Should You Take A Multivitamin?

 

Moderator: Welcome to the Great Cardiac Debate, the show where we discuss the pressing medical issues of our time. The question before the panel today is, “Should you take a multivitamin each day?” To debate this important question, we have in one corner Doctor Sceptic, who will argue that we should not take a multivitamin. In the other corner is Doctor V. T. Amin who will present the data in favor of a multivitamin each day.

Moderator: Before we start, we need some background information. Micronutrients are dietary factors that help to maintain metabolism and good health. There are more than twenty essential micronutrients including: vitamin A, vitamin D, vitamin E, thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), folate (vitamin B9, vitamin B12, iron, zinc, iodine, fatty acids, amino acids, magnesium, selenium and coenzyme Q 10. All of these are important for health and survival. A deficiency of a micronutrient can lead to serious disease (for example, vitamin C deficiency can cause scurvy, vitamin D deficiency can cause soft bones and rickets, vitamin A deficiency results in night blindness). Micronutrients support heart health as well, especially vitamin C, vitamin D, fatty acids, and magnesium. They help the heart by acting as antioxidants, reducing inflammation, decreasing insulin resistance and supporting blood vessel and heart function. The main way to obtain micronutrients is through a good balanced diet. In addition, many foods are fortified with micronutrients (for example, wheat flour is fortified with folic acid, so the prevalence of folate deficiency is very low in the US). If there is a lack of a micronutrient in the diet (for example, vegan diets are low in vitamin B12, this can lead to anemia) then supplementation is needed with the specific micronutrient or a general multivitamin. In addition to low dietary intake, certain disease states require micronutrient supplementation. Patients with intestinal disease (malabsorption, Crohn’s disease, intestinal surgery), alcoholism, pernicious anemia all require additional help. So, should the average person take a multivitamin supplement?

Moderator: Doctor Sceptic, please begin and explain why you feel that a multivitamin is not needed.

Doctor Sceptic: Thank you for inviting me to join this esteemed panel. First of all, due to our diet and the fortification of food that takes place, the prevalence of micronutrient deficiency in the US is very low. When was the last time you heard of someone coming down with scurvy? Next, the data has shown that multivitamin supplementation does not reduce heart disease, cancer or mortality. An early study, The Nurses’ Health Study in the 1980’s, found that vitamin E supplements lowered the risk for heart disease. Unfortunately, higher quality studies later showed that vitamin E, vitamin C and beta carotene (used to raise vitamin A levels) supplementation had no effect on reducing cardiovascular events or mortality. In fact vitamin E may increase the risk for bleeding in the brain (a form of stroke). In addition, extra beta carotene was also found to increase stroke and mortality. It seems that multivitamin use doesn’t prevent disease and may increase health risks and death. So, skip the multivitamin and eat a good balanced diet. You’ll save money and live just as long.

Moderator: Thank you, Doctor Sceptic. Now it is you turn Doctor V.T. Amin.

Doctor V.T. Amin: Yes, it is true that vitamin related illnesses are rare in the US. However, deficiencies are not. A survey of adults over the age of 50 from 2007 to 2014 showed that less than 5% had inadequate intake of copper, iron, selenium and zinc. However, substantial numbers had low levels of vitamin D, vitamin C, vitamin K and B vitamins. In addition, 1 in 3 women in the US have a least one micronutrient deficiency, most commonly low iron levels. A daily multivitamin would help these people as well as other risky populations (such as pregnant women, young children and aging patients with poor dietary intake). In terms of data, it is true that vitamins E and C as well as beta carotene don’t prevent disease, but harm only occurs at very high doses. The doses present in most multivitamins would not cause harm. Some micronutrients actually may be beneficial in reducing heart events and reducing risk factors. These include n-3 fatty acid, coenzyme Q10, zinc, L-arginine and magnesium. Folic acid supplementation improves blood pressure and cholesterol and reduces the risk for heart attacks. Flavanol enriched cocoa extract reduced cardiovascular mortality in a large well-run study. Lastly, some recent trials showed that multivitamin supplementation decreased invasive cancers, reduced the risk of cataracts, slowed memory loss and cognitive decline and actually slowed the aging process. So, given the low risk of harm with a daily multivitamin and the potential benefit from the cardiac and neurological standpoint, go ahead and take that supplement. 

Moderator: Thank you, Doctor Sceptic and Doctor V.T. Amin, for a lively and informative discussion.  Who is the winner? Take a multivitamin each day, or Don’t take a multivitamin? America was polled and America has voted. The answer is….