In a previous column, I discussed the limited efficacy of the $14 billion Americans spend annually on cold and flu supplements. The bottom line is that we can get the vast majority of our immune-boosting vitamins from a varied healthy diet, good sleep hygiene, stress management, and early morning sunlight.
Now comes a massive meta-analysis from JAMA of 84 studies on vitamins and supplements. This review aimed to assess the benefits (or harms) of vitamins and minerals in healthy, non-pregnant adults in the prevention of cardiovascular disease and cancer. This review looked at beta-carotene (a precursor to vitamin A), vitamin D, and vitamin E. Here’s what the researchers found:
Beta-carotene: supplementation associated with increased risk of lung cancer and cardiovascular mortality. Vitamins D and E: Not associated with increased or decreased risk of all-cause mortality, cardiovascular disease, or cancer. In short, no benefit.
Based on these findings, the United States Preventive Services Taskforce 1) recommends the use of beta-carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer and 2) states that there is insufficient evidence to support the benefits or disadvantages of multivitamins or other single or paired nutritional supplements for the prevention of cardiovascular disease or cancer.
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This is a pretty definitive statement, given that Americans will spend $50 billion on multivitamins and supplements by 2021.
Conventional wisdom in medicine holds that multivitamins or nutritional supplements still play a role in certain populations, such as older adults, pregnant people, or special dieters. But there is a lack of definitively consistent evidence for the proven benefit of multivitamins in any of these populations. At an individual level, it remains a better approach to identify and address the specific nutrient deficiency with specific fortified foods or diet.
For example, we continue to recommend pregnant people take prenatal vitamins. Still, the quality of evidence is not very high that this supplementation reduces the risk of a fetus being small for gestational age or developing neural tube defects. It is more likely that the folic acid present in the prenatal vitamin is the most important factor in healthy fetal development. So it may make more sense for pregnant people to take folic acid alone or eat more folic acid-fortified cereals.
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In that sense, this study provides a good opportunity to look at how a broad-based healthy diet can provide some of the most important vitamins and minerals. Here are a few of my favorites:
Vitamin D is key for bone health and immunity, mood, and a healthy circadian rhythm. The best natural source of natural vitamin D is sunlight, which converts precursor molecules in our skin into the active form of vitamin D that we benefit from. The best time of day to get vitamin D is the early morning sun. Doing so right after waking will help maintain a healthy circadian rhythm for the day and also avoid more harmful UVA and UVB rays that are present from the early afternoon.
Fatty fish such as tuna and salmon are high in vitamin D. Egg yolks. Mushrooms also contain steady amounts of vitamin D. Note that the recommended daily intake of vitamin D is 400-800 IU/day – most adults, however, need about 1,000-2,000 IU of vitamin D3 per day, depending on how much sun they get and where they live. I get adequate sun and take 2000 IU a few times a week.
Magnesium is important for blood pressure control and blood glucose control. It is an important cofactor for more than 300 enzymes that regulate protein synthesis and nerve function. Magnesium is necessary for synthesizing and activating vitamin D, so if your diet is low in magnesium, it doesn’t matter how much vitamin D you replenish.
Unfortunately, our Western diet of refined grains and processed foods are poor sources of magnesium. An adequate amount of magnesium can be obtained from dark green leafy vegetables, almonds, legumes such as black beans, and whole grains.
Omega-3 fatty acids are an important part of every cell’s structure. They are an “essential” fat – meaning the body cannot make its fat, and we must get it from our diet. These essential fatty acids are an important part of our brain, the retina of the eyes, the skin, and the nails. They are involved in conducting signals between cells and are a source of energy. While a 2012 meta-analysis found that the heart-protective effects of fish oil weren’t as strong as they used to be, there’s likely a benefit in those at high risk for cardiovascular disease.
Mackerel, salmon, and cod liver oil have some of the highest levels of omega-3.
There are a total of eight essential B vitamins. Primarily, they convert energy sources of carbohydrates, fats, and proteins into energy. For example, 15% of the population is deficient in vitamin B12, especially those who follow a vegan or vegetarian diet. Those who suffer from digestive disorders or who have had gastrointestinal surgery may also be at high risk for vitamin B deficiency.
The main sources of the vitamin B complex are chicken, organ meats, eggs, seeds, nuts, fortified cereals, and grains.
The bottom line is that the most important vitamins and minerals in most healthy adults can be obtained naturally from a balanced diet and daily early morning sunlight. Supplementation may only be necessary for people who cannot get enough sunlight, are older or suffer from high-risk conditions that make it difficult to get vitamins from diet alone.
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Michael Daignault, MD, is a board-certified ER physician in Los Angeles. He studied Global Health at Georgetown University and received a medical degree from Ben-Gurion University. He completed his residency training in emergency medicine at Lincoln Medical Center in the South Bronx. He is also a former United States Peace Corps volunteer. Find him on Instagram @dr.daignault.
