Multivitamins...worth it or waste of money?

Got a question today that made me think...

Patient wanted to know if it was a good idea to keep taking their multivitamin. My usual answer to this is "Sure, why not? Can't hurt, right?"

Well I decided to do a little digging.

So what is a multivitamin?

• Well this is tricky because it depends on which on you are choosing, for men, women, pregnancy, senior citizens, hair, skin, nails, soft gels, gummies, blah, blah, blah, etc. Some of the specialty vitamins can be crazy expensive too!

• For the sake of argument I'm looking at a run of the mill general multivitamin, presumably suitable for all of the above :) but technically any vitamin that contains more than one vitamin can be considered a multivitamin.

• Ideally, it will have your daily allotment of all the vitamins, minerals, and micronutrients that you need. However, this is tricky cause in addition to taking a vitamin you are also eating 3 meals a day that presumably have some nutritional content. Which makes us think, how much is too much?

• The classic teaching is that the fat soluble vitamins, A E D & K, are the dangerous ones because they tend to hang around in your system longer and can thus more easily get to toxic levels. That being said, even getting too much of something like vitamin C, which we all know cures the common cold (it doesn't really, but that's for another post) is correlated with things like kidney stones, diarrhea, and even rebound scurvy.

• Rather than list ad nauseam the different vitamins and their daily recommended values, I will just link to the FDAs Vitamins and Minerals chart: https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/factsheets/Vitamin_and_Mineral_Chart.pdf

Are multivitamins worth it?

• To answer this we need to see if they offer any benefit, or harm. For me, that means does it cover things that are not contributed by your diet, and if it is, will you get those vitamins in doses that are dangerous to your health?

• The short answer is yes and no. Looking at a regular daily multivitamin from the USP list of approved multivitamins there appears to be between 45% and 100% of the recommended amounts of all the main vitamins and minerals. The two that are not 100% are calcium, which you should get enough of with a sensible diet, and Vitamin A, one of those fat soluble vitamins you don't want too much of. This seems like a good deal for one pill.

• Finally, do you get anything that isn't already in your diet?

  • Vit A: 1 whole sweet potato = 561% of your daily amount (RDA), 1/2 cup carrots = 184% of your RDA...and there are many more sources. I'm personally NOT CONVINCED it's necessary to supplement Vit A. (There are several types of dietary vit A but that for another discussion)

• Vit B1 (Thiamin): Found in fortified cereals and breads. About 6% of the population doesn't get the RDA. So again, unless you have special issues, (short gut or bariatric surgery) with a normal diet I'm NOT CONVINCED you need more B1.

• Vit B6: Found in Fish, beef, potatoes, and starchy vegetables. Almost the entire US gets its recommended daily amount of B6. However, there is still up to 1/4 of people in the US have low plasma levels of active B6. Interestingly 11% of B6 supplement users in one study were deficient...So there is some debate as to whether the RDA should be increased. If you are curious you can have your levels checked. However, pretty much all of us get the RDA in our diet so until the new research comes out, I'm NOT CONVINCED we need to supplement it on a regular basis.

• Vit B12: Meat eaters rejoice, this is found predominantly in various meats. Vegetarians you would likely want to add some fortified cereal or supplements to your diet. So I'm CoNvInCeD (that's half convinced) that it's necessary in particular sets of people. However, the research shows that the vast majority of us get the RDA anyway. Older people are also particularly at risk cause they produce less stomach acid to help with the absorption.

-Vit C: Vegetarians rejoice, this is found in many fruits and vegetables. And thusly it is usually not an issue and pretty much everyone in the US meets the RDA. Now about those colds...the research is mixed and I'll tackle it later. But I will say that if you are using it as a cold remedy, you should be taking it prophylactically, not after symptoms start.

-Vit D: tricky tricky. So this one is both dietary and produced by UV light interacting with your skin. So I will start by saying that the mean intake is below the RDA by about 45%. The majority of the dietary Vit D comes from fortified foods such as milk, predatory fish, and liver, which makes sense cause that's where we store it. It is also important to note that I'm not saying to go lay out in the sun and fry yourself...skin cancer sucks so be smart. And there is little to no correlation between latitude and Vit D levels, so it's not all about time in the sun. Plus you can make a bunch in the summer months and store it in your liver for later use as needed. So overall I am CONVINCED that a bunch of us need some dietary supplementation. But keep an eye on it and don't overdo it as toxic levels can lead to vascular disease and arrhythmias.

The list goes on and on and on...and if you want it I will be happy to keep going, but for the sake of my fingers and your eyes I will just say that the majority of what is in a multivitamin is not necessary to the average person. If you are in a resource poor area, or there is a known issue with getting foods that have certain vitamins and minerals, then yes, it might be a good idea.

NIH office of dietary supplements is a great resource for further reading: https://ods.od.nih.gov/Research/Dietary_Supplement_Label_Database.aspx

So what should one do?

• Great question, seems like any run of the mill multivitamin will suffice for most people. Special populations like pregnant women, infants, and children need special attention. Just remember, they are not regulated so buy from a reputable company. It also seems like toxicity will not be an issue so far as you are not going overboard with the vitamins.

Prior posts:
https://steemit.com/medicine/@cbk/hernias-101

This is meant to be informative, not medical advice. Please don't try to diagnose or fix your own medical problems, there are amazing medical professionals in your community who would love to help you!

If there are other topics you would like information on, please let me know and I will do my best to accommodate. If it's something I have NO knowledge about I have NO issue admitting it and hopefully another community member can come to the rescue. Please also let me know how i an improve my posts... more pictures, more science, less science, etc.