Vitamins and Dietary Supplements

Multivitamins: Health Benefit or Waste of Money?

Author: Lisa Jones, MA, RDN, LDN
Registered Dietitian Nutritionist
Advisory Board Member, Nutrition411

Citation: Jones L. Multivitamins: health benefit or waste of money? [Published online July 30, 2019]. Nutrition411.

 

For many patients, taking a multivitamin or supplement along with their breakfast or morning coffee may seem like a key part of their daily routine. Americans spend approximately $12 billion per year on multivitamins and supplements1, the labels of which contain claims for improved health, better hair, skin, and nails, and more. Multivitamins that line grocery store aisles across the country come in variety of colors, shapes, and textures, with some even resembling gummy candy or popular cartoon characters.

However, whether multivitamin and supplement use actually leads to better outcomes in the general population has been controversial in recent years. A number of recent publications, including systematic reviews and meta-analyses, have aimed to clarify the effects of these substances and whether or not it is actually beneficial to recommend them to patients.

A 2019 prospective cohort study funded by the National Institutes of Health evaluated the association of dietary supplement use and levels of nutrient intake from foods and supplements with mortality among US adults.2 The study incorporated 1999-2010 data from the National Health and Nutrition Examination Survey on 30,899 participants aged 20 years or older who had answered questions on dietary supplement use.2 Limitations were noted because recall bias could have affected dietary supplement reporting. The results indicated that the use of dietary supplements was not associated with improved mortality outcomes in US adults.2

In a 2018 article published in the Journal of the American College of Cardiology titled “Supplemental Vitamins and Minerals for CVD Prevention and Treatment,” Jenkins et al identified individual randomized controlled trials from previous meta-analyses and performed further meta-analyses on cardiovascular disease (CVD) outcomes and all-cause mortality.3 The results indicated that there was no conclusive evidence regarding the benefits of supplementation.3 Additionally, the authors reinforced that, when discussing dietary intake with patients, providers should focus on promoting healthy dietary patterns and increased intake of plant foods, which contain many vitamins and minerals required by the body.3

A meta-analysis recently published in JAMA Cardiology in June 2019 aimed to assess the effects of vitamin D supplementation on CVD risk among 83,291 participants in 21 randomized clinical trials.4 A total of 41,669 participants were randomly assigned to vitamin D, and 41,622 received placebo.4 The results of the analysis indicated that vitamin D supplementation was not associated with reduced major adverse cardiovascular events, individual CVD endpoints (myocardial infarction, stroke, and CVD mortality), or all-cause mortality.4 Ultimately, the authors of the study concluded that vitamin D supplementation does not confer cardiovascular protection and is not indicated for this purpose.4

What Should Dietitians Recommend to Patients?

According to the Academy of Nutrition and Dietetics position statement on micronutrient supplementation, “supplements are warranted when requirements are not being met through diet alone.”5 However, the Academy also notes that the routine and indiscriminate use of micronutrient supplements for chronic disease prevention is not recommended, secondary to the lack of available evidence for this indication.5 Many studies have found that healthy individuals do not benefit from taking a multivitamin. Even those who have taken a multivitamin every day for years do not appear to be healthier or have a longer lifespan. However, other experts believe that supplements can help fill the gaps in an individual’s diet. Experts seem to agree that food is the best source for obtaining vitamins and minerals vs taking a supplement.

Next Page: Special Populations and Key Takeaways 

Special Populations

Although evidence has shown that supplementation may not confer many benefits in the general population, dietitians and related clinicians may want to consider recommending a multivitamin or supplement to patients who may be at risk for inadequate dietary intakes, as determined by the following criteria:6

  • The presence of chronic disease
  • Increased requirements secondary to growth
  • Pregnancy/lactation
  • Medication use
  • Malabsorption
  • Aging

 
One useful resource for your patients can be found in JAMA Internal Medicine, which has a patient page that provides answers to common questions regarding supplementation, such as when to consider taking a supplement.7

Key Takeaways

Dietitians and related clinicians can review and adhere to the Academy of Nutrition and Dietetics position statement on micronutrient supplementation. Clinicians should also keep abreast of the latest research pertaining to multivitamin supplementation in order to educate consumers on the potential benefits and safety, as well as regulatory issues. Recommendations for individual patients should be customized based on specific nutritional needs and current health status in an effort to optimize health.

References:

1. Is there really any benefit to multivitamins? Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/is-there-really-any-benefit-to-multivitamins. Accessed on July 11, 2019.

2. Chen F, Du M, Blumberg JB, et al. Association among dietary supplement use, nutrient intake, and mortality among U.S. adults: a cohort study. Ann Intern Med. 2019;170(9):604-613. doi:10.7326/M18-2478.

3. Jenkins DJA, Spence D, Giovannucci EL, et al. Supplemental vitamins and minerals for CVD prevention and treatment. J Am Coll Cardiol. 2018;71(22). doi:10.1016/j.jacc.2018.04.020.

4. Barbarawi M, Kheiri B, Zayed Y, et al. Vitamin D supplementation and cardiovascular disease risks in more than 83000 individuals in 21 randomized clinical trials: a meta-analysis [Published online June 19, 2019]. JAMA Cardiol. doi:10.1001/jamacardio.2019.1870.

5. Updated position of Academy: vitamin, mineral supplements may benefit some but do not prevent disease. Academy of Nutrition and Dietetics. https://www.eatrightpro.org/media/press-releases/positions-and-issues/micronutrient-update. November 19, 2018. Accessed July 11, 2019.

6. Ventura Marra M, Bailey RL. Position of the Academy of Nutrition and Dietetics: micronutrient supplementation. J Acad Nutr Diet. 2018;118(11);2162-2173. https://doi.org/10.1016/j.jand.2018.07.022.

7. Incze M. Vitamins and nutritional supplements: what do I need to know? JAMA Intern Med. 2019;179(3):460. doi:10.1001/jamainternmed.2018.5880.