Thinking About the Multivitamin Controversy

The news is over two years old: Multivitamins found to be a waste of money. The bruhaha started when The Annals of Internal Medicine published a damning report concluding that multivitamin supplements are not only ineffective in providing any measurable long-term benefits, but could actually increase risk in some people. This is concerning for many of us who took these as an easy way to be healthier, and even add a bit of glow to our skin, but will it change the industry?

Why is this news or important?

To be sure, interest levels vary largely on whether you purchase supplements or not. Obviously if supplements are a part of your regular shopping list, then this study’s strong condemnation of supplements is concerning; the title of the article, “Enough is enough: Stop Wasting Money on Vitamin and Mineral Supplements” leaves little room for interpretation. If you weren’t much of a believer in vitamins and nutritional supplements to start with, you might wonder, who cares? It does matter, because it could be the equivalent of, or disturbingly close to fraud on a massive scale. Nearly 40% of Americans take multivitamins on a regular basis. In the United States, the FDA does not regulate the majority of multivitamins and dietary supplements as they do with pharmaceutical drugs. A poorly regulated, but still multi-billion dollar industry that markets products that have little or no evidence supporting them--this is newsworthy.

The folks over at Sciencebasedmedicine.org look at the population that use multivitamins, and what its appeal is. Supplement users were typically older, healthier (those with health insurance compared to those without), wealthier, and Caucasian. This demographic information is interesting, as is the top three reasons for taking them: "to improve overall health", "to maintain health" and "for bone health" in that order. A health conscious set of people taking multivitamins makes sense. What’s interesting is that the reasons for taking them are largely non-specific. Only bone-health (for which there is a huge gender gap with men apparently not nearly as concerned) comes up as a relatively specific use case in the top 3. So the motivation for taking multivitamins seems to be an insurance policy of sorts--in case there’s something to them. Confidence among users is high that the products are not harmful, so it seems that they see it as a no-risk but potentially rewarding proposition to use supplements.

How sure is science that multivitamins aren’t effective?

Herein lies a common tactic that many pseudo-scientific practices use to justify themselves. Prove that it’s worthless. How sure are we that X isn’t effective? Barring unusual circumstances it’s going to be inconclusive when you try to disprove efficacy for unspecified benefits. The problem is that the onus is on the one making the claim to prove efficacy, and the standard is trials with good sample sizes. So far, multivitamins fail the test for general cases. Nutrition science and sport science are notoriously muddled when it comes to clarity of evidence. This can readily be seen by contradictory advice over the decades, fad diets, supplements, exercise routines that are endorsed by TV stars one year, and then gone the next. These murky areas are also gold mines for alternate or yet to be proven therapies and treatments.

Surely it can’t just be a scam. I see whole sections in drugstore aisles.

The world of supplements is vast. There are minerals, vitamins, and all sorts of non-drug ingredients for various benefits. Even though it’s a huge area, let’s remove the 3 big ones: Weight loss products, Muscle building products, Sexual enhancement products. These, as you can imagine, are on a class of their own--just know that the regulation is extremely loose, and that it would be extremely unwise to take these without consulting a medical doctor. Some have very specific and narrow claims, while others like multivitamins are quite generic. There does seem to be evidence for using very specific supplements for very specific conditions, but these edge use cases should be found upon consultation with a medical doctor. What the articles suggest is that there isn’t much evidence from studies that populations who take supplements do any better than those who don’t, so there is little reason to pay good money for a poorly regulated product that doesn’t show evidence of benefit.

The Finer Points of Contention and Conspiracy

As you can imagine, the article denigrating supplements that nearly 40% of Americans take regularly did not come out without opposition. Some arguments defending supplements include:

  • While food based nutrition is best, many people are deficient in certain nutrients and need the vitamins to supplement it to a healthy level.
  • Specific cases like folic acid for pregnant women is supported by evidence.
  • There are some studies that show benefit. What about those?

Then there is the ever-popular, aggressive defense: These “natural” products are not sold by the Big Pharma conspiring with the government. There are certainly regulatory problems with the pharmaceutical industry, and it’s unlikely there will ever be a perfect balance. This attack however, seems to forget first that supplements are itself big industry--a multi-billion dollar one in fact--and that if pharmaceuticals have regulatory problems, supplements are barely regulated at all.

Is this the final word and verdict on multi-vitamins?

There is rarely any consensus on medical matters, never mind gray areas of alternative therapy. In terms of whether it’s likely that people will stop taking multivitamins, I doubt it. There are many homeopathic or natural treatments that medical doctors have largely rejected, and controlled experiments continue to fail evidence that support their claims, but this has barely made a dent in these industries. Although this may cast doubt on the idea that multivitamin use is somehow more evidence-based compared to other alternative therapies, this is unlikely to be anything close to a final verdict in the minds of the public. The key question might be, are vitamins harmful? Possibly, but doubtful. Excepting odd cases of vitamin toxicity (overdose) they are safe to take, so that cost is low, which makes it popular. The same can be said of homeopathy and other alternative forms of treatment. Is it effective? At least, at this time, it seems like the majority of evidence does not support it.