Vitamin and mineral supplements for healthy individuals don’t work

When I was in medical school, our nutrition researchers taught us that vitamins didn’t do much good and only made expensive urine (where the water soluble ones end up).  We did learn about the classic vitamin deficiencies like scurvy, beriberi, rickets, etc.  But the evidence that healthy people should take vitamins was marginal at best.

Is our search for immortality the reason that we turn to the pill or potion?  Do we continue to look for the fountain of youth that is attached to the Spanish explorer Juan Ponce de Leon? (Though de Leon was really looking for the isle of Bimini rather than Florida and there’s no mention historically that he was searching for perpetual youth.)  Yet the myth and tourist site remain popular.

So why do we turn to vitamins, supplements, anti-oxidants, nutriments, etc?  William Osler commented that “the desire to take medicine is perhaps the greatest feature which distinguishes man from animals.” Also Osler taught his medical students, “One of the first duties of the physician is to educate the masses not to take medicine.”

Osler’s concerns have been valid over the years, but often have been drowned out by errant science and the hype of the vitamin and supplement industry.

There have been prominent scientists who have been strong proponents of vitamins and supplements. Linus Pauling discovered the structure of ascorbic acid (vitamin C) and won the Nobel Prize in Chemistry.  Unfortunately he became a “true believer” in vitamin C and other vitamins:

Pauling is largely responsible for the widespread misbelief that high doses of vitamin C are effective against colds and other illnesses. In 1968, he postulated that people’s needs for vitamins and other nutrients vary markedly and that to maintain good health, many people need amounts of nutrients much greater than the Recommended Dietary Allowances (RDAs). And he speculated that megadoses of certain vitamins and minerals might well be the treatment of choice for some forms of mental illness. He termed this approach “orthomolecular,” meaning “right molecule.” After that, he steadily expanded the list of illnesses he believed could be influenced by “orthomolecular” therapy and the number of nutrients suitable for such use. No responsible medical or nutrition scientists share these views.

Finally in modern times we now have a better view and summary of the ineffectiveness and harms of vitamins and mineral supplements published in the Annals of Internal Medicine:  “Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force”.

The bottom line is that vitamin and mineral supplements for healthy individuals don’t work and some may be harmful.  The editorial in the same issue concludes:

β-carotene, vitamin E, and possibly high doses of vitamin A supplements are harmful. Other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases. Although available evidence does not rule out small benefits or harms or large benefits or harms in a small subgroup of the population, we 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. These vitamins should not be used for chronic disease prevention. Enough is enough.

Jim deMaine is a pulmonary physician who blogs at End of Life – thoughts from an MD.

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  • buzzkillerjsmith

    Vitamins are a waste of money. My old path professor said you might as well use the dollar bills to light your cigars for all the good vits do you.
    I just try to keep men from taking Fe.

  • Patient Kit

    So, the calcium/D supplements that I’m taking daily will do no good for my bones, colon health or lipids profile? Rats! I wonder why my doctor recommended taking them? Thankfully, this long cold winter is nearing it’s end and I’ll soon be getting lots more D from sunshine, swimming in the ocean instead of an indoor pool.

    • James deMaine

      Most experts recommend about 600IU of Vitamin D in the diet and from sun exposure – which can be hard to attain. It’s not unreasonable for post menopausal women to supplement Vitamin D and calcium. And probably most of us over age 65 should supplement with Vitamin D which helps with osteoporosis and falls. It’s a fairly safe vitamin. The mega-doses (above 2000IU daily) are not recommended. Hypervitaminosis D with excess calcium intake can be a dangerous medical problem.

    • buzzkillerjsmith

      Ca/vit D help bones when taken as Dr. de suggests (exact dose depends on your individual situation) but won’t do anything for lipids or the colon. Niacin in mega-doses is sometimes used for some types of lipid problems. Usual doses are worthless. High-dose niacin can cause problems and should only be taken under medical supervision.

      A multivitamin won’t kill you and can be taken byr those who just have to take something. Flintstone Chewables are best but only because of the taste.

  • John C. Key MD

    Vitamins and minerals are very important and should be taken AT THE SOURCE. No pills, no elixirs–fruits, vegetables, meats prepared fresh.

    • guest

      Easy to say, hard to do, for about 50% of our population.

    • Patient Kit

      Accepting that we “should” all get good nutrition from the source by eating healthy fresh food, let’s just go out on a limb and assume for a minute, that many Americans, for a variety of reasons, do not get adequate vitamins and minerals from their diet. In that case, would supplements still be totally useless or better than nothing?

      • John C. Key MD

        Probably close to useless, as well as a waste of money.

      • James deMaine

        It’s my impression that many of us are over-nourished not undernourished. We have diets high in sugars and carbohydrates, are too heavy in terms of BMI, and of course, don’t exercise enough. There’s really no evidence that this segment fast food and sugary drinks folks are vitamin and mineral deficient. So the problem involves dietary and life style choices. It’s really not a matter of needing more supplements.

        • guest

          That really doesn’t answer the question which was asked, however. Also, there is actually a fair amount of evidence that low-quality diets are vitamin and mineral-deficient

          • James deMaine

            Can you steer us to your source of evidence that states that Americans with poor dietary habits (often obese but otherwise healthy) are actually vitamin deficient? It’s been a long time since I’ve seen a case of ricketts, beri-beri, or scurvy. Many poor nutritional-value foods and drinks are supplemented with vitamins. So I’m looking for outcome studies that indicate this large segment of the population should spend their hard earned dollars on the billion dollar vitamin and supplement industry.

          • JR

            There have been some animal studies that show if you feed an animal food that lacks proper nutrients, they’ll keep eating until their nutrient needs are met, even if their caloric intake is way too high.

            And Americans eat a lot of low-nutrient, high calorie foods…

  • guest

    With all due respect, I think we doctors have enough problems of our own with providing unneccessary care at the end of life and delivering inadequate care at other times, that we should really not be spending a lot of our time and energy to trying to talk our patients out of taking nutritional supplements, if they choose to do so.

    Why don’t we just limit ourselves to providing specific and factual information regarding whatever risks there actually are to certain supplements, and leave the moralizing to others?

    • James deMaine

      I don’t think the evidence based review in the Annals of Internal Medicine was trying to moralize. In fact, it was “providing specific and factual information” as you suggest we should. A pamphlet summarizing the AIM review might be a nice handout for your patients. You might save them a surprising amount of money.

      • guest

        The evidence based review was fine, but also quoted in your piece was the accompanying editorial which contained sweeping and unsubstantiated statements like “beta-carotene, Vitamin E and possibly high doses of Vitamin A supplements are harmful,” and moralizing-sounding verbiage like “enough is enough.”

        Meanwhile, the only “harm” mentioned by the review article is a possible increase in lung cancer mortality in high-risk populations associated with beta-carotene supplementation. No other “harms” are mentioned, let alone proven. The article also includes the following caveats:

        “Our analysis has some limitations. We considered only primary prevention interventions in generally healthy people and excluded secondary and tertiary prevention trials and treatment studies. Thus, our results do not apply to the targeted use of nutrients in deficient or higher-risk individuals. Only 2 trials of multivitamin supplements were included for efficacy, even though we broadly defined a multivitamin as 3 or more ingredients. Those 2 trials studied very different supplements (19, 21). Because the only multivitamin trial to include women used a supplement with 5 ingredients (19), it could be argued that there are no data on a “true” multivitamin in women. Most of the included vitamin trials provided less than a decade of follow-up, and vitamin effects on CVD and cancer may take longer to manifest. The small number of studies in each pooled analysis made it difficult to evaluate between-study heterogeneity.”

        In closing I would say that I have never encountered a patient who was taking vitamin supplements in order to avoid cancer; most patients I see are chronically ill and/or nutritionally compromised due to social factors, and take a multivitamin as a sort of general precaution. I see nothing in the AIM article that suggests that that is not a perfectly reasonable course of action to take, and since a multivitamin costs about .01/day, I think concerns about “saving my patients money” seem a little overwrought.

        However, if I ever run into a patient with a 40 pack-year smoking history and a penchant for taking beta-carotene supplements, I will be sure to let them know of the risks.

    • buzzkillerjsmith

      I agree that vits/herbals are not usually a big deal. Oxycodone–now that’s a big deal.

  • Suzi Q 38

    So my Vitamin D, B, C, E, Fish oil, CoQ10, probiotic, Glucosomine, Calcium, etc.
    Are worthless??
    Thanks.

    • James deMaine

      Yes, they probably are with the possible exception of Vitamin D and calcium for certain populations (see reply to previous comment)

    • buzzkillerjsmith

      What Dr. deMaine said.

  • James deMaine

    Probably because this would be expensive and promote a new industry. I know of a start-up in the Bay Area that’s planning to offer 30 blood chemistries from a single drop of blood. The problem is that it medicalizes a basically healthy population. Kaiser tried years ago to offer a panel of blood chemistries as a way of health screening. It didn’t pan out, caused worry with false positives, didn’t prevent disease, and was expensive.

    If you are unable to eat a healthy diet, it’s not unreasonable to simply take a generic multivitamin – but it’s unnecessary and expensive for the general population.

  • JR

    So, I suffer from malnutrition (medical condition). Unfortunately, most the information I can find from reliable sources on what vitamins to take are a repeat of this article “healthy people don’t need vitamins”. Ok, fine fine. But I’m not healthy, what are my best choices?

    *cricket… cricket… cricket…*

  • Eric Thompson

    I don’t know anyone who eats a balanced diet. I know a lot of people who eat mostly burgers and fries with ice cream or cheese cake for desert. ‘salads are for sisies’. These people are huge. But I guess they are otherwise healthy.

  • Edithe Jarvis

    Sorry, I forgot to add, that lest they say, yeah but the people in that study had medical issues, let me just add that the main reason we find for people getting mental health issues is the lack of good nutrition. Since this is greatly depleted in even the best of diets, not supplementing is like not putting gas in the car. Eventually the fuel runs out and the car stops functioning.

  • Renee Rabbit

    More is not better…but just because you live in the US doesn’t mean you can’t be deficient. Vitamin D has practically become ridiculed in the press but there are still many thousands who are truly deficient and their needs should not be overlooked in our eagerness to demonize vitamins.

  • Dorothygreen

    All folks who take supplements are not as dumb as this article implies. Some of us supplement a healthy diet, taking into account all the studies that have been done, some perhaps on animals and not yet humans like vitamin K2 that has been shown to keep calcium out of arteries and direct it to the bones and teeth. Many of us are trying to prevent damage of osteoporosis, arthritis, heart disease WITHOUT drugs. We are smart enough to look closely at these the studies and see exactly what is being used – a synthetic, an extremely high dose or far too little to make a difference – without the understanding the synergy that goes on in the human body. And there are plenty of docs now who have become “Hippocratic” followers, promoting healthy diet and high quality nutrient supplements who do understand.

    Please don’t lump us into the general category of those who are looking for the “magic pill” be it a pharmaceutical or some obscure herb.

    How can the medical community, that prescribes drugs like statins (whose new guidelines will gather more followers to this “magic pill” simply by having another birthday), suggest that most folks eat a healthy diet and therefore have no need of any additional nutrients.

    I only know of one diet that has truly been proven healthy. Healthy enough to reverse Multiple Sclerosis and even then some supplements are used. This is the Wahls protocol – by Dr. Terry Wahls and it was her own debilitating secondary RRMS that was reversed. Check it out and see what it takes.

    Beating up on supplements is diverting taxpayer dollars from reforming the US eating culture. The average consumption of sugar at 152 lbs/year, white flour 142 lbs/year and an average ratio of Omega 6 to Omega 3 fats about 20:1 when it should no greater than 4:1. These cause more harm, albeit insidiously, than anything else in the American environment and they are subsidized by income taxpayers. The studies are in. We need a new excise tax – call it a RISK tax (based on the tobacco model) on processed sugar, white flour and oils that are greater than 50% Omega 6. Enough of this misuse of income taxpayer dollars.

    • James deMaine

      “The best doctors in the world are Doctor Diet, Doctor Quiet, and Doctor Merryman.” Jonathan Swift

  • Dorothygreen

    I take and know of many who take supplements as supplements to a healthy diet, taking into account studies like that of vitamin K2 that has been shown to keep calcium out of
    arteries and direct it to the bones and teeth. We are trying to prevent damage of osteoporosis, arthritis, heart disease without drugs. We are aging and are have lost or are losing some of the ability to maintain the right nutrient quantity. We look closely at studies or read about them from the doctors who do. All promote a healthy diet and even with conflicts of low fat-right fat, whole grains-no grains, it is above ground vegetables, vegetables, vegetables, low glycemic fruit that is the core of nutrient intake.

    I only know of one diet that has truly been proven healthy.
    Healthy enough to reverse Multiple Sclerosis and even then some supplements are used. This is the Wahls
    protocol – by Dr. Terry Wahls and it was her own debilitating secondary RRMS that was reversed. It is closer to the hunter
    gatherer diet.

    Beating up on supplements is diverting taxpayer dollars from reforming the US eating culture. The average consumption of
    sugar at 152 lbs/year, white flour 142 lbs/year and an average ratio of Omega 6 to Omega 3 fats about 20:1 when it should no greater than 4:1. These cause more harm, albeit insidiously, than anything else in the American environment and they are subsidized by income taxpayers. The studies are in.

  • JR

    Well, those aren’t studies of multi vitamins in healthy individuals, but rather that those with ADHD (mental illness) may be helped with a multi vitamin.

    I agree with the article that most multi vitamins on the market aren’t effective. They include various nutrients that counter each others absorption (such as calcium and iron in the same pill). They aren’t closely regulated so it’s hard to determine if the dose listed is the dose that is being delivered.

    So for those of use who medically need to supplement our diets, it’s very hard to navigate and find the right combinations and the best quality supplements to take.

  • James deMaine

    Unfortunately, it’s easier for a medical provider to write a prescription than to educate and use “talk therapy”. There are several reasons for this: A tangible transaction takes place; precious time is saved (at 15 min per visit, providers are always time pressured; the placebo effect is real; and there’s a sense of “something was at least tried”. In short, we have a tendency to find hope in a bottle of pills. It’s much easier than life style or dietary changes. Sad but true.

  • James deMaine

    Vitamin D and calcium are needed supplements for many folks. I guess I’d question the need for protein supplements below age 60 when there’s evidence that less protein may enhance longevity. Above age 60, we apparently do need a bit more protein to maintain muscle mass and balance.