The headlines in the medical literature, the mainstream press and the alternative press have shown a rare unanimity, all unequivocally damning – from "Enough Is Enough: Stop Wasting Money On Vitamin And Mineral Supplements"in Annals of Internal Medicine to "Your Multivitamins Aren't Doing A Damn Thing" on the environmental website Grist.
The general message, that the benefits of vitamin and mineral supplements tend to be exaggerated and the products themselves are overused, is a legitimate one.
But we have to be careful not to throw the baby out with the bathwater.
We need to make the distinction between the benefits of vitamins and minerals in our diet, and their consumption in pill form. We also need to not confuse overuse and uselessness and waste of money with physical harm.
Vitamins and minerals are essential to good nutrition and to good health. Ideally, we should get our nutrients and micronutrients in food, in a balanced, healthy diet.
That's not always possible. There are times when supplements are appropriate, essential even:
- Every woman of child-bearing age should take a prenatal vitamin or, at the very least, folic acid. If a woman becomes pregnant, the micronutrient supplementation can prevent such grave conditions as spina bifida and such cancers as neuroblastoma in her child;
- Newborns should get vitamin K injections to avoid potentially life-threatening bleeding;
- Babies should take vitamin D drops, especially if they are breastfeeding (formula and cow’s milk are already fortified with vitamin D);
- Iron pills are an effective and necessary treatment for anemia;
- People in northern climes can lack vitamin D (especially if they are darker-skinned), and supplements can be helpful if they don’t routinely get adequate sunshine;
- Vitamin B12 deficiency is common in older people, and many should take supplements, especially if they take medications like Nexium or Zantac for gastrointestinal ailments.
What people don't need is a cupboard overflowing with vitamin supplements or megadoses of particular nutrients.
The much-cited "stop wasting money" editorial in Annals of Internal Medicine says there is no benefit from daily multivitamins (something that has long been recommended for virtually everyone) and everyone should desist.
But is that actually what the research says?
There were three studies published alongside that editorial: 1) One that followed 6,000 male physicians for 12 years and found a daily multivitamin did not preserve or enhance cognitive function, i.e., it didn't prevent dementia or make them smarter; 2) A study that followed 2,000 adults for an average of four years after they had a heart attack and found taking a daily supplement didn't lower the risk of having another heart attack; 3) A systematic review (compiling of previous research) that showed taking a multivitamin did not reduce the risk of developing cancer or heart disease.
Yet the conclusions drawn from this research are pretty sweeping: Never. Take. Vitamins. Ever.
The premise is that people take vitamins in the belief that they will magically prevent cancer, heart disease, Alzheimer's and every other imaginable condition. Is that true? Or do they take supplements to give themselves a modest sense of well-being, to fill in the gaps in their diet?
Most mainstream medical advice has been to take a daily multivitamin as an insurance policy. Like insurance, you hope you will never need it, but it's good to have it just in case.
None of the studies cited showed any harm from taking a daily multivitamin. Of course, we have to be careful to not fall into the trap of thinking that if a little is good, more is better. You don't need to swim in fish oil or take so much vitamin C that your urine resembles Tang.
Taking excess quantities of some vitamins like beta-carotene, vitamin E and vitamin A can be harmful. Children are particularly susceptible to overdose; any vitamins they take should be in liquid form.
We should definitely reject the hyping of vitamins and supplements as a panacea. Similarly, we should reject the rhetoric that says all vitamins are poison.
What the research has shown consistently for years now is that, for most people, taking a multivitamin or specific vitamins and minerals offers no meaningful health benefits to most healthy consumers. (But are a tremendous benefit for certain people with specific needs.)
The most cited harm is that taking vitamins is a waste of money. But that's not a medical symptom, it's a value judgment.
Vitamins are big business: some $38-billion (U.S.) a year in sales in the United States and more than $3-billion a year in Canada.
Most of those pills are not needed. But nor are the soft drinks, processed foods and many other foodstuffs we consume.
So, let's keep the potential risks to our health in some perspective.
If people want to waste a nickel a day (or $1 a day for a fancier-looking version) on a multivitamin, there's not really any harm in doing so.
Exaggerating the harms of drugs – be they prescription drugs, over-the-counter or multivitamins – is no better than overstating their benefits.
On this issue, we need to take a chill pill.
Follow me on Twitter: @picardonhealth
André Picard