Why everyone needs a multi-vitamin

Why every patient needs a multiple vitamin

Many of you reading this article are over 50, or you have patients who over 50 years of age. Evidence is beginning to emerge suggesting that anyone over the age of 50 should seriously consider taking a multi- vitamin/mineral. It is now stated in no uncertain terms that, “inadequate micronutrient intake among older adults is common despite the increased prevalence of fortified/enriched foods in the American diet” (1). We are not talking about people in their 90s. In this eight-week double-blind, placebo-controlled clinical trial that examined how a multinutrient would impact on micronutrient status, plasma antioxidant capacity and cytokine production, the subjects ranged in age from 50-87 years. All were characterized as healthy, free- living older adults already consuming a fortified diet. The authors concluded that, “supplementation with a multivitamin formulated at about 100% Daily Value can decrease the prevalence of suboptimal vitamin status in older adults and improve their micronutrient status to levels associated with reduced risk for several chronic diseases” (1).

The same author examined how a multvitamin/mineral supplement would influence homocysteine levels in adults ranging in age from 50-87 years who already consumed a folate- fortified diet (3). After an 8-wk period, subjects taking the supplement had significantly higher B-vitamin status and lower homocysteine concentration than controls (P: < 0.01). Plasma folate, B6 and vitamin B-12 concentrations were increased 41.6, 36.5 and 13.8%, respectively, in the supplemented group, whereas no changes were observed in the placebo group. The mean homocysteine concentration decreased 9.6% in the supplemented group (P: < 0.001), while no changes were observed in the placebo group. There were no significant changes in dietary patterns during the trial. The authors concluded that a multivitamin/mineral supplement can improve B-vitamin status and reduce plasma homocysteine concentration in older adults already consuming a folatefortified diet.

In another double-blind, placebo-controlled trial, Chandra (3) examined whether supplementation with vitamins and trace elements in modest amounts might influence cognitive function in apparently healthy, elderly subjects. The study included free-living men and women over 65 years of age, who were randomized to receive a supplement of trace elements and vitamins or a placebo for 12 months. Cognitive function was determined by assessing immediate and long-term memory, abstract thinking, problemsolving ability, and attention. The supplemented group showed a significant improvement in all cognitive tests except long-term memory recall. Those with blood-nutrient levels below the reference standard showed lower responses on cognitive tests. Chandra concluded (3): “This has considerable clinical and public health significance. We recommend that such a supplement be provided to all elderly subjects because it should significantly improve cognition and thus quality of life and the ability to perform activities of daily living. Such a nutritional approach may delay the onset of Alzheimer's disease.”

While I was unable to find similar articles for people under age 50, my experience with assessing nutrient status in the diets of people in this age group suggests that there are similar deficiencies. Many studies indirectly suggest the need for most of us to at least take a multiple- nutrient supplement. Consider that a recent study explained that food “fortification substantially increased the intakes of all nutrients examined except calcium, in all age/gender groups but especially children” (4). As it turns out, breakfast cereals provided most of the fortified nutrients. “In numerous cases, fortification was responsible for boosting median or 25th percentile intakes from below to above the RDA” (4). Fortification represents the addition of nutrients to foods that have been processed. Basic ally, the “food fortifiers” add a cheap multivitamin/mineral to processed foods. This means that an enormous segment of our population already takes a multinutrient supplement, it is just incomplete. Why not provide them with a good supplement instead?

Despite what many believe about the medical profession, many are involved in prevention and many take multivitamin/mineral supplements. For example, in one study involving pharmacy students, researchers found that 47% of 692 students take supplements (5). More recently, a randomly sampled mail survey of 4,501 female medical doctors revealed that 50% took a multivitamin/mineral supplement (6). Clearly, many pharmacists and medical doctors believe that they need supplements – perhaps because they know their diets are deficient, and/or they believe the RDAs are low, and/or they believe that additional nutrients may have a disease preventing effect.

References
1. McKay DL, Perrone G, Rasmussen H, Dallal G, Hartman W, Cao G, Prior RL, Roubenoff R, Blumberg JB. The effects of a multivitamin/mineral supplement on micronutrient status, antioxidant capacity and cytokine production in healthy older adults consuming a fortified diet. J Am Coll Nutr 2000 Oct;19(5):613-21

2. Multivitamin/mineral supplementation improves plasma B-vitamin status and homocysteine concentration in healthy older adults consuming a folate-fortified diet. McKay DL, Perrone G, Rasmussen H, Dallal G, Blumberg JB. J Nutr 2000 Dec;130(12):3090-96

3. Chandra RK. Effect of vitamin and trace-element supplementation on cognitive function in elderly subjects. Nutrition 2001 Sep;17(9):709-12

4. Berner LA, Clydesdale FM, Douglass JS. Fortification contributed greatly to vitamins and mineral intakes in the United States, 1989-1991. J Nutr 2001; 131(8): 2177-83

5. Ranelli PL, Dickerson RN, White KG. Use of vitamin and mineral supplements by pharmacy students. Am J Hosp Pharm 1993; 50(4):674-78

6. Frank E. Bendich A, Denniston M. Use of vitamin-mineral supplements by female physicians in the United States. Am J Clin Nutr 2000; 72:969-75