“Aside from a healthy diet, are multivitamin supplements essential for optimum health?

definition of terms:

health - State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity
diet - food and drink regularly provided or consumed
essential – of the utmost importance
being a substance that is not synthesized by the body in a quantity sufficient for normal health and growth and that must be
obtained from the diet
optimum - greatest degree attained or attainable under implied or specified conditions

main argument:

-supplements are not intended to substitute for food

-Vitamin D is rare in the diet (sunlight as source) pano mga call center agents?
-Nutritional needs is individualistic
-fill gaps in nutrient deficiency
-Pregnant women need 400 mcg/day to prevent neural tube defects
-for people that have nutrient absorption diseases

(Dietiticians of Canada, https://www.dietitians.ca/getattachment/8612a7a9-642d-42dd-8e38-33f908c26c6a/Factsheet-Food-

Sources-of-Folate.pdf.aspx)

Oklahoma medical research foundation (https://omrf.org/2016/06/30/food-vs-supplements-whats-the-verdict/)

Chakravarty emphasized that women should take a calcium supplement, especially once they hit age 35, because of inevitable
bone loss that occurs with menopause. Pregnant women or women thinking about getting pregnant should also take extra folic
acid. Another item worth noting, she said, is most supplements are water soluble, so any excess of what your body needs will
generally be passed in the urine and won’t cause a dangerous buildup in the urine. However, Vitamins D and A are fat soluable
and can build up in the system, making them worth monitoring.

Scientific American (https://www.scientificamerican.com/article/do-vitamins-in-pills-diff/)

For the most part, our bodies appear to absorb synthetic forms as well as they do natural forms. The one exception seems to be
vitamin E, which in natural form (RRR-alpha tocopherol) is better absorbed than in synthetic form (all-rac-alpha tocopherol).
But most supplements now contain more natural vitamin E, so it is well absorbed in pill form.

Luke Bucci, vice president of research for Schiff natural vitamins and supplements, offers this explanation:

For the 13 acknowledged vitamins (A, B1, B2, B3, B6, B12, folate, biotin, pantothenate, C, D, E and K), sometimes the usual
forms found in multiple vitamin pills are identical to those found in foods, and sometimes not. Pharmaceutical manufacturers
have singled out the most useful and most stable forms of each vitamin over the past 100 years for use in vitamin pills. With
only a few exceptions, the vitamins in pills are utilized and handled by the body just as efficiently, or more so, than the vitamin
forms found in foods. Indeed, some of the vitamin forms (called vitamers) found in foods are less active and less easily
converted into activated forms than the vitamers used in pills.

Mayo clinic (https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/supplements/art-20044894)

Who needs supplements?

If you're generally healthy and eat a wide variety of foods, including fruits, vegetables, whole grains, legumes, low-fat dairy
products, lean meats and fish, you likely don't need supplements.

But supplements — or fortified foods — might be appropriate in some situations:

 Women who may become pregnant should get 400 micrograms a day of folic acid from fortified foods or
supplements, in addition to eating foods that naturally contain folate.

 Women who are pregnant should take a prenatal vitamin that includes iron or a separate iron supplement.

 Adults age 50 or older should eat foods fortified with vitamin B-12, such as fortified cereals, or take a multivitamin
that contains B-12 or a separate B-12 supplement.

 Adults age 65 and older should take 800 international units of vitamin D daily to reduce the risk of falls.

Dietary supplements also may be appropriate if you:

 Don't eat well or consume fewer calories than needed

 Are a vegan or a vegetarian who eats a limited variety of foods

 Follow any other type of diet that restricts an entire category of foods

 Don't obtain two to three servings a week of seafood, which supplies omega-3 fatty acids for heart health

 Have limited milk intake due to lactose intolerance or milk allergy, or simply don't consume enough dairy foods

 Have heavy bleeding during your menstrual period

 Have a medical condition that affects how your body absorbs or uses nutrients, such as chronic diarrhea, food
allergies, food intolerance, or a disease of the liver, gallbladder, intestines or pancreas

 Have had surgery on your digestive tract and are not able to digest and absorb nutrients properly

Health Harvard (Getting your vitamins and minerals through diet

The benefits of multivitamins are looking doubtful. Can we do without them?, https://www.health.harvard.edu/womens-
health/getting-your-vitamins-and-minerals-through-diet)
Still, there are some reasons for certain people to take vitamins.

Women should take 400 micrograms of folic acid a day during their childbearing years. This is the amount in a standard multiple
vitamin. Taking in enough folic acid helps prevent pregnant women from having a baby born with spina bifida.
Also, people that aren't exposed to sunlight too often — which can cause a lack of vitamin D — may benefit from a
multivitamin. We need sunlight to change the inactive form of vitamin D in our skin to the active form. Most people in the
upper half of the northern hemisphere don't get enough sunlight during winter and most of spring and fall as well. Also, we
have been told to avoid sunlight because it ages our skin and causes some types of skin cancers.

Here's another reason to take multivitamins: it may help slow down macular degeneration. This eye disease is seen mainly in
older people. But it's not clear whether vitamins actually prevent the disease.

Strict vegetarians should take vitamin B12. They may also need an iron supplement.

The doses in standard multivitamins are safe. If your diet has too little of any vitamin or mineral, multivitamins are still a very
low-cost way to protect yourself against vitamin deficiencies.

Vitamin and Mineral Supplements: Do We Really Need Them? (Farin Kamangar1,2 and Ashkan Emadi3,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309636/) jounal

In special cases, individuals may need vitamins or supplements. For example, periconceptional folate supplements substantially
reduce the risk of neural tube defects.[24] Likewise, iron supplements during pregnancy can substantially reduce the risk of
anemia and perinatal complications in mothers.[25] Physician-recommended treatment of disorders such as osteoporosis,[26]
as well as other diseases, may require use of MVMs or individual vitamins or minerals, but these are not the subject of this
article.

What you need to know about vitamin and mineral supplements

(The Pharmaceutical Journal23 APR 2012By Pamela Mason, https://www.pharmaceutical-journal.com/news-and-

analysis/features/what-you-need-to-know-about-vitamin-and-mineral-supplements/11099947.article?firstPass=false)

In circumstances where nutrient intake from diet is inadequate, a multivitamin or mineral supplement may be recommended.

Pharmacists should emphasise the importance of eating a healthy diet wherever possible, but a supplement containing
recommended amounts of nutrients may be useful where maintenance of health due to nutrient inadequacy is in doubt.

Nutrition Insurance Policy: A Daily Multivitamin (https://www.hsph.harvard.edu/nutritionsource/multivitamin/)

Many older people have trouble absorbing vitamin B12 from food; the Dietary Guidelines for Americans 2010, in fact,
recommends that people over the age of 50 eat foods fortified with vitamin B12 or take vitamin B12 supplements.

What about other studies that appear to show vitamin supplements cause harm? Those studies often suffer from the same flaws
as the Iowa study. Take, for example, a frequently-cited analysis of 68 antioxidant supplement trials that was published in the
Journal of the American Medical Association. (10) That study found that taking beta carotene and vitamin A and E supplements
increased the risk of dying. But most of the studies included in the analysis were done in people who already had some type of
serious illness. It was also impossible to compare interventions because the types of supplements, the dosages taken, and the
length of time they were taken varied so widely in the studies.

Should you get your nutrients from food or from supplements? (Harvard Health Publishing-Harvard Medical School,
https://www.health.harvard.edu/staying-healthy/should-you-get-your-nutrients-from-food-or-from-supplements)

The fresh food you eat is loaded with nutrients necessary for good health, such as magnesium, calcium, and vitamins A and C.
But many older adults aren't getting enough nutrients from their diets.

The typical American diet is heavy in nutrient-poor processed foods, refined grains, and added sugars—all linked to
inflammation and chronic disease. Yet even if you eat a healthy, well-balanced diet, you may still fall short of needed nutrients.
That's a consequence of aging. "As we get older, our ability to absorb nutrients from food decreases. Also, our energy needs
aren't the same, and we tend to eat less," explains Dr. Howard Sesso, an epidemiologist at Harvard-affiliated Brigham and
Women's Hospital.
 Good food sources of important nutrients

Nutrient Found in these foods

Vitamin B Lean beef, turkey, tuna, sunflower seeds, spinach and other
leafy greens, eggs

Vitamin D Salmon, tuna, lean beef, vitamin D-fortified milk and yogurt,
fortified orange juice, egg yolk

Iron Liver, oysters, lean beef, chickpeas, beans, lentils, and sesame seeds

Magnesium Spinach, kale, and other leafy green vegetables; unrefined grains;
and legumes

Calcium Dairy products, fish such as salmon and sardines, and dark, leafy greens.

Do you really need vitamin and mineral supplements for good health (Food and Nutrition Research Institute, DOST,
http://www.fnri.dost.gov.ph/index.php/publications/writers-pool-corner/58-health-and-nutrition/92-do-you-really-need-
vitamin-and-mineral-supplements-for-good-health)

These are times when vitamin and mineral supplements are necessary. One reason is to augment an inadequate diet to prevent
or correct a specific nutritional deficiency.
For example, iron supplementation may be helpful in a patient with iron deficiency anemia or folic acid supplementation maybe
recommended to pregnant women to reduce the risk of bearing children with neural tube defects.
Another use of dietary supplements is pharmacological, where dose above the Recommended Dietary Allowance (RDA) are
used for a specific pharmacological effect, rather than to make up for any deficit in dietary intake.
For instance, patients with acute infection or burns need increased energy and micronutrients for fast recovery, but their weak
bodies prevent them from absorbing the required nutrients from a normal diet.

Multivitamin/mineral Supplements (National Institutes of Health-Office of Dietary Supplements,

https://ods.od.nih.gov/factsheets/MVMS-HealthProfessional/)

Special Considerations for Certain Population Groups

Although MVMs do not appear to reduce overall chronic disease risk, several nutrients in MVMs might benefit certain
population groups. For example:
 Supplementation with calcium and vitamin D might increase bone mineral density and decrease fracture rates in
postmenopausal women [1,30].
 Women of childbearing age who might become pregnant should obtain 400 mcg/day of synthetic folic acid from
fortified foods or dietary supplements. Taking sufficient amounts of folic acid in the first month of pregnancy (a time
when many women do not yet know that they are pregnant) reduces the risk of neural tube defects in newborns
[7,31,32].
  People over age 50 should obtain recommended intakes of vitamin B12 mainly from fortified foods or dietary
supplements, because they could be less able than younger people to absorb the protein-bound, naturally occurring
vitamin B12 in food [7,32]. In addition, vegans should ensure that their intakes of vitamin B12 from fortified foods or
supplements are adequate [32].
 Pregnant women should take an iron supplement as recommended by an obstetrician or other healthcare provider
[32].
 The American Academy of Pediatrics recommends that exclusively and partially breastfed infants receive supplements
of 400 IU/day of vitamin D shortly after birth and continue to receive these supplements until they are weaned and
consume at least 1,000 mL/day of vitamin D-fortified formula or whole milk [33]. Similarly, all non-breastfed infants
ingesting less than 1,000 mL/day of vitamin D-fortified formula or milk should receive a vitamin D supplement of 400
IU/day [33]. According to the Academy, children at nutritional risk who might benefit from supplementation include
those who have anorexia or an inadequate appetite, follow fad diets, have chronic disease, come from deprived
families or suffer parental neglect or abuse, participate in dietary programs for managing obesity, consume a
vegetarian diet without adequate dairy products, and have failure to thrive [34].
No U.S. government health agency, private health group, or health professional organization promotes regular use of an MVM
or individual nutrients without considering first the quality of a person’s diet. However, individuals with poor nutrient intakes
from diet alone, who consume low-calorie diets, or who avoid certain foods (such as strict vegetarians and vegans) might
benefit from taking MVMs [35]. Healthcare providers sometimes prescribe MVMs for people with medical conditions and
diseases that impair digestion, absorption, or use of nutrients. In general, some supplements might help people who do not eat
a nutritious variety of foods to obtain adequate amounts of essential nutrients. However, supplements cannot take the place of
the variety of foods that are important to a healthy diet.

When choosing an MVM product, people should try to find one tailored to their age, gender, and other characteristics (e.g.,
pregnancy). MVMs for men often contain little or no iron, for example, whereas those for seniors typically provide more
calcium and vitamins D and B12 than MVMs for younger adults. Prenatal supplements generally provide no vitamin A as retinol,
and most children’s MVMs provide age-appropriate amounts of nutrients. The U.S. Food and Drug Administration (FDA) has
developed good manufacturing practices for dietary supplements to help ensure their identity, purity, strength, and
composition [44]. The FDA also periodically inspects facilities that manufacture dietary supplements.

Do multivitamins make you healthier? (Harvard Health Publishing, Harvard Medical School,
https://www.health.harvard.edu/mens-health/do-multivitamins-make-you-healthier)

Dr. Sesso (Dr. Howard Sesso, an associate professor of epidemiology at the Harvard School of Public Health) speaks for the
optimists, who urge a wait-and-see approach. "Multivitamin supplementation is low risk and low cost, and it helps to fill
potential gaps in the diet that people might have," Dr. Sesso says. "These are compelling reasons to consider taking a
multivitamin for cancer and eye disease that should be discussed with your physician."

Do not take high doses of specific vitamins, especially A and E. These may actually be harmful. Some research suggests that
generous daily doses of vitamin D could be helpful.

What does the evidence say?

Physicians' Health Study II (The Physicians' Health Study II is the best study completed so far. It was the first and only large-
scale randomized clinical trial to test a commonly taken multivitamin like the ones most people take, containing the daily
requirements of 31 vitamins and minerals essential for good health.)

A large group of male physicians took either a multivitamin or a placebo pill for more than a decade.

Researchers looked at the effect of long-term multivitamin use in healthy men on various aspects of health. Here is what they
found:

 Cancer: Men were 8% less likely to be diagnosed with cancer. The protective effect was greatest in men with a history
of cancer.
  Vision: Lower risk of developing cataracts.

 Cardiovascular disease: No protection against heart attacks, strokes, or death from cardiovascular disease.

 Brain: No protection against declining memory or mental skills.

Caveat: Because of PHSII's design, the findings on memory loss and vision are somewhat more likely to be chance findings than
the cancer and cardiovascular disease results.

Trial to Assess Chelation Therapy

The study tested a therapy for artery blockages (chelation) in people with a previous heart attack; it also included a vitamin
supplement. The trial found no evidence of benefit from taking the supplement.

Caveat: Participants did not take a typical multivitamin, with a variety of essential nutrients in varying doses. It's possible that
taking a standard multivitamin might have worked better, but there is no evidence to suggest that might be the case.