How and When to Do a Multivitamin
More than one in three Americans take a multivitamin supplement, according to the National Institutes of Health, with most multivitamin users citing improved health or prevention
of chronic disease as their main reasons. However, in 2014, the U.S. Preventive Services Task Force said the evidence didn’t support taking—or avoiding—multivitamins.
One problem is that there’s no standardized definition of a multivitamin. Multivitamins may have as few as two micronutrients (vitamins and minerals), and the amounts of each may be minute or way too much. Many recent studies using 10 or more vitamins and/or minerals have shown mild to moderate benefits for reducing risk of chronic disease. What might this mean for you?
The State of the Science. The long-running Physicians Health Study (PHS) randomly assigned about 14,600 male U.S. physicians age 50 or older to take either a Centrum Silver, which contains 30 micronutrients, or a placebo daily for 12 years. Multivitamin use didn’t reduce risk of cardiovascular disease or improve cognitive health, but it did reduce cancer risk.
Howard Sesso ScD, MPH, associate professor of medicine at Harvard Medical School and director of nutrition research in the Division of Preventive Medicine at Brigham and Women’s Hospital in Boston, points out that the PHS, the only large-scale randomized trial in men, “showed a significant eight percent reduction in cancer and nine percent reduction in cataracts, but clinical trial data in women are lacking.”
To clarify the potential health benefits of multivitamins in women as well as men, the COcoa Supplement and Multivitamin Outcomes Study (COSMOS), which Sesso is co-leading, will randomly assign 18,000 women age 65 or older and men aged 60 or older to receive Centrum Silver or a placebo for four years. “COSMOS represents an important opportunity to evaluate whether long-term multivitamin use may reduce cancer risk,” Sesso says of the study, which will also look at effects on cardiovascular disease risk. “It carries potentially important public health implications.”
Covering Nutrient Shortfalls. Food is the best source of micronutrients, and most multivitamin users already eat a balanced, nutrient-rich diet. However, the Dietary Guidelines for Americans acknowledge that many people have diets that fall short on essential micronutrients, and a multivitamin can fill in the blanks. Other people may have specific nutrient needs that are difficult to meet even with a nutritious diet. For example:
- Women who are pregnant or might become pregnant and have increased need for folic acid.
- Adults over 50 who have trouble absorbing vitamin B-12.
- Premenopausal women who struggle with iron-deficiency anemia.
- Individuals who don’t produce enough vitamin D from the sun.
Choosing a supplement tailored to your age, gender, and other characteristics, such as pregnancy, can help you get the right amount of key micronutrients, although most multis don’t contain enough of those we may need a lot of, including calcium, magnesium, and vitamin D (some individuals may need additional supplements of these nutrients). They also don’t contain beneficial food components, like omega-3 fatty acids and phytonutrients (plant compounds with benefits). Make the most of your multi by taking it with a fat-containing meal for the best absorption—especially of the fat-soluble vitamins A, D, E and K—and the least stomach irritation.
—Carrie Dennett, MPH, RDN
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