Multivitamins: Reviews

Do you really need a multivitamin?

Vitamin and mineral sales are on the rise. In November 2011, NutraIngredients-USA, a trade publication covering food and nutrition, reported that sales of vitamin and mineral supplements had increased 8.2 percent in one year. This is amazing growth for a marketplace where Americans spend nearly $5 billion every year on multivitamins, plus billions more on individual supplements, according to ConsumerReports.org. It's understandable, then, that a survey published in The Journal of Nutrition's February 2011 issue states that one-third of Americans take a daily multi. But despite this booming business, the question remains: Do you really need a multivitamin-mineral?

Health experts agree that certain groups of people can clearly benefit from a multivitamin, especially women who are pregnant or may become pregnant. Folic acid supplements can help prevent neural tube defects, which typically occur very early in pregnancy, often before a woman even knows she's pregnant. Expectant moms also need more iron and folic acid. Multivitamins are also a good idea for people with certain diseases, such as diabetes and cancer; the American Cancer Society recommends a multi for any cancer patient who can't eat a normal diet. Strict vegans and vegetarians should consider a multivitamin to replace nutrients like vitamin B12, which they may not consume in their diets -- check the label to be sure your B12 supplement is certified for vegans. As they age, seniors absorb less vitamin B12 from food and have greater needs for calcium and vitamin D, so this group may also benefit from supplements.

However, some experts say that healthy individuals don't require a daily multivitamin. "There is no scientific basis for recommending vitamin-mineral supplements to the healthy population," says Benjamin Caballero, M.D., Ph.D., a nutrition professor at Johns Hopkins University. In an October 2010 article published in the Cleveland Clinic Journal of Medicine, he argues that getting vitamins and minerals from food is best. "No supplement trial has ever been able to reproduce the health benefits of eating adequate amounts of fresh fruits and vegetables," he says. ConsumerReports.org agrees, saying in its latest report on multivitamins, "There's virtually no evidence they improve the average person's health." Other health organizations, including the Academy of Nutrition and Dietetics, say the best way to promote overall health is to "choose a wide variety of foods." In 2003, the U.S. Preventive Services Task Force said there's not enough evidence to support the claim that a daily multi leads to better health.

In addition, a January 2007 study in The American Journal of Clinical Nutrition said those who are most likely to take a multivitamin are already in good health, with a lower body mass index than average, a higher income and education level, and higher level of physical activity. In other words, people who don't necessarily need a multi are most likely to take one, while those with poorer diets who could probably benefit from a daily multivitamin are less apt to take one. One reason may be economics; even inexpensive multis usually aren't covered by insurance or food assistance programs. This same study found that the people who tend to take multivitamins are at higher risk of exceeding the recommended upper limits of some vitamins and minerals, particularly vitamin A, because they already eat a healthy diet and may take multiple supplements.

Some experts also caution that it hasn't been conclusively determined whether multivitamins have negative health effects. In fact,  some studies raise concerns that multis may do more harm than good. In the May 2007 issue of the Journal of the National Cancer Institute, researchers found that men who took a multivitamin more than seven times per week had a higher rate of dying from prostate cancer. Regular multi use of less than seven times per week wasn't associated with the same risk. Likewise, a May 2010 study in The American Journal of Clinical Nutrition found that women who took a multivitamin were 19 percent more likely to get breast cancer than those who didn't. The study followed more than 35,000 women for nearly 10 years. These studies don't prove a concrete link between multivitamin use and these diseases -- multi users may share other common characteristics that weren't evaluated -- but they certainly merit further investigation.

As a result, nutrition experts recommend that healthy individuals get vitamins and minerals from food, especially fresh produce, whole grains and lean proteins. Unfortunately, studies show that the American population as a whole fails miserably at meeting basic nutrition guidelines. According to the U.S. Department of Agriculture, 75 to 88 percent of Americans don't eat five servings of fruits and vegetables every day. So is a multivitamin good dietary insurance? As with most health issues, the jury is still out. This leaves the decision squarely in consumers' laps, so it's best to get your doctor's recommendation.

Choosing a multivitamin can be as difficult as swallowing a horse pill, especially with the multitude of options available. Fortunately, several sources provide good coverage of multis to help narrow your choices. ConsumerLab.com is the best reviewer of multivitamins; it tests dozens of multis to ensure that they dissolve properly, contain the ingredients listed on the label, and aren't contaminated with lead and other toxins. Some manufacturers pay to have their multivitamins included in the testing through ConsumerLab.com's Voluntary Certification Program, but those products are clearly listed in the results table. ConsumerReports.org evaluated multivitamins in September 2010 to ensure they meet nutrient claims and dissolve properly. Both sites make the full details of these tests available only to subscribers.

While you can find multivitamin recommendations and reviews in publications such as Better Nutrition, Pharmacy Times and others, ConsumerLab.com and ConsumerReports.org are the only sources that conduct hands-on testing. User reviews are helpful for information on side effects like stomach upset and how easy a multivitamin is to swallow. Amazon.com and Drugstore.com are the best sources for user feedback.

Are multivitamins safe?

Since 1994, the U.S. Food and Drug Administration (FDA) has regulated multivitamins under the Dietary Supplement Health and Education Act (DSHEA). This act restricts the ability of the FDA to regulate supplements or ensure the safety of their ingredients. It's limited to collecting  information on adverse side effects and monitoring labeling claims, which means the most it can do is pull a product off store shelves after a problem becomes apparent. It's up to the manufacturer to ensure that its multivitamins and supplements are safe. Under DSHEA, multivitamins don't require FDA approval, and manufacturers aren't required to register their supplements with the FDA before putting them on the market.

In an ideal world, manufacturers would be diligent about the safety of their multivitamins and truth in labeling. However, as ConsumerLab.com's testing shows, consumers should be concerned about multivitamin quality -- among 38 products it evaluates, 13 fail at least one test. Many don't meet the nutrient claims on the label, most commonly for vitamin A. Many other multis provide more than the upper limit (UL) for some nutrients, especially niacin, which can cause flushing and tingling at high doses.

More troubling is the issue of lead contamination: Too much may cause birth defects, brain damage and death, and FDA tests of multivitamins in 2008 indicate that most probably contain small traces of lead. None exceeds the upper intake, but some multis contain more lead than others. Among multivitamins for children, two vitamin powders contain the highest amounts of lead -- Nature's Plus Animal Parade Shake (*Est. $10 for 1.3 pounds) with 2.88 micrograms (mcg) of lead per daily dose and Superior Multi Age (*Est. $19 for 60 servings) with 2.24 mcg of lead per daily dose. Even though these products don't exceed the safe/tolerable levels for lead, ConsumerLab.com recommends avoiding any unnecessary lead exposure. See the Our Sources section for a link to the full list of multis tested by the FDA.

The Food Safety Modernization Act (FSMA) passed in June 2011 requires manufacturers of dietary supplements to file a claim of a new dietary ingredient (NDI) for any supplement component that wasn't part of the diet or product before 1994. While the act is a bit confusing for manufacturers, who must now report all ingredients to the FDA and wait to hear whether they're considered NDIs, the act itself allows the FDA to become proactive rather than reactive in regulating dietary supplements. In other words, regulators can prevent a product from being brought to market that they think is harmful or misleading, rather than being forced to wait for evidence of harm or fraud to withdraw the product.

Regardless of existing regulations, consumers should be skeptical about health claims listed on multivitamin labels. While the original provisions of DSHEA require that manufacturers make no claims about their products preventing or curing diseases, some do so anyway. In 2009, the FDA sent a warning letter to Weil Lifestyle, the maker of Dr. Weil multivitamins, because its website implied that the Weil Immune Support Formula multivitamin could help prevent the cold or flu, including H1N1 -- also known as the Swine Flu. A similar letter was sent to the manufacturer of Super Spectrim Multi-Vitamins regarding claims that they help boost immunity against the flu. Bayer paid a fine in 2010 for claiming that the selenium in its One-A-Day Men's multivitamins could help prevent prostate cancer. Through the FSMA and its NDI requirements, the FDA and Federal Trade Commission now have greater authority to crack down on these types of claims.