The Multivitamin Hoax

I was flicking through good old Facebook, the book of face, the other day when I came across an advert for yet another multivitamin product under the name of VITL. Presumably a play on the word vital…as in, you vitally need this supplement to be healthy. Or do you?

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Multivitamin supplements and other products that fall into that sort of category such as anti-oxidant pills are consumed in huge quantities in the UK and US. Many people swear by them and start their day swallowing down a random amount of varied vitamins. Vitamins are good right? They are important in loads of physiological processes so surely more of them is better?

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Looks enticing but 35.99 a month is a bit steep....
Looks enticing but 35.99 a month is a bit steep….

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In reality the science suggests two things rather clearly if you are an average person:

  • All your vitamin needs are met by your diet if its fairly balanced
  • Taking too much of a particular vitamin can have serious repercussions to your health

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I don’t wish to target VITL directly as many companies are peddling their vitamin wares. It’s not the product itself I have an issue with but the target market. It makes medical sense to supplement a vitamin that you are clinically deficient in but trying to sell expensive vitamins to people who don’t need them is a complete waste of the customers money and in some cases potentially harmful to their health.

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What is a ‘vitamin’ 

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 A vitamin can be defined as such :

‘A vitamin is an organic compound and a vital nutrient that an organism requires in limited amounts’ (the key phrase here is ‘in limited amounts’)

Technically speaking, ‘vitamin’ refers to a chemical compound that an organism requires but cannot synthesise by itself in sufficient quantities. The vitamin must therefore largely be obtained from dietary sources.

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Vitamins are classed based on their biological and chemical activity, not on their structure. Therefore a number of vitamin-like compounds (vitamers) may be grouped together under one umbrella vitamin name. For example ‘Vitamin B’ includes a large number of ‘vitamers’ each with their own B number and additional name. Vitamin B9 for example is Folic Acid. Not all vitamers are in the biologically active state but can be converted into this form in the body.

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Thirteen vitamins are currently recognised: Vitamins A, B (8 vitamers), C, D, E and K

 


Physiological Roles

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Vitamins play a varied and diverse role in the body and have widely different functions.

I’ve made a table to summarise this section in brief as it’s fairly in depth!

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vitamin-table-1

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The large group of vitamin B type-compounds  act as co-enzymes (and precursors) in metabolic processes. Co-enzymes are non protein compounds that are required by the protein enzyme to catalyse specific reactions in a cell (1). They therefore perform an extremely important role in the minute by minute function of cells. Acting as co-enzymes is their most recognised functional role but there are many others (2). Large amounts of research effort has been put into uncovering the therapeutic potential of the B vitamin family of compounds. Many do have true therapeutic value but only in the treatment of serve disorders. B9 for example, also known as folic acid, has been shown to reduce the rate of neural tube defects (NTDs) in infants and as a result can be found fortified into many different foods in a hope to reduce the incidence of NTDs in the population (3). There is also some evidence that folic acid supplementation may confer a small reduction in the risk of stroke and cardiovascular disease if taken over a long period of time (4)

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Vitamin D possesses hormone-like functions and act as regulators of mineral metabolism and plays a part in the control of tissue growth and differentiation (5). A chronic lack of vitamin D famously leads to ‘rickets’, a disorder of bone growth and structure. Sunlight (certain wavelengths) modify Vitamin D into its active form which is why at least some exposure to the sun is important. Foods are often fortified with vitamin D in countries that receive lower levels of sunlight (less hours and or/less intensity) but can be found naturally in oily fish and eggs (6).

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Vitamin C acts as both an enzymatic co-factor and also  functions as  an anti-oxidants to protect agasint oxidative stress. The vitamin is a co-factor in a number of important enzymatic reactions, a few of which are related to the synthesis of collagen,  a key structural protein. A lack of vitamin C can impact collagen production leading to scurvy. 

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Yaaaaargh. Eat an orange.
Yaaaaargh. Eat an orange.

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Vitamin C is a well studied vitamin and makes common appearances in health food shops and websites as a sort of ‘cure-all’ especially targeting things like the common cold and other respiratory pathologies (that website link claims you can cure pretty much any disease). However vitamin C supplementation studies have shown conflicting results. A number of studies suggest that vitamin C supplementation may reduce the duration of common colds (7) but it doesn’t seem to prevent colds in the first place (8). The potential protective effects of vitamin C supplements regarding cardiovascular health and lung cancer has also been explored in depth but overall studies suggest no detectable protective effect (9,10,11). Two of these references are systematic reviews and analyse the data from multiple studies. One of which is a Cochrane review who are known to be very thorough in their approach.

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Vitamin E has a number of roles including acting as a fat-soluble anti-oxidant. The vitamin essentially mops up free radicals preventing oxidation stress and tissue damage. This vitamin has also been the subject of a study looking at protective effects against major cardiovascular events in middle aged men but supplementation does not increase protection (12) Surprisingly one report suggested vitamin E supplementation might even increase the risk of lung cancer for already at-risk individuals.(13)

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Vitamin K is required for the complete synthesis of a number of important proteins involved in blood coagulation (various coagulation factors) , vascular biology and bone metabolism (14). In somewhat of a developing theme, vitamin K supplementation was explored as a means to prevent or reduce the incidence of cardiovascular disease. This makes sense as vitamin K deficiency is associated with the stiffening of arteries (15). Despite this, there is no good evidence that vitamin K supplementation will stop cardiac events occurring in the first place (16). The science also refutes fairy common claims that vitamin K supplements can slow cancerous tumour growth (17).

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Overall, studies which look at standard supplementation (rather than the effects of over-supplementation) have produced few promising results. Unless you are deficient in a particular vitamin then supplementation has no detectable benefit to your health. The only possible exception to this is vitamin C supplementation in regards to common cold duration. Additionally, vitamin C supplementation may help in the prevention of common colds when individuals are exercising rigorously in cold environments (18, 19). This seems like a super specific scenario but if you plan on skiing naked for a prolonged period of time than maybe pop a vitamin C tab or two (but not three…that’s just getting silly)

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*Tactical dong strap*

 


Daily multivitamins are potentially harmful

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I’m going to take aim at Berocca here as an example. Berocca is an effervescing tablet that you plop into a glass of water and it releases all it’s tasty, healthy vitamins and minerals (we know the truth berocca you scum bag!). Now, unlike VITL, who I assume have done their research on vitamin absorption, the people behind Berocca have added a ludicrously large % of your RDA (Recommended Daily Allowance) for many of the vitamins. I mean, 1071% of your recommended daily allowance of B1! That is mental for a number of reasons.

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A quick excerpt from the brilliant website quackwatch.org about RDAs:

”The RDAs have been published by the National Research Council approximately every five years since 1943. They are defined as “the levels of intake of essential nutrients that, on the basis of scientific knowledge, are judged by the Food and Nutrition Board to be adequate to meet the known nutrient needs of practically all healthy persons.” Neither the RDAs nor the Daily Values listed on food labels are “minimums” or “requirements.” They are deliberately set higher than most people need. The reason quacks say that the RDAs are too low is obvious: if you believe you need more than can be obtained from food, you are more likely to buy supplements”

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The doses in VITL stay within recommended limits
The doses in VITL stay within recommended limits

 

1000 % of your RDA is 900 % too much!

Firstly I have already shown you that for the average healthy person, supplementing with any vitamin doesn’t provide protection against diseases or make you ‘healthier’ in general. 

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Secondly, vitamins are only required in limited quantity. The phrase ‘more is better’ is almost always wrong when applied to biology. Any additional vitamins taken in are excreted as waste so those doses are needlessly high.

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Finally, those super high percentages may hide a sinister detail. Not only are excess vitamins pointless they have also been linked to increased risk of a variety of diseases. Over-dosing on some of the vitamins can also induce a specific set of symptoms depending on the vitamin as summarised below.

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Major studies looking into the effects of long term vitamin supplementation have produced surprising but solid data.

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General Mutlivitamin Tablets: Two large meta-studies, headed by the same researchers, that had access to data from hundreds of thousands of people (more likely to show a true effect) found that individuals taking daily multivitamins had an INCREASED RISK OF MORTALITY in comparison to people who don’t (20,21). Mortality of course covers death from all causes so those people taking multivitamins daily have an increased risk of dying in general. That’s pretty bleak. Other studies have looked at certain vitamins in particular and their effects on the incidence rates of specific diseases. The situation is no less bleak unfortunately…

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Vitamin A: As the table further up the article shows, vitamin A can be found in green leafy veg, oranges and milk to name just a few sources. Carrots are also a great source. You only need to eat half a carrot to obtain you recommended daily allowance. Now these studies are specific to smokers but beta-carotene (form of vitamin A) was explored for it’s therapeutic value in lung cancer development. Shockingly those smokers on beta carotene supplements saw a 28% increased incidence of lung cancer (which is already comparatively high in smokers), a huge increase! So unexpected was this result that the trial was terminated ahead of schedule. (22, 23)

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The horror!
The horror!

 

Vitamin E: A large number of studies have been conducted concerning Vitamin E supplementation and, like vitamin A, the results are rather disturbing. A study trying to determine if vitamin E could be used to reduce cancer and cardiovascular disease uncovered an increased risk of heart failure in patients taking ‘excessive amounts’ of vitamin E (this why those crazy high % RDAs in some products are dangerous!). These patients all had existing vascular disease or diabetes mellitus (24). Perhaps excessive vitamin E exacerbates circulatory problems that surface with both vascular disease and chronic diabetes.

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Another study produced a similar finding to the Vitamin A meta-studies in that vitamin E supplementation correlated with increased mortality (25). This was a large study involving over 100,000 individuals. The conclusion says it all:

”High-dosage (> or =400 IU/d) vitamin E supplements may increase all-cause mortality and should be avoided.”

Of relevance to men, a more recent 2011 study with 35,000 participants  showed that vitamin E supplementation significantly increased the risk of prostate cancer (26)

Ultimately, the science refutes the phrase ‘you can’t have too much of a good thing’. Multivitamins and specific vitamin supplements have been linked with an increased risk of death in general, prostate cancer in men, skin cancer in women and  heart failure in those already at risk.

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Admittedly, these trials expose participants to vitamin levels far above their recommended allowance but that shows us how potentially dangerous it is for companies to make products (for daily consumption) with 5 or 10 times the recommended levels. 

 


Summary: Do you need daily multivitamin supplements?

 

For the average person, the simple answer is a resounding no. All your vitamin needs are met by your diet.

In fact, it should be an aggressive  ‘no’ because you may in fact actually be damaging your health. If you do still wish to take daily vitamins then for the love of god at least check the % RDA on the back and stay away from those products that provide 1000% of your RDA in one daily serving.

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”2000 percent of my RDA? F*ck that sh*t!”

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Whats important to remember is that although the evidence shows that vitamin supplements, in general, will not make you ‘healthier’ this is all assuming you have a fairly balanced life style and diet to begin with. If you are known to have a deficiency in a particular vitamin then supplementing may still be helpful as long as you stay within recommended daily intakes. Of course, listen to your doctor.

Finally, as an added note: I’ve written this article without touching on fitness or training at all. Not many studies focus on this topic and it would be a very short article if I did. The story is much the same as has been told above. Unless you have a legitimate reason to take vitamins, taking extra won’t effect your general health or really impact your training in any meaningful way. Vitamins are peddled all over fitness and body-building websites just like at health food equivalents but now you know that they are a TOTAL WASTE OF MONEY. 

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My only advice, and this applies to all supplements, is that actual food should always come first. That’s the whole idea of a supplement, to supplement what you are are (or are not) getting through your diet. Your money would be much better spent on frequent purchases of fruit and vegetables.

Any questions? Feel free to reach me at ed@scienceguysupplements.com

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Thanks for reading,

ScienceGuy

 


Text References 

I recommend using Google Scholar to quickly find these studies in full detail.

1) University of Bristol (2002). “Pantothenic Acid”. Retrieved 16 September 2012.

2) National Academy of Sciences. Institute of Medicine. Food and Nutrition Board, ed. (1998). “Chapter 6 – Niacin”. Dietary Reference Intakes for Tjiamine, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin and Choline. Washington, D.C.: National Academy Press.

3) Bailey, Lynn B. (2009). Folate in Health and Disease, Second Edition. CRC Press. p. 198

4) Li Y, Huang T, Zheng Y, Muka T, Troup J, Hu FB (2016). “Folic Acid Supplementation and the Risk of Cardiovascular Diseases: A Meta-Analysis of Randomized Controlled Trials”. J Am Heart Assoc. 5 (8)

5) Holick MF (March 2006). “High prevalence of vitamin D inadequacy and implications for health”. Mayo Clin. Proc. 81 (3): 353–73.

6) Holick, M.F. The Vitamin D Deficiency Pandemic: a Forgotten Hormone Important for Health. Health Reviews. 2010; 32: 267-283.

7) Douglas RM, Hemilä H, Chalker E, Treacy B (2007). Hemilä H, ed. “Vitamin C for preventing and treating the common cold”. Cochrane Database Syst Rev (3): CD00098

8) Heimer KA, Hart AM, Martin LG, Rubio-Wallace S (May 2009). “Examining the evidence for the use of vitamin C in the prophylaxis and treatment of the common cold”. J Am Acad Nurse Pract. 21 (5): 295–300

9) Fulan H, Changxing J, Baina WY, Wencui Z, Chunqing L, Fan W, Dandan L, Dianjun S, Tong W, Da P, Yashuang Z (October 2011). “Retinol, vitamins A, C, and E and breast cancer risk: a meta-analysis and meta-regression”. Cancer Causes Control. 22(10): 1383–96.

10) Ye Y, Li J, Yuan Z (2013). “Effect of antioxidant vitamin supplementation on cardiovascular outcomes: a meta-analysis of randomized controlled trials”. PLoS ONE. 8 (2): e56803.

11) Stratton J, Godwin M (June 2011). “The effect of supplemental vitamins and minerals on the development of prostate cancer: a systematic review and meta-analysis”. Fam Pract. 28 (3): 243–52.

12) Rimm E, Stamper M, et al.(May 1993). ”Vitamin E consumption and the risk of coronary heart disease in men” The New England Journal of Medicine . 328 (20) 1450-1456.

13) Heionen OP, Albanes D (April 1994). ”The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers” The New England Journal of Medicine. 330:1029-1035

14) “Vitamin K Overview”. University of Maryland Medical Center.

15) Maresz K (2015). “Proper Calcium Use: Vitamin K2 as a Promoter of Bone and Cardiovascular Health”. Integrative Medicine (Encinitas, Calif.) (Review). 14 (1): 34–9.

16) Hartley L, Clar C, Ghannam O, Flowers N, Stranges S, Rees K (2015). “Vitamin K for the primary prevention of cardiovascular disease”. Cochrane Database Syst Rev (Systematic review). (9)

17) Ades TB, ed. (2009). “Vitamin K”. American Cancer Society Complete Guide to Complementary and Alternative Cancer Therapies (2nd ed.). American Cancer Society. pp. 558–563.

18) Douglas RM, Hemilä H (June 2005). “Vitamin C for Preventing and Treating the Common Cold”. PLoS Medicine. 2(6):

19) Hemilä H, Chalker E (January 2013). “Vitamin C for preventing and treating the common cold”. Cochrane Database of Systematic Reviews. 1

20) Bjelakovic G, Nikolova D, Simonetti RG, et al. Antioxidant supplements for prevention of gastrointestinal cancers: a systematic review and meta-analysis. Lancet. 2004 Oct 2-8;364(9441):1219-28.

21) Bjelakovic G, Nikolova D, Gluud LL, et al. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA. 2007 Feb 28;297(8):842-57.

22) Omenn GS, Goodman GE, Thornquist MD, et al. Risk factors for lung cancer and for intervention effects in CARET, the Beta-Carotene and Retinol Efficacy Trial. Journal of the National Cancer Institute. 1996 Nov 6;88(21):1550-9.

23) The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The New England Journal of Medicine. 1994 Apr 14;330(15):1029-35

24) Lonn E, Bosch J, Yusuf S, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005 Mar 16;293(11):1338-47.

25) Miller ER, Pastor-Barriuso R, Dalal D, et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Annals of Internal Medicine. 2005 Jan 4;142(1):37-46.

25) Klein EA, Thompson IM Jr, Tangen CM, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011 Oct 12;306(14):1549-56.

Table References

1) Penniston KL, Tanumihardjo SA (2006). “The acute and chronic toxic effects of vitamin A”. The American Journal of Clinical Nutrition. 83 (2): 191–201.

2) “Thiamin, vitamin B1: MedlinePlus Supplements”. U.S. Department of Health and Human Services, National Institutes of Health.

3) Hardman, J.G.; et al., eds. (2001). Goodman and Gilman’s Pharmacological Basis of Therapeutics (10th ed.). p. 992.

4) Brunton, Laurence L.; Lazo, John S.; Parker, Keith, eds. (2005). Goodman & Gilman’s The Pharmacological Basis of Therapeutics(11th ed.). New York: McGraw-Hill.

5) Pantothenic acid, dexpanthenol: MedlinePlus Supplements”. MedlinePlus. Retrieved 5 October 2009.

6) Perry, T. A.; Weerasuriya, A.; Mouton, P. R.; Holloway, H. W.; Greig, N. H. (2004). “Pyridoxine-induced toxicity in rats: a stereological quantification of the sensory neuropathy”. Exp. Neurol. 190 (1): 133–144.

7) FAO; WHO (2002), “ch. 4, Folate and Folic Acid”, Human Vitamin and Mineral Requirements

8) The Dark Side Of Linus Pauling’s Legacy, Quackwatch

9) Masterjohn, C (2007). “Vitamin D toxicity redefined: vitamin K and the molecular mechanism”. Med Hypotheses. 68 (5): 1026–34. doi:10.1016/j.mehy.2006.09.051.

10) Gaby, Alan R. (2005). “Does vitamin E cause congestive heart failure? (Literature Review & Commentary)”. Townsend Letter for Doctors and Patients.

11) Rohde LE; de Assis MC; Rabelo ER (2007). “Dietary vitamin K intake and anticoagulation in elderly patients”. Curr Opin Clin Nutr Metab Care. 10 (1): 1–5.

7 thoughts on “The Multivitamin Hoax”

  1. Hey Science Guy:

    Thanks for this very important piece on an ongoing controversy. You do have to be careful about making sure that you are not ingesting mega-doses of vitamins and such willy-nilly. The consequences of that, as you point out, can be terrible.

    I do take a few supplements — mostly things like turmeric (which is an ancient medicine for inflammation), moringa (which is a major stockpile of amino acids) and a pill with trace minerals that are hard to come by. One friend quipped, “That’s not medicine…that’s FOOD!”

    The debate remains ongoing because, for real, the food we eat these days (unless we are dedicated organic food farmers) has been processed and handled so much that it could be argued that our modern foods may not have as much of the nutrients as foods grown a hundred years ago and may be loaded with not-good things like pesticides and other awkward chemicals.

    I think the main thing is not to go overboard with all this stuff.

    1. Hi Netta,

      Thanks for reading. I think you brought up a really important point there which I failed to talk about in the article and that is that vegetables grown today are reported to contain considerably less ‘nutrients’ than our grandparents would have enjoyed. I think the iron content of spinach is often brought up in this regard. I think this can be partly offset by essentially supplementing the soil but year on year but the downward trend continues – so that is definitely something to bare in mind. Thanks for bringing that up.

      By all means continue to take a few supplements here and there (yours sound very specific which I think is much more useful than just taking everything all the time) – my main gripe is companies framing the whole issue by saying you wont be at your best unless you take this pill every day. Berocca’s slogan is ‘you but on a really good day’ but there is zero evidence for vitamin-based performance boosting in healthy people. I just find it all a bit misleading, which as you can probably tell, really winds me up!

      Like you said/ it’s about not going overboard. I think a lot of people buy into the idea that you simply cannot have too much of a good thing. Oh yes you can!

      Cheers

  2. This is an incredibly interesting post. I was wondering if there is any science on the best foods to eat that are comparable to the vitamins from these supplements. It would be hard to imagine that a diet of pizza rolls and soda could give us adequate nutrition. Just hoping I could get some clarification, this opened up my eyes. Now I will go check my multivitamin bottle!

  3. Just wondering what the best foods are to get the recommended vitamins. I could imagine that frozen foods like pizzas and such will not give us the adequate vitamins for a healthy lifestyle. Also, how does exercise help in these processes, if at all. In case I was interested in doing some research, I think it might help to have a place to start from. Thanks!

    1. Hi Kfan,

      It’s hard to highlight specific ‘best foods’ overall for vitamins (super food sellers will tell you differently) but usually it comes down to your common sense. You are quite right that frozen pizzas and ready meals aren’t the best things to be eating and are also also laden with fat and salts. On the other side, fruits, vegetables and non-processed meats are a good source of the vitamins and other nutrients you need. In the article (near the top) I have made a table which lists common food sources for all 12 vitamin forms – most of these are things like leafy green vegetables, nuts, fish and eggs. The take home message is that a balanced diet is what almost all people require – a good mix of fruit and veg, protein (from either animal or veg or fungal source) fats (aim of poly or mono unsaturated) and carbohydrates – think like whole wheat pasta and rice are great.

      It’s hard to link vitamins to exercise per se – they are involved in so many processes and vital to life that singling out the role of one vitamin in exercise or the effects that exercise has on one vitamin is extremely difficult. Really its all about maintaining a healthy physical body. If you exercise you are developing your body in numerous ways (muscle and bone strength, enhanced cardiovascular system, you may see some positive immune system effects, also don’t forget positive effects to your mental health) which in general will lead to a longer life with less instances of diseases. If you are lacking in key vitamins you won’t perform your best in physical or mental tasks.

      My main point in the article is that unless you feel you are suffering with symptoms of vitamin deficiency (which vary from vitamin to vitamin) you don’t need daily pills to fill the gap. Start eating a few more portions of fruit and veg a week with maybe an egg or two and a handful of nuts. That’s all you really need. The government RDAs are set purposefully high to be on the safe side – most people require less than what is stated. On top of this many multi-vitamin pill companies pile a crazy huge amount of vitamins into their product which is for daily consumption – some evidence suggests this may even be bad for your health in certain situations.

      Sorry for the long comment but hopefully you can dig out something of use in here!

      Cheers

  4. I was really under the impression that your body on a daily basis with a clean and good diet still neglects to receive all the daily amount of nutrients it needs. Is there a way I can test to see if i need to use a multivitamin with my diet? How would I know if I am lacking in one nutrient area or another? Wouldn’t it be safer to just have extra vitamins and let your body process and dismiss any extra as needed?

    1. Hi Kurtis,

      If you are worried you are deficient in a certain nutrient the best bet is to see your doctor. Numerous tests can uncover things like iron deficiency and specific vitamin deficiencies. However deficiencies like these come with noticeable symptoms and if you feel fine then you probably are fine (regarding vitamins).

      There is no immediate harm in taking slightly more than the recommended daily intake of vitamins if you are worried you are not getting enough. If you want to take multi-vitamins then I’d suggest looking at the packaging of the product and avoiding taking pills which have 100s of % of RDA i.e. Vitamin B12 700% RDA.

      That’s 6 times more B12 than you need in 1 serving.

      Aside from the potential waste of money there is some evidence that chronic elevated intake of vitamins may be detrimental to health – look back to the article for more info.

      I’d say to be safe, take a multi vitamin, ONCE A WEEK. Not everyday.

      Thanks for stopping by!

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