To Multivitamin or Not to Multivitamin?

Introduction

About 30% of adults in the western world take a multivitamin. Multis alone make up about 40% of all vitamin and mineral supplement sales. However, research evidence supporting the use of multis is mixed at best with recent large population studies reporting no association between use of multis and better cardiovascular or brain health, and only modest cancer protection. In contrast, one 2011 study, the Iowa Women’s Health Study, showed an increased risk of death in women who took multis.

I’m aware of these ‘fors’ and ‘againsts’ and have for year taken a daily multivitamin (and Flaxseed oil – source of Omega 3, 6 and 9). I eat very healthily with plenty of natural cereals, 5 servings of vegetables a day and at least 3-4 serves of fruit a day. However, I’m also very active exercising 1-2 hours a day. My belief is that despite eating a nutritious and well-balanced diet, my multi a day might cover my butt with any dietary deficiencies I may have in vitamins and minerals.

Recently I found a great discussion paper in a journal where four experts from Tufts University in the USA discussed their thoughts on use of multivitamins. One was a professor and director of an antioxidant research laboratory, one a professor of nutrition and contractor to the Office of Dietary Supplements in the USA, one a professor of nutrition science and director of a cardiovascular nutrition laboratory, and the other a professor and director of a vitamin and cancer lab. Collectively, world leaders in the field I feel!

What were the main points raised?

  1. Multis are not harmful and help fill the inadequacies in the average requirements for vitamins D, E and K and minerals magnesium and potassium that about 60% of Americans fail to meet. Moreover, about 40% of them fall short on vitamins A and C. Why are this happening? Because sadly people aren’t eating fruit, vegetables and whole grains where collectively all these great vitamins and minerals are found. In general masters athletes like us tend to be well-educated and eat well. So maybe we don’t need multis if we are eating natural foods and not hammering the junk food and take-aways!
  2.  Not every person needs a multi.Some examples where they might be needed include:
    • the very old and / or frail who don’t eat a lot
    • people with disease or illness who may not eat well
    • athletes who train hard and / or long and are not getting enough energy intake in a day so are losing weight
  3. People who might need supplements such as iron or calcium supplements should be taking these supplements and not a multi. The belief that a multi contains enough of a particular vitamin is wrong. In general, the amount of any one vitamin and/or mineral in a multi is not enough to make up for a problem a particular individual may have. This is where a dietician or doctors input is critical.
  4. If you are shown to have an inadequacy in a vitamin or mineral look for a natural food solution rather than a pill. For example, the intake of the mineral calcium and vitamin D is often found to be inadequate in older people, especially in post-menopausal women who don’t get much sun, including older female athletes. So is low-fat greek yoghurt or increasing your dairy intake a better option? These experts think so!
  5. What about the 2011 study that said women who take multis are at higher risk of death than those that don’t? This study has not been supported by other studies since. Moreover, it did not tightly control for other factors that may have contributed to deaths such as smoking, obesity and pre-existing illness. The consensus at present is that taking multis does not increase how long we live but equally it does no harm either. A recent study called The Physician’s Health Study II tested a complete multivitamin in 15,000 men and actually found a reduction in cancer incidence in those men who took multis. They also controlled for confounding variables like smoking.
  6. Taking too much of a vitamin does not appear to be an issue. Except taking too much vitamin A which has been linked to bone loss.
  7. Bottom line is to personalise your intake of vitamins and minerals based on your nutritional intakes, health status and exercise habits. While a multi may not do any harm, they have small amounts of everything and may miss something you as an individual may need. Chat with your doctor or dietician is my suggestion.

Source:  Should you take a multivitamin? Four Tufts experts tackle the multi-billion-dollar question, Tufts University Health & Nutrition Letter Sept. 2015.

 

Multivitamin-Multimineral Supplements and Longevity

Introduction

I’ve long advocated taking multivitamins and multiminerals as an older athlete. Why? Because despite eating a healthy balanced diet full of fruit and vegetables, a hard training athlete of any age needs to ‘cover their bases’. Thus, a typical multivitamin and multimineral supplement that has moderate levels of B-group vitamins and sprinkling of other vitamins and minerals just gives me the piece of mind that I am getting the nutrients I need to keep training and performing.

Some research published in 2011 from The Iowa Woman’s Health Study showed an increased risk of death in 38,772 older women with an initial average age of 61.6 years  were regular supplementers and tracked since 1986. This study showed that regular use of multivitamins increased the risk of death by 2.4% compared to non-users. Increased risk of death in other vitamins and minerals included vitamin B(6) (4.1%), folic acid (5.9%), iron (3.9%), magnesium (3.6%), zinc (3.0%), and copper (18.0%) were associated with increased risk of total mortality when compared with corresponding nonusers. in contrast, use of calcium reduced mortality by 3.8%. However, this study was clouded by the fact that supplement use was higher in those with a history of disease and therefore more likely to pass away. So what does research say about regular use of multivitamins and multiminerals and how long we live for?

The Research

A group of Australian scientsist from Melbourne’s Swinburne University of Technology performed a large (meta-) analysis of all the vious research studies examining longevity and multivitamin and multimineral use. 21 eligible studies (91,074 people and 8794 deaths) investigated daily multivitamin-multimineral supplementation for ≥1 y. Studies using people described as institutionalized or as having terminal illness were excluded.  The scientsists used sophisticated statistical analysis to determine what we call the relative risk (a ratio of the probability of the event occurring in the exposed group versus a non-exposed group) of death.

The Results

The average age of the sample was 62 years and the average duration of supplementation was 43 months. Across all 21 studies, no effect of multivitamin-multimineral treatment on all causes of death was found. Furthermore, use of multivitamin-multimineral supplements had no effect on mortality due to vascular causes (eg. stroke, heart disease) or cancers.

The So What

This very rigorous study highlights that use of multivitamin-multimineral supplements won’t help us live longer. However, in older athletes who train regularly, use of a multivitamin-multimineral supplement that has a range of vitamins and minerals included in them should be considered. Importantly for older endurance athletes or those who train hard and often, multivitamin-multimineral supplements should be considered. For the most definitive discussion related to sports nutrition for older athletes that you will ever read (biased as I am!) check out Chapter 16 (Nutrition for the Masters Athlete) of my book The Masters Athlete, now available online in pdf format as a whole book or chapter by chapter. Also strongly consider a visit to a sports dieticiano have your own dietary needs and food intake analysed by a professional. In Australia you can find one by clicking here. In the USA, click here, and the UK here.

Source: Macpherson, H. and others (2012). Multivitamin-multimineral supplementation and mortality: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, Dec 19. [Epub ahead of print]

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