“Multivitamins”, What are they?

Source: Claus Hancke, 05 August 2024

“Multivitamins have no effect”, “Multivitamins do not prolong life”, “Multivitamins are a waste of money” and other similar headlines have been seen recently in various newspapers and media.

The observational study
All of these headlines are based on an observational study from the US, published on the 26th of June this year.

An observational study is a study in which you “observe” various data that has been agreed in advance in an experimental protocol.

It is a relatively inexpensive method because it does not require changing the behaviour of the experimental group, but simply observing how the selected data is distributed in relation to the behaviour, lifestyle
diet, or anything else that the observation group self-reports on a questionnaire.

In the current study (Multivitamin use and mortality risk in 3 prospective US cohorts,
JAMA Network Open. 2024;7(6):e2418729) used data from 3 such observational studies and concludes that there is no effect on life expectancy, which is the factor they focused on.

Strangely enough, the focus is on longevity, because the authors themselves write in the introduction that
the population’s motivation for taking multivitamins is to prevent disease.

But the incidence of disease does not appear in the data presented in the article in JAMA (Journal of American Medical Association). They only focus on life expectancy. They do use the word mortality, but that’s pretty meaningless as mortality is approx. 100% for us humans.

The study has been heavily hyped by the mainstream media, and we have to take it seriously, so that the worst misconceptions can be cleared up.

The funny thing is that if this had shown that multivitamins were healthy and good, it would not have been accepted precisely because it was an observational study. Because those rank low on the ladder of evidence in scientific studies.

The reason is that observational studies have quite a few potentials for error, so-called bias. It is up to
people themselves to answer the questions that the researchers have asked, and it’s neither half blinded,
completely blinded or double-blinded, so it requires extremely unbiased researchers.
But never mind study quality, bias and the usual researcher bias when it comes to vitamins.
Let’s look at what these “multivitamin pills” really are.

When I write like this, it’s because those standard multivitamin pills from the supermarket are not my cup of tea either. Most multivitamin pills contain a wide range of vitamins and minerals, typically 100% of the
recommended daily allowance, also known as the RI (reference intake). This RI dose is too low for some substances (vitamin C, vitamin D, selenium etc.), while for iron in particular it is far too high.
Others contain virtually unabsorbable salts of some substances (magnesium, selenium, etc.)

A little about iron
Those who have listened to my lectures over the past 30 years also know that you should not buy vitamins
with iron unless you have been diagnosed with iron deficiency or are pregnant in the last trimester.

The body normally loses around 2 mg of iron per day, and since most multivitamin pills contain around 14 mg of iron, there is a theoretical net surplus of 12 mg of iron every single day. And this iron accumulates in a protein, the phase reactant ferritin.

Over the years, simply by taking multivitamins, you can build up a depot of iron in this ferritin. Iron is one of the most powerful catalysts for the formation of free radicals (ROS), which in excess can cause major damage to cell membranes and DNA in particular.

If a toddler is taken to the emergency room after eating an entire jar of regular multivitamins from the supermarket, there’s only one thing to worry about – and that’s the ingestion of the large amount of iron.

Iron is easy and quick to top up if you lack it, but incredibly difficult to get rid of if you have had too much. It must be done intravenously with substances such as Desferoxamine or EDTA, both of which bind iron. But it’s cumbersome and slow. The age-old bloodletting is almost faster.

Serum Ferritin is an important marker and if it is above 200 µg/l, there is an increased risk of cardiovascular
disease and cancer. So you have to be careful with iron. It’s a double-edged sword.

To summarise: Never take multivitamins with iron – unless you have been diagnosed with iron deficiency in the form of low S-Ferritin.

Back to the study.
When you consider that a cohort of people have been taking these multivitamins for years, they’ve had it both ways, it’s completely impossible to make an informed assessment as you really have no idea what they have ingested.

I could easily design a multivitamin pill that mainly has a negative effect on the body. It would be cheap, and with enough advertising money, it would probably be sold to the big supermarket chains who look at price, discounts and shelf life.

I would use sodium selenite as the selenium. It costs nothing and I could declare it as selenium. It’s just not absorbed in the body. So the effect that could halve the incidence of heart disease and death, well, it won’t happen.

I would use chromium chloride as chromium. It costs nothing, but is quite inactive compared to chromium yeast, where chromium chloride is converted into GTF chromium (glucose tolerance factor), which stabilises blood sugar levels. Chromium chloride does not have this effect, but can be labelled as chromium on the packaging, so most people would think they’re getting enough.

Every single ingredient found in multivitamin pills can be labelled in this way, even if it’s in a (often cheap) form that has no positive biological effect.
As I wrote above, you can easily construct a very cheap pill with a nice declaration, but without any kind of benefit.

This is not to say that there are only such “junk pills” in the study, but simply to illustrate that when you haven’t defined the quality or content of what people have actually taken, it is more than difficult to get an overview of something as colourful as the concept of “multivitamin pills.”
And when it’s not a well-defined product, it’s frivolous, to say the least, to conclude anything health-related from the given data, and the authors are content to conclude that they saw no difference in mortality in the two groups.

Let me conclude by saying that vitamins and minerals rarely help anything.
-You just can’t be without them.

The most important thing is, of course, a healthy diet, and where this is lacking in content, you should
supplement with good quality vitamins and minerals.

Take care of yourself and others
Claus Hancke
Specialist in general medicine