June 12, 2023 – Teresa Stull swears by her multivitamin formula. Tired of taking pills, the 62-year-old Frederick, MD-based aesthetician and business owner turned to a each day liquid formula for skin health and anti inflammatory advantages. She liked the product (which she also offers to her clients) due to its high absorption rate, the incontrovertible fact that the corporate published data on its website, and most significantly, its advantages for her skin and overall health.
“I've been using it for 6 years,” she said. “It helps the heart with the flaxseed oil, lysine and all the inflammation. And the side effects are healthy skin, healthy nails, healthy hair with the biotin and collagen and the way it's delivered. I feel very balanced.”
Stull is among the many 70% of Americans who take a multivitamin each day. But unlike Stull, many lack a transparent understanding of the “why and what” — why am I taking this and what is going to it do for me? There are many questions on whether these supplements help prevent diseases — namely cancer and heart disease — and plenty of people wonder in the event that they even must take a multivitamin.
One reason for that is that nutrient needs change throughout life. In middle and old age, aspects akin to a slower metabolism, problems with food intake and chewing, chronic low-grade inflammation, and taking multiple prescription medications can result in vitamin and mineral deficiencies.
In addition, the provision of food that meets our each day dietary needs is unreliable. Commercial agriculture today suffers from overuse of fertilizers and pesticides and fewer frequent crop rotation—all practices that impact soil health. Combine these aspects with climate change, and it's likely that the dietary value of most of the fruit and veggies we eat will probably be compromised. Even more likely, middle-aged and senior residents who swear by healthy diets are more likely to have significant dietary gaps.
“Soil quality has deteriorated significantly over the past 50 years, and produce is not as nutrient-dense as it once was,” says Dr. Melina Jampolis, an internist, nutritionist and writer in Valley Village, California.
Soil quality also varies from farm to farm.
“When we buy spinach or other foods, we don't actually know how much magnesium, vitamin K or calcium is in the products from the soil, because these depend on the soil and the soil is different,” says Dr. Christopher D'Adamo, director of research on the Center for Integrative Health on the University of Maryland School of Medicine.
Prevention vs. preservation
In 2022, the US Preventive Services Task Force concluded that There was insufficient evidence to support the usage of vitamin and mineral supplements – alone, together, or in multivitamin form – to forestall cancer, heart disease, or related deaths. The working group also found an association between beta-carotene intake and an increased risk of lung disease in certain high-risk groups. Vitamin E offered little overall profit in stopping heart disease or cancer.
Why trouble?
“In a perfect world, everyone would get their nutrient status tested. For example, I need magnesium but not calcium, and I need B1 but not B12. That would be ideal, but it's just not feasible,” D'Adamo explained.
“When you look at the data, the reason multivitamins can be helpful is because they can cover the basics.”
They might also help preserve memory in old age, in keeping with two studies by researchers at Columbia University and Brigham Women's Hospital/Harvard University.
The Study website on the results of cocoa supplements and multivitamins (often called COSMOS-Web) included roughly 3,500 adults over 60 years of age who were randomly assigned to receive a each day multivitamin or placebo and who underwent a battery of cognitive tests annually for 3 years.
“We tested what I would call learning or short-term memory, our ability to encode or initially store information in memory so that we can access it more easily later,” said study leader Adam Brickman PhD, professor of neuropsychology on the Taub Institute for Research on Alzheimer's Disease and the Aging Brain.
At the tip of the primary 12 months, the multivitamin group showed significantly greater improvements in memory than in the beginning of the study and in comparison with the placebo group.
“We found that the memory effect lasted, on average, over the three years of this study,” Brickman said.
This improvement corresponded to roughly three years of age-related memory loss.
The study also supported the outcomes of a previous COSMOS study (COSMOS-Mind), which found that the results were more pronounced in individuals with heart disease, who had lower baseline memory scores than healthy participants in each studies.
“There is evidence that people with vascular disease and vascular risk factors have lower levels of certain micronutrients than people without these conditions, so we believe the multivitamin supplement compensates for these relative deficiencies,” Brickman said.
There was a 3rd group within the studies that received a cocoa complement or a placebo. separate evaluation showed that folks with pre-existing flavanol deficiency who got the cocoa complement also showed an improvement in memory function.
Important considerations
- At least for now, multivitamins stands out as the best choice. In the COSMOS studies, it was unclear whether there was a particular element in multivitamins that led to the memory improvements, or whether flavanols from one source are more helpful than others. It can be necessary to contemplate the potential role that individual vitamins, akin to D3, play in supporting Maintaining bone density and possibly prevent fractures, or the B vitamins (especially B6 and B12) within the formation of red blood cells or the production of energy from food. Without widespread personalized nutrition and genetic testing, the one-size-fits-all approach will suffice so long as people follow a food-first approach.
“The idea behind multivitamins is that your diet is not necessarily perfect, so you supplement with the multivitamin to give yourself a little margin for error,” said Dr. Alexander Michels, a research associate on the Linus Pauling Institute at Oregon State University in Corvallis, Oregon.
He referred to newly published data from his organization that showed that the majority older men with low vitamin levels who got a each day multivitamin had improved blood concentrations and overall status of a number of vitamins (but not minerals) at the tip of the study. At the beginning of the study, most participants were deficient in at the very least one vitamin (most were deficient in three to 5), which is where the best improvements were seen. Taking multivitamins also slowed the decline of a certain marker of how well cells use nutrients; suggesting they may help maintain metabolism and immune health in older adults.
- The reception varies from individual to individual. Researchers are still working to raised understand how well the body uses multivitamins. “They are absorbed, but the amount can vary from person to person,” Michaels said.
Several aspects play a decisive role:
- “A mess of Medications can deplete nutrients,” D'Adamo said. Statins and acid blockers deplete certain nutrients. Aspirin can cause vitamin C to be lost quickly through urine, and other vitamins such as calcium, magnesium and zinc can reduce the absorption of certain antibiotics. (The Linus Pauling Institute offers a comprehensive list about drug, vitamin and mineral interactions on its website.)
- Certain foods can also interfere with absorption. “Some of the really high-fiber foods can interfere with absorption. Fat-soluble vitamins like vitamin K are higher absorbed when taken with fat. And people don't realize that tea can interfere with the absorption of iron,” Jampolis said.
- The data on the difference between vitamin tablets and liquids is less clear. Michels noted that this is pure speculation. “Every complement company thinks they’ve the reply, and … after they have the information, they keep it to themselves,” he said.
- Multivitamins are mostly safe. None of the experts we spoke to had concerns about the safety of multivitamins, but they all recommended that people check the label for quality and manufacturing certifications. NSF certifies dietary supplements according to NSF/ANSI 173, the only American national standard for testing and certifying dietary supplements for content and purity. Consumer Lab also offers access to product testing and reviews. (Full access requires a paid subscription.)
- The best time to start may be middle age. When a person reaches age 50, it may be time to start taking a multivitamin. “We see nutrient deficiencies starting within the mid-50s, and as people grow old, there tends to be increasingly more problems with suboptimal nutrition,” D'Adamo said. Jampolis advises starting even earlier — around age 45.
- They usually are not for everybody. Before you begin taking a multivitamin, it is best to seek the advice of your doctor, especially when you are taking medications or produce other health problems. Multivitamins usually are not suitable for everybody, so your doctor can provide you with the most effective advice in your needs.
Correction: Alexander Michels, PhD, of Oregon State University, was incorrectly identified as Adam Michaels in an earlier version of this story.