So… do we really need a multivitamin?

Well, “need” is a strong word…

Okay, should we take a multivitamin?

Some of us definitely should!

You definitely want to consider a multi if you don’t eat a balanced diet. Or you’ve got some malabsorption issue – think celiac, inflammatory bowel disease, etc. Or you’re on severe caloric restriction. A nutritional safety net is a good idea when you’re pregnant, and when you’re limited to repetitive, unimaginative cafeteria food.

(Individual vitamins and minerals, of course, can and should be deployed situationally where appropriate. Sometimes instead of a multi, sometimes in addition to one).

But should the “average” among us take an “A to Z” multivitamin as a matter of course?

I’m going to say yes. But I want to start by acknowledging some of the reasons people say no.

A number of studies have examined multivitamin use relative to disease risk, in particular cancer, heart disease, and dementia. For the most part, multis have not demonstrated benefit around heart disease and cancer. For the most part… They have, however, demonstrated benefit around dementia risk. Again, for the most part.

And then it gets confusing.

Remember how multis generally don’t reduce heart disease? Well, one study tracked more than 18,000 doctors for 12 years, and indeed found no association between multivitamin use and any cardiovascular endpoint. However, doctors that were already taking a multi 20 years before the study did have significantly less major heart disease. What does that tell us? That multis don’t work? Or that they do work – but only if you take them for 30+ years? Or there’s a 30-year lag between taking a multi and seeing the benefit? Or there’s a crucial window in age where they’ll work?

Or – does it tell us that the type of person who took multis back in the 1980s was generally more health-conscious – that taking a multi was a marker for healthy habits, vs. a healthy habit in its own right?

Like I said, it’s confusing.  None of the science is crystal clear. (It rarely ever is!)

Is that the only way the science is unclear?

No! The biggest uncertainty by far surrounds the word “multivitamin” itself.

When journalists, doctors, scientists, and the rest of us talk as if a single study can speak for all multis, we assume that all multis are the same. Yet the term “multivitamin” encompasses a widely diverse category of supplements – everything from a Flintstones(tm) brand chewy vite that’s basically candy, up through a Life Extension(tm) brand 18-pill-a-day megadose. It conflates a carefully crafted bouquet of organically grown fruits and vegetables, with something created entirely in a lab; straight-up vitamins and minerals, with formulas that include a cornucopia of protective nutrients like green tea, grapeseed extract, turmeric, CoQ10, etc. Not to mention that some multis are made with artificial colors, flavors, and preservatives.

So, even if a study were able to prove conclusively that a particular multi did (or did not) do something, it would have very little bearing on any other formulation.

So… assuming we’re going to take a multivitamin, what should we look for?

This is going to sound weird, but… less vitamins!  Or to put it another way: more other stuff.

Let me explain.

The world of food is full of things that are generally good for you. For example, oranges have something called ascorbic acid. Pomegranates have something called ellagic acid. Green tea has a compound with so many syllables we just called it “EGCG.”

All three are good for you. Only one is a vitamin.

That one is ascorbic acid. Most of us recognize it by its common name, “vitamin C.” Why is ascorbic acid a vitamin, and ellagic acid isn’t?

Well, to qualify as a vitamin, a nutrient has to meet three criteria. Among them, it has to be:

1. necessary to life, i.e. without it you die (or at least can’t reproduce).
2. unable to be synthesized by the body, i.e. you have to get it through the diet.

So, vitamins are defined by their deficiency diseases. The government has established recommended daily values, which prevent those diseases. The vitamin C deficiency disease is called scurvy, and the daily value was just raised to 90 mg. Meanwhile, there is no deficiency disease linked to EGCG. It doesn’t kill you not to get it. So, it’s not a vitamin.

In this sense, vitamin C is “more important” than ellagic acid, or EGCG, or curcumin, or CoQ10, etc. BUT – just because something is important enough you can die without it, it doesn’t mean it’s something we want more, and more, and more of.  Yes, we want the baseline level that prevents scurvy. And yes, we want a little bit more. Some of us even want a lot more. But if you’re looking for general protection, if you’re looking to optimize health and minimize the risk of disease, I’d argue that, past a certain point, EGCG and the other compounds from green tea are “better for you” than vitamin C is.

It’s in the complex stew of diverse protective nutrients that you start to see the real proactive benefits you’re looking for in a high-end multivitamin. Not going “A, B, C, D…” More on the topic next month…