15For healthy adults, there is absolutely no benefit to taking multivitamins, writes MedicalBrief columnist Alastair McAlpine. But slick marketing, wishful thinking, and medical doctors taking the line of least resistance, all conspire to fuel the illusion of good health from popping a single pill.
"Go to any pharmacy and you will see aisles lined with them. Colourful boxes, adorned with pictures of happy and healthy humans, promising health and vitality. So successful is the marketing of these products, that the public discourse is no longer whether one should take them, but simply which brand is best. But, you see, we’ve been thoroughly duped. Tricked by slick marketing, dodgy science, and a desire to ensure good health through the daily popping of a simple tablet. Yes, I’m talking about multivitamin and mineral supplementations. And it’s time we called them out for what they are: a scam.
“So, what are multivitamins? Why do we need them? First discovered in 1912, vitamins are essential compounds which an organism requires in limited amounts for physiological reactions.
“Ask someone on the street, however, what vitamins and minerals do, and you’ll probably get a perplexed look, followed by some mumbling about ‘Don’t they prevent scurvy…? And oh yes, energy! I feel so much better after my B12 shot in the bum! And… maybe something about stopping cancer?’
“The truth is that vitamins are essential to living. Whether they are contributing to vision, preventing bleeding, facilitating thousands of enzymes throughout the body, strengthening our bones, or regulating our immune system, they are essential for our survival, and we can’t make them ourselves, so they have to be acquired through an outside source.
“So right about now, an unholy alliance between Big Pharma and naturopathy steps into the void. Instead of having to obtain all these pesky vitamins and minerals through a balanced diet, they’re all available in an easily digestible tablet form! Naturopaths get to claim that they’re all ‘natural’ (because multivitamins aren’t ‘chemicals’) and Big Pharma gets to mass produce them and sell them for exorbitant profits.
“Before continuing, it is worth noting that there are specific instances where taking vitamins and minerals are necessary and advised. Firstly, if you have a documented deficiency, or serious medical condition, and have been prescribed them by a doctor, then their consumption is completely legitimate. Pregnant women should all take folic acid to reduce the incidence of neural tube defects, and anyone who is malnourished for whatever reason should be supplementing their daily intake. Children should all receive routine boosts of vitamin A. South Africa has a high rate of vitamin D deficiency, so taking vitamin D on its own is not a terrible idea. The people I’m talking about here who don’t need them are healthy adults who take multi-vitamin tablets to simply maintain good health, increase energy levels, or ‘boost’ their immune systems.
“If you don’t feel like actually eating these tablets, unethical doctors out there will put up a drip and give you an intravenous (IV) cocktail bag of vitamins for around R2,000 a pop. They’ll give them exotic names like ‘HYDROMAX’ and ‘ULTRAVIV’ and mumble some nonsense about the IV being needed to ‘avoid first pass metabolism’, but make no mistake, you’re simply getting a bag of vitamins that you could easily drink, and which cost approximately R20 to make, and paying some quack a fortune to pour it into your veins.
“Speaking of quacks, there are those who believe that high dose vitamin C cures cancer, and advocate its use instead of chemo or radiotherapy (see https://www.chrisbeatcancer.com/high-dose-vitamin-c-protocol-for-cancer/ or http://www.alternative-cancer-care.com/high-oral-dose–intravenous-vitamin-c-and-cancer.html). This is an old trope, and has been thoroughly debunked, but makes headlines every now and then. Indeed, the latest evidence is that high doses of multivitamins and anti-oxidants may actually inhibit the ability of chemotherapy to fight cancerous cells.
“McAlpine’s 3rd Law of Quacks states that when in doubt about something, look at what the uber-quacks (Joseph Mercola, The Health Ranger, etc) are saying, and believe the opposite. And the only thing they love more than multivitamins is extravagant claims based on no evidence.
“The message that is often peddled by Big Pharma, or your local neighbourhood naturopath, is that multivitamins are, at worst, harmless, and may offer benefit. But vitamins are not inert, and it is probably best to think of them in the same way we think of drugs, which unfortunately means there may be significant downsides to the ingestion of high doses of them on a daily basis.
“Vitamins A, D, E and K are water insoluble, so you can’t just pee out excess volumes of them, and as a result they accumulate in the body. Increased consumption of Vitamin E has been shown to significantly increase both the risk of prostate cancer in men, and all-cause mortality in adults, while excess beta-carotene is associated with an increased risk of lung cancer in smokers and those exposed to asbestos. Very high doses of vitamin A have also been associated with an increase in all-cause mortality. There is also some preliminary evidence that excess folic acid (in rats) may promote breast cancer.
“When it comes to vitamin D and calcium, there is conflicting evidence that this supplementation may modestly increase the risk of cardiovascular disease, but results have not been shown in all studies. High doses of calcium may also cause kidney stones. Regardless, there is little evidence that taking regular Cal-C-Vita, for example, is helpful in preventing bone weakness or osteoporosis.
“So those are the downsides. Are there any upsides? Unfortunately, the evidence is once again clear that the routine ingestion of multivitamins has no beneficial effect on cancer, cardiovascular risk, or mortality. Unless you’re an athlete, high dose vitamin C won’t do anything for your cold, but will turn your urine a lovely orange colour. Echinacea is not a vitamin, but is often included with multivitamins, and will do absolutely nothing for your runny nose, either.
“In addition, there is almost no regulation of multivitamins. A consumer watchdog in the US, ConsumerLab, recently surveyed 41 multivitamins sold there and found that almost a third failed basic checks, including: having more vitamin E than was labelled, or higher doses of niacin and folic acid than were advertised. There was no relationship between the cost of the multivitamin, and the likelihood of having dodgy ingredients, so paying extra from a reputable pharmacy did nothing except burn a deeper hole in the wallet.
“So, given that for healthy adults, there is absolutely no benefit to taking multivitamins, and some potentially scary outcomes, why do we persist? It probably stems from a combination of factors: wishful thinking (‘My fatigue can be alleviated by a vitamin shot in the ass’); and slick marketing which uses fancy phrases like ‘natural’, ‘anti-oxidants’, ‘immune-boosting’ (ask anyone with an autoimmune disease just how much fun a ‘boosted’ immune system is).
“The bigger question is why healthcare professionals, who should probably know better, persist with the idea that multivitamins are of benefit, and continue to prescribe them. The reasons are, I suspect, variable. Doctors are often a stubborn lot (we needed to be to get through the gruelling hours of medical school and internship) and getting us to change our minds can be difficult. When the multivitamin craze hit 20 years ago, many would have jumped on board. Getting colleagues to jump off and admit error takes time.
“In addition, the placebo effect of multivitamins cannot be ignored: many people swear by their vitamin B shots, even though there is no plausible evidence for their use. Telling them that they’re wrong, and should rather save their money, is likely to be met with a withering look, and a cancelled future appointment, so many docs just shrug and continue.
“Finally, problems like fatigue and stress are difficult for healthcare professionals to properly deal with and take time and effort to improve. Long discussions about work, sleep, nutrition and exercise are necessary. Many would rather scribble a prescription for a multivitamin than go down the arduous path of dealing with the root causes of the complaint.
“At the end of the day, there is nothing glamorous about telling people that everything they need from a vitamin perspective is available from a balanced, healthy diet (that includes protein, fat, fruit, veggies and carbohydrates, in case you were wondering). Nobody gets rich from silly vitamin bags if you are aware that your grocery cart contains more nutrients and minerals than a thousand bags of ULTRAVIV ever will. Unethical pharmacies wouldn’t be able to pilfer your hard-earned cash if they told you the reality about the efficacy of the products they advertise so enthusiastically. So, the incentive to tell people the truth is pretty low, because where there’s money to be made, extravagant promises and dodgy products win over boring evidence-based medicine.
“But evidence-based medicine is what we should believe. And the message is clear: throw the multivitamins away, go to the local grocery store and buy proper food instead. Don’t forget the ice-cream.”
Previous Digital Clubbing columnsMcAlpine: Noakes spreads dangerous and untrue information about vaccines
Aided by the likes of Noakes, anti-vaxxers are causing real damage
A smorgasbord of pseudo-science but lessons for GPs
The simple but profound values of dying children in their final days
Less lore and more science, please
1. 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 2011:306(14):1549-1556. 2. Miller ER, 3rd, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar D.
Meta-analysis: High-dosage vitamin E supplementation may increase all-cause mortality.
Ann Int Med. 2005;142(1):37-46. 3. Albanes D, Heinonen OP, Taylor PR, et al. α-Tocopherol and β-Carotene Supplements and Lung Cancer Incidence in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study: Effects of Base-line Characteristics and Study Compliance
J. Natl Cancer Inst. 1996;88(21):1560-1570. 4. Bjelakovic G, Nikolova D, Gluud C. Antioxidant supplements to prevent mortality. Jama. 2013;310(11):1178-1179. 5. Deghan Manshadi S, Ishiguro L, Sohn KJ, et al. Folic acid supplementation promotes mammary tumor progression in a rat model. PLOS One. 2014;9(1):e84635. 6. Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis. BMJ 2011;342:d2040. 7. Harvey NC, D'Angelo S, Paccou J, et al. Calcium and Vitamin D Supplementation Are Not Associated With Risk of Incident Ischemic Cardiac Events or Death: Findings From the UK Biobank Cohort. J Bone Miner Res. 2018. 8. Sorensen MD. Calcium intake and urinary stone disease. Transl Androl Urol. 2014;3(3):235-240. 9. Reid IR. Should we prescribe calcium supplements for osteoporosis prevention? J Bone Metab. 2014;21(1):21-28. 10. Macpherson H, Pipingas A, Pase MP. Multivitamin-multimineral supplementation and mortality: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2013;97(2):437-444. 11. Hemila H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2013(1):Cd000980. 12. Karsch-Volk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2014(2):Cd000530.