Multivitamins, yes or no?

As a registered, practicing pharmacist, with 30 plus years experience, I can honestly say that I have never recommended any adult take a general multivitamin just for the sake of taking one, or just for the sake of selling something to a customer! I have however, spent many counselling sessions with patients explaining how to increase their natural multivitamin intake using everyday food, in place of swallowing a pill a day! It has always been my gut belief that all our general “multivitamin” requirements should come from our diet and by ensuring we eat nutrient dense food, incorporating fresh, good quality vegetables and fruit along with the best quality protein we can afford, we can rest assured we will always be getting enough general “vitamins” in the best possible form, in the ideal recommended daily amounts, straight from mother nature, just as she intended us to consume them. There are times however, when clinically implicated, that I have recommended individualised, targeted supplementation of a vitamin or mineral. This recommendation has always been done in combination with dietary advice and with an end point in sight. I have worked in hospital pharmacy, community pharmacy, clinical trials and drug information. I have read medical, pharmaceutical and nutritional journals for more than 30 years. I have read the good, the bad and the ugly regarding multivitamins. I remember the Pan Pharmaceutical debacle. So what do I believe? For the person who eats a well balanced diet, supplementing with multivitamins is only of benefit to the drug company that manufactures the multivitamin!

Multivitamins by definition, are preparations containing a combination of vitamins. The discovery of various vitamins and how they could prevent certain diseases in days gone by, was by far one of the best success stories of modern medicine. We all know the historical story of the sailors with scurvy and the miracle of it’s prevention with Vitamin C. We need to remember however that vitamins are just like other medications and are associated with both benefits and risks, so prescribing them should be evidence based and with an end date or point in sight. Indiscriminate use should be discouraged as it could have negative consequences.

Over the last 30 years, I have witnessed a huge growth in the Complementary Medicines industry. Television, radio and print advertising and or marketing are powerful factors in convincing the general public they would be more “healthy” if they took one or other branded multivitamin. Popular, well-known and usually local, Australian personalities, are also generally used as ambassadors to sell these products. The day after any complementary medicine is featured on “A Current Affair” or “Today Tonight” or the day after a write up in a major city newspaper (locally for me, this would be The Advertiser), I have experienced a huge increase in demand for the product featured. Most times the articles or features are slanted in such a way that the true benefit of the product is not revealed, or there is much more to the story than what was reported. This is pure marketing to increase sales and ultimately could be detrimental to the unsuspecting public.

The complementary medicines market is tipped to grow at a rapid rate in the coming years. Complementary Medicines Australia (cma) in its industry survey published last July 2014, predicted that the Australian $3.5 billion complementary medicines market value is expected to grow to $4.6 billion in 2017/2018 (1). Multivitamins and other complementary medicines are aggressively marketed to the general public, who are generally vulnerable and all in search of vitality, good health and longevity.

Surveys have shown that multivitamin and supplement use increases with age, income and education and within this group, there would be more women than men seeking and using supplements. Generally the supplement users have already adopted a healthier lifestyle by improving their diet, exercising more and removing/reducing unhealthy habits like smoking (2). Ironically these are the people that theoretically should have no need to take multivitamins or supplements.

The Iowa Women’s Health Study concluded that several commonly used vitamin and mineral supplements, when taken by older women (and we know from surveys that older women are consuming more supplements than younger women) may be associated with increased total mortality risk and that this association is strongest with supplemental iron (3).

There is a large body of accumulated evidence to support the fact that routine multivitamin use is of very little or no benefit to healthy adults and it is suffice to advise against the routine use of supplements. Most supplements do not prevent chronic disease or death, their use is not justified and they should be avoided, seeing that the population of people who are routinely taking these supplements already have improved their diet and lifestyle (4).

At last the tide appears to be turning. Good, old fashioned, healthy food, including fermented food is at last receiving the attention it deserves. Just earlier this month at the American Psychiatric Association 2015 Annual Meeting, a paper entitled “Beans, Greens and the Best Foods for the Brain” was presented by Bret S Stetka, MD (5).

A survey conducted by Dickinson, MacKay and Wong (6), showed that the 80% of those surveyed agreed that dietary supplements should not be used to replace healthy dietary or lifestyle habits, and 82 % agreed that people considering taking a high dose, single nutrient supplement should talk with their physician.

In conclusion, I would like to add that in my search for ultimate health, I have researched the use of multivitamins, minerals and supplements as a means of helping one achieve the best health one can. No amount of chemical manipulation of ingredients used in the pharmaceutical manufacturing process should ever take the place of consuming healthy macro and micronutrients across all the colours of the rainbow, in our search for health. Safe exposure to the sun, reducing stress, good quality sleep, some form of exercise, minimising environmental toxin exposure together with good dietary habits are essential for our health and longevity. I truly believe that we owe it to ourselves to treat our bodies with respect and in turn they will hopefully reward us with vitality, health and longevity.

  1. Complimentary Medicines Australia. Industry Survey. 2014 http://www.cmaustralia.org.au/ resources/Documents/Reports/CMA Industry Audit 2014.pdf
  2. Dickinson A, MacKay D. 2014. Health habits and other characteristics of dietary supplement users: a review. Nutrition Journal. Volume 13. http://www.nutritionj.com/content/13/1/14.
  3. Mursu J, Robien K, Harnack LJ, et al. 10 Oct 2011. Dietary supplements and mortality rate in older women: the Iowa Women’s Health Study. Archives of Internal Medicine. 171 (18) 1625-33
  4. Guallar E, Stranges S, Mulrow C, et al. 17 Dec 2013.Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Annals of Internal Medicine. Vol 159 (12) 850-51Bret S.
  5. Stetka B. Jul 07, 2015. Beans, Greens, and the Best Foods for the Brain. Medscape. www.medscape.com/viewarticle/847304_2
  6. Dickinson A, MacKay D, Wong A. 2 July 2015. Consumer attitudes about the role of multivitamins and other dietary supplements: report of a survey. Nutrition Journal. Volume 14. http://www.nutritionj.com/content/14/1/66