After my post from yesterday, I had a great follow up question from my friend regarding multivitamins. I have far less strong opinions on this subject, unless it involves herbal supplements as well. Those also make me sad and angry inside. I’ll explain why:
As I mentioned about protein powders, dietary supplements are not regulated by the FDA the same way food and drugs are. They should be, to avoid instances like the ephedra fiasco, where lots of people died taking this weight loss pill, but the drug wasn’t banned until someone famous was affected. Basically, herbal supplements (including vitamins) can proceed to market essentially unchecked (unlike drugs, which take up to 15 years to get on the market). Technically, there are rules about the claims they can make and the ingredients they can contain, but no one checks until something goes wrong.
Herbal supplements in particular concern me. They make huge claims for energy, memory, insomnia, weight loss, etc., without needing any safety or efficacy studies to back them up. And don’t trust the studies they run themselves– of course they show good results!! There is additionally the concern of drug or food interactions, which can be life-threatening, even with very common supplements like St. John’s Wort and licorice root. If there is one herbal supplement in particular that you’d like to try, speak to a doctor or dietitian to check for interactions and consult a trustworthy resource like the Natural Medicines Comprehensive Database. This website has user-friendly safety and efficacy ratings as well as full, third-party studies from which they create the ratings. Consumer Lab is another great resource.
Nutritionally, though, do we need mineral and vitamin supplements (MVI is the hospital abbreviation, so I may instinctively use that throughout the post)? If you’re eating a well balanced diet with plenty of fruits and vegetables, probably not. But let’s be real, no one eats a perfect diet all the time. Because a complete MVI is not very expensive, go right ahead and take one. It’ll fill in any gaps you may have. Assuming the multivitamins are from a reputable company, they are safe. Any extra water-soluble vitamins (all vitamins but A, D, E, and K) will just be excreted, so no issues there. One small issue is that taking large doses of vitamins and minerals may decrease their bioavailability, meaning that less is able to be absorbed than the vitamin actually contains.
There are some nutrients in particular that you should be careful about when choosing an MVI. Vitamins A and D can have toxicities at very high intakes, so check the Upper Limit for your age and gender and choose a vitamin with amounts well under this to avoid any issues (remember, you also get these nutrients from your food). Iron and calcium can cause issues with the absorption of other nutrients, so make sure you’re getting enough of these but more is not better. Folate can mask a vitamin B12 deficiency in the elderly and in vegetarians (see below), which can cause irreversible nerve damage, but this is generally not an issue for most people.
There are some people that I absolutely recommend an MVI for. Vegetarians and vegans may need supplements of B12, iron, and calcium. Vitamin B12 is only available in animal products, so a supplement is almost always necessary. Iron from vegetables has much lower bioavailability than from meats, especially in the presence of oxalic acid found in vegetables like spinach and Swiss chard which binds iron and calcium and prevents absorption. Vitamin C, on the other hand, aids in iron absorption, so consider taking your supplement with OJ or citrus fruits! Vegetarians who eat plenty of dairy products shouldn’t have an issue with calcium and vitamin D, but vegans and lactose intolerant, as well as most women in general, should take a calcium and vitamin D supplement, just to be safe. It’s not expensive, not difficult, and not dangerous, so the potential benefits far outweigh the risks.
Children and the aging should also be taking complete MVIs. They may not be eating enough to intake all the micronutrients they need and deficiencies in these populations can be very dangerous. Be careful with vitamin B12 and folate though, and make sure that both amounts are adequate to avoid any issues with deficiencies.
If you are pregnant, could become pregnant (yes, even if you are on birth control– it’s not perfect. Hope that didn’t come as a shock.), or lactating, you should absolutely be taking MVIs. (Potential dads, this couldn’t hurt for you either). I seriously can’t emphasize this enough. If you can’t afford them, please find a WIC office, clinic, or food bank that will provide them free. Folate deficiency, which is surprisingly easy to achieve, prevents the fusing of the neural tube (i.e. the spine) of the fetus before a mother may even know she is pregnant. The fetus will also take iron from the mother, even if the mother is already deficient, so anemia is common in pregnancy but easily preventable with a supplement. Calcium has similar issues. With all other micronutrients, the mother’s body takes what it needs and the baby gets the excess, so a well-rounded supplement will fill any gaps in the mother’s diet and protect the baby’s development. So, just take the vitamin. Please.
Other groups of people who would benefit from an MVI are special cases such as celiac disease (which effects absorption if uncontrolled), cystic fibrosis, anemia, osteopenia/osteoporosis, cancer, etc. If you have a condition like these, though, hopefully you are well aware of the supplements you need, and if you’re not… find a new doctor. And a dietitian.
Just about everyone is deficient in omega-3 fatty acids, but the efficacy of supplements is as of yet unproven (and they smell like fish), so do your best to get these through real food like fish, flax, chia, and walnuts!
In all of these cases, I’m talking about a one-a-day type vitamin that supplies all necessary vitamins and minerals, not individual vitamin and mineral supplements. They are much cheaper and easier to deal with. If you feel like your MVI doesn’t supply enough calcium and vitamin D, combination supplements of those are fine. Calcium citrate is the most readily absorbed, so look for supplements with that rather than other forms of calcium.
For some reason, people are obsessed with what their doctor/dietitian do in terms of supplements, even though these are very specific cases, as you are now aware. But just in case you are one of these people, I have MVIs in my house, specially formulated for women. I don’t fit any of the above categories and I eat a fairly healthy diet, so I take them if I remember or if my diet has been lacking (i.e. during exam week).
As a side note, MVIs make some people, including myself, feel nauseous. If you want/need to take vitamins but experience this issue, try taking smaller vitamins or splitting larger ones in half and taking them twice a day. Always take them with food, and consider taking them at night so the nausea occurs in your sleep.
In conclusion: DO NOT rely on supplements or fortified foods like Total Cereal to replace the nutrients you get from food. The number of times I’ve heard “I take a vitamin so I’m healthy”……. no. Just, no. Food always comes first. Supplements just fill in the gaps.