Posted by Let me begin by saying that certain vitamins and minerals are crucial for particular patients. On the flip side, taking certain vitamins and minerals can also be dangerous for particular patients. Me telling you that it is going to be 100% beneficial for you to take a multivitamin is NOT an easy answer for me to give. Every person’s needs are different. Please understand that prior to taking an over the counter (OTC) multivitamin or supplement, you should CONSULT YOUR HEALTHCARE PROVIDER. Ok, enough of me yelling, and let’s move on to helping you understand the benefits/risks, and if they’re even worth taking.
Picture this: you’re perusing the vitamin aisle at your local pharmacy. There are hundreds of options. Some are multivitamins, some are minerals, some are labeled as supplements, some are gummies (yum) and chewables, some are age-related (children, 65+, etc), some are condition-related (bone health, immune health, pregnancy, etc), and some are gender-specific. This differentiation that companies place on the label is mainly to help you just identify with one and make a choice. But it can be so confusing! I recall spending 15 minutes choosing a prenatal vitamin (spoiler alert: I chose the gummies). I think it’s really important for you to understand, though, the difference in all of these offerings, and how these supplements can affect your body.
A vitamin includes vitamins like A, B, C, D, E, H, and K. They all do very different things but taking them isn’t always appropriate. For instance, if you’re on a blood thinner called warfarin (or Coumadin), vitamin K is NOT a good idea. It’ll help to clot the blood, and it’s not ideal for you. Vitamin K is in many multivitamins, so that patient should be wary of this one. Taking vitamin K while on warfarin is potentially deadly. Also, if you have an actual vitamin D deficiency, the vitamin D level in an OTC multivitamin isn’t good enough (around 1-3,000 international units), and you’ll need a much more substantial dose weekly (50,000 international units). There are several B vitamins. B1 is thiamine; it helps with brain function. B3 is Niacin and is hugely important for your body’s basic metabolic functioning. B6 helps the immune system. B9 is folate, and folic acid is a derivative of this. Pregnant women or those who are interested in becoming pregnant NEED THIS if they hope to prevent spina bifida in their fetus. Folic acid is crucial in utero for forming a normal spinal cord. You’ve heard of B12 anemia; it’s kind of miserable to have this disorder, and important to get treated if you are victim to it. I didn’t touch on all the Bs, but these are good ones to mention.
A mineral is something like potassium, iron, calcium, iodine, phosphorus, sodium, and magnesium. Think of the elements on the periodic table from high school chemistry (rough memories, I know.) Potassium, for instance, is very important to be cautious with, because patients on certain diuretics (AKA “water pills”) have to keep this one in balance. If you’re on something like hydrochlorothiazide (HCTZ— one of the most commonly used diuretics), you’ll want to keep an eye on your potassium levels via regular blood draws and potentially take a prescribed potassium supplement. This water pill helps rid of extra fluid in your body via urination, but can also take potassium with it. Again, something your healthcare provider would help you with. Calcium, phosphorus, and magnesium are important for folks with kidney failure to be cognizant of, especially those on dialysis. Imbalances in these minerals in anyone can cause seizures, abnormal heart rhythms, and breathing difficulties. But trust me when I say, if you’re on dialysis, your levels are obsessively monitored by your dialysis team, and you’ll be coached heavily on what foods to eat and avoid…particularly pumpkin pie at Thanksgiving dinner (bummer)! If you have iron deficiency anemia, the iron supplementation OTC isn’t enough. These patients normally need prescribed doses, or even iron infusions to maintain an appropriate level of iron in the blood. Iron is important for the oxygen-carrying function in the blood (it’s complicated so I won’t bore you with it today). One patient population, though, that I urge to take certain supplements is my aging female population who have osteopenia and osteoporosis. Daily intake of vitamin D and calcium is beneficial to help prevent bone fractures.
You’ve probably also seen enzymes on the shelves for sale. Claims are strong by their manufacturers that they’ll help to boost digestion and immunity, for instance. My advice? DON’T WASTE YOUR MONEY. These come with a high price tag, usually, and it’s sad. Sad because people are falsely led to think they’ll be superhuman after taking them. Enzymes are already naturally in your body. Enzymes are crucial for all metabolic processes. If you’re deficient in an enzyme, you know it, because it’s usually genetic and/or inborn (severe ones include PKU). Lactose-intolerant people find it helpful to take lactaid prior to eating dairy. Lactaid is just lactase, an enzyme humans have to break down the sugar lactose in the gut. Okay, so this oral supplemental enzyme is actually helpful. Most of these enzymes in a bottle, though, get broken down by your stomach acid and never truly make a difference. Not many enzyme supplements actually make it into your bloodstream. This is when I shout, “Placebo!” Obviously, if you have a known enzyme deficiency (on the rarer and serious side if you have one), consult with your nutritionist on how to maintain proper levels of such. For more info on enzyme disorders, visit: https://www.sciencedirect.com/topics/medicine-and-dentistry/enzyme-defect.
A common question patients ask me in the office is, “I’m so tired all the time! What vitamin can I take to boost my energy?” FYI, if I had a vitamin that made you feel like Wonder Woman, I’d be a billionaire and would be on my own tropical island somewhere. But seriously, being healthy is much, MUCH more complicated than just taking a multivitamin. Do Vitamin D deficient people have more energy once their level is normalized? YES. Do iron deficient folks feel a lot better once their level is normalized? YES. Now, a healthy and balanced diet should prevent you, the average Joe, from being deficient in any micronutrient, especially here in the US where we are provided with ample opportunities to eat a nutritious diet. But if we were to criticize the statement I just made, we’d know that many of our US citizens cannot justify buying fresh produce when Mac N Cheese is $1 per box and ramen noodles are 10 cents per package (I’m getting flashbacks of my college diet right now). This cost difficulty leads to developed countries having citizens with diets lacking proper necessary nutrients.
Here’s the thing: if you’re trying to swallow the least pills possible on a daily basis, I say spend your money on healthy food rather than a multivitamin. Like me, Guallar et al at Johns Hopkins suggest to stop wasting your money! They discovered that out of 450,000 people, a multivitamin did NOT reduce the risk for heart disease or cancer. In a separate 12-year study of nearly 6,000 patients, no reduced risk for mental decline/ memory loss was seen. Will it hurt you to take a multivitamin? Likely, no! Again, ask your healthcare provider for guidance on any exceptions you need to be aware of and any potential drug interactions you could have based on medications you already take. But, if you’re an average Joe and think it’ll give you this outstanding quality of life, I’ll tell you not to bother, and buy yourself some brussel sprouts, instead.
DISCLAIMER: This post is intended for adult health only and not to be referenced for the pediatric population.
References
Berkely Wellness. Enzyme supplements: Yay or nay? 2011. Retrieved November 2, 2019 from https://www.berkeleywellness.com/supplements/other-supplements/article/enzyme-supplements-yea-or-nay
Blaine J et al. Renal control of calcium, phosphate, and magnesium homeostasis. CJASN July 2015, 10 (7) 1257-1272
Huskisson E et al. The role of vitamins and minerals in energy metabolism and well-being. The Journal of International and Medical Research. 2007; 35: 277-289. Retrieved November 2, 2019 from https://journals.sagepub.com/doi/pdf/10.1177/147323000703500301
Johns Hopkins Medicine. Is there really any benefit to multivitamins? 2019. Retrieved November 2, 2019 from https://www.hopkinsmedicine.org/health/wellness-and-prevention/is-there-really-any-benefit-to-multivitamins.
Medical News Today. A complete guide to B vitamins. Retrieved November 2, 2019 from https://www.medicalnewstoday.com/articles/325292.php#vitamin-b-6
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