If you didn't hear, there was a pretty controversial report in the Annals of Medicine put out claiming that consumers should stop wasting their money on Multivitamins (1). In my opinon, a more appropriate summary is to not expect anything that great from popping your daily.
I've got a lot of thoughts on this issue so let's break it down:
1. May the Odds be Ever in your Favor - tossing a bunch of vitamins and minerals into the intestines at once is a bit like the Hunger Games- you've got a bunch of competitors, some will beat out others (for absorption) and maybe one will win out (be highly bioavailable) at the end. if you've ever taken a course on micronutrient metabolism, you'll probably hear this report and think ..'duh?' Mineral bioavailability is dependent upon a number of factors, and is largely inhibited by the presence of other minerals. Think back to your high school chemistry days - what happens when you put a bunch of positive charged minerals into a tight space with each other? Not to mention several of these minerals compete for the same absorption sites in the body. Take your multivitamin with your morning coffee? You won't be absorbing much iron. Same for calcium carbonate if you're taking it on an empty stomach. If you're not consuming much fat at breakfast, you won't be absorbing those fat soluble vitamins. I could go on and on, but the issue of bioavailability is a major one with multivitamins, and a lot of it comes down to chance regarding what will be absorbed. Until we further understand the rest of the food matrix and its effects on nutrient bioavailability, we won't be able to create perfectly absorb-able supplements - see the effects of citrus bioflavanoids on ascorbic acid (vitamin C) bioavailability (2), and the growing interest in mineral chelation to improve bioavailability (more applied in animal science/nutr currently) (3).
2. But are they really useless? - So multivitamin bioavailability isn't the best. But that doesn't mean you're not absorbing any nutrients. A lot of what the doc in this article is referencing is that multivitamins aren't doing anything to prevent chronic disease or cognitive decline. But should we be expecting that much of vitamin and mineral supplements alone to begin with? Let's say you've got a vegetarian, whose diet is probably low in zinc and higher in zinc inhibitors (phytates,etc). His/her body will probably absorb a bit more of the zinc in that multivitamin, and that may contribute to any of the hundreds of bodily processes that require Zinc as a cofactor. Will that translate to reduced disease risk? Probably not. But it's really hard in a study to quantify minor physiological changes, that may have a beneficial effect on aging/mood/behaviour/general well-being. If you're measuring the worth of a multivitamin by end goals it probably never was going to affect anyway, you're going to see them as useless. If you see them as an insurance policy, your expectations are probably more in line with their potential. **Note: I pointed out aging here because Multi-vitamin use has been associated with longer telomeres - shorter telomeres are signs of aging, likely due to oxidative stress and inflammation throughout the lifespan (8).
3. Are you getting what you're buying? - Supplements go largely unregulated in the USA. Take this recent study, for example, showing that common herbal supplements are contaminated (with potential allergens) (4). Independent testers of protein powders have found that they don't contain all of the protein they claim, and have a number of fillers (5). If you're interested in the politics of this regulation, check out Marion Nestle's foodpolitics.com/tag/supplements for a number of articles on the ways the supplement interest lobbied against regulations and have continued to push their products, whether or not they contain what they claim to. Interestingly, they're also the main culprits in ensuring that dietitians don't have sole nutrition therapy counseling rights.
4. Extension of this research - Is this all about multivitamins? In my opinion, no. This research's conclusions should be extended to virtually every fortified product. Adding a bunch of vitamins doesn't make a ClifBar healthy - especially not with 20+g of extra sugar. I was appalled yesterday to see the American Heart Association heart healthy stamp on vanilla almond milk, with 13g of added sugar per cup - sure, it's a great source of calcium, but almond milk is nothing more than 5-7almonds, water, sugar (unless you get the unsweetened versions), and a multivitamin in liquid form - I love their claims about being a great source of vitamin E (fortified, not from the almonds), even though meta-analyses on high doses of vitamin E have found increases in all-cause mortality (7) - I'm not actually very worried about the results of these meta-analyses in reference to almond milk, but what they do show is that tossing some water miscible vitamin E into almond water doesn't deserve the health halo that the front package is advertising. The same can be said for all of the sugar-y cereals marketed to children that boast being a great source of 12 vitamins and minerals - they aren't preventing chronic diseases and they certainly aren't undoing the fact that these products are loaded with added sugars and refined starches. Nutrition's effect on health is about a lot more than vitamins and minerals.
I don't mean to come across as overly woeful regarding supplements. They certainly have their place in health, in the event of diets low in specific nutrients. It's much easier, however, to use the USDA's SuperTracker or go see a clinician (doctor/dietitian) to analyze your diet and see which specific nutrients you might be low in. You can then enact steps to add foods rich in those nutrients to your diet, and supplement if necessary.
I'll be interested to see what the market response to this is. For now, I don't know of enough research to say that taking a multivitamin is a bad thing - but I wouldn't fret too much if you miss your daily. I personally take a MV once every 3 days or so to cover up any loose ends. Given the general low nutrient intake Americans have overall, as NHANES data shows us (9), I don't think this opinion article adequately addresses the population's severe nutrient gaps and multivitamins role in filling them.
The Natural Products Association issued a response (6) to this research stating that multivitamins shouldn't be expected to prevent chronic disease, unless the person is physically active and consuming a well balanced diet. But isn't someone who is consuming a well-balanced diet already getting their nutrients? Until we can find two populations of healthy individuals, who are regularly active, where one takes vitamin supplements and the other doesn't, we won't really know the role of multivitamins in aging and disease.
There have been some good points made that most individuals in America are not meeting the DRIs for many vitamins and minerals, and that multivitamins can fill this gap. In these situations, which may be the norm more so than those who are consuming well-balanced diets, multivitamins are likely playing an important role in maintaining nutrient statuses. I think it's important to note too, that while bioavailability is variable from multivitamins, they can also provide essential vitamins like folic acid - it's quite important for a woman of child bearing age to have excellent folic acid status when entering a pregnancy to deter Neural Tube Defects. As many woman don't know they're pregnant by the time the neural tube closes, multivitamin usage could play a big role here - still not replacing a healthful diet though.
1. http://annals.org/article.aspx?articleid=1789253
2. http://www.ncbi.nlm.nih.gov/pubmed/3414575
3. http://pubs.acs.org/doi/abs/10.1021/bk-1991-0445.ch024
4.http://www.biomedcentral.com/1741-7015/11/222
5. https://www.consumerlab.com/reviews/Nutrition_Powders_Shakes_and_Drinks_Including_Protein_Diet_Meal-Replacement_and_Sports_Endurance_Recovery_Products/NutritionDrinks/
6. http://newhope360.com/health-conditions/npa-defends-multivitamins-response-review
7. http://annals.org/article.aspx?articleid=718049
8.http://ajcn.nutrition.org/content/89/6/1857.full
9. http://fnic.nal.usda.gov/surveys-reports-and-research/food-and-nutrition-surveys/national-health-and-nutrition-examination
I've got a lot of thoughts on this issue so let's break it down:
1. May the Odds be Ever in your Favor - tossing a bunch of vitamins and minerals into the intestines at once is a bit like the Hunger Games- you've got a bunch of competitors, some will beat out others (for absorption) and maybe one will win out (be highly bioavailable) at the end. if you've ever taken a course on micronutrient metabolism, you'll probably hear this report and think ..'duh?' Mineral bioavailability is dependent upon a number of factors, and is largely inhibited by the presence of other minerals. Think back to your high school chemistry days - what happens when you put a bunch of positive charged minerals into a tight space with each other? Not to mention several of these minerals compete for the same absorption sites in the body. Take your multivitamin with your morning coffee? You won't be absorbing much iron. Same for calcium carbonate if you're taking it on an empty stomach. If you're not consuming much fat at breakfast, you won't be absorbing those fat soluble vitamins. I could go on and on, but the issue of bioavailability is a major one with multivitamins, and a lot of it comes down to chance regarding what will be absorbed. Until we further understand the rest of the food matrix and its effects on nutrient bioavailability, we won't be able to create perfectly absorb-able supplements - see the effects of citrus bioflavanoids on ascorbic acid (vitamin C) bioavailability (2), and the growing interest in mineral chelation to improve bioavailability (more applied in animal science/nutr currently) (3).
2. But are they really useless? - So multivitamin bioavailability isn't the best. But that doesn't mean you're not absorbing any nutrients. A lot of what the doc in this article is referencing is that multivitamins aren't doing anything to prevent chronic disease or cognitive decline. But should we be expecting that much of vitamin and mineral supplements alone to begin with? Let's say you've got a vegetarian, whose diet is probably low in zinc and higher in zinc inhibitors (phytates,etc). His/her body will probably absorb a bit more of the zinc in that multivitamin, and that may contribute to any of the hundreds of bodily processes that require Zinc as a cofactor. Will that translate to reduced disease risk? Probably not. But it's really hard in a study to quantify minor physiological changes, that may have a beneficial effect on aging/mood/behaviour/general well-being. If you're measuring the worth of a multivitamin by end goals it probably never was going to affect anyway, you're going to see them as useless. If you see them as an insurance policy, your expectations are probably more in line with their potential. **Note: I pointed out aging here because Multi-vitamin use has been associated with longer telomeres - shorter telomeres are signs of aging, likely due to oxidative stress and inflammation throughout the lifespan (8).
3. Are you getting what you're buying? - Supplements go largely unregulated in the USA. Take this recent study, for example, showing that common herbal supplements are contaminated (with potential allergens) (4). Independent testers of protein powders have found that they don't contain all of the protein they claim, and have a number of fillers (5). If you're interested in the politics of this regulation, check out Marion Nestle's foodpolitics.com/tag/supplements for a number of articles on the ways the supplement interest lobbied against regulations and have continued to push their products, whether or not they contain what they claim to. Interestingly, they're also the main culprits in ensuring that dietitians don't have sole nutrition therapy counseling rights.
4. Extension of this research - Is this all about multivitamins? In my opinion, no. This research's conclusions should be extended to virtually every fortified product. Adding a bunch of vitamins doesn't make a ClifBar healthy - especially not with 20+g of extra sugar. I was appalled yesterday to see the American Heart Association heart healthy stamp on vanilla almond milk, with 13g of added sugar per cup - sure, it's a great source of calcium, but almond milk is nothing more than 5-7almonds, water, sugar (unless you get the unsweetened versions), and a multivitamin in liquid form - I love their claims about being a great source of vitamin E (fortified, not from the almonds), even though meta-analyses on high doses of vitamin E have found increases in all-cause mortality (7) - I'm not actually very worried about the results of these meta-analyses in reference to almond milk, but what they do show is that tossing some water miscible vitamin E into almond water doesn't deserve the health halo that the front package is advertising. The same can be said for all of the sugar-y cereals marketed to children that boast being a great source of 12 vitamins and minerals - they aren't preventing chronic diseases and they certainly aren't undoing the fact that these products are loaded with added sugars and refined starches. Nutrition's effect on health is about a lot more than vitamins and minerals.
I don't mean to come across as overly woeful regarding supplements. They certainly have their place in health, in the event of diets low in specific nutrients. It's much easier, however, to use the USDA's SuperTracker or go see a clinician (doctor/dietitian) to analyze your diet and see which specific nutrients you might be low in. You can then enact steps to add foods rich in those nutrients to your diet, and supplement if necessary.
I'll be interested to see what the market response to this is. For now, I don't know of enough research to say that taking a multivitamin is a bad thing - but I wouldn't fret too much if you miss your daily. I personally take a MV once every 3 days or so to cover up any loose ends. Given the general low nutrient intake Americans have overall, as NHANES data shows us (9), I don't think this opinion article adequately addresses the population's severe nutrient gaps and multivitamins role in filling them.
The Natural Products Association issued a response (6) to this research stating that multivitamins shouldn't be expected to prevent chronic disease, unless the person is physically active and consuming a well balanced diet. But isn't someone who is consuming a well-balanced diet already getting their nutrients? Until we can find two populations of healthy individuals, who are regularly active, where one takes vitamin supplements and the other doesn't, we won't really know the role of multivitamins in aging and disease.
There have been some good points made that most individuals in America are not meeting the DRIs for many vitamins and minerals, and that multivitamins can fill this gap. In these situations, which may be the norm more so than those who are consuming well-balanced diets, multivitamins are likely playing an important role in maintaining nutrient statuses. I think it's important to note too, that while bioavailability is variable from multivitamins, they can also provide essential vitamins like folic acid - it's quite important for a woman of child bearing age to have excellent folic acid status when entering a pregnancy to deter Neural Tube Defects. As many woman don't know they're pregnant by the time the neural tube closes, multivitamin usage could play a big role here - still not replacing a healthful diet though.
1. http://annals.org/article.aspx?articleid=1789253
2. http://www.ncbi.nlm.nih.gov/pubmed/3414575
3. http://pubs.acs.org/doi/abs/10.1021/bk-1991-0445.ch024
4.http://www.biomedcentral.com/1741-7015/11/222
5. https://www.consumerlab.com/reviews/Nutrition_Powders_Shakes_and_Drinks_Including_Protein_Diet_Meal-Replacement_and_Sports_Endurance_Recovery_Products/NutritionDrinks/
6. http://newhope360.com/health-conditions/npa-defends-multivitamins-response-review
7. http://annals.org/article.aspx?articleid=718049
8.http://ajcn.nutrition.org/content/89/6/1857.full
9. http://fnic.nal.usda.gov/surveys-reports-and-research/food-and-nutrition-surveys/national-health-and-nutrition-examination
Really enjoyed reading your post! Being HIV/HEP-C positive I got caught up in this mega dosing trend with vitamins for several years. I never got better, and felt it was a total waste of my time. A close friend told me I should do all I can, and learn to eat clean & get the nutrients for my health through the foods I eat; so I did that. I also got caught up with Pre workout drinks "that promise me the strongest workout of my life", BCAA's. all I got was jitters, a lot of bloating, and my weakest workout's ever. Well here I am at the end of the year, and all I take is a during workout protein drink called XOJO by myxojo.com, eat clean all day, and have a glass of my ON 100% Whey protein before bed for 2 months now. I have to report that I had by far my most strongest workouts when I made these changes, and stopped all that other crap. I feel super strong, have energy that's natural & clean I am alive now this is what fitness is about. Good bye Jitters & bloating! "peace"
ReplyDelete