Should I Take a Multivitamin?

Multivitamins are one of the most controversial topics in the word of nutrition and wellness. Some people proclaim the benefits of a nutritional “insurance policy” in the form of a daily multivitamins. Others remain adamant that these pills are a massive waste of money. So, should you take a multivitamin every day?

Multivitamin Benefits

Daily supplements that contain small quantities of the 31 most important vitamins and minerals are the most common supplement in the US. These low-dose capsules, tablets or gummies round-out your daily intake to make sure that you’re always getting all of the nutrients your body needs to function at its best.

It is entirely possible to get all of your essential nutrients from diet alone, but many people’s daily diets don’t contain enough variety. (When was the last time you got your 5-a-day?) So, while a pill can never replace healthy eating, multivitamins can help fill in the nutritional gaps. This si why cautious health professionals often recommend – or at least support – daily multivitamin supplement use.

Who Should Take a Multivitamin?

Individuals at higher-risk of individual or multiple vitamin or mineral deficiencies should take a daily multivitamin. These people may include:

👶  Young children or older adults

👩‍🦰  Women of child-bearing age

👱‍♂️  People with a highly-restrictive diet

👵  Individuals with increased needs

1. People at Specific Life Stages

Young children may benefit from supplemental vitamin A, C and D. On the opposite end of the spectrum, older adults are often lacking in vitamin D, certain B vitamins and magnesium. They may also benefit from extra supplementation of calcium.

Women of child-bearing age need sufficient iron to prevent anemia related to menstruation, plus folic acid to prevent neural tube defects in babies. Breastfeeding women may also benefit from a multivitamin/mineral supplement. If you fall into this category, make sure to check with your doctor to discuss your individual needs.

2. People with Restrictive Diets

Another group who may benefit from multivitamin supplementation is people who follow a restrictive diet – either by choice or out of necessity.

Strict vegetarians (vegans), for example, often require supplemental vitamin B12, zinc, iron and calcium if they do not consume any animal products. Likewise, people that follow restrictive diet for weight loss, or as a result of extensive food allergies or intolerances, are more likely to miss some critical micronutrients. Taking a basic multivitamin supplement each day helps these individuals fill-in potential gaps.

3. People with Increased Needs

Individuals with a condition or addiction that impacts absorption or utilization of nutrients may also need extra, or a more bioavailable form, of a specific vitamin or mineral. Likewise, certain conditions seem to improve with supplementation of specific vitamins or minerals.

For example, research shows that people with type 2 diabetes tend to have lower levels of chromium: a mineral critical to insulin regulation and glucose metabolism. These patients are often advised to take extra chromium picolinate.

When to Take a Multivitamin

Some vitamins have very specific dosing instructions. Many single-vitamin supplements, for example, need to be taken either fed or fasted, or with or without certain types of foods, to achieve their maximum effect. Multivitamins, however, aren’t that complicated. Since they are a compound pill with a cumulative effect, the most important thing is that you take it each day. It’s not as important when exactly you take it.

Still, if you’re looking for a specific recommendation, just before lunch or dinner is a great time to take your multivitamin. Fat-soluble vitamins (A, D, E and K) are best absorbed with a fatty meal. Water-soluble vitamins (the Bs and C), on the other hand, are best absorbed on an empty stomach. Multivitamin supplements contain both types. More, women’s multivitamins typically contain iron, which can cause stomach upset if taken on an empty stomach (e.g. before breakfast). 

As a result, most people take these supplements with a larger meal because its when they best-tolerate the pill. That being said, if you prefer to take them at another time of the day (e.g. first thing in the morning) and don’t experience any adverse side effects, that’s perfectly fine too!

Reasons NOT to Take a Multivitamin

Many health professionals support the use of multivitamins given the pills’ potential benefit and relatively low risk. Still, others point to the lack of proven efficacy, high cost and potential for toxicity as reasons to NOT take a multivitamin each day.

1. Questionable Effectiveness

One of the main arguments against multivitamins is that they’re not proven effective. While they may help, they don’t definitely provide any benefit. Plus, taking too much of certain nutrients – such as vitamin A  or E – causes damage.

In fact, a 2013 editorial published in the Annals of Internal Medicine called-out the numerous faults of multivitamins saying:

“The studies published in this issue and previous trials indicate no substantial health benefit… multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases… [W]e believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful.”

Read the whole editorial here: Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.

2. Wasteful if Unnecessary

Relatedly, there is a widespread belief that healthy, well-nourished people have no need to supplement. This is not to say that every day is nutritionally perfect. There may be some days, or even many days, when people don’t get all of the necessary vitamins and minerals through food and drink. However, over the course of several days, most well-nourished adults receive the nutrients they need.

Plus, if someone isn’t getting enough of the vitamins they need over an extended period of time, years of taking multivitamins won’t help much. Water-soluble vitamins, especially, are metabolized quickly and any extra supply is excreted within days. As a result, it’s not possible to “stock up” on vitamins Bs and C. Fat-soluble vitamins and minerals are stored for longer, but consuming too much for too long can lead to toxicity (poisoning).

3. High Cost

Another common argument against multivitamin/multi-mineral supplements is the exorbitant cost. Despite the relatively low cost of production, it’s common to see them sold for more than $20 per bottle.

More, OTC supplements are not approved or regulated by the FDA. This means that companies self-report the dose and purity of their vitamins, but do not rely on a third party for verification. As a result, the concentration and quality of supplements varies significantly by company, product and even batch.

So, a common criticism of OTC supplements in general, including multivitamins, is the high cost for unknown and unverified product.

The Most Important Vitamin

Folic acid is the one vitamin that experts agree proves worthwhile as a supplement.

Folate, also called vitamin B₉, is critical for cell growth and development. Folic acid is the synthesized form of this essential nutrient.

All women of child-bearing age should consume at least 400mcg of folic acid per day to protect against spina bifida and other neural tube defects in early pregnancy. It’s important to consume plenty of folate whether or not you’re trying to conceive because neural tube development occurs in the first 3-4 weeks of pregnancy, before most women even realize they’re pregnant. So, an underlying folic acid deficiency can easily become tragic if a woman gets accidentally pregnant. This is why many physicians recommend that all women of child-bearing age take either a folic acid supplement or multivitamin each day.

To reduce the incidence of this serious and largely-preventable birth defect, the US has fortified grains with folic acid since 1998. Cereal, bread, flour, pasta, cookies and crackers have been fortified for over 20 years, which has significantly improved folate consumption by the average American. In 2016, the FDA also approved voluntary fortification of corn masa flour.

If you don’t eat grains, folate is found naturally in dark, leafy green vegetables, dried legumes (beans, peas) and some fruits too.

In case you skimmed all of that…

Young women should supplement, just in case they accidentally get pregnant. So should young children, older adults or anyone who follows a restrictive diet, such as vegans or people with food allergies. Multivitamins may not hold as much value for healthy, well-nourished adults.