US Preventive Services Task Force Recommends Against Multivitamins

I get a lot of questions about whether or not I should take a multivitamin. It makes sense on the superficial level. We may not be getting all the vitamins and minerals we need from our Western Industrialized diet, so it's important to get supplemental vitamins and minerals. There is a huge marketing campaign selling vitamins, they are mostly pushed by gurus, and the claims for them seem overstated. What is the location of the truth?

Since at least 2008 we have been saying that vitamins are useless. The conclusion is supported by the US Preventive Services Task Force. Three basic recommendations are made by the USPS.

• The USPSTF recommends against the use of beta carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer.
• The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of multivitamin supplements for the prevention of cardiovascular disease or cancer.
• The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the use of single or paired nutrient supplements (other than beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer.

The recommendations are for adults who are not pregnant. Folate and iron should be taken by pregnant women and their OB. Individuals may need to treat a deficiency or have an illness that can benefit from specific supplements. Under the guidance of a physician, targeted supplements should be based on blood levels of specific vitamins and minerals.

For healthy non-pregnant adults, there is not a lot of evidence to support the idea of taking individual vitamins and supplements. There is evidence that the risk of cardiovascular mortality, lung cancer, and overall mortality can be increased by taking vitamins.

vitamins aren't necessarily benign To support a $50 billion industry, the supplement industry spends almost a billion dollars a year. Vitamins are marketed as harmless but they aren't. If the dose is too high, the vitamins are more likely to be toxic. The risk of major diseases, like cancer, may be increased by the use of vitamins. One theory is that vitamins can help the cancer cells. As the potential for harm increases, it's easy to avoid high doses of vitamins or supplements.

There is insufficient evidence to recommend the use of vitamins other than vitamins A, C, and E. There are many large studies that we have. There are two-fold problems. It's hard to do large controlled studies with vitamins. Most of the data is related to health outcomes. The problem with ecological data is that it is correlation only.

There could be both healthy user and sick user effects. Exercise and eating well are things that people who take vitamins can do. What is the cause of the better outcomes? People who are sick are more likely to take vitamins because they think they will help. Dieting results from and doesn't cause being overweight. How do these two different things work together? We don't have a clue.

There isn't enough evidence to know what the net health effect of supplements is. We could see the benefit from vitamins in the data. There would be a strong signal. It is impossible to prove a negative with outcome data, even high-quality data, and the evidence can set statistical limits on the effect. We can say that any possible effect is very small. It's likely to be insignificant as a public health measure because we can chase that tiny effect with more powerful and rigorous studies.

There is an important conclusion to be reached by the USPSTF and JAMA editorial recommendations. It's likely to distract from more effective measures. Almost half of Americans take routine supplements for no apparent benefit. The feeding supplement industry makes a lot of money.

There are health benefits to having a balanced diet with lots of fruits and vegetables. People may be given permission to not spend as much time on their diet if they take a supplement. Negative health outcomes will be experienced by this. A host of health benefits can be attributed to exercise. Good sleep, not smoking, and using alcohol with moderation are lifestyle choices that are proven to have health benefits.

Diet, exercise, sleep, and avoiding smoking are the big five. The factors have shown benefits in the evidence. Many people focus on the margins, thinking that there are small benefits. There is a self-help and "wellness" industry that focuses peoples attention on the wrong things. They may pay lip service to the proven lifestyle factors above, but for them their real value added is being an expert in natural medicine, bogus nutrition advice, and pushing trendy trends like organic food.

The industry of health and well being is expensive. The answer to a healthful lifestyle is already out there, and already part of mainstream medicine. Most healthy adults don't need anything else. The information can be found in a pamphlet. That's the percentage.

Making healthy choices easier and more affordable is what public health needs to be focused on. Many people live in food deserts because of the high cost of healthy food. Bad food choices are inexpensive and plentiful. It is possible to redesign cities to make it easier to walk and ride bikes. Sitting at a desk all day is not good for your health and can be encouraged by the workplace. Improving sleep hygiene can be aided by public education.

These measures have been shown to have health benefits. Multi vitamins are expensive and useless.

• Steven Novella is the founder and currently Executive Editor of Science-Based Medicine. The Great Courses and The Skeptics Guide to the Universe were both written by Dr. Novella.

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