American Society For Nutrition

Multivitamins: Is the Debate Over?

Multivitamins: Is the Debate Over?

Excellence in Nutrition Research and Practice
Posted on 01/06/2014 at 09:18:03 AM by Student Blogger
By Colby Vorland

Several weeks ago an editorial in the Annals of Internal Medicine declared the last word on multivitamins after new trials failed to demonstrate benefit. "Enough is enough," the authors wrote. “[W]e believe that the case is closed- supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful.” A review in Advances in Nutrition also looked at recent developments in multivitamin/mineral research. It is true that many studies have demonstrated no benefit- a few even suggest a slight risk of harm from supplementing specific vitamins or minerals.  However there is a nuance missing from such strong viewpoints worth highlighting.

The authors reiterate several times that the population is well nourished. “This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries (9).” That reference is to an NCHS Data Brief that showed “no clear evidence of micronutrient deficiencies” though it is of course true that micronutrient deficiency symptoms are not common in the U.S. But are we truly a well-nourished population?

To add to the discussion, I graphed the proportion of the population that falls short of the Dietary Reference Intake (DRI) for each of 21 micronutrients for four groups: males and females age 19-30, and males and females over 70. This is 2009-2010 NHANES data. The DRIs are set by committees named by the Institute of Medicine to review literature on each nutrient in its relation to various disease endpoints (or to achieve balance). If sufficient research is available, an Estimated Average Requirements (EAR) is set, a level that is estimated to meet the needs of 50% of the population. If an EAR can be established, a Recommended Dietary Allowance (RDA) can be set, estimated to cover the needs of 97-98% of the population. If not, an Adequate Intake (AI) is set.

It is clear that a majority of Americans fall short of DRIs for many nutrients. Below that graph is the same data assuming everyone in the population took a Centrum Adults multivitamin (this brand is used is several trials). Much of the population now achieves recommended intakes where they didn't before.

DRI

centrum
Data from NHANES 2009-2010, day 1 dietary intake, weighted. Nutrients for Centrum® Adults from centrum.com. Nutrients are an RDA unless starred* which are an AI.

Further, I calculated that only 0.5% of Americans in these age groups achieve all 21 DRIs, and the average person achieves about 11.

So with such strong plausibility that multivitamins would mitigate disease, why are trials mostly showing no effect?

It helps to first understand what endpoints are used when setting DRIs. Here are a few examples of what research has been considered when setting the DRI (just picking some from each):
●   Vitamin E: hydrogen peroxide-induced hemolysis, LDL-oxidation (cardiovascular disease), diabetes, diabetic neuropathy, cancer (prostate), immune function, cataracts, Parkinson's disease, Alzheimer's disease
●   Folate: Vascular disease (homocysteine), megaloblastic anemia
●   Iron: anemia, reduced physical work capacity, delayed psychomotor development in infants, impaired cognitive function

It should be noted that for some nutrients, like zinc, we simply don't have sufficient research yet to set DRIs based on specific disease endpoints, so they are set largely by rate of excretion (to achieve balance). It is likely that many nutrient-disease relationships simply remain undiscovered. It should also be noted that many nutrients (like zinc as well) are cofactors in many enzymes important for many critical biological pathways, which is why this is plausible.

The takeaway here is that for each nutrient, there are multiple disease/endpoints that influence the DRI.

In contrast, multivitamin (and individual nutrient) trials so far have focused mainly on cardiovascular disease and cancer. Here are disease endpoints specific to multivitamin trials (3 or more micronutrients): cardiovascular events, cognitive function, cancer/CVD/mortality in women, acute respiratory tract infections. Contrary to what the editorial proclaims, there are some trials that have suggested multivitamins do have positive effects: (small) reduced cancer risk in men, reduced cancer and all-cause mortality in men (but not women), cancer and total mortality (in an undernourished population), reduced age-related macular degeneration, reduced cataract in men (but not AMD), cataract progression, reduced risk of immune decline and morbidity in HIV.

And that isn't breaking down significant variation in trial differences by primary vs secondary prevention, issues such as trial length (cancer and CVD are long latency diseases after all), genetics (e.g. MTHFR/folate and riboflavin), age, etc. For instance, two different epidemiological cohorts suggested that it takes over 10-15 years of supplementation to reduce colon cancer risk. Most clinical trials don't do this long, and it isn't practical to do many trials to test against all plausible outcomes.

Of course, it is ideal to get nutrients from food. But as an example, Centrum Adults is just over 7 cents per day, an inexpensive and simple intervention, though we do need more research on possible behavioral licensing effects. It is also true that the supplement industry is an unregulated mess and there are safety issues and many claims for micronutrients that go way beyond the data. But this is a separate issue, and it is important not to let that influence our interpretation of research. Given the significant population below recommended micronutrient intakes, I think it is very premature to close the door on multivitamins.


2 Comments

Great post and visualization of NHANES data - it's a huge stretch to say they're useless because claimed usage doesn't translate to reduce CVD/cancer/etc. If anything, it seems that multivitamin use doesn't overcome poor diet and lifestyle factors (60+% of Americans being overweight/obese)

http://nutrevolve.blogspot.com/2013/12/controversy-over-multivitamins.html


Dr Oz Garcinia Cambogia is one of the most popular weight loss remedies today available. You have probably heard a whole lot about how exactly Garcinia helps you shed weight – without having to struggle with any complicated diets or going right through a demanding workout program.

The simplicity with which one could shed weight is one of the key attractions of Garcinia Cambogia. You've questions and concerns, if you're like the majority of people that are holding you back from seeking Garcinia Cambogia products. In this detailed Garcinia Cambogia extract evaluate, we're looking at all facets of this weight loss solution.

When Dr. Mehmet Oz presented Garcinia on his display, he used phrases like “revolutionary weight loss system” and “miracle cure”. It looked a bit over the top, but a few months down the road term about its wonderful advantages is spreading like wild-fire. The simple explanation being—it performs! Ounce was nevertheless really communicate around the sort of Garcinia he promoted.

This is actually the checklist he later published on his site for people searching for Garcinia Cambogia acquire tips to use. garcinia cambogia walmart (yourleanbody.com) At the least 50percent HCA information.

Stated in a cGMP and FDA approved facility.

Featuring a striking label “Garcinia Cambogia” on its deal.

Made in America, please avoid models made in China or other nations that don’t possess apparent Garcinia producing directions.

Experts also warn against acquiring Garcinia that is uncommonly valued.

Situations of faux Garcinia that has substances such as for instance grain, carbs and unnatural binders include in the recent times been rising. Such Garcinia is less efficient and might not be powerful although you are following appropriate quantity even.

An average Garcinia dosage is 500 to at least one,000 mg taken 3 times per day with a lot of water prior to meals. The recommended daily allowance for this supplement is 2,500 to 3,000 mg. You have to get two tablets per day before main dishes in case your product is in capsule type.

Local plumber to take your product are at least 1-hour before food. This is to allow the time for HCA to begin operating. The level of appetite may decrease during this period of time making you to consume significantly less than you (possibly) decided for originally.

You may want to contact your neighborhood company for further direction, if you're uncertain about exactly what volume of Garcinia to consider. Besides doing that, you're able to tell your doc of the choice to use this product. The good news is that effects of an overorunder serving are often mild and tolerable: vomiting, faintness, mild allergy and complications. This however does not supply you with the lee-way when utilizing Garcinia products to put caution for the wind.

Not everyone qualifies to work with Garcinia. If you're pregnant, below age eighteen or diabetic, you are supposed to speak with a wellness professional before attempting this or another product (be it natural or old-fashioned).

where can you buy garcinia cambogia walmart (Leroy) Garcinia Cambogia can be a tropical fruit that grows on trees mainly in South and Southeast-Asia. It belongs to the same household as mangosteen. It is a tiny pumpkin shaped fruit that's green when natural and becomes yellowish or lime as it ripens. The useful area of the berries is its rind. The dried rinds are employed for food preparation while in the neighborhood cuisines to impart a bitter flavour and taste.

Though its large-scale business use as a weight loss remedy is actually a comparatively new development, there is nothing new about its rewards. Folks in Asia recognized about its medical qualities for centuries.

Weight reduction is merely one of these.

Generate Ounce Garcinia Cambogia supplements-are made from the extract of the fruit skin. Because of the simple accessibility to the berry in large quantities, they are typically cheaper than different natural weight loss products.

Not really a day passes without someone mentioning the Garcinia Cambogia Extract. It's swiftly become known as nothing in short supply of a surprise berries. It’s not merely the press which were promoting it during the last few months. Everyone from health experts to well-known celebrities have been performing from the roof tops in what Garcinia Cambogia did for them and their statistics. If that wasn’t adequate the Garcinia Cambogia Extract in addition has been a part of many studies that have scientifically proven its insane fat using strength.

Folks will have a huge amount of issues when it involves Garcinia Cambogia and whether it can help them shed the weight they’ve been stuck with for what appears like an eternity. Continue looking over this article and I’ll reveal to you precisely how Garcinia Cambogia Extract will help you lose a huge amount of weight in almost no time in any respect.

A lot of analysis continues to be done and continues to be being done on the benefits of HCA. Many research came to the conclusion that HCA is effective for weight decrease as there was a notable variation inside the results obtained between review groups who were actually offered HCA and placebo groups. garcinia cambogia extract liquid (yourleanbody.com) You should always read and follow the instructions that are included with the products.

The proposed serving of HCA is 500 to 1000mg thrice each day. The most quantity is 3000mg daily. Greater doses must be taken solely around the recommendation of the doctor. Each serving should really be taken at the very least around 30 minutes before meals with loads of water.

HCA is water-soluble and it will help in correct assimilation of the supplement.

Getting garcinia cambogia generate ounces products below the lowest recommended dosage or not following directions will often produce weak outcomes. Besides using the products appropriately, there are some other things you can certainly do to attain greater and faster outcomes.