Multivitamins a waste of money?

[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/