Investigative Analysis

Making the Case for Multivitamins

September 2002

According to recent surveys, approximately 40 to 47 percent of the U.S. population use vitamin or mineral supplements at least occasionally. Slightly more than two thirds of supplement users take only one supplement, typically a multivitamin.1 But is this supplementation warranted? More and more studies suggest it is.

A recent scientific review published in the Journal of the American Medical Association (JAMA) indicates that, although vitamin deficiency is uncommon in developed countries, inadequate intake of several vitamins has been linked to chronic diseases, including coronary heart disease, cancer, and osteoporosis. Inadequate folate status is associated with neural tube defects. Folate and vitamins B-6 and B-12 are required for homocysteine metabolism and are associated with cardiovascular risk. Vitamin E and lycopene may reduce prostate health risks. Vitamin D is associated with decreased occurrence of bone fractures when taken with calcium. And new research suggests that high intakes of the antioxidant vitamins C and E may protect against mental decline.3 But can't we get enough of these vitamins in through dietary sources? Many nutrition experts say that the question is not whether we can, but if we do.

According to the JAMA review, elderly people, vegans, alcohol-dependent individuals, and patients with malabsorption syndromes are at higher risk of inadequate intake or absorption of several vitamins. The position of the American Dietetic Association is that the best nutritional strategy for promoting optimum health and reducing the risk of chronic disease is to choose wisely from a wide variety of foods. However, they note that additional vitamins and minerals from fortified foods and/or supplements can help some people meet their nutritional needs. The Food and Nutrition Board of the Institute of Medicine, National Academy of Science, recommends that supplements or fortified foods be used to obtain desirable amounts of some nutrients, including folic acid for women capable of becoming pregnant and vitamin B-12 for persons over age 50. The elderly may also require supplemental sources of vitamin D if they do not drink generous quantities of fortified milk.

Supplements can also be useful for meeting nutrient intake recommendations when dietary selection is limited. Examples include vitamin B-12 supplements for strict vegans who eliminate all animal products from the diet; vitamin D for those with limited milk intake and sunlight exposure; calcium supplements and/or fortified foods for those with lactose intolerance or allergies to dairy products; and multivitamin/mineral supplements for those following severely restricted weight-loss diets.

While research into the roles of vitamins and health maintenance continues, many people are asking themselves "do I need a multivitamin?" The answer depends on several factors. Most nutrition experts agree that multivitamins can play crucial role in meeting nutrient intake recommendations for people on restricted diets, the elderly, and other groups at increased risk for nutrient deficiencies. For the general population, however, the question remains under debate. But given their safety, relatively low cost, and growing evidence linking vitamin status and chronic disease, more and more nutrition experts are recommending multivitamin supplements as dietary "insurance policies" to cover the body's basic nutritional needs.

Vital Health Stat,11 (244): I-iii, 1-14, 1999.

JAMA, 287: 3116-26, 3223-9, 2002.

J Am Diet Assoc, 101 (1): 115-25, 2001.

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