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Ask a Doctor


SHOULD I TAKE A MULTIVITAMIN? HERE’S WHAT THE SCIENCE SAYS.


THERE’S SOME ENCOURAGING DATA ON THE BENEFITS OF MULTIVITAMINS FOR HEALTHY
ADULTS. BUT THE SUPPLEMENT ISN’T A CURE-ALL.

Advice by Trisha Pasricha, MD
Contributing columnist
April 1, 2024 at 7:00 a.m. EDT

(Washington Post illustration; iStock)

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Q: What are the benefits of taking a multivitamin? Should I take one even if I’m
healthy?

A: About one-third of Americans take multivitamins regularly. Many purchase the
supplement because they think it can impact broad health outcomes — help them
live longer, decrease cancer risk and reduce cardiovascular disease. Otherwise
healthy people also take it to fill gaps in their diets.



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I wish it was that straightforward. Though there’s some encouraging data on the
benefits of multivitamins for healthy adults, the supplement isn’t a cure-all.

There have been three main studies looking into whether multivitamins impact
important health outcomes, all of which had private and public support,
including from supplement companies:

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 * A French study of about 13,000 adults between ages 35 and 60 found an
   improvement in cancer risk and mortality in men, but not women, after 7½
   years of daily supplementation.
 * Another study investigated over 14,000 U.S. male physicians age 50 or older
   and showed that multivitamin use for a median of about 11 years was
   associated with an 8 percent reduction in cancer, though there was no
   difference in mortality.
 * A study called COSMOS examining multivitamin use over a median of about 3½
   years in over 21,000 older adults found no improvement for men or women in
   cancer risk, mortality or cardiovascular disease. An ancillary study did find
   that certain aspects of cognition significantly improved for men and women
   over age 60.

Taking a multivitamin daily is generally regarded as safe. But because there
isn’t enough evidence of benefits for healthy adults, the United States
Preventive Services Task Force does not recommend it.

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My takeaway? Eating a healthy diet has been well established in multiple large
studies to improve numerous health outcomes, from reversing coronary heart
disease to reducing cancer risk.

You can’t redeem a poor or unbalanced diet by popping a pill to fill in the
nutrient gaps.

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IS IT BETTER TO EAT HEALTHY OR TAKE VITAMINS?

Many people have studied the health benefits of supplementing particular
nutrient gaps with a pill — for example, magnesium, which is popular as a
supplement and a common feature of many multivitamins.

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Studies consistently find that magnesium supplementation is insufficient to
achieve the benefits that come with a diet high in magnesium. This is likely
because of numerous other health benefits that accompany a balanced diet that
are not easily distilled to one — or even a handful — of nutrients taken out of
their original forms.

DO MULTIVITAMINS HELP COGNITION?

A large study published in 2023 derived from the COSMOS database found that
people taking a multivitamin for a year performed better on an immediate word
recall test. In this test, participants read 20 unique unrelated words several
times in a row, then were asked to read a new list of 20 words as a distraction,
before being asked to recall as many words as possible from the first list. The
study authors concluded that multivitamin supplementation had the effect of
improving age-related memory changes on this test by about 3.1 years.

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This data is encouraging. We likely need additional research to understand more
about the extent of this effect and to target the right population. For
instance, the people who appeared to benefit most are those with baseline
cardiovascular disease. It’s not clear why, but it may be that these patients
had micronutrient deficiencies, perhaps related to certain cardiac medications.

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Still, studies that have used a more extreme endpoint, like the development of
dementia, have not shown a benefit from over-the-counter supplements — something
that is associated with a healthy diet. And in the 2023 study, multivitamins did
not have a significant impact on other cognitive tests evaluating executive
function or new object recognition.

WHO SHOULD TAKE A MULTIVITAMIN?

There are a few scenarios where we know multivitamins are important:

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 * People with nutritional deficits: This could include people with alcohol use
   disorder or elderly people living in long-term-care facilities who may have
   poor fruit and vegetable intake. Other people with specific nutritional
   deficits, such as vitamin B12 deficiency among vegans, could also reasonably
   take a multivitamin daily to target their deficiency if a multivitamin
   contains an appropriate percent daily value.
 * People who have undergone bariatric surgery. These patients need to be
   careful to ensure they are also meeting their calcium as well as iron, copper
   and zinc goals in their supplementation, as many multivitamins may not
   contain a full daily value of minerals.
 * People who are pregnant or breastfeeding. In this case, a multivitamin
   containing 400 to 800 mg of folic acid should be taken as directed by their
   physician.

HOW SHOULD I CHOOSE THE BEST MULTIVITAMIN FOR ME?

Multivitamins are not regulated as medications by the Food and Drug
Administration, so there can be wide variations in what goes into each brand’s
formulations.

Typically, they contain some percent daily value of key vitamins and minerals.
Some brands may contain 70 percent of the daily value of one such nutrient —
say, vitamin C — while others contain 200 percent.

Do you really need 200 percent of the full daily value of vitamin C supplemented
if you’re healthy? Few clinical trials exist to give these kinds of specific
answers.

But generally, it makes most sense to pick a vitamin that targets your sex and
age group. Multivitamins targeted at younger women tend to contain higher
amounts of folic acid (in case of pregnancy) and iron, which is often low
because of losses due to menstruation.

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Participants in the COSMOS trial took a Centrum Silver daily multivitamin
containing high values of vitamin D and vitamin B12, which are often found in
multivitamins targeting older individuals.

If you’re someone who takes multiple supplements, read the labels carefully; you
don’t want to overdo it on any nutrient.

People who smoke should avoid multivitamins that contain over 20 mg a day of
beta carotene, as several studies have noted an increased risk of lung cancer in
this group.

WHAT I WANT MY PATIENTS TO KNOW

Putting anything into our bodies involves a risk-benefit calculation. Many
people feel that taking a multivitamin is better than nothing and that the risks
are extremely low. While I agree with at least the second part of that
reasoning, in the bigger picture, the harm may come less from the multivitamin
itself than from what we as health-care providers and society fail to address
more fundamentally. When an otherwise healthy patient tells me about their
multivitamin, I use that as a starting point to explore what nutrients they may
be worried they’re not getting through their meals and ways we can support them
to eat a more balanced diet.





WHAT YOU SHOULD KNOW ABOUT SUPPLEMENTS

Many Americans report taking dietary supplements, which are not regulated. These
articles delve into the science behind certain supplements.

Fish oil claims for heart health are overstated, study shows.

Turmeric supplements may help with pain and inflammation, but the substance is
hard to study.

Probiotic supplements may do the opposite of boosting your gut health.

Vitamin D isn’t the panacea some believe it to be. But it has shown promise in a
few key areas.

Here is what to look for in multivitamins, which scientists say can convey
health benefits.

You should avoid kava and 9 other risky dietary supplements.

What to look for when you’re buying a nutritional supplement.

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