Can Multivitamins Actually Improve Your Health?
What registered dietitians want you to know about these popular supplements.
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Multivitamins are the most widely used nutritional supplement in the United States. But despite their popularity, there is a lot of debate as to whether multivitamin supplements are necessary.
While some diseases and health conditions can be caused by nutrient deficiencies, in the developed world, where there is a wide availability of nutrient-dense foods, some question how common true nutrient deficiencies are. And yet, the majority of Americans fall short of the recommended fruit and vegetable intake. Read on to hear what registered dietitians have to say about supplementation with multivitamins.
What Are Multivitamins?
Vitamins are nutrients that the body needs to maintain normal cell function, growth, and development. Typically, multivitamins are used when someone’s not able to get enough of these nutrients from their diet. There also are multivitamin-mineral supplements that provide minerals as well as vitamins.
An analysis of dietary supplement use in the United States from the 2017–2018 National Health and Nutrition Examination Survey (NHANES) found that multivitamin-mineral supplements were the most commonly consumed supplement among adult men and women, with 24% of adults ages 20 to 39 taking them regularly. For people ages 40 to 59, usage increased to 29.8% and grew to 39.4% for people ages 60 and older.
Who Needs a Multivitamin?
Despite their popularity, not everyone needs a multivitamin — but a few groups may benefit. Here's a look at who falls into these groups.
Those Following Restrictive Diets
Multivitamins can be a nutritional tool to help bridge the gap for those who are following patterns of eating that restrict or omit food groups, such as vegans and vegetarians, says nutrition expert Maya Feller, MS, RD, CDN, the author of Eating from Our Roots: 80+ Healthy Home-Cooked Favorites from Cultures Around the World.
Keep in mind that if you have one or two dietary gaps to cover, you may not need a multivitamin. For example, if you follow a vegan diet but eat a wide variety of foods, you may just need to supplement nutrients that are generally not present in large amounts in plant foods, such as vitamin B-12, vitamin D, omega-3 fatty acids, and possibly calcium and iron, Feller says.
Or if you have iron deficiency anemia, your healthcare provider will likely recommend an iron supplement to help you get to a healthy range and then assess whether or not to continue that supplement, depending on what’s causing the anemia.
Those Who Are Pregnant or Trying to Conceive
Feller also notes that people who are pregnant or trying to conceive can also benefit from a multivitamin — specifically, a prenatal.
Similar to multivitamins, prenatal vitamins are meant to fill the gap in nutrients you may be missing or need to boost while pregnant so your body can grow a healthy baby. For example, folate or folic acid is particularly important before and during pregnancy, as it helps prevent major birth defects of the fetus's brain and spine, according to the American College of Gynecology (ACOG).
Related: The Best Prenatal Vitamins, According to Ob-Gyns (Plus, Why You Need Them In the First Place)
Those With G.I Disorders
Multivitamins may be beneficial for people living with G.I. disorders that can cause excessive vomiting or diarrhea (and subsequent nutrient malabsorption), like celiac disease, Crohn's disease, and ulcerative colitis. Similarly, people who've had surgery to remove parts of their digestive organs may also benefit from a multi.
Those Taking Certain Medications
Nutrients also can be depleted by certain medications. For example, proton pump inhibitors prescribed for acid reflux can decrease the body’s ability to absorb vitamin B12, and certain diuretics used to manage blood pressure can lead to decreased levels of calcium, magnesium, and potassium. Even certain oral contraceptives may impact nutrient levels.
Talk to your healthcare provider about how a drug may impact nutritional status when starting a new medication. If you’re curious about the potential effects of a medication you’ve been on for a long time, don’t be afraid to ask.
Potential Downsides to Multivitamins
There are some potential downsides to taking a multivitamin-mineral supplement. For starters, if you don’t need one, it can be an unnecessary expense. It's also possible to overdo it on certain nutrients. “There also are tolerable upper limits for multivitamins," Feller says. "When taken in excess specifically, the fat-soluble ones (vitamins A, D, E, and K) could potentially lead to toxic buildup in tissues. Therefore, it’s not recommended to supplement fat-soluble vitamins without having accurate lab work to verify that those vitamins or minerals supplements are needed."
Meanwhile, water-soluble vitamins taken in excess simply don’t reach the cells in the body — that’s when you see that technicolor urine, Feller says. "You pee out what the body doesn’t use. It doesn’t mean the multivitamin isn't working; it just means that you’re flushing your money down the toilet.”
Be mindful of minerals found in these products, too — especially if you take a few different supplements. For example, if you're taking a multivitamin-mineral supplement that has a day's worth of zinc and then you also take an immune-supporting supplement that provides a therapeutic dose of zinc, you may start to experience symptoms of excess zinc intake. Iron is another nutrient where getting enough is important, but too much can lead to severe adverse symptoms.
Multivitamin Limitations
If you generally follow a well-balanced diet but still experience symptoms like fatigue, brain fog, poor immune system function, neurological symptoms, or other issues, a multivitamin may not resolve the issue. Talk to a healthcare provider and explore potential underlying factors and solutions.
How to Balance Multivitamin Use
When considering a multivitamin, "food first" is an important principle to live by, meaning try to first get most of your nutritional needs met through the foods you eat, says Dawn Jackson Blatner, RDN, a registered dietitian and author of The Flexitarian Diet. However, it’s often very difficult to get everything from food alone, so supplements can be an additional strategy to help people meet their nutrient needs.”
It's important to note that this principle doesn’t necessarily mean “food only." Multivitamin minerals serve as a moderate insurance policy to get more of the nutrients you may not be eating enough of, Blatner says.
""Multivitamins are not magic bullets. But they can be part of a healthy lifestyle." — Dawn Jackson Blatner, RDN"
She also points out that research suggests that when compared to food alone, taking a multivitamin-mineral supplement has been associated with higher nutrient intake and lower prevalence of inadequacies.
However, multivitamins are not magic bullets, Blatner notes. "But they can be part of a healthy lifestyle. A research study looking at various components of a healthy anti-inflammatory lifestyle found multivitamin minerals were a top habit of those with the lowest inflammation.”
How to Tell if You Are Nutrient Deficient
Overall, it is difficult to know if you are deficient in a particular nutrient because even blood tests generally don’t pick up deficiencies unless they are on the more severe spectrum, Blatner says. However, nutrients like iron, B12, folate, vitamin D, and omega 3 deficiencies often do show up in blood work, she says.
If you have increased nutrient needs, are on a very restrictive diet for longer than a week, restrict certain food groups due to allergies or preferences, have limited variety in your diet, or have a condition associated with increased needs or impaired absorption of nutrients, it’s a good idea to talk to a healthcare provider about what kinds of supplementation you may benefit from.
Paying attention to your body can also give clues as to whether you’re properly nourished. For example, if you notice your energy, mood, workout performance, or GI function are compromised, or you’re experiencing any new issues, talk to a healthcare provider about how your nutrition status may play a role.
Related: Do You Need A Hormone Balancing Supplement?
Tips for Choosing a Multivitamin
The supplement industry is not regulated by the Food and Drug Administration (FDA), so it can be challenging to know that what you’re buying supports your goals. To start, look for a reputable brand.
“If you aren’t using a reputable brand, you could be setting yourself up for taking harmful impurities or harmful amounts of nutrients," Blatner says. "Choose a brand that is 100% transparent about how they test for purity, quality, and safety. You can do this by checking product labels or visiting company websites to read about their testing protocols and possible third-party certifications.”
Choosing the right formula for your unique needs also matters, she adds. “Choose a multivitamin that’s formulated for your age, gender, and stage in life. This is important because not all nutrients are healthy or necessary for all people. For example, men and menopausal women generally do not need additional iron.”
Finally, take a look at the number of pills, capsules, or gummies per serving, Blatner says. “Some brands are just a one-a-day, while other brands you’d need to take many more per day to get the amount of nutrients on the label.” If you know that you’re going to have a hard time taking multiple pills per day, that’s a clue that you may do better with a one-a-day product.
Questions to Ask Your Provider
If you are considering a multivitamin, don’t be afraid to ask for guidance from a healthcare provider. Here are some things to ask:
What reputable brands do you recommend?
What is the best form of this supplement? (i.e., capsule, liquid, gummy)
Will any of the medications I’m taking interact with certain supplements?
Does it matter what time of day I take this supplement?
Does this supplement need to be taken with food?
Are there any supplements I should take based on my health/medical history?
Are there any supplements I should not take based on my health/medical history?
Bottom Line
When it comes to vitamins and minerals, your primary focus should be on eating a balanced diet. Diverse patterns of eating — specifically where you consume an abundance of plants from all sources, grains from a variety of sources, beans, nuts, seeds, as well as animal proteins — should be prioritized.
But if you need additional support meeting those needs, a multivitamin or supplement that covers the specific nutrient gaps in your diet can be a valuable tool. Consult with a healthcare provider for guidance, and make sure to choose a reputable brand. Also, be mindful to cover your nutrient bases while remembering that too much of a good thing is also a possibility.
If you do not have access to a healthcare provider, Blatner recommends the USDA’s MyPlate planner. This tool uses information such as your age, gender, height, weight, and physical activity to create a personalized food plan revealing how many daily servings of each food group you’d need to meet your nutrient needs.
Related: The 13 Best Protein Powders for Every Health Goal, Tested and Reviewed
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