Originally published 10 Feb 2017. Last updated 22 August 2020.
Listen to Dr. Neal address this topic on Episode 20, Episode 150, Episode 755, and Episode 905 of the podcast Optimal Health Daily.
There seems to be so much conflicting data with regards to taking vitamins or supplements. It seems like scientists, doctors, and dietitians or nutritionists cannot come to a decision on whether taking them will help at all.
Plus, if you do decide to take a vitamin or supplement, you may not know whether they are free of contaminants or actually contain the nutrients they’re supposed to and at the right dosage. I believe I’ve said this before, but I’ll say it here again: the supplement industry right now is similar to the Wild West… it’s every person for themselves.
We as consumers have to do our research and make sure we are not causing more harm than good.
Should You Take Daily Vitamins and Supplements?
Here is the “no B.S.” answer: most people do not need to take any vitamins or supplements.
You may not have liked that I said “most people,” but it’s important I make this distinction. What I mean here is that most healthy adults do not need to take a multivitamin every day, or extra vitamin C, or zinc, or calcium, or a sports supplement, and so on.
There have been a number of published studies looking at whether supplementing with vitamins and minerals can prevent disease and prolong your life. It turns out they don’t seem to help with either one. Instead, getting your vitamins and minerals from eating real foods that have been minimally processed is best. This is because our bodies are better equipped to extract the nutrients from whole foods as opposed to supplements.
If you think about it, many supplements contain weird combinations of nutrients–combinations you wouldn’t find in nature. The body gets confused and is unsure of how to process these weird combinations of nutrients. Because it doesn’t know what to do, the body gets rid of them. For many of us, when we take these supplements, we just end up with nutrient-rich urine.
There’s also the risk of toxicity. This usually happens when people take it upon themselves to supplement with minerals like iron, magnesium, or zinc. Plus, there are those vitamins and minerals that we know increase disease risk when we supplement with them. Vitamin E and conjugated linoleic acid (CLA) come to mind.
All that said, taking a multivitamin is like having an insurance policy. It likely won’t hurt, but may help if under certain conditions. Here’s why: in industrialized countries like ours, the abundance of food has prevented many of the common nutrient deficiencies that used to be so common.
The risk for developing a vitamin or mineral deficiency is pretty low. There are of course exceptions to this. For example, as we get older, we may become deficient in certain nutrients. This happens for a number of reasons — for example, it’s quite normal to lose some of our ability to absorb vitamin B-12 as we age.
And even with all of this abundancy, we may not always select the most nutritious foods.
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What are the Benefits of Keeping a Food Journal?
When someone tells me that they are consuming a well-planned, balanced diet, I usually don’t take their word for it. I like them to tell me what they are eating so that I can “cross-examine” them a bit. I like to get a bit more detail and see if they’re being honest with me.
Something you can do is start writing down everything you eat and drink and in what amounts. Do this for at least 3 days each week for the next 4 weeks. Try and choose days that are representative of how you normally eat. So, don’t select holidays for example. But do make sure that at least one of the days is a Saturday or Sunday. This is because we often eat very differently on the weekend when compared to weekdays.
The advantages to keeping a food journal include the following:
- It will help you observe patterns in your diet so that you may begin to notice which foods you consume too little or too much of.
- You can bring it to your next doctor’s visit and show your physician. He or she may then be able to better assess whether a daily multivitamin is right for you.
- It can help you set SMART healthy eating goals.
Who Should Take Vitamin and Mineral Supplements
Many of us have access to fresh fruits and vegetables, but we also have access to lots of fast food and sit-down restaurant options. Not that everything found in your local supermarket is the most nutritious, either. That’s why so many health professionals, including me, say that when you are grocery shopping, it’s best purchase nutrient-dense foods. These would be:
- fruits and vegetables
- whole grains
- fish
- nuts
- legumes
- seeds
Vegetarians & Vegans
I’ll give you an example. I’ve had excited patients tell me that they have switched to a vegetarian lifestyle.
I’ll respond, “Ok, so tell me about what you’ve been eating.”
And they’ll say, “Oh, you’ll be so proud of me… for breakfast, I will eat a bowl of oatmeal with a whole grain English muffin on the side. For lunch, I will have a peanut butter and banana sandwich on whole grain bread. And for dinner, whole wheat pasta topped with marinara sauce and a whole wheat roll on the side!”
Uh… did you notice what happened to be missing from this meal plan?? Vegetables! This isn’t a vegetarian diet, it’s a carb-a-tarian diet. Vegetarian diets actually require the consumption of vegetables.
In this case, I would be concerned that the person isn’t consuming enough nutrients to support optimal health. In addition to trying to get them to consume more vegetables and other fruits besides just bananas, I would recommend they think about taking a multivitamin to prevent any vitamin and mineral deficiencies.
If someone isn’t consuming a well-planned, balanced diet, I may recommend they speak to their doctor about taking a multivitamin. But, there are other folks that may want to consider this, too.
Those that follow a vegan lifestyle may want to consider a multivitamin, too, at the very least, a vitamin B12 supplement and possibly an omega-3 supplement. This is because the form of vitamin B12 the body needs only comes from animal products. Furthermore, the type of omega-3 fats found in cold water, fatty fish are different than the types found in plant-based foods like flaxseeds and walnuts.
People with Iron Deficiency
Young men and women are often iron deficient. On top of that, during adolescence, they may not follow the healthiest eating patterns. In fact, if they are anything like me when I was an adolescent, breakfast and lunches are skipped and fast food is the dinner of choice. It’s possible that they are missing out on other important nutrients. During this stage of development, rapid growth is taking place so it’s important that the body has everything it needs to support this. Therefore, pediatricians may recommend that some younger folks take a multivitamin.
Older People
As we get older, we find that we aren’t able to digest and absorb nutrients as well as we did when we are younger. Plus, we’re more likely to have issues with our teeth and taste buds, which influences which foods we prefer, and making our food choices much more limited. We’re also more at-risk for developing chronic conditions like osteoporosis. Here again, it may be helpful to consume a multivitamin, particularly one that is specially formulated for older adults.
Women particularly are at an increased risk for developing osteoporosis after the age of 45. Osteoporosis is that nasty disease that leads to holes forming our bones. The word “osteo” or “osteon” refers to bone and “porosis” or “porous” refers to something having small spaces or holes in it. I know there has been some controversy lately about the effectiveness of calcium supplementation and osteoporosis prevention, but the majority of studies do find some benefit especially if someone isn’t getting enough calcium in their diet. I would consider asking your doctor about continuing with 300-500 mg of calcium each day.
Also, if your doctor hasn’t done this already, go ahead and request a blood test that looks at your vitamin D levels. If your levels are low, it may be worthwhile to consider a vitamin D supplement, too. If your test comes back normal, there may be no need to supplement with vitamin D.
Those With Digestive Issues
Some folks may suffer from digestive issues like Irritable Bowel Syndrome (IBS) or Inflammatory Bowel Disease (like Crohn’s disease and ulcerative colitis). These individuals may benefit from supplementing with specific nutrients like folic acid, magnesium, and probiotics.
Others Who May Benefit From a Daily Multivitamin
- Those with eating disorders, like anorexia or bulimia
- Folks that suffer from anemia
- Menopausal women
- Folks that rarely consume fruits or vegetables
- Marathon runners or athletes that perform high intensity physical activity on a regular basis
- Those that suffer from alcoholism or those that regularly smoke cigarettes
There are certain situations where a doctor or a dietitian/nutritionist may recommend a supplement. But often times, they don’t recommend you start taking a multivitamin – they’ll recommend a specific supplement for a specific condition. For example, those that regularly smoke cigarettes should take a vitamin C supplement. Vitamin C can help offset some of the damage caused by smoking. Marathon runners or those that perform regular high intensity physical activity should also consider taking a vitamin C supplement.
You are probably wondering if I take any supplements. Because most of my workouts last at least an hour and incorporate high intensity training, I take a vitamin C supplement every day. But that’s it.
Finding the Best Vitamin and Mineral Supplements
Whatever you and your doctor decide, just keep in mind that some of the vitamins and minerals you get in pill form may not always be absorbed. There are a number of reasons for this.
First, our bodies are better equipped to pull nutrients from food instead of a pill.
Second, the way the supplements are manufactured affects how the body absorbs them. Some vitamins are immediately destroyed when they hit the stomach because of the stomach’s strong acid content. Others are better absorbed when you take them with food.
Calcium and Vitamin D
Calcium is often found in 2 forms when you buy it as a supplement: calcium citrate and calcium carbonate. Calcium carbonate, specifically, is better absorbed when taken with food. Calcium is better absorbed when some vitamin D is present, too.
Tips When Buying a Supplement
If you and your health care practitioner decide you should take a supplement, please take a moment to research the various brands to be sure you are buying a quality product.
One of the most complete resources I have ever seen with regards to supplement safety is Consumer Lab. They are an independent company, which means they don’t get paid by any supplement manufacturers, and they randomly test supplements for quality and purity. They will even tell you where to find the cheapest ones. Consumer lab is not a free site, but it's very affordable, and if you're a student, you may find that your school is actually paying for access to their database. Definitely ask your librarian!
For about $40 per year, you can subscribe to Consumer Lab. I use their website all the time and have found that their testing is far more thorough than that of United States Pharmacopeia. Plus, they are not owned by any private or public agency, which hopefully helps keep them free from bias.
Is That Supplement You’re Taking Good For You and Safe?
The Food and Drug Administration (FDA) has been tasked with monitoring the safety of supplements sold in the U.S. Unfortunately, because the sheer volume of supplements sold on the market, the FDA is unable to test each one so there’s very little guarantee that those that are currently sitting on store shelves are safe to consume.
For example: in 2013, Bodybuilding.com hailed the supplement, Craze (marketed as a sports performance enhancing supplement) as the “New Supplement of the Year.” Unfortunately, scientists in the U.S. and the Netherlands discovered that Craze contained banned substances, namely methamphetamines (aka speed). Also in 2013, Jack3d (another performance enhancing supplement) was found to contain DMAA (aka methylhexanamine, or 1,3-dimethylamalamine) – a stimulant which has been associated with increased blood pressure and heart attacks.
Researchers at Harvard University discovered that many supplements that have been banned or recalled are still being sold in the marketplace. The worst offenders appear to be sports supplements: the researchers discovered that 85% (roughly 8 out of 10) of them contained banned substances like anabolic steroids. But they are still being sold online and in brick and mortar stores. According to USA Today, supplement sales totaled $30 billion in 2018-2019 and many new products are entering the marketplace without FDA approval. Some scientists compare the supplement industry to the lawlessness of the Wild West.
How Can I Avoid Harmful Supplements?
So, how can you be sure that the supplement you buy is free from potentially harmful substances?
1. While there’s no guarantee, it is helpful to look for these symbols on the supplement packaging:
USP stands for United States Pharmacopeia. A nonprofit organization, USP’s mission is to ensure the quality and safety of foods and medicines (of which, supplements are a part).
NSF is an abbreviation for National Sanitation Foundation International. Their mission is to “protect and improve global human health” (NSF, n.d.). NSF is also an independent organization that tests for the quality and purity of many of the supplements sold on the market.
2. Do your homework and check for quality and purity. You can also check out the aforementioned ConsumerLab.com and do a quick search on their website.
3. Always discuss the supplements you are taking or planning to take with your primary care physician. This will ensure that the product will not conflict with any medications you may also be taking or worsen a preexisting condition. They can also recommend the correct dosage.
4. A pharmacist or Registered Dietitian can also be valuable resources. These individuals are often most up-to-date about recent supplement recalls and can also provide dosing recommendations.
5. Ignore misleading claims – sadly, misleading claims on the packaging of nutritional supplements can still happen. If a supplement promises to be a cure for something, ignore it and definitely don’t buy it
6. Take a look at the form the supplement is in – for example, omega-3 supplements should be “enteric-coated” which helps prevent it from being absorbed too quickly. Also, don’t buy chewable vitamin C because vitamin C is an acid (ascorbic acid) and this acid can eat away (pun intended) your tooth enamel.
Conclusion
Taking a multivitamin daily probably won’t hurt you — it’s possible that it may help. But of course, talk to your doctor to be sure that it’s right for you and if there are other specific supplements they would prefer you take along with it or instead.
Listen to Dr. Neal address this topic on Episode 20, Episode 150, Episode 755, and Episode 905 of the podcast Optimal Health Daily.
