What Vitamin Supplements Do and How to Pick One
Here’s another perspective on the pieces run in the New York Times and the Annals of Internal Medicine. There are many systemic flaws with the studies referenced in these editorials.
The first and most significant is that they used the same methodologies that are employed in drug studies: Give one group a placebo and give the other group a “multivitamin” (a low quality item that had all of three vitamins in it, unlike any actual multivitamin on the market) and see what happens over a period of years. The problem, of course, is that vitamins and minerals occur naturally in our food supply, so someone in the placebo group eating well would have had more adequate levels of vitamins and minerals in their body than those in the “multivitamin group” who ate poorly. They also failed to control for whether the people in the placebo group were taking a separate multivitamin (one that might contain more than three vitamins), which renders the studies virtually meaningless.
What is a multivitamin?
But it gets to the heart of an interesting question: What is a multivitamin? Or what is a vitamin D supplement? Or why would I ever take curcumin? The term “supplement” gives us a clue: A multivitamin is intended to supplement one’s diet. If a person ate a perfect diet he or she would have absolutely no need for a multivitamin.
But here’s the problem: Americans eat very, very imperfectly. The Standard American Diet is high in processed foods and low in the fresh, whole foods rich in vitamins and minerals, which is why many Americans have suboptimal levels of certain vitamins.
There are 13 essential vitamins—A, B complex vitamins, C, D E, K, pantothenic acid, biotin, and folate (folic acid). They are called essential because “they are needed for the body to function” in the words of MedlinePlus. If you’re low on essential vitamins, whatever function that vitamin is responsible for will suffer. To use an automotive analogy, if you’re low on coolant, your engine will overheat. If you’re low on oil, your engine will self-destruct. If you’re low on brake fluid, your car won’t stop.
Vitamins and minerals are much the same: Vitamin A helps form and maintain healthy teeth, bones, soft tissue, mucus membranes, and skin, and is important for vision. Vitamin B6 helps form red blood cells and maintain brain function, vitamin B12 is important for metabolism, vitamin E is a potent antioxidant, and so on. Every one of these vitamins plays a very important role—if your levels are deficient, that deficiency will manifest in various types of disease or less-than-ideal health.
It will be illustrative here to explore the difference between adequate (i.e., not deficient) and optimal. CDC data from 2012 found that 8.1 percent of Americans were deficient in vitamin D—but they defined deficiency as less than 12 ng/ml in the blood.
But numerous studies show that higher concentrations of vitamin D in the blood mean lower cancer risk. “If you take 1,000 IUs of vitamin D per day … you reduce your risk of developing colorectal, breast, prostate, and ovarian cancer by approximately 50 percent,” said Michael Holick, PhD, MD, in an interview with our sister journal Alternative Therapies in Health and Medicine. A Harvard study also noted that women with 48 ng/ml of vitamin D in the blood (or four times what the CDC considers sufficient) have a 50 percent lower risk of breast cancer. Another study in postmenopausal women who took 2,000 IUs of D3 daily had a 90 percent reduction in respiratory tract infections compared with women who took 400 IU per day (formerly the US recommended daily allowance).
The cost of taking 2,000 IUs of Solgar Vitamin D for a month is $2.50. The cost of breast cancer? Slightly higher.
This is not to say that “more is better” when it comes to vitamins, but rather to say that it is worth it to do further research rather than simply accepting government recommendations for a minimum standard.
Avoiding system failure
To return to our auto analogy, the reason you maintain your car is so that it will function well and not break down. You (hopefully) check your oil level and add to it if you are low, so that your car will have an optimal level of something that is essential.
Susan Mitmesser, PhD, is the director of nutrition research for American Health. In a recent interview she said, “One of the main reasons for taking a multivitamin is to supplement essential nutrients that we may not be getting from diet alone. In our fast food world, individuals may not be meeting their dietary intake goals for certain nutrients. A multivitamin acts as an insurance policy to ensure that nutritional gaps are filled to support overall health and wellness.”
Do you know what your level of B6 is? Me neither. I suspect it would be adequate without a multivitamin, but for a few pennies a day, I can know that my levels are fine and that my body has everything it needs to function.
The Annals editorial encouraged us to “save our money,” but the reality is we spend $8,323 dollars a year per capita on healthcare and $79 a year per capita on supplementation, so we pay over 100 times more to treat disease than we pay for a simple step toward prevention.
The Times editorial also warned us about “50,000 adverse reactions a year” from supplementation. These adverse reactions are most often reported as headaches, stomachaches, or diarrhea. Non-steroidal anti-inflammatories, such as acetaminophen, kill 15,000 people a year in this country from bleeding ulcers (bizarre, but it’s true) and an estimated 200,000 people die per year as a direct result of the prescribed medications they’re taking, so warning Americans away on the basis of safety rings a little hollow.
How do I pick one?
As with most things, it depends on what is important to you. The lower-cost vitamins will tend to be synthetically derived. Dr. Mitmesser says, “Wonderful advancements in technology have afforded the opportunity to manufacture ‘synthetic’ vitamins and nutrients in the laboratory, helping to drive down costs while still providing efficacious supplements.”
Supplements that are higher end will often be naturally derived. “The FDA has not offered a definition of ‘natural,’ however, natural-based supplements are typically derived from a once-living source or are mined from the Earth and have undergone minimal processing,” said Dr. Mitmesser.
In fact, nature designed an ingenious cycle, where plants extract minerals and nutrients from the earth, then plants and animals manufacture vitamins and make minerals more accessible for our bodies. Food-derived vitamins may cost a little more, but the increased bioavailability of these nutrients may make them a better investment. If you find a brand you feel comfortable with and that works for you, brand loyalty can be a simple way of winnowing down the possibilities, as many brands make a full line of supplements.
You can also pick them by stage in life: Prenatal supplements are an obvious example. Or, as Dr. Mitmesser said, “Reputable companies design products to meet certain demographic needs based upon well-established science. As we age, nutrient requirements change. In turn, the need for a senior multivitamin may be warranted for someone aged 65. Certain vitamins and minerals have been shown to support the aging process and many individuals would benefit from these respective nutrients.”
The risk involved in taking multivitamin supplements is so low as to be nearly nonexistent, the cost is minimal, and the potential benefits are no less than continued good health—to me, that’s easy math.