Doctor's Note

I’ve previously addressed multivitamins in my videos Are Multivitamins Good For You? and Multivitamin Supplements and Breast Cancer (with a follow-up in my Q&A Is multivitamin use really associated to an increased risk of breast cancer?). I also touched on potential risks in Dietary Theory of Alzheimer’s.

With the exception of vitamins D and B12 (Vitamin Supplements Worth Taking), we should strive to get our nutrients from produce, not pills.

In my video on Monday I'll cover all the new science on fish oil supplements in Is Fish Oil Just Snake Oil?

If you haven't yet, you can subscribe to my videos for free by clicking here.

  • basskills

    Interesting video… I’ll experiemnt with taking a multi but only once a week rather than everyday (as a mental reassurance). What about B12, Vit D and Iodine, the vitamins vegans are encouraged to take?

    • guest

      What about the added vitamin E to vegan DHA?

    • Aaron

      Dr Fuhrman has the best multi. It has B-12, sufficient Vitamin D and Iodine. he leaves of certain vitamins that may be harmful in isolated forms

      • JD

        dr fuhrman is in the business of selling supplements. You don’t need them if you eat a WFPB diet. Just B12 and D

        • Mark R. Mach

          Why take D if you can make it yourself?

          • Thea

            Mark: A lot of people live in areas where they do not get enough of the right kind of sunlight to be able to make adequate vitamin D ourselves. And then there are the kind of people, like me, who spend most days inside, especially during the noonday sun.

            I think you would be interested in seeing the vitamin D recommendations that Dr. Greger makes. He breaks it down by where people live so that you can see when and if you can get enough vitamin D from sunlight alone. Scroll down on this page:
            http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

    • http://www.naturallifeenergy.com/ Aqiyl Aniys

      B12 and D are vitamins vegans and non-vegans are lacking in. It is difficult to get the proper amounts even from eating healthy foods. I get all my other nutrients from my plant based diet, but I do alternate between vegan sublingual B12 and spirulina/chlorella to make sure I get enough B12. Again most/many people are lacking in D also. It is best to get D from sun exposure but many of us who are living in colder climates or because it is winter time don’t get enough sun exposure. In this case Sublingual D supplements is better than not getting vitamin D. Basskills I assume you are a vegan, as I am a vegan. I don’t do multivitamins. I just eat a well rounded calorie dense wholefood plant based diet. The way I approach my diet I haven’t been sick in over 2 years since adopting a plant based diet.

  • Pete Greider

    Thanks. Fascinating!

  • deana

    I think it is important to note that the December 2013 meta-analysis, as far as multivitamins, actually only analyzed one study – and that was the Physicians’ Health Study mentioned earlier in the video. The rest were studies of supplements containing only one or just a few nutrients. So we still don’t really have that much info.(http://www.drfuhrman.com/library/multivitamins.aspx) That being said, I think this would all make more sense to the general public if we could clarify the goal of multivitamins – the point of eating healthy food is to prevent heart disease and cancer; the point of supplements (including multivitamins) is different – it is insurance against deficiency, since there is no such thing as a perfect diet.

    • Tom

      The trick/difficulty is that not only is hard hard to always eat healthy, but it’s been reported that our food isnn’t as nutrient rich as it was years ago. So, what’s a person to do? I’m in charge of the juicer in our house and we do lots of green juices in hopes to get the nutrients.

    • yardplanter

      True, there is no perfect diet, nor perfect science, clinicals, cars, houses, pets, jobs, significant others. But there are multitudes of perfectly satisfactory and more than adequate examples of each.

      But you do have a point, more than , what ? , 100,000 subjects with all the data pointing in the same direction ( no significant benefit ) could be misguided. So let’s get on with the business of showing that MV prevent deficiencies better than WF.

    • http://www.naturallifeenergy.com/ Aqiyl Aniys

      Hi Deana,
      The point of eating healthy food is to load up on natural synergistic combinations of vitamins, minerals, fats, carbs, fiber, and phytonutrients to prevent heart disease and cancer. The point of taking supplements is for the same reason, in case we are not eating enough good foods to get all the nutrients we need, supplements will fill in. It appears the study is saying that supplements really don’t make a difference, and that we need to get our nutrients from real food like fruits and vegetables to protect against disease.

    • Julia Kravets

      I agree. These studies show that multivitamins don’t prevent cancer and heart disease. Those are pretty big things to prevent for a small pill, which is why diet is so important. But not everyone can eat a wholly nutritious diet all the time. These nutrient gaps can cause a host of problems like acne, brittle hair and nails, poor eyesight, and weak immune system. A quality multivitamin can plug in the nutrition gaps and that prevent those things. While it’s true that a people who eat tons of fruits, vegetables, nuts and seeds probably don’t need a multivitamin; it’s just not the case for most Americans.

      • Timar

        Actually the study (PHSII) *does* show that multivitamins prevent cancer, even in a well-nourished, highly educated population of physicians (RR 0.92, P=0.04), and this finding was *not* limited to those with a history of cancer. To quote directly from the abstract:

        “Daily multivitamin use was associated with a reduction in total cancer among 1312 men with a baseline history of cancer (…), but this did not differ significantly from that among 13 329 men initially without cancer (…). Conclusion In this large prevention trial of male physicians, daily multivitamin supplementation modestly but significantly reduced the risk of total cancer.”
        http://www.ncbi.nlm.nih.gov/pubmed/23162860

        Further investigations from the same trial found that the multivitamin also siginificantly decreased the risk of age-related macular degeneration (RR 0.91, P=0.04) and a non-significant but nevertheless remarkable reduction in all-cause mortality (RR 0.94, P=0.13).

        Given those results (and other intriguing observations from well-controlled cohort studies, as I reviewed here: http://www.longecity.org/forum/topic/67591-us-preventive-services-task-force-report-on-vitamin-and-mineral-supplements/ ), I have to say that I am somewhat disappointed by Dr. Greger chiming in with the recent media campaign against (multi)vitamins, by giving a distortive account of the evidence.

  • Yann

    Dr. Greger, what about Vitamin-D and B-12? Might they be useless in a “capsule” form?

  • Jocelyn

    Yes! I whole heartedly agree. Thanks again.
    This reminded me of when I was in the pharmacy the other day, they had loads of vitamin pills located right next to the rack of chips, chocolate bars and candy – not really a place supporting healthy lifestyle!

  • pm

    The studies failed to distinguish between the type of multivitamin and mineral supplementation. Most over the counter pharmaceutical brands, like centrum, aren’t effective because they contain synthetic forms of the vitamins and minerals, which may be toxic and have absorption issues.

    Vitamins taking in the right whole food form, and minerals in trace ionic forms, are not only safe but contribute to health and the prevention of disease as well as natural organic foods. http://www.orthomolecular.org/resources/omns/v09n18.shtml

    There is much research not funded by pharmaceutical corporations to support this contention. The orthomolecular institute is an excellent place to start. http://www.orthomolecular.org/resources/omns/index.shtml

    • pm

      Another flaw with these studies critical of supplementation has to do with dosages of vitamins and minerals. The RDA of all vitamin and minerals is too low to meet the full requirements needed by the body for health and disease prevention effects measured in this so called research.

    • Ravi K

      I completely agree with you on this. All of these studies used store brand crap like Centrum. Yeah with those you are wasting your money.

      • guest

        For the most part, all multi-vitamims contain vitamin E, and Dr. Greger has a video saying we should not be supplementing with any vitamin E.

        I sort of think this alone makes taking a multi-vitamin a no-no, according to this website.

        • Ravi K

          There are multivitamins and then there are whole food supplements :-).

      • Soaring Falcon

        This is an imperative point. It troubles me that Dr. Greger didn’t point-out this / these glaring failure of the studies. He knows most vitamins come from sources that can be less-than-healthful. I hope it was just an oversight ?? and not convenient for him to overlook the studies deficiencies since they fit into his paradigm. Another dent on absolute honesty in reporting …

    • guest

      For the most part, all multi-vitamims contain vitamin E, and Dr. Greger has a video saying we should not be supplementing with any vitamin E.

      I sort of think this alone makes taking a multi-vitamin a no-no, according to “nutrition facts.org”.

  • puntloos

    Indeed the thing missing in this discussion is preventing deficiencies. Mild deficiencies aren’t life threatening even in the long run, and that was what these studies were looking for.

    If you are prone to deficiencies (hint: if you’re eating a roughly western diet: you are.) then eat a supplement, but there’s little point to do ‘across the board’ vitamins.

    Try to be specific to what you are deficient in, esp given that some vitamins are toxic if you overdose.. if you already get enough, don’t take more…

  • Robin D. Everson

    Great video, good information and the focus back to the things we should be taking into our bodies (fruits and veggies).

    • Soaring Falcon

      Robin, if you have ever performed a scientific investigation … the framing of the questions … and the issues and framing of the results makes all the difference in the world on the results. These were significantly flawed studies in that they did not segregate wholistic food source vitamins as a sub-group with separate out-comes than oil-based vitamins or vitamins that were created with excess heat; chemicals, etc.

  • guest

    Is vitamin E safe to take? All multi-vitamins I am aware of contain vitamin E, and you have a video in your archive suggesting/saying to not take supplemental vitamin E. Based on this, I feel it is safe to assume that you would not recommend anyone take a multi-vitamin that contained vitamin E, unless their health and or situation somehow warranted it, or for whatever reason trumped your belief that we should not be supplementing with E. I have not been able to find a quality multivitamin that does not contain vitamin E. And the science against taking vitamin E has been published in many places outside of here as well.

    • Karen Andrews

      FYI, As noted above, Dr. Joel Fuhrman’s multivitamins do not contain Vitamin E.

      • guest

        yes, but his DHA supplement does contain vitamin E “mixed tocopherols”….and in supplement form it has been advised by Dr. Greger that it is likely prudent not to ingest vitamin E.

  • Scott

    Maybe it’s just me, but I found it difficult to get all the minerals required in my mainly plant-based-diet to sustain the enamel in my teeth. If I don’t supplement with a multivitamin my teeth get chalky and stained. I’ve also had to supplement with calcium since I also refrain from dairy and don’t drink a lot of almond milk or other foods that are fortified with calcium. Every diet is different, but mine tends to be high in citric and phytic acid, which is another contributing factor to the daily tight rope I walk to maintain my tooth enamel.

  • sarah

    One problem I have with these studies is they pre-suppose the purpose of a multi-vitamin is heart-health or longevity, when in fact I take vitamins for quality of life: that is, for energy and vitality. And on that basis I find them to be pretty damn excellent — especially the whole food based vitamins.

  • Jason C Venckus

    I am always looking for someone that agrees with me. I just convinced my wife that she does not need a calcium supplement during pregnancy because we eat a lot of foods high calcium. We are vegans but she has been craving cheese. So in addition i’ve been feeding her plenty of greens, beans, almonds, organic tofu and have her using organic molasses.

    • Adrien

      If she worried so much for Calcium, we don’t have to tell her to take B12, I’m right ? Maybe she could replace Calcium by algae DHA, here’s why it might be a good idea: http://nutritionfacts.org/video/algae-based-dha-vs-flax-2/

    • Guest

      If she worried so much for Calcium, we don’t have to tell her to take B12, I’m right ? Maybe she could replace Calcium by algae DHA, here’s why it might be a good idea: http://nutritionfacts.org/video/algae-based-dha-vs-flax-2/

      • Jason C Venckus

        We do take a vegan dha as well. Thank you.

    • DGH

      What is her specific concern regarding calcium intake during pregnancy?

      • Jason C Venckus

        That she is not getting enough because we are vegan. I am a holistic health coach so she wants to believe me but I am also her husband so she finds it hard to trust my advice. I am close on this one with her. I hold some merit because I solved her allergy problems with green tea and raw local honey.

        • DGH

          How would green tea and raw local honey solve an allergy problem?
          W.R.T. calcium and pregnancy, I would check the veganhealth.org website, or post a question to Jack Norris – jacknorrisrd.com (he runs both sites).

          • Jason C Venckus

            Green tea and raw local honey help the body produce it’s own natural antihistamines. My wife had horrible allergy attacks that would just put her out. She has not had one in over 8 months since using this combination 4-5 days a week.

        • b00mer

          Have you ever tallied up the numbers for her with something like cronometer? Before I did myself, I had some little nagging worries re: zinc, calcium and iron. Those nutrients that you “hear” vegans tend to be deficient in. I wanted to believe when various experts would say that as long as the diet is relatively varied and nutrient-dense I would get everything I needed (except of course B12 and D), but seeing the numbers there in black and white is what really put me at ease.

    • Thea

      Jason: Have you heard of Vegetarian Resource Group (VRG)? They are a group that is very careful about the information they present. I don’t always agree with everything they post, but it is generally a good site. The following page contains a link to a .pdf document brochure which talks about pregnant women as well as a link to an article on another page on the site:
      http://www.vrg.org/family/kidsindex.htm

      For after the baby is born, here is my favorite article about raising vegan kids:
      http://www.vrg.org/nutshell/kids.htm

      Maybe if your wife sees these documents, she will find them helpful (and authoritative).

      Hope that helps.

  • DGH

    I am very cautious about subgroup analysis, as time and again they have failed when replicated in prospective hypothesis-directed trials. One can think of many examples of this phenomenon. The PHS II found an *overall* cancer benefit across the entire population. The researchers then went into the study and tried to tease out which subpopulations had more or less benefit, but trials aren’t powered or designed to really do that, and subtyping by previous malignancy does not make a lot of sense, because many patients who appear to be asymptomatic are harboring occult malignancies (in fact, we all have cancer cells within us). If I recall correctly, the interaction p value by history of malignancy was not statistically positive, but I could be wrong on that. Bottom line: PHS II does show a small but significant reduction in cancers, and this same trial also showed a statistically significant large reduction in fatal MI. I don’t tell people to take multivitamins but those who are taking them (at least males), I encourage them with this news.

    Vegans are a special group that is not well represented in multivitamin trials. We need targeted vitamins in somewhat higher doses than are found in MV’s.

  • Michael

    I think the concern is that if people take a multivitamin they might not try as hard to eat vitamin rich foods (plants). However, in introducing people to a plant based diet a multivitamin can provide some peace of mind that potential gaps are being filled with the pill. This could help people transition to a plant based diet or stick with it. The second most popular concern I hear after protein is micronutrient adequacy in a plant based diet. Maybe a multivitamin can ease some of that concern for those interested in switching.
    Of course B12 supplementation is mandatory and a long chain omega 3 fatty acid supplement is recommended.

  • mrhoagie

    Soils are mineral depleted compared to previous decades. These studies as already expressed primarily use synthetic, man-made, right handed molecular supplements as opposed to whole food based left handed molecular supplement that contain phytonutrients too.

    A an Iowa state professor once told Charles Walters, founder and editor of ACRES USA magazine, “for $100,000 dollars I can prove anything” meaning that, depending upon whom is funding a study will often predetermine the results. The studies I have read by a whole food company like Standard Process of Wisconsin give different results compared to the imitation, synthetics typically used.

  • fracritel

    Hi
    Whenever they do these studies usually they are done with cheap,low dosage, synthetic vitamins which the body does not recognize or assimilate

    • mely

      I am using products from The synergy Company, because Idon’t like cheap symthetically produced supplements because of the fillers, and other ingredients. So far so good!

  • Sebastian Tristan

    Could you please review studies on oat bran? Usually we’re told to eat whole foods, but oat bran seems to have a better nutrition profile than whole oats. I wonder if that translates into better health effects.

  • Broccoli

    “Imagine if instead we spent those billions on healthy food?”
    That may be bad, prices may go up up up up….. or down?

  • naturodoc

    Hi Doc. Your video and the studies raise interesting points. However, while one of the points made was that multivitamins are a distraction from focusing on eating well, exercising, etc I also feel that studies like these on multivitamins can cause people to turn away from other, more specific supplements, some of which have shown incredibly positive effects. Here are some examples:
    http://www.healthstudiescollegium.org/docf/HSC_BFCD6CardioprotectiveNutrients.pdf

    Here is an interesting critique to the editorial you mentioned:
    http://www.lef.org/featured-articles/Flawed-Research-Used-to-Attack-Multivitamin-Supplements.htm?sourcecode=INL303E&utm_source=ConsumerAlert_1217&utm_medium=email&utm_term=ConsumerAlert_1217&utm_content=text_link&utm_campaign=INL303E

    I do not feel the case is closed.

  • JDUB

    I believe the research on Vit D is significant in terms of disease prevention I wouldn’t throw the baby out with the bath water.

  • william doubleday

    can anyone recommend a good multivitamin for men?

    • Brenda

      I can recommend to you one of the most balanced out there and it has nothing in it that nature has not provided. Company has been around for over 58 years with never a product recall. Send me a reply if you would like to read about it. pabranco@fuse.net

    • Troy

      Try eMulti by evolved Natural Solutions. It’s a whole food multivitamin/mineral enhanced with organic superfoods.

  • Interested

    Curious and would like to know if there have there been any long-term studies/trials that actually prove that eating real food fruits and vegetables protect against heart disease, cancer, diabetes, etc – more so than multi? any comparative studies?

  • sue

    There are a number of factors to consider here. Is the nutrition we expect to be actually present in our food? How do we know what kind of soil it was grown in, how long it was stored, whether cooking destroyed any of the nutrition etc. Also, how do we know our body actually takes up the nutrition we provide for it? There are a number of health issues like Coeliac Disease that interfere with absorption. Multivitamins should be plant based not synthetic too. Many nutrients are only absorbed when in the presence of certain others so giving big doses of synthetic single nutrients may result in them passing through

  • Brenda

    Videos like this annoy me! The bigger questions should be: Who did the randomized studies and what TYPE of supplements were being used. As I whole heartedly agree that diet is extremely important to a healthy lifestyle and that supplements are no replacement for a poor diet, but what about the choices as far as diet goes too??? Did they do a background check on the people taking the supplements as far as their diets and what type of supplements were being used? Were they using the tens of thousands of SYNTHETIC supplements out there today that actually do DO more harm than good? I really just shake my head when I see videos like this… they are just not fully researched for one thing, because if you want them, I can show you over 100 peer reviewed medical journal studies that prove that vitamin supplementation works. Check out Shaklee Corporations Landmark Study, done by Gladys Block, ( a very reknowned epidemiologist) and by the way is the only Landmark Study out there that shows that supplements do improve health? (LandmarkStudy.com) They compared people taking multiple Shaklee supplements for over 20 years to people taking random multi vitamins and people taking nothing. The average age was 62 AND the results were better than our scientists ever thought. They tested markers such as C- reactive protein, triglycerides, cholesterol and so much more. So before you snuff out the vitamin issue, please make sure everything is researched. If our diets were so impeccable, we wouldn’t have the obesity pandemic or the “diseases” that we have today and we wouldn’t be ranked 49th in overall health in the world being a country that spends more per person on healthcare than any other country in the world to boot. Time to take control of our own health!

    • Brenda

      P.S. I am 56 years old, I have lived organically and taken supplements my whole life. I have not had a drug, not even an aspirin in my body since the birth of my 24 year old son, and that was only because I had a C-section. As good as I think I eat on a daily basis, I still don’t get everything every day. Therefore, supplements, which are a supplement to your healthy diet, fill in the voids on a daily basis for me. I bike, weight train, run, work out and can complete with 20 year olds, so I will never be convinced that supplements don’t work. And for any athlete, the nutrients you burn up need to be replaced, and you can’t eat enough to get everything you need.

    • Linda N

      Amen Brenda!!

  • DoctorDave

    Anyone out there still confused? I am. This is so because virtually all of the study participants in these huge meta-analyses were eating a standard american diet. Thus, the conclusions really should say “Multivitamins offer little or no value to those eating a standard american diet.” So, given the gross inadequacies in the participant’s diets, they still offered little or no value – so much for fixing diets with multivitamins. Further, the little value that they seemed to offer to some cancer patients could be vastly improved upon if they simply would adopt a low fat, whole food, plant-only diet.

    Products like multivitamins always come from fear mongering and the sales pitch always sounds like an insurance program (Gee, am I getting enough?). Forget about multivitamins. Fix your food choices first, then trust God, nature, or whatever that your food will be adequate. Many studies and extended clinical practice have already clearly shown that it will be (see PCRM’s Kickstarter Program if you are healthy, or Dr McDougall’s resident programs if you are already sick).

    Everyone out there please remember to ask – what was the gross background diet that the subjects were eating? Adding multivitamins to an inadequate diet, or any diet, to fix it is like giving a man dying of thirst some vinegar. If there is anything in the last decade that we have learned it is that here is a lot more in food that we need than a fairly short list of synthetic, concentrated vitamins and/or minerals. Another thing that we have learned is that we vegans do need B12 and vitamin D, from natural sources as much as possible. Let’s trust our low fat, whole food, organic vegan diets for the rest.

  • Bob Stein

    What is your opinion of the research reports done by the Life Extension Foundation? The articles they publish in their magazine look well researched and endnoted but their work often does not agree with yours.

  • Ali

    I wonder if all the vitamins and minerals used in the trial were laboratory produced and not from food sources.

  • Ilana125

    What about if my dr tells me to take a mult because I’m low on iron? (I’m already vegan and eat lots of veggies.)

  • RK

    Hey!!!! What happened to my question to doc???
    Reg rebuttal by Rhonda Patrick….. can I please know why it was deleted?!!

    • Tommasina

      Hey RK, Sorry about that, it had gotten stuck in the spam filter! Comments with links sometimes do. I released it so it should be up now. Thanks!

      • RK

        no worries… thanks for releasing it.

      • RK

        I tried to re-submit… pls feel free to delete one of them if you wish. Thanks!

  • RK

    (Okay, I’ll try again)

    Hi Doc,

    Please take a few minutes to see a rebuttal of the mentioned article ‘

    Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements’ by Dr. Rhonda Patrick who is Ph.D in biomedical science and expert
    on nutritional health. — http://youtu.be/o0u8UdZeOhc

    Really appreciate your feedback.

    Many thanks!

    RK

  • Eskil J.

    What does this mean for fortified foods and drinks? That supplementation in general doesn’t provide any conclusive health benefits? Or just multivitamins?

  • Simeon Long

    hmmm im confused. What if the multivitamin has vitamins b12 or D2 in them… arent we recomended to take these supplements? Went to my local healthfood store today and they were out of B12 and they recomended me a multivitamin… it says 100 procent daily dosage of B12 on the back… shouldnt the control groups have reeped the benifits of atleast B12 and D2… sorry im probably missing something important here. Please help :-)) (by the way been taking alot of your advice for about the last 3 weeks now… its been alot of fun sofar and i really feel great!)

  • igbymac

    Obviously multivitamins are not all the same. Studies of random people taking random MVMMs over random time-frames are meaningless.

    Much time and wasted ink could have been saved had the author turned his mind toward what was being recorded, rather than shilling against supplementation.

    The Journal of the American Medical Association (JAMA) stated:

    “Most people do not consume an optimal amount of all vitamins by diet alone … it appears prudent for all adults to take vitamin supplements,” states the article by Robert H. Fletcher, MD, MSc and Kathleen M. Fairfield, MD, DrPH, both affiliated with Harvard Medical School.”

    Enough said. Do your own research.

  • DRMurphy

    Kind of a “sideways” question. I read that high levels of B12 are associated with an increased risk of prostate cancer ( my affliction). Could it be that one reason a vegan diet is effective in the control of prosate cancer is the inherent constraint on B12 levels? If I should be limiting B12 in order to constrain my cancer, but must have it to be otherwise healthy, then what should I do about B12 supplemetation and what level of B12′ however measured, should be my target?