Using Science to Make Sense of Contradictory Multi-Vitamin Headlines

By Dr. Michael Roizen

Chair, The Cleveland Clinic Wellness Institute and Chief Wellness Officer, The Cleveland Clinic

Today, there is substantial evidence of benefits for long-term multi-vitamin use for supporting overall wellness and reducing the risk of various illnesses, including cardiovascular disease.  A new study from the same research group at Harvard University that previously reported no health benefit of multi-vitamin use [1], found that male physicians with who took a multi-vitamin a day for more than 20 years had a 44% lower risk of heart attacks or strokes, and a 14% lower risk of needing cardiac revascularization (stents and/or cardiac surgery) [2]. No change was found in the first 10 years of these men who were on average under 50 years of age at the start of the data collection, as reported in an earlier study by the same group [1]. This process is not unexpected as most heart attacks and strokes occur after age 60; it takes events happening to be able to prevent events. So in this long-term study among initially healthy men, multi-vitamin use for more than 20 years was associated with a significant reduction of major cardiovascular disease.   

I have been taking half of a multi-vitamin in the morning and at night since I reviewed research data for the RealAge.com program in 1994. At that time and today, the data is strong enough to convince me that some vitamin supplements including a daily multi-vitamin (in small doses to insure against an insufficient diet), and some other nutritional supplements, have plenty of health-protecting benefits. This is especially true if you are over 50, munch a less-than-perfect diet, are a woman of reproductive age or are among the tens of millions [3] of Americans who take nutrient-zapping drugs for high blood pressure, diabetes or to tame stomach acid. So, why the opposition to multi-vitamins?

Opposition to Multi-Vitamins 

One meta-study conducted for the U.S. Preventive Services Task Force looked at 27 supplement studies involving more than 400,000 people [4]. It found no benefit for longevity, cancer prevention or heart health in people without nutrient deficiencies. The second followed 5,947 men for 12 years and found that multi-vitamins did not sharpen thinking or memory in men who ate healthy diets [5].

The third study tracked more than 1,700 heart-attack survivors for a very short period of time, and, again, found no heart-health benefits for those who took a multi-vitamin, but plenty of people dropped out of that study. All three studies appeared in the same issue of the Annals of Internal Medicine [6]. As a result, a journalist told readers, “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.”  

Health Benefits of Multi-Vitamins  

These studies found that if you eat well almost all the time or only take your vitamins some of the time and are 50 years of age, you may not experience heart health benefits from multi-vitamins. Clearly the data show, especially in cardiovascular health, that the older you are, and the longer you take a multi-vitamin, the greater and more substantial the benefit. And the benefit – 44% for cardiovascular disease prevention [2] in healthy eaters who exercise is more substantial than in those who have an average American diet or who do not exercise regularly. The studies also showed no harm from taking multivitamins.  

Here are a number of other health benefits to consider when deciding to take a multi-vitamin or not. 

• A multi-vitamin can reduce the risk for non-prostate cancers in men by 6 to 18% [7] and cut risk for adenomas (polyps that can become colon cancers) by 20% [8].  
• To help slow the progression of age-related macular degeneration (AMD), add 900 mg of DHA and a lutein and zeaxanthin supplement to help guard your eyes, according to the Age-Related Eye Disease Study (AREDS). 
• Taking a diuretic, an acid-blocking proton pump inhibitor (PPI), or a diabetes drug? If so, some diuretics can reduce your body’s stores of potassium and magnesium needed for healthy muscle function and blood pressure. PPIs, can lower levels of B12, [9] a vitamin that helps your body make red blood cells, nerves and DNA. What’s more, some diabetes drugs can reduce magnesium [10] (important for healthy blood pressure) as well as B12 [11].
• You may be iodine deficient as well if you are using iodine free sea salt.  

Since more than 90% of those taking the nutrition test at RealAge.com do not consume recommended amounts of vitamins or minerals in their diet, half a multi-vitamin twice a day is an inexpensive insurance policy against an imperfect diet. Take enough magnesium, folate, B12, B6 and vitamin D3 and turn to brown rice, almonds, hazelnuts, spinach, shredded wheat, lima beans and bananas to top off your tank.

Why should you split multi-vitamin down the middle, and take half in the morning and half at night?

You'll urinate out soluble vitamins in 12 to 16 hours, so this split will keep the level in your body steady [12]. In addition, I take a daily DHA omega-3 supplement (900mg – I am over 60 and my tabs have lutein and zeaxanthin, too); vitamin D-3 (2,000 IU), and suggest up to 600 milligrams of supplemental calcium.  

Thanks for reading. Feel free to send questions to youdocs@gmail.com and follow me on Twitter @YoungDrMike or listen on RadioMD.com. 

Disclosure: Dr. Michael Roizen previously chaired the scientific advisory board of a company that produces omega-3s and whose parent company is a leading vitamin supplier.

1. Sesso HD, Christen WG, Bubes V, Smith JP, MacFadyen J, Schvartz M, Manson JE, Glynn RJ, Buring JE, Gaziano JM. Multivitamins in the prevention of cardiovascular disease in men: the Physicians Health Study II randomized controlled trial. JAMA 2012;308:1751–60.
2. Rautiainen S, Rist PM, Glynn RJ, Buring JE, Gaziano JM, Sesso HD.  Multivitamin use and the risk of cardiovascular disease in men.  J Nutr 2016; 146:1235-40.
3. IMS Institute for Healthcare Informatics: "The Use of Medicines in the United States: Review of 2010," April 2011.
4. Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP. Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: an updated systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2013; 159:824-34.
5. Grodstein F, O'Brien J, Kang JH, Dushkes R, Cook NR, Okereke O, et al. Long-term multivitamin supplementation and cognitive function in men. A randomized trial. Ann Intern Med 2013; 159:806-14.
6. Lamas GA, Boineau R, Goertz C, Mark DB, Rosenberg Y, Stylianou M, et al, TACT (Trial to Assess Chelation Therapy) Investigators. Oral high-dose multivitamins and minerals after myocardial infarction. A randomized trial. Ann Intern Med 2013; 159:797-804
7. Gazino JM, Sesso HD, Christen WG, et al.  Multivitamins in the prevention of cancer in men.  JAMA 2012; 308(18):1871-1880.
8. Massa J, Cho E, Orav EJ, Willett WC, Wu K, Giovannucci EL. Long-term use of multivitamins and risk of colorectal adenoma in women. Br J Cancer 2014 Jan 7;110(1):249-55. doi: 10.1038/bjc.2013.664. Epub 2013 Nov 12 http://www.ncbi.nlm.nih.gov/pubmed/24220696
9. http://jama.jamanetwork.com/article.aspx?articleid=1788456
10. http://www.plosone.org/article/info:doi/10.1371/journal.pone.0074355
11. http://www.diabetes.org/news-research/research/access-diabetes-research/long-term-metformin-use-may-1.html
12. http://health.clevelandclinic.org/2012/05/multivitamins-insurance-against-an-imperfect-diet/

Other references used to prepare this blog post:

• Neuhouser ML, Wassertheil-Smoller S, Thomson C, et al.  Multivitamin use and risk of cancer and cardiovascular disease in the Women’s Health Initiative Cohorts.  Arch Intern Med 2009; 169(3):294-304
  
  

• Mursu J, Robien K, Harnack LJ, Park K, Jacobs DR Jr.  Dietary supplements and mortality rate in older women:  the Iowa Women’s Health Study.  Arch Intern Med  2011; 171:1625-33.