Should I Take a Multivitamin?

About 1 in 3 Americans takes a multivitamin. Is that helpful, harmful, or just a harmless waste of money? In 2011, the Iowa Women’s Health Study reported that multivitamin use was associated with a higher risk of total mortality, meaning in effect women who took a multivitamin appeared to be paying to live shorter lives.

But this was an observational study, meaning they didn’t split them up into two groups and put half on multivitamins to see who lived longer, they just followed a large population of women over time and found those that happened to be taking multivitamins were more likely to die. But maybe they were taking multivitamins because they were sick. The researchers didn’t find any evidence of that, but ideally we’d have a randomized double-blind placebo controlled trial, thousands followed for over a decade. Half given a multivitamin and half a placebo and see what happens, and that’s what we got the following year in 2012.

The Harvard Physicians’ Study II. And after a decade no effect on heart attack, stroke, or mortality.

The accompanying editorial concluded that multivitamins are a distraction from effective cardiovascular disease prevention. The message needs to remain simple and focused: heart disease can be largely prevented by healthy lifestyle changes.

They did, however, find that for men with a history of cancer, the multivitamin appeared to be protective against getting cancer again, though there was no significant difference in cancer mortality or cancer protection in those who’ve never had cancer before. Still, though, that’s pretty exciting. It is just one study, though, ideally we’d have like 20 of these placebo-controlled trials and then compile all the results together, and that’s what we got in 2013, a meta-analysis of randomized controlled trials.

Twenty-one of them, covering more than 90,000 individuals and no influence on mortality either way. Some found more cancer mortality, some found less cancer mortality, but all and all it was a wash.

And that was heralded as good news. After the Iowa Women’s Health Study came out we were worried multivitamins could be harming millions of people, but instead they don’t appear to have much affect either way. The accompanying editorial asked should meta-analyses trump observational studies? I mean Iowa Women’s Health Study followed tens of thousands of women for nearly 20 years.

What if we put all the studies together? The big observational studies along with the experimental trials? And that’s what we got December 2013, concluding that multivitamins appear to offer no consistent evidence of benefit for heart disease, cancer, or living longer.

Why though? Aren’t vitamins and minerals good for us? One explanation for this result could be that our bodies are so complex that the effects of supplementing with only 1 or 2 components is generally ineffective or actually does harm. Maybe we should get our nutrients in the way nature intended.

The accompanying editorial concluded enough is enough; we should stop wasting our money on vitamin and mineral supplements. Americans spend billions on vitamin and mineral supplements. A better investment in health would be eating more fruits and vegetables. Imagine if instead we spent those billions on healthy food?

This is not the aisle we should be getting our nutrients from. With the money we save on pills we can buy more of the best multivitamins on Earth.

Written by Dr. Michael Greger, MD

Sources Cited

J. M. Gaziano, H. D. Sesso, W. G. Christen, V. Bubes, J. P. Smith, J. MacFadyen, M. Schvartz, J. E. Manson, R. J. Glynn, J. E. Buring. Multivitamins in the prevention of cancer in men: the Physicians’ Health Study II randomized controlled trial. JAMA. 2012 308(18):1871 – 1880.

H. D. Sesso, W. G. Christen, V. Bubes, J. P. Smith, J. MacFadyen, M. Schvartz, J. E. Manson, R. J. Glynn, J. E. Buring, J. M. Gaziano. Multivitamins in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA. 2012 308(17):1751 – 1760.

E. Guallar, S. Stranges, C. Mulrow, L. J. Appel, E. R. Miller. Enough is enough: Stop wasting money on vitamin and mineral supplements. Ann Intern Med. 2013 159(12):850 – 851.

H. Macpherson, A. Pipingas, M. P. Pase. Multivitamin-multimineral supplementation and mortality: A meta-analysis of randomized controlled trials. Am. J. Clin. Nutr. 2013 97(2):437 – 444

M. Cully. Prevention. Multivitamins do not reduce the risk of cardiovascular disease. Nat Rev Cardiol. 2013 10(1):7.

S. M. Chang. Should meta-analyses trump observational studies? Am. J. Clin. Nutr. 2013 97(2):237 – 238.

S. Rautiainen, L. Wang, J. M. Gaziano, H. D. Sesso. Who uses multivitamins? A cross-sectional study in the Physicians’ Health Study. Eur J Nutr. 2013 [Epub ahead of print].

L. Anekwe. Daily multivitamins do not protect against cardiovascular events, finds study. BMJ. 2012 345:e7599.

R. Vogt. The importance of translating research skillfully to benefit the public. Arch. Intern. Med. 2012 172(5):449; author reply 449-450.

E. M. Lonn. Multivitamins in prevention of cardiovascular disease. JAMA. 2012 308(17):1802-1803.

F. Greenway, K. Fujioka, Y. Yu. Vomiting from multivitamins: A potential drug interaction. Am J Ther. 2011 18(6):453 – 457.

S. P. Fortmann, B. U. Burda, C. A. Senger, J. S. Lin, E. P. Whitlock. Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann. Intern. Med. 2013 159(12):824-838.

J. Mursu, K. Robien, L. J. Harnack, K. Park, D. R. Jacobs Jr. Dietary supplements and mortality rate in older women: The Iowa Women’s Health Study. Arch. Intern. Med. 2011 171(18):1625 – 1633.

R. F. Redberg. Vitamin supplements: More cost than value. Arch. Intern. Med. 2011 171(18):1634 – 1635.