The Limited Value of Multivitamin Supplements
jamanetwork.com
jamanetwork.com
This the composition of needed nutrients can vary greatly for person to person. But in general, a good diet is the way to go. On that is also adapted to change conditions.
For instance, the lack of sunlight in Scandinavian countries during the winter, which makes consuming foods rich in Vitamin D is important.
However, a lot of people are not motivated and/or privileged¹ enough to do so.
A question that then must be asked, if you are not able to compose and consume a healthy diet does a multivitamin have a positive effect?
¹ Using this term may seem controversial but I think it is accurate.
If a person is poor and does not have food safety the fight is to find enough food. Not finding the exact food needed for a balanced diet. In general, the food that food banks give out will not be able to provide a proper balance. Add to that though that multivitamins can be expensive and is also out of reach. I have never heard of a food bank providing multivitamins. (even though it would probably be a good idea)
Then some people will feel that they do not have the time. Some people have not learned to cook well.
Eating healthy was a lot easier when I lived in the US the availability of a broad selection of fruits, vegetables and nuts is great. Norway has in general a small selection of all of the above.
In any case, vegetables are now many times cheaper and more accessible than before. As a species we have hundredfold better access to nutrition than a century ago.
The fact is most people feed themselves mostly on flour and oil. That's what's causing a malnutrition epidemic, not poorer vegetables.
Casimir Funk is one of the best names I’ve ever heard
Predictably, my "lazy bachelor vegan" lifestyle wasn't quite hitting the RDI for everything but as soon as I keyed in a multivitamin I had plenty of slack (at least according to this software).
Apart from dispelling my concerns about my diet choices it made me realize the number of things that are fortified with vitamin additives: [soy] milk, flour, salt, to say nothing of processed foods like breakfast cereals.
So maybe for most omnivores a vitamin supplement is harmlessly redundant given the way modern food is processed?
I think when people are saying that vitamin supplementation isn't necessary in general, they are not talking about vegans.
For example: the Silk soy milk I buy includes the following ingredients: Calcium Carbonate, Vitamin A Palmitate, Vitamin D2, Riboflavin [B2], Vitamin B12. Do they juice it with extra 12 because they know dirty hippies like me aren't eating eggs? I'd believe it.
So do I really need a separate B12 supplement? Now that I'm a [just as lazy] middle-aged vegan with better access to groceries and a partner that loves to cook I really wonder.
For everything else its guidance (for non-pregnant adults) is that you should be able to get it from your diet.
Not that it says don't or that it's really bad, or especially if you have some inherent deficiency (or you're a menstruating vegetarian, etc.) it could be a very good idea to take the relevant supplement to make it easier than getting it from food, I just thought it was interesting when I was looking through recently that the language is very consistent for all of them, except vit D which has the relatively strong 'should consider taking it'.
I have had two doctors in Canada tell me that the government health plan does not cover Vitamin D testing because everyone at our latitude is expected to be vitamin D deficient and should be on a supplement.
There is a lot of argument about the appropriate dosage for vitamin d supplementation, so repeated testing might actually be the only way to make sure you're taking the right amount.
So basically what the doctors/gov health plan say in Canada according to GP makes sense to me wrt that in the sense that you almost certainly are deficient, 10ug is enough, an order of magnitude more than that is still safe; so just take it.
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...
(I don't know about the cost to the Canadian government if they wanted to provide it obviously, but to me as an individual it's cheaper to get 365x 10ug supplements than it is to get 1x test to see if I'm deficient.)
I wish they would say exactly what it is I can eat today to get 100% of my nutritional needs met and not blow my calorie budget.
People overestimate how much sun someone in Australia is exposed to on a daily basis for one, especially if I want to protect my skin from dangerous UV radiation. And throw in some very regular WFH on top of that...
It was really hard to get every mineral and some vitamins in a regular calorie budget. And then to balance omega 3:6, get lots of protein, etc.
It can be done but I wonder if the recommended nutrient requirements are accurate. No human ancestor ever ate the crazy complicated diet I made!
And even if we could know out needs from day to day, the food varies quite a bit, by varietal, location and season.
There's still more wiggle room, bc if we get excesses or shortages, our responses may vary unpredictably. With extra calories, we might suddenly decide to clean the garage.
We are not precise machines in a precise environment. Our sexual reproduction and mutations -and that of our food- constantly reshuffle the deck, guaranteeing we can only make broad predictions.
The best we can do is accumulate knowledge, observe and create feedback.
As others have noted, you just need few main vitamins/supplements to cover your most likely deficiencies (Vitamin D, Zinc, Magnesium, Omega, etc.)
If you really care about this then find and do a simple general blood test for your micros/vitamins. It will show you where you are deficient and can focus on supplementing on only those. No not much point supplementing micros that are already OK.
I wish they were cheaper (a broad set is >£100) - would love to do it say weekly, and be able to really see it against the food I've been eating (maybe keep a rough note of that, or just be able to think about it in terms of seasonally what I've been eating).
Presumably this will only show what you are deficient in based on the previous few days diet, right? So to have a decent measurement you should already have a very stable diet. If you eat like I do, random things from day to day, then your vitamin levels should differ from week to week, or are they much longer lasting?
Feelings of well-being have also been shown to be negatively correlated with morality.
If this is a causal relationship, and vitamins cause these things to improve, then mortality should also improve. The fact that this is not the case therefore suggests that either 1) the relationship between these things and mortality isn't causal, 2) vitamins are not improving these things (or I suppose, 3) the relationship is causal and vitamins are decreasing mortality by improving these things but also increasing mortality by other effects in a way that balances out).
While it is theoretically possible that none of these things have a causal relationship with mortality and it would therefore be be possible to improve them without decreasing mortality, I'm not sure it's likely.
It just seems pretty improbable to me that multivitamins are having all these wide-ranging health benefits that people are claiming and none of these benefits are having even the slightest effect on mortality.
For this reason, I think evidence that vitamins don't decrease mortality is actually pretty strong evidence that they are not having these other effects.
Are you saying that vitamins have improved mortality over time but increasing heart disease and cancer rates have balanced that out over time? If so, that's not what's being talked about here. The study in the article is comparing people who take multivitamins with people who don't, not looking at the overall rate in multivitamin usage compared to mortality over time in the entire population.
Or are you saying that people who take vitamins are more likely to have heart disease and cancer? That can be an issue in this type of study but there's no reason to think that's true. If anything, I think there is a concern that the confounding factors go in the opposite direction, where people who take vitamins are more likely to do other things that improve their health like exercise more. However, the study in the article also controlled for various potential confounding factors like BMI and physical activity.
I think I was clear, but I'll spell it out for you:
Imagine this possibility. Everyone gets cancer and dies at 65 years old. Everyone starts taking vitamins and therefore starts sleeping better, getting stronger, etc. They all still die at 65 years old though because of cancer. Suddenly, cancer is cured. All those people now live to 85, except the ones who still don't take vitamins. They only live to 66. Vitamins caused a 20 year increase in lifespan, but this was undetectable because cancer was killing everyone at 65. In all cases though, everyone slept better and were stronger after taking vitamins.
Mortality is a terrible measure of whether people are sleeping better and stronger after taking vitamins. It would be better to measure sleep and strength directly if that's what one wants to know about. I hope your mistake is clear to you now.
Cancer isn't killing everyone at 65 years old. Not everyone dies of cancer at all. Even if you assume that vitamins have no effect on cancer rates, if they decrease mortality due to other causes, people who take vitamins should have lower overall morality than people people who don't take vitamins.
So again, you would have to have a situation where vitamins are improving sleep and strength, which are both inversely correlated with mortality, but somehow not decreasing mortality, as I said in my previous comment.
Yes but are there other metrics that can better measure quality of life that are uncorrelated with mortality?
It has an interesting quote about fish oil.
> Fish oil doesn't benefit us, but oily fish do.
What I still don't understand is why everyone is talking in 'servings' of vegetables and fruit, instead of cups or ounces.
A good example of where it's not is baking. Cup works for the wet stuff but will ruin your baking if you use it with flour. Because of flour's ability to compact, 1 cup is a wildly different amount. That really impacts how dry or mushy your bread turns out.
I found a table with the density of various flours and many other things: https://www.kingarthurbaking.com/learn/ingredient-weight-cha...
My favourite was seeing "half" a tablespoon of something.. not having a full derivative of measurement devices for this unit, thankfully with 3 teaspoons to a tablespoon that was merely 1.5 teaspoon.
And then they have eg "sprinkle", "dash" and "pinch". As in "add a dash of water". Grr, those are _not_ beginner friendly units. I've destroyed a dish by adding a "big pinch" of salt (my fingers probably much bigger than theirs).
I find measuring with grams and millilitres much easier.
That said, one key part of cooking is knowing when the measurements matter. Most herbs and spices will flavor a dish exactly the same if you add a teaspoon or a tablespoon.
Those measurements matter the most when there's a chemical reaction that's strongly influenced by the ratios. For example, having enough emulsifier in a cheese sauce.
Obviously doesn't work everywhere, but it does work in many places.
Cups makes it either very old or very American, and from what I've seen American recipes tend not to measure anything by mass. (Even butter is measured by the 'sticks' that it's sold in there. They're obviously some standard weight, but if you're not American (and so did not buy your butter in a stick) you'll have to try to look that up.) And in a vicious circle, as I understand it most American home kitchens don't have scales?
Personally I think cups (or call it anything, doesn't matter) are nice when absolutely everything is going to be described in a volumetric ratio. That works nicely, it's easy to scale, and it doesn't matter at all what a 'cup' is, everything's just relative to everything else. But even then, especially with wet & dry ingredients, you probably want multiple 'cups' of the same size, it's not completely convenient.
(I believe this one and the imperial one (which definitely is) both make some sort of sense in being the same as half a pint. For whatever reason that's consistent, but the US needed to reinvent the pint (and gallon, ton[ne], ...).)