eaten in natural food, so I may just be wasting my money.

 

[Ivan Seeking]

But what were the results of your blood tests? Do you need iron? The body doesn't really excrete iron, and very little is used.

I don't need a blood test to know if I am getting the RDA. At my age I should be getting at least 8 mg of iron a day. You get about 5 mg [typically considered to be 40% of the daily requirement] from a bowl of most breakfast cereals which, again, I can't eat and is really just an iron supplement [not naturally occurring]. And it takes more broccoli and spinach than is practical to get 8 mg every day.

One interesting source of iron is licorice. It is about as good as red meat. But I'm not sure if that will be practical.

Given the amount of muscle that I am now adding, I should probably be getting more like 10 mg a day.

 

[Pythagorean]

You can get quite a bit of iron from nuts and seeds.

 

[Ivan Seeking]

You can get quite a bit of iron from nuts and seeds.

I tend to pig out on nuts so I have limited my purchases of that but I will take a look. That might be a good option. I have started adding peanut butter to my protein drink each day. I think that is good for a couple of mg.

I eat a lot of veggies but they are only good for about 4 mg a day.

 

[strangerep]

I don't need a blood test to know if I am getting the RDA.

You're blindly missing Evo's point. What matters is whether the actual iron levels in your blood are within a healthy range. E.g., someone with a haemochromatosis gene needs to ingest less iron than the normal RDA, since they have difficulty getting rid of it when there's too much in their bloodstream. Iron overload is potentially serious.

You need to know your actual situation reliably when making nutrition decisions, not use guesswork or generalized figures applicable to the fictitious "average" member of the population.

 

[Ivan Seeking]

You're blindly missing Evo's point. What matters is whether the actual iron levels in your blood are within a healthy range. E.g., someone with a haemochromatosis gene needs to ingest less iron than the normal RDA, since they have difficulty getting rid of it when there's too much in their bloodstream. Iron overload is potentially serious.

You need to know your actual situation reliably when making nutrition decisions, not use guesswork or generalized figures applicable to the fictitious "average" member of the population.

I'm not missing the point. When I have my next physical we will see where things land. But I'm not talking about some crackpot iron binge based on voodoo science. I am talking about the recommended minimums. You don't have to see a doctor every time you adjust your diet to meet the minimum standards. Because I gave up breakfast cereals and significantly reduced the red meat in my diet three years ago [red meat especially over the last year] I reduced my iron intake by probably 80% or more.

There is no reason to believe that I have a problem with iron overload, especially considering that it was never a problem when I got twice as much iron or more compared to what I am trying to get now.

 

[Evo]

I'm not missing the point. When I have my next physical we will see where things land. But I'm not talking about some crackpot iron binge based on voodoo science. I am talking about the recommended minimums. You don't have to see a doctor every time you adjust your diet to meet the minimum standards. Because I gave up breakfast cereals and significantly reduced the red meat in my diet three years ago [red meat especially over the last year] I reduced my iron intake by probably 80% or more.

There is no reason to believe that I have a problem with iron overload, especially considering that it was never a problem when I got twice as much iron or more compared to what I am trying to get now.

You don't know unless you get a blood test.

That goes for needing anything. But iron is very serious, as too much can kill you and you won't know unless you have a blood test. The symptoms of too much iron are the same as what people think is too little iron, such as fatigue, that is a sign of too much iron, but many people think it's a sign of not getting enough iron and kill themselves.

 

[Chronos]

There is no clinical evidence a normal, balanced diet deprives you of any essential nutrients, aside, perhaps, in some third world countries. IMO, it's just an advertising gimmick designed to profit from 'miracle' supplements that have little, if any, known health benefits [Linus Pauling anyone?].

 

[bohm2]

There is no clinical evidence a normal, balanced diet deprives you of any essential nutrients, aside, perhaps, in some third world countries. IMO, it's just an advertising gimmick designed to profit from 'miracle' supplements that have little, if any, known health benefits [Linus Pauling anyone?].

I agree with this. Most health professional guidelines, however, still recommend Vitamin D supplementation for osteoporosis (particularly in elderly women) but the most recent meta-analysis suggests that it is also a dud:

A new meta-analysis of trials of vitamin D supplements for the prevention of myocardial infarction (MI), stroke, cancer, or hip fracture in seniors finds that, in general, taking vitamin D does not lower the incidence of these outcomes...In a review published in the Lancet by the same New Zealand research group last October ( Lancet. 2014;383: 146-155) , vitamin D supplements had no meaningful effect on bone density, "and this taken together with the current findings that vitamin D supplements do not prevent fracture suggests that they don't have a role in preventing osteoporosis," Dr. Bolland added.

Future Trials Unlikely to Support Vitamin D Supplementation
http://www.medscape.com/viewarticle/819670

 

[Monique]

There is no clinical evidence a normal, balanced diet deprives you of any essential nutrients, aside, perhaps, in some third world countries. IMO, it's just an advertising gimmick designed to profit from 'miracle' supplements that have little, if any, known health benefits [Linus Pauling anyone?].

This is not true.

First: what is a normal balanced diet? No such thing exists.
Second: clearly people can have problems absorbing nutrients (genetically or environmentally) as shown by many studies, such as this recent one published in JAMA: http://www.ncbi.nlm.nih.gov/pubmed/24327038

 

[Pythagorean]

More literature following Monique's second point:

Prevalence of nutritional deficiencies caused by gastroinstestinal nematodes (about 25% of the world population has them, one article even says 50% are affected by them):
http://www.annualreviews.org/doi/abs/10.1146/annurev.nutr.21.1.297

prevalence of iron deficiency in Yupik population:
http://jama.jamanetwork.com/article.aspx?articleid=415156

prevalence of Vitamin D deficiency in he US (about 40% of people):
http://www.sciencedirect.com/science/article/pii/S0271531710002599

 

[bohm2]

Second: clearly people can have problems absorbing nutrients (genetically or environmentally) as shown by many studies, such as this recent one published in JAMA: http://www.ncbi.nlm.nih.gov/pubmed/24327038

I didn't interpret Chronos as arguing against supplementation in people with such deficiencies (most of which can be picked up by blood tests, symptomology, etc.), but whether supplementation is necessary in well-nourished individuals in the industrialized nations. Many individuals also have thyroid deficiencies (hypothyroidism) but we don't recommend thyroid medication to the general public because some individuals have low levels and require thyroid medication.

 

[Monique]

I didn't interpret Chronos as arguing against supplementation in people with such deficiencies [..]

I interpreted it as an argument that one cannot be deficient with a "balanced" diet.

[..] but whether supplementation is necessary in well-nourished individuals in the industrialized nations. Many individuals also have thyroid deficiencies (hypothyroidism) but we don't recommend thyroid medication to the general public because some individuals have low levels and require thyroid medication.

Well-nourished individuals in industrialized nations can be deficient. Just think about pregnant women, they should be monitored and treated for deficiencies. Half of women are marginally deficient for biotin, at levels that is harmful in mice: http://www.ncbi.nlm.nih.gov/pubmed/19056637. Not to speak about B11 deficiency that can cause spina bifida..

Becoming a developed and rich nation can actually cause vitamin deficiency, such as beriberi that results from vitamin B1 deficiency, caused by the rich dehusking rice and washing it to get white rice: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889456/

 

[Evo]

Well-nourished individuals in industrialized nations can be deficient. Just think about pregnant women, they should be monitored and treated for deficiencies. Half of women are marginally deficient for biotin, at levels that is harmful in mice: http://www.ncbi.nlm.nih.gov/pubmed/19056637. Not to speak about B11 deficiency that can cause spina bifida..

Agree, pregnant women definitely need monitoring and pre-natal vitamins.

Menstruating women can become iron deficient.

Fad diets are unlikely to provide adequate nourishment, we know vegan diets must be supplemented as it is not a sustainable diet.

A very simple blood test will check common areas of concern. I was taking vitamins with iron, thinking like most people do that I needed it, I couldn't have been more wrong. Your doctor can help you decide what is right for you.

I was so deficient in potassium that I had to be given a potassium IV in the ER and was prescribed potassium supplements.

I also suffer from too much calcium, (hypercalcemia) and I really don't consume much calcium, far less than the RDA.

 

[bohm2]

Well-nourished individuals in industrialized nations can be deficient. Just think about pregnant women, they should be monitored and treated for deficiencies. Half of women are marginally deficient for biotin, at levels that is harmful in mice: http://www.ncbi.nlm.nih.gov/pubmed/19056637. Not to speak about B11 deficiency that can cause spina bifida..

You're right about pregnant women as there is evidence of benefit with respect to birthweight, etc. of a multivitamin and particularly with folic acid with respect to decreasing risk of neural tube defects as you mention. I've never seen biotin as one of the peri-pregnancy recommendations, however, in any of the guidelines.

Note, there are also studies suggesting very high rates of Vitamin D deficiency. For example:

The overall prevalence rate of vitamin D deficiency was 41.6%, with the highest rate seen in blacks (82.1%), followed by Hispanics (69.2%).

Prevalence and correlates of vitamin D deficiency in US adults
http://www.ncbi.nlm.nih.gov/pubmed/21310306

So one would think that Vitamin D supplementation would bring major health benefits. It doesn't appear to, however, as pointed out in the largest meta-analysis published in the Lancet piece linked above. Even with respect to fractures there was actually a slightly increased risk (but not statistically significant) with Vitamin D supplementation. This was surprising to me because Vitamin D was one of the few vitamins that I actually recommended to patients/clients.

 

[AlephZero]

First decide what is "normal".

Currently, individuals with serum 25-hydroxyvitamin D levels of <11 ng/mL are classified as vitamin D deficient. Experts collectively have proposed that minimum levels be at least 20 ng/mL.

from http://www.ncbi.nlm.nih.gov/pubmed/19255005

If you can pull numbers out of the air and change the definition of "deficient" by nearly a factor of 2, you can probably get any result you like.

BBC Radio had a long running series of medical programs called "Am I normal". http://www.bbc.co.uk/programmes/b007v7py/episodes/guide#b012p92l Often the conclusion tended to be "no you are not normal, but don't worry about it, because neither is anybody else".

 

[Pythagorean]

I think the point Monique was making about balanced diets is that "normal" is defined differently for different ethnic and cultural groups and it's worthwhile being aware of deficiencies, not that you should take supplements.

To me, that means food selection: try to include more vitamin D rich foods in your diet. Speaking of which, did the meta-analysis mention anything about the efficacy of Vitamin D fortification? Or can you even draw conclusions about fortification from supplementation?

 

[edward]

It all comes back to that well balanced diet with lots of fruits and vegetables...or does it? Our fresh produce just doesn't have the nutrients that it did 50 years ago.

The main culprit in this disturbing nutritional trend is soil depletion: Modern intensive agricultural methods have stripped increasing amounts of nutrients from the soil in which the food we eat grows. Sadly, each successive generation of fast-growing, pest-resistant carrot is truly less good for you than the one before.

A landmark study on the topic by Donald Davis and his team of researchers from the University of Texas (UT) at Austin’s Department of Chemistry and Biochemistry was published in December 2004 in the Journal of the American College of Nutrition. They studied U.S. Department of Agriculture nutritional data from both 1950 and 1999 for 43 different vegetables and fruits, finding “reliable declines” in the amount of protein, calcium, phosphorus, iron, riboflavin (vitamin B2) and vitamin C over the past half century. Davis and his colleagues chalk up this declining nutritional content to the preponderance of agricultural practices designed to improve traits (size, growth rate, pest resistance) other than nutrition.

http://www.scientificamerican.com/article/soil-depletion-and-nutrition-loss/

The good new is that people are eating more than we used to which one would think should help some what. The bad news is we are eating too much fat in the form of oils.

If we compare the current American diet with our diets forty years ago, we find similar levels of sugars, amino acids, and total fats, but the amounts of the two types of omega fats have changed very dramatically. In a natural diet of grains, meat, dairy foods, fruits, and vegetables, there is a bit more omega-6 than omega-3, but today there is more than twenty-times more omega-6 than omega-3. This shift in the proportion of these different fats is by far the biggest change in our diets over the past forty years.

Bold mine.

http://www.psychologytoday.com/blog/why-women-need-fat/201205/why-are-we-eating-so-much-more-we-used

All of the TV doctors say cut down on processed food but that is where all of the synthetic vitamins are.

OK OK I can only assume that despite the fact that farm grown foods are less nutritious (see above) we don't need to take vitamins or minerals because they are ever present in the processed foods we shouldn't eat. There is a contradiction in there somewhere. I love nitrates.

 

[edward]

Here is a good starting point. Your mileage may vary.

http://ods.od.nih.gov/factsheets/list-all/