Erin is a 23-year-old student at Arizona State University who is concerned about nutrition. She admits she doesn’t always eat healthy but really tries. She buys organic vegetables and makes a big salad for herself most days of the week. Since she says she eats a large quantity of vegetables most days, she wonders whether she needs to take a multivitamin. She has heard conflicting stories from her mom and friends. She is also active, runs most days of the week and in general feels well.
My quick answer is a firm, “Probably.” However, a careful look at her individual circumstances is needed before I can make a recommendation. Here are factors I consider:
- A true and detailed look at the actual diet — It’s possible to get all your nutrients from food if you maintain a varied, high-quality, whole-food diet. This, of course, is a challenge, and most people fail to meet the goal of 5 to 13 servings of fruits and vegetables a day as recommended by the Dietary Guidelines for Americans. When questioned in more detail, Erin buys vegetables for her salad on Sunday, then uses the ingredients for a salad through Wednesday. The other days she eats mostly on the run.
- Age and health circumstances — Erin is of childbearing age. If she could potentially get pregnant — meaning she is sexually active with or without contraception — she should be taking a multivitamin. Women who have trouble absorbing foods, including those with health conditions such as inflammatory bowel disease, should take a multivitamin. If she’s had weight-loss procedures or surgeries, she absolutely needs to continue taking vitamins.
- Medications you are taking — Some medications can interfere with your ability to absorb nutrients. This can include medications for heartburn that reduce stomach acids, which can affect this early step in digesting foods. Other common medications, such as diuretics or “water pills” often used for high blood pressure, can flush out nutrients in the system that later need to be repleted.
- Food quality — Trend data for nutrients in some common crops have shown statistically significant declines. There is also some data that suggest organic foods do seem to have a higher concentration of phytonutrients.
It’s not surprising that Erin is confused. Not everyone, even health and nutrition experts, agrees that multivitamins are necessary. In 2006, the National Institutes of Health (NIH) convened a state-of-the-science conference to review the evidence on whether multivitamins prevent chronic disease. A 2013 review analyzed studies involving more than 25,000 participants to see if multivitamin intake reduced the risk of heart disease and cancer. Unfortunately, neither showed sufficient evidence to recommend for or against their use. That being said, the U.S. Preventive Services Task Force has recommended for over a decade that women take a multivitamin prior to conception. Since approximately half of the pregnancies in the U.S. are unintended, and even more than that in women ages 18 to 24, it’s reasonable to encourage all sexually active women to take a prenatal vitamin.
What’s the final verdict? In an ideal world, people would get all the nutrients they need from a varied diet of healthy, whole foods. I suggest that Erin continues her efforts to purchase salad fixings, maybe purchase even more salad fixings so that she can have fresh vegetables daily. She can continue to improve her diet by eating a wider variety of minimally processed whole foods, including beans and legumes, nuts, whole-grain bread and pasta, brown rice, herbs, and spices, berries and in-season fruits. If she is able to incorporate organic foods, all the better. Perhaps a weekly visit to a farmers market can be arranged.
However, she remains in an age bracket for which I strongly recommend a multivitamin. It may be an insurance policy for likely gaps in nutrients ingested or absorbed from foods.
What multivitamin should you choose? Here are my recommendations:
- In Erin’s case, she is best served by a prenatal vitamin. Women outside of childbearing age will want a mature women’s formula.
- Check the label for approximately 100% of the Daily Value for all of the nutrients and not much more.
- Watch for added sugars, such as you find in gummy multivitamins, and artificial coloring.
- If pills seem quite large, try to find one with a lower dose of calcium. This is typically the largest particle in the tablet.
- Don’t be fooled by the extensive list of additional ingredients. Typically, there is not enough of each component to confer a benefit.
- Price is not necessarily equivalent to quality. Check for a product with the United States Pharmocopeia (USP) seal to ensure quality manufacturing integrity. This seal is conferred on products that have been rigorously evaluated by USP to determine the product has “truth in labeling” — meaning, the supplement actually contains what it claims to contain.
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Jane B. Northern, A.P.R.N., F.N.P.-BC, M.S.
Jane Northern is a Women’s Health/Family Practice nurse practitioner and Integrative Medicine specialist at Mayo Clinic in Scottsdale, Arizona, where she lives with her husband. She has three grown daughters and one son.