Vitamins and minerals are very important to health and many of us do not get enough of certain ones.  The research below will show many good effects from multivitamin and mineral preparations.  However, not all vitamins and mineral supplements are good for all of us.

Multi-Vitamins with minerals are good for children and pregnant women, but vitamin A and beta-carotene supplements have been shown to have many harmful effects in middle-aged adults including increasing cancer, fractures, and Parkinson's disease.  Also, the dosages in multivitamins of folic acid, vitamin D, vitamin K, magnesium, and selenium are all too low.  In addition to this, iron might increase heart disease in middle-aged and older adults and calcium may increase prostate cancer and Parkinson's disease in middle-aged and older men.  Calcium is good for women, but the amount in multivitamins is too small.  Vitamin E, pyridoxine (B-6) and zinc might also be bad for older adults and should probably be avoided until more research is available.

Vitamin A and B-6 can be better obtained by a healthy diet with plenty of vegetables, fruit, nuts, and whole grains.

Non-pregnant adults should not take any of the multivitamin formulations on the market.  For my vitamin and mineral recommendations, see my Recommendations for Healthy Living.  All of the benefits of multivitamin-mineral formulations should be better accomplished for adults by using individual supplements as I have outlined.  This can still be done at a very low cost, although the number of pills might seem excessive to some who want it all in a single tablet.

Multivitamin Studies

Anti-Social School Behavior: Decreased: DB PC 463 Hispanic students ages 6-12 at half-dose. 47% less in vitamin-mineral tabs. Lasted entire school year and teacher gave pills. The effect of vitamin-mineral supplementation on juvenile delinquency among American schoolchildren: a randomized, double-blind placebo-controlled trial. Schoenthaler SJ, Bier ID. J Altern Complement Med 2000 Feb;6(1):7-17. Calif. State Univ., Stanislaus; See similar study with prisoners below.

Birth Defects: Multivitamins Reduce: Ginecol Obstet Mex 2000 Dec;68:476-81 found less anencephaly with multivit. Cleft Palate Craniofac J 2001 Jan;38(1):76-83 found marginally lower cleft palate. Third study found fewer isolated major heart defects in an Atlanta study under multivits. Also cuts urinary tract defects. N Engl J Med 2000 Nov 30;343(22):1608-14 while anti-folate meds like carbamazepine, phenobarb, phenytoin increase all of these defects in pregnancy unless supplemental folate.

Birth Defects: Multivits Decrease Omphalocele: Periconceptional multivitamin use was associated with a 60% reduction in the risk for nonsyndromic omphalocele, an abnormality of the abdominal wall. Case-control in Atlanta of 72 cases and 3023 control infants. Botto, CDC, Pediatrics 2002 May;109(5):904-8 

C-Reactive Protein Lowered in Small Study: A retrospective analysis of blood samples of 87 patients in a six-month DB PC study of multivitamins found that multivitamins lowered C-reactive protein.  Reduction of C-reactive protein levels through use of a multivitamin. Church TS, Earnest CP, Wood KA, Kampert JB.  Am J Med. 2003 Dec 15;115(9):702-7

Cataracts: Multivit-Mineral, Folate, B-12 Help Prevent: 2873 examined for cataracts. Multivit RR 0.6 thiamine, 0.6 niacin 0.7, folate 0.6, Vit A. Use of vitamin supplements and cataract: the Blue Mountains Eye Study. Kuzniarz M, Mitchell P, Cumming RG, Flood VM.

Cancer of the Colon Reduced by Past Multivitamin: In a 10 year follow-up of 145,000 adults, current multivitamin use not related to colon cancer but use 10 years early had an RR of 0.71. Amer. Cancer Soc. Multivitamin use and colorectal cancer incidence in a US cohort: does timing matter? Jacobs EJ, Connell CJ, Chao A, McCullough ML, Rodriguez C, Thun MJ, Calle EE. Am J Epidemiol. 2003 Oct 1;158(7):621-8

Coronary Heart Disease: Multivit-Mineral, Vit C, Vit E No Value Health MDs on CHD, CVD: US study 83,639 MDs 5.5 yr no difference in self-medication. Vit E RR 0.90, Vit C RR 0.86, Multivit RR 1.04. Vitamin supplement use in a low-risk population of US male physicians and subsequent cardiovascular mortality. Muntwyler J, Hennekens CH, Manson JE, Buring JE, Gaziano JM. Arch Intern Med 2002 Jul 8;162(13):1472-6 

Cancer of the Brain: Neuroblastoma: Maternal Use Reduces in Children: Case-control study of over 500 children with disease (9/1,000,000 annual risk) vs. over 500 controls found maternal use of multivits reduced risk by 30-40%. Epidemiol 9/02, UNC.

Cancer of the Breast: Multivitamin Helps Decrease Alcohol-Related Breast Cancer: A 1999 JAMA study found breast CA highest for drinkers who consumed low levels of folate. The risk decreased if they took a multivit, a major source of folate.

Cancer of the Breast: Multivitamin Not Helpful: The risk of breast cancer was associated with increased fat in the diet ((RR=1.45) but not associated with consumption of vegetables rich in beta-carotene, multi-vitamin tablets or other dietary supplements, coffee, tea, sugar or artificial sweeteners. Denmark 1,468 cases with 1,300 controls. Int J Cancer 1990 Nov 15;46(5):779-84

Cancer of the Colon: Multivit with Folate Helps Especially in Drinkers: 806,000 adults 6 year f/u RR 0.71 in drinkers 2 or more per day and only 0.89 for everyone. Multivitamin use and colon cancer mortality in the Cancer Prevention Study II cohort (United States). Jacobs EJ, Connell CJ, Patel AV, Chao A, Rodriguez C, Seymour J, McCullough ML, Calle EE, Thun MJ. Cancer Causes Control 2001 Dec;12(10):927-34

Cancer of the Lungs: Multivitamins May Help: In 1129 non-small cell lung cancer patients, 714 were vitamin/mineral users of either multivitamins or other specific vitamin/mineral supplements, and the rest non-users. Median survival was 4.3 years versus 2.0 years for vitamin/mineral users and non-users, respectively with a 26% lower death rate (p < 0.01) in favor of vitamin/mineral use after adjustment for multiple prognostic factors, including tumor stage and a trend toward a better quality of life among vitamin/mineral users. Is voluntary vitamin and mineral supplementation associated with better outcome in non-small cell lung cancer patients? Results from the Mayo Clinic lung cancer cohort. Jatoi A, et al. Mayo Clinic, Rochester, MN. Lung Cancer 2005 Jul;49(1):77-84.

Cancer of the Prostate: Multivitamins Cause Marginal Increase: A total of 5585 deaths from prostate cancer were identified during 18 years of follow-up of 475,726 men who were cancer-free and provided complete information on multivitamin use at enrollment in the Cancer Prevention Study II cohort in 1982. The death rate from prostate cancer was marginally higher (7%) among men who took multivitamins regularly (> or =15 times/month) compared to non-users; this risk was statistically significant only for those multivitamin users who used no additional (vitamin A, C, or E) supplements, risk was greatest during the initial four years of follow-up. Use of multivitamins and prostate cancer mortality in a large cohort of US men. Stevens VL, et al. American Cancer Society, Atlanta. . Cancer Causes Control 2005 Aug;16(6):643-50.

Cancer of the Stomach: Multivit, Vit E, Vit C No Help: 1,045,000 adults in national CA study. Vitamin C, vitamin E, and multivitamin supplement use and stomach cancer mortality in the Cancer Prevention Study II cohort. Jacobs EJ, Connell CJ, McCullough ML, Chao A, Jonas CR, Rodriguez C, Calle EE, Thun MJ. Cancer Epidemiol Biomarkers Prev 2002 Jan;11(1):35-41

Cataracts Decreased by Multivit: Physicians’ Health Study 17,744 healthy MDs 5 yr found those taking multivit had RR 0.73 for developing cataracts. Those on vit E-C alone too small for analysis. Harvard, Am J Pub Health ’94;84:788; Long-term use of multivitamins, B group and vitamin A supplements was associated with reduced prevalence of either nuclear or cortical cataract. A strong protective influence on cortical cataract, from use of folate or vitamin B12 supplements, is a new finding. Australian Blue Mountain study. Am J Ophthalmol 2001 Jul;132(1):19-26; Multivit use may increase dry eye syndrome. RR 1.35

Cognition: Multivit-Mineral Helps in Elderly: DB PC 96 >65yos 1 year. Those on multivit improved on every test of cognition except long-term memory. Newfoundland; Effect of vitamin and trace-element supplementation on cognitive function in elderly subjects. Chandra RK. Nutrition 2001 Sep;17(9):709-12

Cognition: Mega Multivit Helps Female Attention: In a 12-month DB PC study of 127 healthy young adults given nine different vitamins and 10 times the Daily Value, only females showed any benefit and only on two measures of attention. Univ. Swansea. The impact of long-term vitamin supplementation on cognitive functioning. Benton D, Fordy J, Haller J. Psychopharmacology (Berl). 1995 Feb;117(3):298-305

Cognition: Multivit No Benefit: In a 6-month DB PC study of 220 healthy, free-living women (ages 60-91 years), a multivitamin supplement resulted in no significant differences in pattern-recognition and intelligence score. Cognitive performance in relation to vitamin status in healthy elderly German women-the effect of 6-month multivitamin supplementation. Wolters M et al. University of Hanover, Germany. Prev Med. 2005 Jul;41(1):253-9

Exercise Not Helped by Multivit: Small DB 22 men 90 days those on high potency vitamin-mineral supplement did not better. Med Sci Sports Exerc 1992 Jun;24(6):726-32

Eyes: Vitamins Help Prevent AMD: A National Eye Institute study of 4757 55-80yo Americans in Oct 2001 Arch Ophthalmol found 25% decrease in risk of getting advanced age-related macular degeneration from daily supplements of 500mg Vit C, 400 IU Vit E, 15 mg beta-carotene, 80 mg Zn, and 2 mg Copper, all above Adult Daily Requirement except copper.

Fertility Increased with Multivitamins: Hungarian DB PC study led to significant benefit to fertility. Czeizel, Int J Vit Nutr Res ’96;66:55

Fertility Increased with Multivitamins: DB study found 5% faster conception due to pre-conceptual multivit. Int J Vitam Nutr Res 1996;66(1):55-8

Headaches Helped by Multivitamins: 66 female inpatients with dysfunction pain syndrome, chronic cephalgia and facial pain participated in a randomized, placebo-controlled double-blind study, half the patients receiving a multivitamin preparation for 12 days and the other half a placebo. Those deficient in folate and B-12 helped more. Germany. Vitamin status of inpatients with chronic cephalgia and dysfunction pain syndrome and effects of a vitamin supplementation. Mader R, Deutsch H, Siebert GK, Gerbershagen HU, Gruhn E, Behl M, Kubler W. Int J Vitam Nutr Res 1988;58(4):436

HIV Pregnancy Multivitamins Improve Weight Gain: Multivitamin supplements increased weight gain during pregnancy in a randomised, placebo controlled study of 957 HIV positive women in Dar es Salaam, Tanzania, reports a study in the American Journal of Clinical Nutrition (2002;76:1082-90).

Immune System in Elderly Helped: In a DB PC 1 year study of 47 adults over age 61, those on placebo had decreases in T cells and CD4 cells and CD4:CD8 ratio. The multivitamin group had an increase in CD57 killer cells. Newfoundland. Effect of vitamin and trace element supplementation on immune indices in healthy elderly. Pike J, Chandra RK. Int J Vitam Nutr Res 1995;65(2):117-21

Infections Not Helped by Multivit: B1, B2, B6, A, C, E and folates in multivit in French DB for elderly over 60. Int J Vitam Nutr Res 1993;63(1):11-6

Infections in Elderly Reduced, One Study Negative: 96 health >65yos DB PC 1 year. supplement group had higher numbers of certain T-cell subsets and natural killer cells, enhanced proliferation response to mitogen, increased interleukin-2 production, and higher antibody response and natural killer cell activity. These subjects were less likely than those in the placebo group to have illness due to infections (mean [SD] 23 [5] vs. 48 [7] days per year, p = 0.002). Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects. Chandra RK. Lancet 1992 Nov 7;340(8828):1124-7; However, negative study: Chavance M, Herbeth B, Lemoine A, Zhu BP. Does multivitamin supplementation prevent infections in healthy elderly subjects? A controlled trial. Int J Vitam Nutr Res. 1993;63:11-16.

Infection Reduced by Multivit-Mineral, Mainly in Diabetics: 73% placebo group suffered infection-related illness, only 43% of the multivitamin group (P < .001) in 158 adults >45yo. These infections led to a 57% rate of any infection-related absenteeism in the placebo group vs. only 21% in the multivitamin group (P < .001). A detailed review of these data revealed that these differences were almost entirely due to subjects with diabetes. The prevalence of infection for diabetic participants was 93% in the placebo group vs 17% in the multivitamin group, RR = 0.18. Barringer TA, Kirk JK, Santaniello AC, Foley KL, Michielutte R. Annals of Internal Medicine. 2003;138(5):365-371 

Infections: Multivits Cut Sick Days, Colds: Three studies by Ranjit Chandra of Memorial Univ in Newfoundland involving 900 adults over 50 found half as many sick days, half as many days with colds or flu (11 vs 24/yr), and 14% fewer infections. Nutr Action 3/02. Lancet 340:1124 ’92; Nutr Research 22:5 ’02; Am J Clin Nutr 60:437 ’94. Chandra's work has been questioned as using flawed data (BMJ 2005;331:324-9).

Infections: Multivit-Mineral, Vit E 200, Not Help URIs: In a 441-day DB PC study of 652 Dutch adults over age 59, 68% got an average of 2.5 colds (URIs). Multivitamins had no signficant effect (RR 0.95), and vitamin E was associated with an increase (RR 1.21). Effect of daily vitamin E and multivitamin-mineral supplementation on acute respiratory tract infections in elderly persons: a randomized controlled trial. Graat JM, Schouten EG, Kok FJ. JAMA 2002 Aug 14;288(6):715-21

Intelligence: Multivit + Minerals Help Kid Nonverbal: 10 of 13 DB studies to date have such a findings. U Wales Swansea. Micro-nutrient supplementation and the intelligence of children. Benton D. Neurosci Biobehav Rev 2001 Jun;25(4):297-309

Intelligence: Helped Kids Nonverbal: DB 8 months 12-13yos England 90 kids, those on vitamin/mineral supplement QD did better. Lancet 1988 Jan 23;1(8578):140-3

Intelligence: Help Junior High Nonverbal: 600 8-10^th graders in California on placebo, half, standard, or double strength multivit & mineral. Standard strength did best. Schoenthaler, Pers & Indiv Differences 12:335-41, 1991

Intelligence: Helped School Kids Non-verbal IQ 2.5 points: DB PC 243 hispanic students at half-dose. Says other 12 studies show average of 3.2 point gain. The effect of vitamin-mineral supplementation on the intelligence of American schoolchildren: a randomized, double-blind placebo-controlled trial. Schoenthaler SJ, Bier ID, Young K, Nichols D, Jansenns S. J Altern Complement Med 2000 Feb;6(1):19-29

Mood & Cognition: Multivit Helps: Large DB PC. J Aff Disorder ’01;64:107-19

Multiple Sclerosis: Vitamins No Benefit: Nurses Health Study and Nurses Health Study II of Harvard found 214 cases MS. No relationship to vitamin C, vitamin E, carotene, lutein, lycopene, multivitamin intake, fruits or vegetables and development of MS. Intakes of carotenoids, vitamin C, and vitamin E and MS risk among two large cohorts of women. Zhang SM, Hernan MA, Olek MJ, Spiegelman D, Willett WC, Ascherio A. Neurology 2001 Jul 10;57(1):75-80

Periodontal Disease: Multivitamin Helps: DB PC 63 with periodontal disease. Multivitamins with 7 vitamins. Definite benefit in 60 day study. Loma Linda. Effects of a nutritional supplement on periodontal status. Munoz CA, Kiger RD, Stephens JA, Kim J, Wilson AC. Compend Contin Educ Dent 2001 May;22(5):425-8, 430, 432 passim; quiz 440

Prisoners: Vitamin-Mineral-Fatty Acid Supplement Helped: A 4 month PC DB English study of 231 prisoners treated with placebo or a supplement. Those receiving the active capsules committed an average of 26% fewer offenses (P=0.03, two-tailed). Compared to baseline, the effect on those taking active supplements for a minimum of 2 weeks (n=172) was an average 35%  reduction of offenses (P<0.001) including decreases in anti-social and violent behavior. Univ Oxford. Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial. Gesch CB, Hammond SM, Hampson SE, Eves A, Crowder MJ. Br J Psychiatry. 2002 Jul;181:22-8

Simvastin-Niacin: Anti-Oxidant Vitamins Might Not Be Good with:160 cardiac pt DB PC 4 cells. Simvastin-niacin had decrease LDL 47%, increase HDL 26% and 3% regression vascular defects. Anti-oxidants no effect on LDL-HDL and caused only slightly less progression than placebo and may have interfered with simvastin-niacin. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. Brown BG, Zhao XQ, Chait A, Fisher LD, Cheung MC, Morse JS, Dowdy AA, Marino EK, Bolson EL, Alaupovic P, Frohlich J, Albers JJ. N Engl J Med 2001 Nov 29;345(22):1583-92

Stress: Multivit Decreases: DB 300 high stress patients in South Africa 30 days on multivit led to significantly less stress. S Afr Med J 2000 Dec;90(12):1216-23 

Multivits for Everyone: Nearly all adult Americans have dietary deficiencies in one or more vitamins and should be taking multivitamin supplements, a new paper has asserted (JAMA 2002;287:3116-29). Just a research review. Recommends two a day for elderly. The Harvard authors searched the Medline database for articles and randomized trials involving vitamins published from 1966 to January 2002.

Morbidity or Mortality: No Benefit: Large US adult study found no assoc with lower morbidity or mortality. Kim, Am J Publ Health 83:546, ’93. Med Letter 7/31/98 recommends only folic acid for young women and vitamins D and B-12 for elderly.

Skin Damage: DB Anti-oxidants Decrease Photo Damage: Carotenoids (beta-carotene and lycopene), vitamins C and E, selenium and proanthocyanidins combination in DB placebo controlled German study with UV light x 2 weeks. Skin Pharmacol Appl Skin Physiol 2002 Sep-Oct;15(5):307-15

Teeth Not Helped in Short Study: vit/mineral supplement for 21 days in DB. J Periodontol 1985 Sep;56(9):558-61

Underweight Patients: Multivitamin Decreased Hospital Stay:  DB of 1561 underweight admissions. Half were given a multivit. It resulted in 0.4 days shorter stays. Vlaming, Royal London Hosp. Clin Nutr 2001

Thomas E. Radecki, M.D., J.D.

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