Saturday, July 2, 2022

What to Look for in a Multivitamin

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The first multivitamins hit the market in 1943. By the 1950s, their bottles could be found on many family dinner tables. Americans were taking them down – and still are. But do we need them?

“People see them as a form of insurance,” says Joanne Manson, a professor of medicine at Harvard Medical School and chief of the division of preventive medicine at Brigham and Women’s Hospital. “They are hedging their bets. I don’t stop anyone from taking a multivitamin. But multivitamins and other supplements will never be a substitute for a healthy diet.”

An estimated one-third of American adults and one-quarter of children and teens take multivitamins, according to the National Institutes of Health’s Office of Dietary Supplements, with US sales totaling $8 billion in 2020.

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Some experts believe that a nutritious, complete diet should be sufficient for many people. Donald D., associate professor of nutrition and preventive medicine at the Mayo Clinic College of Medicine. “I put my emphasis on whole foods,” says Hensrud. “I focus on helping my patients eat a healthy diet.”

But other experts say it’s more complicated, as people often need more vitamins at certain stages of life or have health conditions that make it difficult to absorb vitamins from food. Some need supplements in addition to multivitamins.

“Some nutrients are very difficult to get from food, such as vitamin D, because foods naturally contain so little,” says Bonnie Liebman, director of nutrition at the Center for Science in the Public Interest (CSPI). “Many older people do not produce enough stomach acid to extract natural vitamin B-12 from milk, meat or eggs. Vitamin B-12 deficiency can cause irreversible nerve damage and mimic dementia. Something you want to avoid.”

Facts about multivitamins

Scientists studying multivitamins say there is increasing evidence that multivitamins may offer additional health benefits, including delaying cognitive decline in older people. For example, a recent three-year study of more than 2,200 participants 65 years of age and older, funded by the National Institute on Aging, found that those who took a daily multivitamin demonstrated significant cognitive improvements in abilities, compared with those of a normal age. They tend to decrease as they grow, including in the short term. memory and executive functions, such as decision making, when compared with those receiving a placebo.

The unpublished results, which were presented at a scientific meeting in the fall, showed that those taking multivitamins exhibited only 1.2 years of mental decline instead of three years. In other words, they preserved 1.8 years — about 60 percent — of their mental sharpness. The research was part of a larger trial that looked at the effects of multivitamins on cancer. The results of Anubhuti are expected to be published soon.

The larger study, known as the COcoa Supplementation and Multivitamin Outcomes Study, or COSMOS, began in 2014 to try to replicate the findings of an earlier trial, the Physicians’ Health Study II, which began in 1997. Lasted till 2011. PHS II saw 8. Percentage reduction in total cancer in people 50 and older who took a daily multivitamin, but — unlike COSMOS — showed no cognitive benefit. On the other hand, the COSMOS study, which lasted only three and a half years, found no reduction in cancer.

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But the researchers – the same in both studies – emphasize that the differences in the design and length of the two studies lead to seemingly contradictory results.

“Cosmos was not enough to offset the effects of cancer,” says Howard Seeso, MD, associate professor of medicine at Harvard Medical School and one of the investigators. “For cancer, you really need more time to figure out the impact of nutritional interventions. We’re running with participants, sending out surveys to find out if they’re still taking multivitamins and that To see if they have developed cancer.

There were also significant differences between the two studies in how they measured cognition. For example, the first baseline cognition assessment in PHS II occurred one to two years after the participants took the pills, meaning the researchers would have missed any cognitive improvement that occurred in those first two years, Sesso says.

“Cosmos had a better study design,” he says. “The first baseline cognition assessment took place before starting to take a multivitamin or placebo. Potential benefits were seen at one, two and three years at follow-up assessments.”

Regardless, experts say multivitamins are important for people who suffer from impaired absorption, the result of medications, gastric bypass surgery or digestive disorders such as Crohn’s disease, ulcerative colitis, inflammatory bowel disease and celiac disease.

Multivitamins can also provide essential nutrients during specific life stages. Anyone considering becoming pregnant should take a multivitamin before and during pregnancy to ensure they get enough folic acid, which prevents neural tube defects of the fetus, such as spina bifida. Conversely, postmenopausal women should avoid multivitamins containing iron, as they no longer lose iron through menstruation.

How vitamin D plays a role in your health

Some people also need additional supplements such as B-12 and vitamin D. The latter, essential for bone health, is often insufficient for those who avoid sun exposure — a wise practice to prevent skin cancer — and those in confined homes, such as nursing home residents.

Manson has conducted several studies on vitamin D supplements that suggest that taking extra vitamin D can reduce the risk of developing autoimmune diseases and reduce cancer deaths, although it does not prevent it. can go. “Vitamin D can modify the biology of tumors, so they are less likely to metastasize,” she says.

She is also studying the effect of vitamin D on coronavirus symptoms – specifically, whether it can reduce upper respiratory infections – but has no results yet. Still, she thinks it’s a good idea to take a little more of it. (The recommended daily allowance, or RDA, is 600 international units, or IU, or 15 micrograms, but the amount varies among multivitamins.)

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“During a pandemic I recommend 1,000 to 2,000 IU, even though the jury is still out on benefits during COVID,” she says. “It’s very safe. 600 to 800 is enough for bone health and other chronic diseases.”

It’s also smart to take vitamin B-12 supplements later in life, experts say. Most multivitamins contain 2.4 micrograms, the RDA for adults, but some people may need more, experts say.

“About 15 percent of people over the age of 65 have an early vitamin B12 deficiency,” Hensrud says. He recommends that his patients in this age group take 500 to 1,000 micrograms daily. “Vitamin B-12 is not well absorbed and has a large safety range,” meaning higher doses won’t hurt, he says. “It’s probably the safest vitamin.”

Most dietary supplements do nothing. Why do we spend $35 billion a year on them?

CSPI warns consumers not to rely on multivitamins for adequate calcium and potassium. “You’re better off getting enough potassium by filling half your plate with fruits and vegetables rather than looking for supplements,” says Liebman. “Whether or not you need a calcium supplement depends on how much you’re getting from foods.”

Premenopausal women and men up to age 70 need 1,000 milligrams of calcium per day, she says. “You can’t rely on a multi to get it because it won’t fit in a tablet, and because you can get enough from food.”

She says women need 2,600 milligrams of potassium daily, while men need 3,400 milligrams. “Potassium may help lower blood pressure or help prevent it from rising as we age,” says Liebman. In addition to fruits and vegetables, other potassium sources include dairy foods, beans and seafood.

Most experts agree that taking multivitamins may do no harm and probably help, and that people don’t need to spend a lot of money on them.

“I think a simple multivitamin-and-mineral supplement is appropriate for many people,” Liebman says. “You don’t need a Cadillac of multivitamins. A Chewy is fine. Several store brands are usually totally enough.”

What vitamins should be in your multivitamin

Vitamin A 700-1,050 mcg (2,300-3,500 IU)

vitamin D 20-25 mcg (800-1,000 IU)

Vitamin E 13-35 mg (20-80 IU)

Thiamine (B-1) 1.1 mg or more

Riboflavin (B-2) 1.1 mg or more

folate premenopausal women 660-680 mcg DFE (dietary folate equivalent) (400 mcg folic acid); All else 400-680 mcg DFE (235-400 mcg folic acid)

Vitamin B 12 2.4 mcg or more

calcium Don’t Rely on Multivitamins

Iron premenopausal women 18 mg; All else (no more than 8 mg)

potassium Don’t Rely on Multivitamins

(Note: “or higher” does not mean that the nutrient is safe at any dosage, but levels in multivitamins are unlikely to be high enough to cause harm. This list does not apply to prenatal multivitamins for pregnant people. It happens. See your doctor.)

Source: Center for Science in the Public Interest

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