Supplements: Multi-Vitamin / Mineral

Please consult a doctor before taking any supplements! Now that that is out of the way here is an overview of how the benefits of multivitamins for generally healthy individuals are negligible and that especially Scandinavians seem to produce evidence that supports that these pills promote cancer. This is all of what comes in a nutshell but see for yourself ;).

What are multivitamins ?

Multivitamins are dietary supplements which contain macronutrients like vitamins and dietary minerals. They are recognized by the Codex Alimentarius Comission as food. There is no commonly accepted definition in markets or from scientists and the term can apply to a wide variety of products. This is a reason why pills with the same ingredients can be found as in antioxidants or multivitamins on the shelves. Therefore the ingredients of multivitamins vary greatly based on marketing strategies and local preferences. The first multivitamins in the states were available in 1940.

In the United States, a dietary supplement is considered to be a multivitamin when it contains 3 or more vitamins and minerals without containing any herbs, hormones or drugs. Usual multivitamin formulas contain:

Vitamin C
B1
B2
B3
B5
B6
B9
B12
Biotin
A
E
D2 (or D3)
K
Potassium
Iodine
Selenium
Borate
Zinc
Calcium
Magnesium
Manganese
Molybdenum
Betacarotene
Iron

and come as tablets, capsules, pastilles, powders, liquids, and injectable formulations (only per prescription). For men there is usually less iron in the multivitamins, as this group usually already has enough in their system naturally, while for 50+ the vitamin D doses might be increased as in this age group absorption of nutrients like calcium, vitamins b6 and 12 seems to slow down.

As age groups and gender, specific pills are available, which could also be called special formulas, you will also find cocktails which will give 100% to 1000% of the recommended daily intake of the certain macronutrients. So-called "high-potency-formulas" or "overdose multivitamins" are usually paired with extreme health or sports benefit claims. Some nutrients, mainly calcium and magnesium, are usually not included in MVMs as this would make the pill too large.

In the 1999–2000 National Health and Nutrition Examination Survey, 52% of adults in the United States reported taking at least one dietary supplement in the last month and 35% reported regular use of multivitamin-multimineral supplements. That the use of multivitamins is further underpinned by the graphic shown below which shows the trends from 2003 through 2006:

Theoretically, multivitamins are the best option for lower income parts of the population to get all of the nutrients they need which they can not afford to consume via a more balanced natural diet. Practically, though, according to this study in the time period from 2003 to 2006 use is more frequent among women and the children of women who use supplements; the elderly; those with more education, higher incomes, healthier lifestyles and diets, and lower body-mass indexes; and residents of the western United States. So if you are living in L.A., have a university degree, work in the movie industry & exercise regularly it is very much more likely that your children will also use supplements and that your household will make the pill manufacturers happy.

You can obtain multivitamins online, in local shops and basically anywhere where you would do your normal shopping. Price ranges differ from 5 USD / Euros to 50 USD / Euros. Here you find a selection of different products as an overview.

Products available from Holland's and Barrets:

From bodybuilding.com:

And there is also a further article @ Muscle & Fitness magazine discussing several multivitamin options.

What are the benefits of multivitamins ?

All in all, it seems that you only benefit von multivitamins significantly when either your diet is not very balanced or when you are old. Specific groups would be the very young and the very old, or very sick people who eat an extremely limited diet. Cases in which MVM supplementation can be potentially of advantage:

Supplementation with calcium and vitamin D might increase bone mineral density and decrease fracture rates in postmenopausal women
People over age 50 should obtain recommended intakes of vitamin B12 mainly from fortified foods or dietary supplements because they could be less able than younger people to absorb the protein-bound, naturally occurring vitamin B12 in food
Pregnant women should see benefits from supplementing iron
Vegans can supplement easier based on their dietary needs
If you have problems eating, supplementing might be beneficial after seeing a doctor
A 450.000 people analysis found no clear evidence that multivitamins prevent cancer or heart disease
Some studies with high variability so that some certain individuals do benefit while others do not

IN summary, it seems like that benefits for generally healthy individuals who eat a healthy diet are slim to none. The dynamic changes for special subgroups like the elderly, people with special diets or pregnant women. As this usually should go with being observed by a doctor go with the prescriptions you will get.

What are the risks of multivitamins ?

This is a mixed bag. Some, it seems especiaEuropeanpean, studies claim that multivitamins can increase the risk of cancer and mortality.

Other big studies that went for years and seem to adhere to best practices for testing (read Ben Goldacre's books to understand this better) seem to find no significant positive or negative effect by MVMs.

The main risks are overdosing on multivitamins when taken too often or taking the pills as a supplement for a healthy diet... The side effects can be many depending on individuals for being either undernourished or having too high levels of certain vitamins.

How good is the quality of the products ?

Labdoor tested 68 multivitamins across 1.072 assays based on their labeling in correspondence with recommended daily intake. They also analyze if there are any harmful substances in the products which should not be in it and/or are not stated on the label. The outcomes were as followed:

Labelling was incorrect with a range from -11.330 to +3000 (see website for details what this means)
Gummy and Chewable multivitamins had on average 52.8% less vitamin and 77.3% lesser minerals
Generally little sugar in the products

Here is the top ten of multivitamins based on this analyses:

Garden of Life Vitamin Code for men
Garden of Life Vitamin code perfect weight
Nature's way alive max potency multivitamin
Rainbow light men's one
Garden of life vitamin code for women
NOW Foods adam men's multivitamin
NOW Food's Eve Women's Multivitamin
GNC Mega Men
Carlson Labs super 2 daily
Rainbow light Women's One

What is your experience with Multivitamins ?

I have used the solvable tablets which you can get at Lidl in Ireland and MYPROTEIN Alpha men. I mainly use them to make my water a bit more interesting. As I am eating generally healthy (at least I'd like to think so) and do not monitor my intake I can not say whether it is beneficial or harmful tot ake them or not. Here you can also see the dilemma of individual experiences vs big data analyses in randomized trials. There is little chance that I will personally pinpoint any positive or negative impacts of the multivitamin intervention in my diet apart from placebo effects. This is due to too many factors coming into play and too little data points to balance out.

So I have not dropped dead yet because of them, but also did not turn into the hulk.

Conclusions

Based on what I looked at generally supplementing multivitamins seems only to make sense for certain subgroups of the population like the elderly, sick and people on a special diet. Even then the benefits seem to be minimal rather than breathtaking, which becomes a more common observation the more I look into different types of supplements. The risks seem to be minimal and inconclusive for now based on what study you look at. Again the final conclusion is: Pay attention to a healthy diet with good ingredients and you won't need to supplement unless you get sick and need to see a doctor.