Multivitamin does not improve longevity | Hacker News Reader

Multivitamin does not improve longevity

jamanetwork.com

38 pointsfbn7975 comments

>In this cohort study of 390 124 generally healthy adults with more than 20 years of follow-up, daily multivitamin use was not associated with a mortality benefit.

Aren't most of them the kind of people that are generally middle class and above types, with access to better nutrition and healthcare, and the associated mindset for health improvement, that's a prerequisite to consistently buy and consume multivitamins?

That is, the kind of people to not have many vitamin deficiencies to begin with, compared to some working class person who can't afford time to cook, nor had such ideals instilled upon them since childhood, and eats fast food and microwaved stuff 24/7...

I'd like to see how e.g. adding multivitamins to industrial foodstuff consumed by poorer families, in the school lunches of poor districts, and so on, improves or doesn't improve health outcomes...

I do believe you’re describing food fortification, which the US performs liberally: https://en.m.wikipedia.org/wiki/Food_fortification#United_St...

I’d honestly be curious to see if this study accounted for socio-economic class and overall policy around food enrichment or fortification in the regions the participants lived in. I’d expect multivitamins to have a more noticeable impact in places where food wasn’t enriched.

Vitamins are naturally present in good non-processed food.

Fortification is only required in processed food.

Not disputing that, but the line gets blurry when you consider things like golden rice (https://en.wikipedia.org/wiki/Golden_rice) as a method of food fortification.

The purpose for golden rice touches on a big consideration for nutritional policy: diets aren't always diverse and don't always include enough sources of nutrition. History is rife with stuff like beriberi or scurvy due to cultural norms or inability to find varied sources of nutrition.

> by pooling data from 3 large cohorts, we could explore heterogeneity across key population subgroups, including understudied sociodemographic subgroups, which was identified as a research gap in the 2022 USPSTF review.3 In stratified analyses, we found no evidence of effect modification by race and ethnicity, education, or diet quality.

> Participants were adults in the National Institutes of Health–AARP Diet and Health Study (NIH-AARP) cohort; the PLCO Cancer Screening Trial cohort; and the Agricultural Health Study (AHS) cohort (eFigure 1 in Supplement 1). The NIH-AARP Diet and Health Study began in 1995 to 1996, when questionnaires were mailed to current AARP members who were aged 50 to 71 years and resided in 1 of 2 US metropolitan areas or 6 states.

> The PLCO study was a randomized cancer-screening trial that enrolled 154 887 participants at 10 US centers between 1993 and 2001.23 Participants were aged 55 to 74 years at baseline.

> The AHS enrolled 52 394 licensed pesticide applicators, 4916 commercial pesticide applicators, and 32 345 spouses of private applicators who were aged 18 years or older from Iowa and North Carolina from 1993 to 1997.

That sounds like more a broader approach then just "middle class and above types".

I don't think people take it to improve longevity. I take it because I have periods of times when I can't eat well enough and I can feel myself getting sluggish. Multivitamin actually help me feeling a little better in those periods (it may be a placebo but I would prefer a test on that specifically instead of longevity)

You can run double-blind studies on yourself, if you are curious.

Gwern is famous for running lots of self-blinded experiments on himself.

There's various ways to go about this. But basically, you need to find a way to get two different pills that look and taste the same, one containing your active ingredient and one containing a placebo. Eg you quickly crush your vitamin pill (and the placebo) and fill the result in a capsule each. Put each in an empty film canister (or so) and label the bottom.

Shuffle both canisters (not looking at the bottom), and pick one at random. Consume the pill, and note down the effects over time. Keep the two canisters.

Repeat for as many days as you like.

After you've run your experiment, and collected all your data and wrote all your analysis software, you can unblind and actually look what you took each day (and put that in your data collection, too).

Instead of varying each day, you can also randomise to vary entire weeks or months; that's especially useful for vitamins that might take a while to show any effect. (You can pick based on how fast they seem to help with your sluggishness.)

If you have a friend to help you even a little bit, blinding becomes a lot easier.

Makes me wonder if there's a risk of losing a placebo effect by knowing it's a placebo effect.

Now, designing a controlled experiment to investigate that claim is a good challenge!

We know that placebo can work even if you tell the person that they're taking a placebo. The placebo effect is so famous that people already expect a benefit from it.

But I guess it varies by individuals so maybe some people would lose it.

Hmmm, I have no idea how to get or make the placebo pills, I don't have any tools to make them myself, I wonder if my pharmacy or a local lab would accept to do it for me. I might actually do that but I would need to try two cures instead of a random pill every day because I currently start "feeling better" after a few weeks of taking it.

I am actually curious enough to try it but I would need to do it next semester or next year because I would need to also buy or secure enough multivitamins for the year (two cures a year, it would not be a double blind anymore if I get them just before the cure) and since some of them are prescription I'll have to talk about it with my doctor, see if he would prescribe enough and if yes, how long is their shelf life and how I would go to get placebos.

You can buy empty capsules that you can fill yourself.

So you fill some inert powder into the placebo capsules, just so they have the same weight as the one you crush your non-placebo in.

I am also taking to prevent petty non-dangerous diseases or to raise some aspects of my everyday life above baseline, where the baseline is the ballanced diet (yet not rich in some ingredients by nature). Not to mention counter ballancing one prescription medicine's side effect. Basically for quality of life and for feeling good, not to avoid death. : )

Pretty much this (and it was doctor prescribed - as much as this might be debatable)

Life is not just how many years you live, or rigid classifications of diseases

I'm more interested in finding out if multivitamins improve quality of life and reduce instances of disease. You can have both and not have an increase in longevity. For me, I feel as if I need multivitamin I take daily or I don't feel as well mentally or physically.

> I feel as if I need multivitamin I take daily or I don't feel as well mentally or physically.

which might be enough reason to keep buying and eating it, esp. if the cost isn't that high. Even if it is a placebo effect, it has genuinely improved your health.

> ... improve quality of life and reduce instances of disease. You can have both and not have increase longevity.

You can, but wouldn't we expect them to be correlated? E.g., better health and less disease should lead to a longer life (as we assume all non-health related deaths to be random and not correlated to health)

I don't think I've seen this suspected correlation receive a lot of credit. A lot of deadly health issues are not correlated to your nutriments intake. Cancer for exemple, thyroid issues, and many others. You would need to take lifestyle into account to even start assessing how multivitamins could potentially increase life expectancy.

Take two groups of people who live active lifestyles in non polluted areas, who don't smoke and don't have any other health issues (including mental health issues because a lot of them are correlated with a shortened lifetime). Give placebos for one of these groups.

This study would help a bit, but would be impossible : we don't have enough people who live this lifestyle and are available for long testings on multivitamins. They may also change their lifestyle, get into an accident, develop mental health issues, travel...Which would poison the results.

I think no one should take multivitamins expecting to live longer. Take them for the other proven benefits - they counteract deficiencies, that's all. My blood tests already show this, I take a blood test before an Iron Supplementation Cure and after, the benefit is clearly visible on the test.

I do think my vitamins cause me to have less small sicknesses, or make them less worse. Like, less common colds etc.

The debate over multivitamins tends to miss the forest for the trees, in my opinion.

One, there is no real downside to taking them other than their cost.

Two, there are definite and dramatic benefits to taking specific vitamin supplements if you're deficient. E.g. if you don't get enough vitamin C in your diet a supplement will protect you from getting scurvy. A more modern example is iron deficiency, a third of American women are iron deficient. Vitamin D supplementation is recommended in the winter, etc.

So the idea behind the multivitamin is it may help you out with stuff you don't know you need, basically, and also it may not, but you have nothing to lose by taking one.

To date I haven't come across a study which attempts to frame the issue in this light. A study about longevity doesn't really change my point of view: I take them after a night of drinking where a hangover is probably incoming and god knows precisely what I'm deficient in the next day. The medical system's only advice is don't drink and I already blew that one :)

There was an article about vitamin d supplement might not improve anything, popped recently on HN. Sorry I can't find a link right now.

The idea is that the vitamin d improves, but it's not capturing the actual benefits of sun exposure

I'd imagine use would be most beneficial for people who have diets that don't supply necessary vitamins.

If it were, why wouldn't it promote longevity

isn't the US full of unhealthy food that is "fortified with vitamins" to distract from the fact that it is unhealthy?

Like what exactly?

Vitamin Water.

Like all kinds of industrial produced crap that it's better to not consume, with a health-washing badge about how they "contain vitamins" - from corn-flakes and energy drinks to "wonder bread", "Mentos gum with vitamins" and others.

Flour is produced industrially (and pre-industrially, in any case, it's heavily processed). Do you include that in your 'industrially produced crap'?

Flour is not that good for your diet to begin with, regardless of being produced industrially or not. The kind of crap supermarket breads popular in the US, doubly so.

But, to answer you question no, I make the common sense distinction, between food stuff produced at industrial scale, and "industrial produced crap", like things that involve preservatives, food additives, sweeteners, artificial coloring, hefty does of corn syrup, lab chemicals, and other such crap, which can range from the plain shitty ("wonder bread") to the spectaturaly shitty (sodas, gum, doritos, skittles, and on and on).

In other words, I don't fall for thought-stopping arguments like "Ackchyually, just so you know, water is a chemical too, so what's so bad with industrial food-stuff designed in a food chemistry lab vs grass-fed meat, fish, veggies, and fruits?"

Unfortunately a vast section of the population are are classed poor or in poverty, and so cant afford anything better than wonder bread. This is why fortified foods were introduced in the first place.

Its not a conspiracy to make you think that chemically created foods are as good as naturally produced unprocessed foods, its so that people who cant afford or dont have access to healthy natural food dont get deseases like rickets, spinal conditions, or other growth mutations which are common from malnutrition.

I feel like your argument has its heart in the right place, but is incredibly uninformed.

>Unfortunately a vast section of the population are are classed poor or in poverty, and so cant afford anything better than wonder bread.

I don't think that's the case. Both because poor people, in countries with lower wages and higher cost of living, still buy regular bread, and also because in the US that shit is also consumed by not-so-poor and middle class families too.

>Its not a conspiracy to make you think that chemically created foods are as good as naturally produced unprocessed foods, its so that people who cant afford or dont have access to healthy natural food dont get deseases like rickets, spinal conditions, or other growth mutations which are common from malnutrition.

I doubt this as well, since the "with vitamins" badges are also on food that's way beyond necessary spending, from gum to expensive "high end" "healthy" cereal, all the way to power drinks that cost as much as a Starbucks latte.

I'm not talking about official state sponsored/mandated programs to add some beneficial substances to food stuff for the general population (which of course is good).

> I doubt this as well, since the "with vitamins" badges are also on food that's way beyond necessary spending, from gum to expensive cereal, all the way to power drinks that cost as much as a Starbucks latte.

Well, I guess that's just basic marketing? Vitamins are approximately free to add, and some people are more likely to buy stuff that makes vitamin health claims, while approximately no one dislikes vitamins enough to stop buying a product because of vitamins in it.

> Unfortunately a vast section of the population are are classed poor or in poverty, and so cant afford anything better than wonder bread. This is why fortified foods were introduced in the first place.

Supermarket bread in Germany is very cheap, and looks a lot less suspicious than 'Wonderbread'. (Never having had Wonderbread, I can't tell anything more past the looks.) I don't the poverty argument: the US is a lot richer than Germany.

German supermarkets like Aldi and Lidl aren't charities: obviously they also use industrial processes to make bread really cheap and turn a profit. But given consumer preferences in Germany, you get something that looks like this https://www.aldi-nord.de/produkt/krustenbrot-7256-0-0.articl...

It's 1.49 Euro for 1kg of bread.

I can believe that this style of bread would be a lot more expensive in the US. It certainly is where I am living now in South East Asia. But that's not because of poverty, but because without widespread demand for 'real' bread you don't have the scale necessary for industrial production to make sense.

(And it's not like stuff like Wonderbread is illegal in Germany. You can buy fluffy white bread just fine, too, if you really want it.)

Well, I have to say that German supermarket bread stacks up pretty well against so-called artisanal bread in many other parts of the world, and definitely against their industrial bread. (That's purely a judgement of taste and texture. I'm not making any health claims here.)

The German supermarket bread is obviously produced on an industrial scale to keep the costs down, but given the preferences of German consumers, the bread still gets enough time to ferment and there's no sugars nor shortening added. (One of our my goals here in Singapore is, funny enough, to recreate a 'normal' German bread, a so called Mischbrot, in my home kitchen.)

So it's not so much that industrial is bad, as that certain types of processing and ingredients are probably bad. I agree that especially corn syrup seems very suspicious, whether lovingly hand crafted or industrially produced.

>The German supermarket bread is obviously produced on an industrial scale to keep the costs down, but given the preferences of German consumers, the bread still gets enough time to ferment and there's no sugars nor shortening added

Yes, hence the distinction I made [between food stuff produced at industrial scale, and "industrial produced crap"]

OK, then we are mostly on the same page.

It's a bit sad, but many systems _do_ give people mostly what they want, be that for consumer goods or in politics. Even if it's not necessarily what they, in polite society, would admit to wanting.

All flour in the western world is fortified with vitamins, which is mandated by governements. This then filters through the entire food chain so pretty much any thing you eat has fortified ingredients in.

There is nothing bad about it, it is there to replace the natural vitamins and minerals removed in the milling process.

https://en.wikipedia.org/wiki/Food_fortification#United_King...

> All flour in the western world is fortified with vitamins

All white/highly milled flour; there is no requirement for wholemeal flour to be fortified as nothing is being lost.

I found this out recently from the place I buy my wholemeal bread flour as they had a notice about the requirement, and that it doesn't apply to the wholemeal varieties they sell.

You hold the implicit assumption that for something to be efficacious it must correlate with longevity. But it is possible for something to increase your day-to-day experience and quality of life without a meaningful affect on how long you live.

A good example might be Crohn's disease: not having Crohn's disease barely affects your life expectancy, but your quality of life is vastly improved.

People that feel their health getting worse might try to compensate with multivitamines?

Also, the degenerate case of having a bad vitamine defficiency and also not taking vitamine pills might be too rare to show in the statistics.

I mean about a third of the subjects take pills. How many does not take pills and would benefit greatly from it? Only those would move the needle.

Perhaps the sample group didn't have a deficiency to start with.

Yeah, that makes the most sense. Take supplements if and when you need it. I think the real study would be if someone did trended vitamin deficiency data from all the subjects and then co-related the intake (for deficient persons) with health outcomes.

The British government recommends everyone take vitamin D during winter, and to consider it all year round if you have dark skin.

Running the numbers, the difference in cost of taking a multivitamin all year versus taking just vitamin D works out around the price of a pint of beer.

So I might as well take the multivitamin. How do I know I'm getting enough molybdenum (whatever that does)?

> So I might as well take the multivitamin

It is possible to overdose on vitamins, and you can get adverse effects. It‘s not really a good idea to indiscriminately ”just take everything every day“.

That's true, but you have to do some really silly things to get to that point. You're not going to overdose on a multivitamin from the supermarket.

Depends on the vitamin. It's difficult to overdose on Vitamin C for example. Vitamin D should be dosed with caution, but taking e. g. 1000 IU a day should be safe even if you get it from other sources.

overdosing on Vitamin D is not really a thing

Hypercalcæmia?

Actually, it is possible to overdose on vitamin D, though it’s relatively rare. Vitamin D toxicity, also known as hypervitaminosis D, occurs when there is an excessive amount of vitamin D in the body. This can happen through very high doses of supplements over an extended period or by accidental ingestion of high-dose vitamin D supplements.

everything including water can be toxic at high doses. when I say its not really a thing, it means that it is indeed very uncommon compared to the amount of people who take supplements.

Ok, so paracetamol (aka Tylenol, acetaminophen) overdose is also 'not really a thing', because despite it being absolutely possible to trash your liver and die, the number of people who do that (including as a suicide attempt, as does happen) is miniscule compared to the approximately everybody who takes it.

The safety margin for Vitamin D is on a totally different scale vs the safety margin of Paracetamol (which is very thin, it's easy to overdose on it). bad analogies are bad.

Unfortunately, this is quite common among parents who want to make their own infant formula. They don't know how to dose milligrams and give ten or a hundred times the prescribed dose to infants.

https://www.anses.fr/en/content/vitamin-d-opt-medicines-avoi...

The blood test for vitamin D my doctor showed me includes a safe range.

The trouble is that supermarket multivitamins don’t contain the amount of Vit D required to make up for lack of sunlight in the UK; you need a high-strength D tablet in addition to the D in your multivitamin

(The UK govt recommends a 100IU supplement of Vit D per day and this is what most multivitamins provide, but current understanding is that an adult needs 1000-2000IU total per day, which is hard to achieve from sunlight and food in the UK)

Quite right. I recently started taking multivitamins, and was told by the doctor I need to take 800IU per-day (based on my blood levels) of Vitamin D (I have "Olive" skin), the multivitamin provides only half of that (400IU/10uG).

You shouldn't double up on the multivitamin or you'll be overdosing on other vitamins it contains, so an additional Vit D is required.

> The UK govt recommends a 100IU supplement [...] current understanding is that an adult needs 1000-2000IU

The NHS recommends you consider taking 400IU, and not more than 4,000IU: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...

(That page also says 400IU is what adults need, do you have a source for your 'current understanding' by any chance?

Devastating news for all 10 of the people who were taking multivitamins in the hope that it would prevent them from dying of cancer or heart disease.

https://www.cancer.gov/about-cancer/causes-prevention/risk/d....

Vitamin D is absent from many multi-vitamins because it is fat-soluble rather than water-soluble, more expensive and the recommended doses are open to debate. What's more, it's one of the few vitamins with significant negative effects if overdosed. People don't know how to dose milligrams and give absurd quantities to newborn babies with terrible consequences.

Oral absorption is not very good. It is generally more effective to spend an afternoon outdoors.

They didn't specify what they qualified as a multivitamin, my guess is that the definition is rather loose due to the scale of the study. There's a lot of different mixes of multivitamins in the store. You would buy the one that fit's the efficiency pattern you want to prevent. If your goal is to specifically reduce mortality rather than prevent short term fatigue, you would need to pick the right one.

From what I can tell, they haven't ensure that the long term consumption pattern was consistent either, so they may be mixing people who took multivitamins for a year around the initial study with those who took it every day for their whole life. That would reduce the effect size significantly.

The general advice on vitamin supplements is usually to take the ones you have explicit reasons for taking and to focus more on food in general. This study, while possible useful as a way to debunk highly unrealistic claims of multivitamin effectiveness, doesn't really change the picture here.

From the conclusion section:

    MV use was not associated with lower all-cause
    mortality risk in the first (multivariable-adjusted
    HR, 1.04; 95% CI, 1.02-1.07) or second (multivariable-
    adjusted HR, 1.04; 95% CI, 0.99-1.08) halves of
    follow-up.

Do I read this correctly, that the hazard rate in the multivitamin group was 4% higher than in the non-multivitamin group?

And do I read the CI of 1.02-1.07 correctly in that this difference is statistically significant?

The Limited Value of Multivitamin Supplements

https://news.ycombinator.com/item?id=40828179

Hello everyone, I believe that the studies done so far have considered all possible variables such as different ethnicities, lifestyles in general as well as the health conditions of the various subjects. However, they have forgotten the most important variable, which is the quality of the ingredients in multi-vitamins. We cannot assume that a hatchback can perform as well as a Porsche, even if they are both cars. All supplements still have no real discipline and, as yet, there are no testing requirements for manufacturers. Raw materials are of vegetable origin and are imported from third countries without any quality guarantee. Supplements often contain bacterial contaminants such as aflatoxins, heavy metals, active ingredient titres that do not correspond to those declared, and dosage variations from batch to batch can have an effect on human health. Glauco

I thought it was well known that we cannot determine how well it absorbs into the body in isolation like this?

Also a lot of seemingly textbook examples of the placebo effect in this thread

I take multivitamins but acknowledge they may be doing nothing more than placebo

Yet another statistical analysis of self reported questionnaire about if death can be avoided by something.

How about other measures of one's life before the inevitable? Life quality that is there not only for those with diabetes, cancer or cardiovascular problems having less or more known mechanism that (as far as I am aware) not strongly correlates (yet has casual effect) to the consumption of vitamins. I am the only one tired of these statistical analyses with insignificant deviation smearing billions of aspects together through general public created guided data drawing grandiose conclusions only in titles, while the scope of the title is also very limited despite playing the tune of primal fear to inflate its self importance beyond the content?

btw it improves health , i don't take it for longevity just for good health with less disease

Alas, there's no evidence it does so.

This study wasn't about it. Do you have one claiming that?

There's basically no evidence anywhere that vitamin supplementation does anything at all for generally healthy people who don't currently suffer a specific deficiency.

If you do find some studies that find some evidence for vitamin supplements doing anything (for generally healthy people), please let me know!

See https://www.youtube.com/watch?v=NmJsCaQTXiE for a quick intro. (Sorry, don't have enough time to find exactly the right video and/or paper.)

The person you're answering to didn't say anything about "healthy people who don't currently suffer a specific deficiency". I don't think multivitamins are meant for this population anyway, it's for people who know they're prone to deficiencies or even know they have one specific issue (e.g women and iron, dark skin and vitamin D)

I've anecdotally heard of iron supplementation working for some women.

However, if I remember right, even for the seemingly clear case of dark skinned people vitamin D supplementation basically has no evidence. But I'd be happy to see any randomised controlled study (or similar) that says otherwise!

There's plenty of observational studies that people with lower than average vitamin D also have various other health problems. But I don't know of any study that shows that vitamin D deficiency helps eg dark skinned people (or any group at all).

Again, correlation or causation?!

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