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home : columns : dr. k May 25, 2016

6/21/2014 10:40:00 AM
Jury is still out on taking multivitamins

DEAR DOCTOR K: I'm a healthy 50-year-old woman. Do I need to take a multivitamin/mineral supplement?

DEAR READER: Following the news on supplements is like watching a pingpong match. One study finds supplements improve health, then another study questions their benefit. Back and forth they go.

One recommendation about vitamin supplements is not in dispute: Women of childbearing age should take folic acid supplements. Folic acid (often classified with the B vitamins) reduces the risk of a woman giving birth to a baby with neural tube defects. The most common of these defects is called spina bifida. Neural tube defects can cause permanent neurological damage: difficulty swallowing, breathing and moving. IF YOU ARE A WOMAN OF CHILDBEARING AGE WHO WANTS CHILDREN, AND YOU ARE NOT TAKING DAILY FOLIC ACID SUPPLEMENTS, TALK TO YOUR DOCTOR: YOU PROBABLY SHOULD BE. Did I say that loud enough?

Another recommendation that is not in dispute: If you have osteoporosis (thin bones) or osteopenia (borderline thin bones), you should talk to your doctor about taking vitamin D, along with calcium. They protect your bones.

Now we get into the controversy. Last year, the U.S. Preventive Services Task Force, a panel of disease prevention experts, reviewed research published over the past decade. The task force concluded there isn't enough evidence to support use of vitamin and mineral supplements to prevent heart disease, cancer, or deaths from these diseases in healthy adults. So does this close the book on supplements for disease prevention?

My colleague Dr. Howard Sesso, an epidemiologist at Harvard-affiliated Brigham and Women's Hospital, doesn't think so. As an example, he points to the Physician's Health Study. This large, well-designed study found taking a daily multivitamin significantly reduced cancer risk.

Individual vitamins and minerals, such as vitamin D, also warrant further study. A number of observational studies suggest vitamin D may help prevent chronic diseases, besides its beneficial effect on thin bones. Dr. Sesso is working on a large, long-term trial that will study the effects of vitamin D on cancer, heart disease and stroke risks.

While the research continues, ask your doctor for an individualized recommendation. If you have or are at risk for osteoporosis, for example, your doctor will likely recommend calcium and vitamin D.

You can also consider a daily multivitamin if your diet is less than perfect. It doesn't replace a balanced diet, but it can help fill nutritional gaps. And we don't know of health risks from taking a multivitamin.

If you choose to take a supplement, stick with the major brands. They are well tested and are more likely to fall in line with recommended doses. (I've put tables listing recommended amounts of vitamins and minerals on my website,

Avoid specialized multivitamin formulations -- for immunity support, heart health, energy, etc. -- unless your doctor recommends otherwise. One exception: If you are over age 50, choose a vitamin designed for seniors. It will contain the right vitamin and mineral levels for you.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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