This blog unlike our usual ones focuses on a topic that’s rather out of the ordinary for us: ‘Multivitamins’.
But why Multivitamins?
Because it is a fascinating topic and we’ve been asked a lot about multivitamins and multivitamin-multimineral products (MVMMs) on social media!
So, What exactly are these MVMMs? What do they all contain? And How useful are they to us?
Let’s begin with, What are MVMMs?
I am sure many of us have taken, thought about taking, or have been ‘incessantly pestered’ (by that one friend/colleague) into considering Multivitamin consumption over the years.
But, have you stopped and thought about what exactly is a Multivitamin or Multivitamin-Multimineral supplement? (besides that all the MLM peeps seem to be selling those in some shape or form)
Worry not! I have done just that, and after reading a fair bit about it.
I can safely say that I know just as much to be sure that, no one knows exactly what it is.
To be more specific and scienc-y;
“Although multivitamin-multimineral (MVMM) and similar terms (eg, multis or multiples) are commonly used, they have no standard or defined meaning and can refer to products with widely varied compositions and characteristics.” (here)
This means anything with 2 or more (‘multiple’ in a crude sense) vitamin or mineral components, in any odd quantity (not exactly regulated), can be named and sold as MVMMs.
Stuff like composition, bioavailability, bioequivalence, and potential for drug interactions is crucial in determining whether a product is good enough for consumption and whether any data published on such a product & its effectiveness can be effectively compared, interpreted & generalized to a population subgroup.
For example, survey results on multivitamin use/intake over the years in a population can be easily confounded(thrown off) by the ever-evolving compositions and marketed ‘intended use’ of a particular MVMM product. (can’t be much ‘reliable’ right?)
Like, a company selling a product ‘X’ as Classic X vs Ultra Strong X (maybe in two different forms; a syrup vs a pill) has the same constituents but vastly different compositions(amount of vitamins/minerals), maybe some added non-vitamin/mineral components as well (eg, dietary fiber, botanicals, glucosamine, lycopene, etc.).
On top of that categorization and defining categories of MVMMsupplements (among other types of supplements) is a whole other rabbit hole. Meaning, that if I were to sell an antioxidant pill (containing >2 vitamin sources and minerals) or an MVMM capsule (with similar composition), or anything marketed in dose form (eg, capsules, tablets, sachets, etc) for use by humans to supplement the diet by increasing the total dietary intake; concentrates, metabolites, constituents, and extracts; or combinations of one or more of these ingredients, I would be near the multivitamin sphere but at the same time very confusingly away from it (from a scientific perspective).
And this vagueness in the categorization of MVMMs and other supplemental products creates a disparity between public opinion and the scientific process, wherein
A layperson can easily confuse ‘similarly marketed’ products like (botanicals, sports drinks amino acids, DHEA, coenzyme Q10, etc.) ultimately confounding the data of a survey they might participate in.
Further, categories like (bodybuilding, weight loss, antioxidants, daytime, nighttime, performance, energy, menopause, hair, and cancer supplements) can be equally misleading for a consumer’s decision-making.
Bioavailability and Bioequivalence are other areas where the MVMM sphere gets blurry,
To simplify, Bioavailability is referred to as the extent and rate to which the active ingredient from a product is absorbed and becomes available at the site of action.
(i.e. After we consume product X and after our body’s metabolic (homeostatic) processes are done with it, how much of the good stuff are we left to work with?)
Similarly, when we say products X and Y are bioequivalent, we assume that they will provide the same effect or that they are therapeutically equivalent. (which is unlikely, given the obtuse selections of MVMM compositions available even among comparable categories.)
Studies on MVMs often use the concepts of ‘absorption’ or ‘utilization’ in defining their ‘bioavailability’, where there are chances of missing the usefulness of certain ‘unabsorbed’ minerals, which can lead to a higher composition in the product. (more isn’t necessarily good always)
Based on this, certain components are balanced for nutrient availability. Like niacin, vitamin B-6, and vitamin B-12 (where bioavailabilities and bioequivalencies are based on mixed diets) making their supplemental use problematic.
For example: balancing folate supplements into DFE(dietary folate equivalents) in this way, can create a problematic situation where a subgroup of the population (even though a small number of people) when taking folate supplements with an already folate-rich diet, can cross the tolerable intake upper limit of 1,000 mcg/day(quite problematic indeed
And not to forget Drug interactions (supplements interfering with some drugs, their actions, and/or producing unexpected results),
Which are unsatisfactorily studied and are downplayed by ‘warning labels’ intentionally put by MVMM manufacturers, as putting these eliminate the need for drug labelling instead of supplement labelling and these statements do not require review or approval by a health & safety administration. Moving on,
Besides the obvious shortcomings, there are certain oversights in the multivitamin world.
And that is, the fact that those who consume and can afford various MVMMs and supplements are unlikely to have vitamin, mineral, or macronutrient deficits in their regular balanced diets,
In fact, demographic literature shows that;
“Adults and adolescents with suboptimal intakes from food sources are less likely to be dietary supplement users. Also, some subgroups of the population who report higher prevalence rates for use of both MVMM products and single vitamin and mineral supplements may be at increased risk of excessive intake.” (here)
That means, people who usually take Multivitamin-Multimineral supplements are likely to be more educated(High school graduate or more), proportionally ‘fit’( BMI <25.0, non-smokers), physically active Moderate-vigorous daily PA), economically stable and older(>35 years) than people who don’t: people who would otherwise benefit the most from MVMM consumption.
Whereas, people who usually consume MVMMare at an elevated risk of excessive vitamin or mineral intake simply because, their dietary nutrient intakes report higher micronutrient intakes from food and healthier diets already. Although MVMM formulations do not typically contain excessive amounts of micronutrients, these products do contribute to the total vitamin and mineral intake of these individuals. (Which if in excess; can produce certain adverse effects in the long run.)
In conclusion:
If you are looking for a product that would add to your performance in some ways or produce some wondrous effects on your physical or mental health, you’d benefit more from better-planned and prepared meals. [Otherwise: look this up (placed just for my amusement)]
If you are a person who falls into certain demographic categories(race, gender, age, ethnicity, or sociocultural groups) which are likely to have certain vitamin or mineral deficiencies like:
South Asian females and anaemia (iron deficiency).
Females planning or capable of pregnancy (likely to benefit from folate supplements).
Otherwise restrictive dietary habits, cutting out certain food groups (vegetarians, vegans, people with eating disorders, or athletes).
Children with PEM.
Other medical/non-medical susceptibilities.
You could benefit from supplementing your diet with MVMMs.
Following are a few recommendations by USPSTF(The U.S. Preventive Services Task Force) regarding Multivitamin-Multimineral consumption. (here)
Harms & Gains considered: USPSTF discourages the use and prescription of Beta Carotene and Vitamin-E in the prevention of cardiovascular diseases and cancer (as evidence shows increased cardiovascular disease mortality and an increase in lung cancer incidence with Beta carotene supplementation and hemorrhagic stroke incidents following supplementation of vitamin E)
USPSTF acknowledges that although there is little evidence of serious harm with MVMMuse in community-dwelling, nonpregnant adults.
Children, pregnant persons, or persons who are chronically ill or have a known nutritional deficiency can benefit from nutritional supplements.
They recommend that all persons who are planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg of folic acid. (additionally: here, here)
Hope this clears a broader stance on where I stand on MVMMs.
More on this topic and Nutrition would be covered in subsequent blogs, subscribe for more.
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Disclaimer: This blog is for educational purposes only.
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