Quite frankly, I was astounded to learn that five doctors penned a guest editorial titled “Enough is Enough” for The Annals of Internal Medicine (AIM) which concluded that “supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful.”
 
Really? What’s truly astonishing is that they purport to come to this conclusion after reviewing three studies published in the same issue of AIM—and none of those studies support that conclusion. I’ve read all three, and yes, this morning I took my multivitamin, along with a handful of other supplements just like I’ve been doing for years. Call it an act of scientific defiance!
 
The first study, which served as the basis for a new USPS Task Force (USPSTF) recommendation, conducted a systematic review to explore the relationship between multivitamins and cancer and multivitamins and cardiovascular disease. While the conclusion of that report is disappointing—it found only limited evidence to support any benefit from vitamin and mineral supplements for prevention of either disease—it is hardly a reason to change your vitamin regimen.
 
Based on very selective inclusion criteria, the review located only two clinical trials that met its standards. From those two trials, there was no benefit for cardiovascular disease, but a “statistically significant protective effect from multivitamin supplementation” for men for cancer risk reduction. The researchers were wise to point out that studying nutrition is complex, and using drug-like models may not be the most appropriate way to do it.
 
The second study was limited to investigating high dose multivitamins for secondary prevention of cardiovascular events. In other words, would introduction of a high potency multi help prevent a second heart attack? Not surprisingly, the investigators found no statistically significant benefit, but the authors bent over backwards not to shut the door on research, emphasizing there were high rates of non-adherence and withdrawal from the study. An 11% relative risk reduction was not enough to meet statistical significance given the limited power of the study. Positive results here would have been akin to getting an extra prize in the Cracker Jack box, but it’s hardly a reason to stop taking your multivitamin.
 
The third study cited was the cognitive function arm of the Physicians’ Health Study II (PHS II). While the researchers did not find a benefit on cognition among multivitamin users, they noted that the rates of age-related cognitive decline among all the participants was smaller than they had expected, making a significant difference between the two cohorts that much more difficult to show. It raises significant questions more than answers.
 
Safety Concerns?
What’s compelling is that all three of these studies commented on the safety of the multivitamin. None of them revealed any safety concerns for these nutrients at the levels present in a typical multivitamin. (And even the high dose vitamins—not something that we recommend unless in consultation with your doctor—were found to have no safety issues by the authors of the second study.)
 
In addition to the promising results in PHS II on cancer, there was another recent arm of that study that found benefit for reducing cataract risk. And separate pre-clinical data continue to support the rational concept that people who use multivitamins enjoy better health. What’s particularly interesting about the PHS II is that all the participants were male doctors. Since doctors tend to enjoy more education and higher economic status than most, their diets reflected better than average nutrition. And even then, the benefits for cancer and cataracts are apparent. Just imagine how much more pronounced these benefits are likely to be in a less healthy diet.
 
In addition to all this promise for reducing chronic diseases, multivitamins are just an excellent source of nutrients to fill in those gaps we miss in our less-than-perfect diets. Multiple years of NHANES data demonstrate that Americans don’t meet the Recommended Dietary Allowance of many of their essential nutrients. Vitamin users tend to be healthier eaters than their counterparts, but even for them, the NHANES evidence reveals that without the addition of the multivitamin, they would not “hit” their recommended levels of nutrients on a consistent basis.
 
Filling Gaps
Separately, years of CRN’s consumer surveys demonstrate that most Americans who use multivitamins do so mainly for overall health and wellness and to fill in those nutrient gaps. They are not primarily thinking about preventing a heart attack or a bout with cancer as the reasons to take their multivitamin each morning. But if the research supports those added benefits, that’s a welcome bonus.
 
So let’s review: We know Americans don’t eat well and don’t get their all their needed nutrients from food. Multivitamins help to fill in those nutrient gaps. Study after study shows multivitamins are safe. Research supports their ability to reduce the risk of cancer, birth defects and cataracts. Even the actual research published in AIM supports the safety of the multivitamin and raises important hypotheses about its additional benefits. No one should expect the multivitamin to be a cure-all magic bullet for all disease. All three studies stress the need for more research to further examine the benefits of the multi for chronic diseases.
 
Why would anyone suggest that a multivitamin is a waste of money? Maybe it’s time to tune out medical journals that are more interested in promoting an anti-supplement agenda than in following where their own published research leads. Enough is enough.  
 
Steve Mister is the president/CEO of the Council for Responsible (CRN), the leading trade association for the dietary supplement industry.