The Setright Letter
Multivitamins Nutritional insurance, Are multivitamins
beneficial or of no use?
An Independent review of Complementary Medicine Evidence
By Russell Setright
Taking multivitamins is said to help the immune system, improve memory, enhance wellbeing, reduced risk of Autistic Spectrum disorder, and reduce cancer risk, birth defects, cataracts and Macular Degeneration. Some have stated that taking vitamins in any form is a waste of money and there is no evidence that they are beneficial to health.
These are big statements but is there any evidence to support the use of multivitamins? A literature search was undertaken on the use of vitamin/mineral combinations (multivitamin formulas) and there effect on health.
Following are few examples of clinical trials and studies that have reported the positive effects of multivitamin supplementation.
Basically there are two types of immune-functions; our adaptive immune system, which is activated when we mount a defence against a new invader and then retain antibodies and memory for immunity in the future. And our innate immune system, the almost immediate reaction your body has, for instance, when you get a cut or a skin infection.
In primates, this action of "turning on" an optimal response to microbial attack only works properly in the presence of adequate vitamin D.
The benefits of improved nutrition by the use of multivitamin and mineral supplementation on immune function and general wellbeing have been demonstrated.
A study found supplementation with a multivitamin containing the B group of vitamins, vitamins C and E + selenium slowed the progression of the HIV virus by half in the first two years(1)
Previous studies have also found that HIV progression is slowed in those taking multivitamin mineral formula compared to placebo (2) However, this is the first trial to look at early intervention that is before HIV infection has progressed to AIDS. The authors of the study stated that immune system support given by multivitamin + selenium combination could explain the statistically significant benefit in the reduction of HIV progression to AIDS.
There are many types of cancer. The most common causes are thought to be due to immune suppression, free radical disease, poor diet, or toxic substances. However, most cancers have one thing in common. Cancer cells form tumours that destroy or compress other normal tissues. These malignant tumours are characterised by unrestrained cell growth and can spread to other parts of the body (metastasis). Up to 25% of Australians may develop some type of cancer, however, it is important to remember that cancer is a word not a death sentence. Early detection and prompt treatment combined with a good diet and improved lifestyle can make the difference between health and disease
An 11 year plus study, Physicians’ Health Study (PHS) II) of 14,641 male health professionals who were randomly assigned to receive a daily multivitamin or placebo has again found that vitamin supplement users receive a number of important health benefits; the study found that a daily multivitamin use may reduce the risk of developing cancer by 8% and although no significant reductions were observed for major cardiovascular events including heart attack and stroke, the study did find among a smaller number of multivitamin users who already had cardiovascular disease at the start, there was a significant reduction in the risk of dying from a heart attack by 44 per cent (3)
Multivitamin supplementation may also help protect women from certain cancers. A study of 7,728 women who developed invasive breast cancer was undertaken and a comparison of mortality rates revealed that women with invasive breast cancer who took multivitamin/mineral supplements were 30 percent less likely to die from their cancers than women with invasive breast cancer who hadn't taken the supplements(4)
Another study of 1,100 current and former smokers found that those supplementing with multivitamins had a 43 per cent reduction in gene suppression/damage (gene methylation) in the airway epithelium of smokers. Suppression of this process, such as caused by smoking, is associated with the development of cancer.
The authors stated the study is further evidence that nature-identical, synthetic micronutrients in multivitamins can be effective in disease risk reduction as micronutrients from vegetables and fruits(5)
In an animal study The authors concluded that "multivitamin and mineral supplements synergistically contribute to the cancer chemopreventative potential, and hence, regular supplements of multivitamins and minerals could reduce the risk of colon cancer(6)
Vitamin B3 and skin cancer
There were a total of 463 nonmelanoma cancers diagnosed in the placebo group and 336 in the intervention group over the 12-month intervention period. During this time, the mean number of cancers per person was significantly lower for the intervention group versus the placebo group (1.8 and 2.4, respectively). This represents a rate that was lower by an estimated 23% with the use of nicotinamide after adjustment for study center and nonmelanoma skin cancer history, and a reduction of 27% without adjustment (P = .02). The rate of new nonmelanoma skin cancers was lower in the nicotinamide group at each 3-month visit during the 12 months that the drug was administered; however, the effect dissipated at the 6-month follow-up after nicotinamide was discontinued.
The reduction in the rate of new basal cell carcinomas specifically was an estimated 20% after adjustment (P =.12), and the reduction was 30% for the development of new squamous cell carcinomas (P =.05). At the 6-month follow-up after treatment with nicotinamide was stopped, there were no significant differences noted with regard to either rate.
The number of actinic keratoses specifically also was found to be significantly reduced, with an average of 3 to 5 fewer actinic keratoses observed from the baseline count in the nicotinamide group compared with the placebo group. Despite the fact that study participants were a high-risk population, only approximately one-half used sunscreen within the week before the study and the rate of sunscreen use in the nicotinamide group was lower throughout the study period compared with the placebo group. No differences in the number or type of adverse events were noted between groups.
(Andrew C. Chen, M.B., B.S., et al. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention N Engl J Med. 2015;373:1618-1626)
Memory and Alzheimer’s Disease (AD)
Alzheimer’s disease accounts for around 50 per cent of all senile dementia sufferers and without doubt, as we grow older, this form of dementia is the most dreadful. This disease is distinguished by a steady and progressive loss of memory due to the deterioration of brain function and wasting. This deterioration is also associated with the presence of tangles of fibres and plaques within the brain nerve cells.
Alzheimer’s disease may begin at any age after forty but is most likely to affect individuals over fifty years of age. Over the years there has been a better understanding of this disease, but with all our modern technology and knowledge, modern medicine still has no answer to its treatment and/or cause.
There are many theories regarding the cause of Alzheimer’s disease, ranging from genetic deficiencies to slow acting viruses and although these may indeed have merit. Nutritional deficiencies and toxic mineral accumulation over the years may be the key to the cause of both Alzheimer’s disease memory loss and other types of senile dementia.
Studies have found that multivitamins supplementation may also improve memory, mood and general wellbeing. A systematic review of randomized controlled trials was performed and a meta-analysis of 10 studies was undertaken. The results found that supplementation with multivitamins were found to enhance immediate free recall memory (7)
In an older Cross-sectional and prospective study of dementia among 65 years or older people were assessed in 1995 to 1997 for prevalent dementia and AD, and again in 1998 to 2000 for incident illness and supplement use was ascertained at the first contact.
The authors concluded that the use of vitamin E and multivitamin containing vitamin C supplements in combination is associated with reduced prevalence and incidence of AD. Antioxidant supplements merit further study as agents for the primary prevention of AD(8)
The effects of multivitamins are most often researched in the elderly. However this study looks at multivitamin mineral supplementation and psychological functioning in healthy middle aged adults.
The study shows how a proprietary multivitamin and mineral supplement improves mood and mental performance while also reducing stress, mental tiredness and fatigue in healthy males.
In a randomized, double-blind and placebo-controlled study, 215 men in full-time employment aged between 30 and 55 were given either a multivitamin or a placebo for a period of 33 days. The group reported significantly improved ratings of general mental health, reduced subjective stress and increased ratings of 'vigour', with a strong trend towards an overall improvement in mood.(9)
Another study found that vitamin and mineral supplements can enhance mental energy and well-being not only for healthy adults but for those prone to anxiety and depression(10)
Autism Spectrum Disorder
The term “Autism Spectrum Disorder” includes Autism/Autistic Disorder, Asperger’s Syndrome and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS).
ASD often causes individuals to struggle to understand and relate to other people and to their environment and this can often result in extreme behaviour, which can be seen as tantrums in children or rudeness in adults. It is the only way they have to indicate how anxious they are feeling
Supplementing with multivitamins peri-conventionally may help reduce the incidence. A study found that women who reported not taking a daily prenatal multivitamin immediately before and during the first month of pregnancy were nearly twice as likely to have a child with an autism spectrum disorder as women who did take the supplements and the associated risk rose to seven times as great when combined with a high-risk genetic make-up, a study by researchers at the UC Davis MIND Institute (11)
The most common cause of blindness in Australia is macular degeneration (MD) with 12,000 cases of late stage MD diagnosed each year. MD affects twice as many women as men.
The symptoms of MD include blocked central vision or empty spaces, straight lines appear distorted or wavy and colours can be hard to distinguish. MD usually affects people over the age of 50 years and its onset has been associated with long-term exposure to sunlight, smoking and a lack of the important dietary antioxidants including vitamin C, E and the minerals zinc and copper. Studies have found that supplementing with a combination of the above antioxidants can reduce the incidence of the disease by up to 25 per cent and may reduce the progression of the degeneration resulting in vision loss by around 19 per cent. Also emerging epidemiological and clinical data for the carotenoids lutein and zeaxanthin and for omega-3 fatty acids.is positive(12)(13)(14)
A cataract, or a clouding on the lens, is a problem that affects people as they grow older. Vision is affected and the eyes can have a watery look. The work comes from the Greek for 'falling water'.
The cause is not fully understood but it is believed free radicals can be one of the causes. It is more common for cataracts to develop in elderly people. Research has found supplementing with antioxidant nutrients (beta-carotene, vitamin E and C) may reduce the occurrence.
Daily multivitamin supplement use over a long period was found to lower cataract and ARMD risk in men, The study was part of the Physicians' Health Study II (PHS II) and was a randomized, double-blind study from 1997 to 2011 of 14,641 U.S. male doctors age 50 and older. 50 per cent took an antioxidant formula and multivitamin supplements daily. The other half took a placebo.
The results showed a 9 to 13 percent decrease in risk of developing cataracts for those that took the supplements(15)
There are a number of factors that contribute to an increased risk of birth defects. These include nutritional status of the parents, sex of the infant, birth weight, and environmental factors. It is more probable that birth defects are caused by a combination of these factors, all of which should be modified in our endeavour to reduce the problem.
Spina bifida, one of the most prominent neural tube defects, is a congenital birth defect that affects more than one in 2,000 babies. During the third and fourth weeks of embryonic life, the neural groove, which runs along the back of the embryo, fuses to form the neural tube, the forerunner of the central nervous system. If the neural tube in the spine does not fully close during the prenatal period, this leaves the spinal cord unprotected and may result in protrusion of part of the contents of the spinal canal through this opening. There are three forms of the condition, ranging from very slight to very severe.
To number of studies examine the effect of multivitamin supplementation on the incidence of children being born certain birth defects have been undertaken. One of these examined the incidence of cleft pallet and supplementing with multivitamins. Eighty-six cases and 172 controls were enrolled. The results found that mothers who took a vitamin supplement were significantly less likely to have a child with cleft pallet(16)
Another study was undertaken to determine the association between prenatal multivitamin supplementation and congenital genitourinary tract anomalies.
In this study a total of 46,850 births were registered and 122 (26/10,000) of them were identified to have a genitourinary tract anomaly.
The results found that prenatal multivitamin supplementation during the first, second, and third trimesters of pregnancy was associated with a reduction in the risk of these anomalies.
The authors of the study concluded that maternal prenatal multivitamins may reduce the risk of congenital genitourinary tract anomalies, not only during the first 8 weeks of gestation but also later in pregnancy(17)
Multivitamins containing folic acid appear to be more effective at preventing neural tube defects than high dose folic acid supplements, It concludes that multivitamins should contain between 0.4 - 0.8 mg of folic acid for pregnant women to prevent neural tube defects and some other congenital abnormalities.
This randomized and two-cohort controlled trials showed that periconceptional multivitamin supplementation can reduce the occurrence of some other structural birth defects. The first intervention trial was a randomized controlled trial involving 2,819 participants supplemented with multivitamins containing 0.8 mg of folic acid, and 2,683 unsupplemented participants. The second trial was a two-cohort controlled trial involving 3,069 participants supplemented with the same multivitamins, and 3,069 unsupplemented participants.
A comparison of these results found multivitamins containing 0.8 mg of folic acid were more effective for the reduction of neural-tube defects than high dose folic acid supplements. Also, only multivitamins were able to reduce the prevalence at birth of obstructive defects of urinary tract, limb deficiencies and congenital pyloric stenosis. Folic acid was effective in preventing some part of rectal/anal stenosis/atresia, and high dose of folic acid had effect in preventing some orofacial clefts.
The authors concluded that the findings are consistent that peri-conceptional multivitamin and folic acid supplementation reduce the overall occurrence of congenital abnormalities in addition to the demonstrated effect on neural-tube defects (18)
Multivitamins and Cardio Vascular Disease Prevention
Although taking a daily multivitamin was found to slightly reduce the incidence of all cause death, it was not significantly associated with a reduction in death from cardio vascular disease (4).
1. Marianna K. Baum, Adriana Campa, et al. Effect of Micronutrient Supplementation on Disease Progression in Asymptomatic, Antiretroviral-Naive, HIV-Infected Adults in BotswanaA Randomized Clinical Trial JAMA. 2013;310(20):2154-2163.
2. Jiamton S, Pepin J, Suttent R, et al. A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok. AIDS. 2003;17(17):2461-2469
3. Gaziano J, Sesso HD, Christen WG, et al. Multivitamins in the Prevention of Cancer in Men: The Physicians' Health Study II Randomized Controlled Trial. JAMA, 2012; DOI: 10.1001/jama.2012.14641
4.. S. Wassertheil-Smoller, A. P. McGinn, N. et al. Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the women’s health initiative. Breast Cancer Research and Treatment, 2013; DOI: 10.1007/s10549-013-2712-x
5. C.A. Stidley, et al. Multi-Vitamins, Folate, and Green Vegetables Protect Against Gene Promoter Methylation in the Aerodigestive Tract of Smokers, Cancer Research 2010 Jan 15;70(2):568-74
6. Albert Baskar Arul, Ignacimuthu Savarimuthu, et al Multivitamin and mineral supplementation in 1,2-dimethylhydrazine induced experimental colon carcinogenesis and evaluation of free radical status, antioxidant potential, and incidence of ACF. Canadian Journal of Physiology and Pharmacology, 2012; 90 (1): 45 DOI: 10.1139/y11-100
7. Grima NA, Pase MP, Macpherson H, et al. The effects of multivitamins on cognitive performance: a systematic review and meta-analysis. Alzheimers Dis. 2012;29(3):561-9. doi: 10.3233/JAD-2011-111751.
8. Peter P. Zandi, PhD; James C. Anthony, PhD et al. Reduced Risk of Alzheimer Disease in Users of Antioxidant Vitamin Supplements. Arch Neurol. 2004;61:82-88.
9. Northumbria University (2010, May 20). Multivitamins can add sparkle for healthy young people News Release
10. Panel discussion July 15 2013 Institute of Food Technologists (IFT) Annual Meeting & Food Expo® held at McCormick Place.
11. Rebecca J. Schmidt, Robin L. Hansen, et al. Prenatal Vitamins, One-carbon Metabolism Gene Variants, and Risk for Autism. Epidemiology, 2011
12. Aslam T, Delcourt C, et al. Micronutrients in age-related macular degeneration. Ophthalmologica. 2013;229(2):75-9. doi: 10.1159/000343708. Epub 2012 Nov 20.
13. Chew EY1, Clemons TE, et al. Long-term effects of vitamins C and E, β-carotene, and zinc on age-related macular degeneration: AREDS report no. 35. Ophthalmology. 2013 Aug;120(8):1604-11.
14. Chew, E. Presentation at Retina Subspecialty Day, American Academy of Ophthalmology Annual Meeting, Las Vegas USA, 10 Nov, 2006.
15. William G. Christen, Robert J. Glynn, et al. Effects of Multivitamin Supplement on Cataract and Age-Related Macular Degeneration in a Randomized Trial of Male Physicians. Ophthalmology, 2014; 121 (2): 525 DOI
16. McKinney CM1, Chowchuen B et al. Micronutrients and oral clefts: a case-control study. J Dent Res. 2013 Dec;92(12):1089-94. doi: 10.1177/0022034513507452. Epub 2013 Oct 4.
17. Fernández N1, Henao-Mejía J et al. Association between maternal prenatal vitamin use and congenital abnormalities of the genitourinary tract in a developing country. J Pediatr Urol. 2012 Apr;8(2):121-6. doi: 10.1016/j.jpurol.2011.07.005. Epub 2011 Sep 17.
18. Czeizel AE. The primary prevention of birth defects: Multivitamins or folic acid?. Int J Med Sci 2004; 1:50-61.
The information given by Naturopath Russell Setright in this article is for general educational purposes only and not for the treatment of any disease or condition. Always see your Healthcare Practitioner for any suspected disease accident or condition and follow there expert advice.