Do I Really Need a Multivitamin?

INTRODUCTION

At the start of my career as a holistic health practitioner in the early 2000s, I was an advocate of obtaining all of one’s nutrients exclusively from food. With a few notable exceptions, such as folate for pregnant women, I did not prescribe multivitamins to my clients. I deemed them to be generally ineffective and even potentially hazardous additions to a health regimen, as I will explain later.

Until relatively recently, I personally did not take supplements outside of a supergreen powder and medicinal herbs as needed. I had operated under the conviction that my diet surely met and probably exceeded my need for nutrients. After all, for most of my adult life I have consumed a wide variety of nutrient-dense foods, avoided empty calories like refined sugar and processed foods, and eaten pasture raised organic meat and mostly organic produce, with a substantial percentage grown locally. How could I possibly have a nutrient deficiency?

The belief that food alone was amply meeting my nutrient needs was reinforced by my favorite source for nutritional guidance, Sarah Ballantyne, Ph.D. in medical biophysics and award winning researcher (nutrivore.com). Ballantyne is a voice that I trust for evidence-based nutrition information, and a strong advocate of acquiring one's nutrients via consumption of a wide variety of nutrient-dense whole foods. So, when she interviewed Chris Kresser, founder of Adapt Naturals, and endorsed the use of his line of food derived and bioidentical nutrient-based supplements, my interest was piqued. I decided to reevaluate the stance on vitamins I had adopted over twenty years prior in light of significant advances in functional medicine and the concomitant improvements in supplement formulations over that time period.

In this article, I will share some of the evidence that has reshaped my position on supplementation, discuss who can benefit from taking a multivitamin, as well as provide guidance on what to look for and what to avoid when choosing one. But first, I will briefly summarize what had informed my previous view.

FOOD IS BETTER THAN SUPPLEMENTS

The case for obtaining nutrients from food is a strong one. In the paper from the American Journal of Clinical Nutrition entitled Food Synergy: An Operational Concept For Understanding Nutrition, the authors state 

The concept of food synergy is based on the proposition that the interrelations between constituents in foods are significant. This significance is dependent on the balance between constituents within the food, how well the constituents survive digestion, and the extent to which they appear biologically active at the cellular level. A person or animal eating a diet consisting solely of purified nutrients in their Dietary Reference Intake amounts, without benefit of the coordination inherent in food, may not thrive and probably would not have optimal health. This review argues for the primacy of food over supplements in meeting nutritional requirements of the population.

The authors then provide several examples of studies that revealed more potent therapeutic effects from whole foods versus the active isolates within those foods. For example, whole tomato consumption has a more positive impact on human prostate tissue than ingesting the equivalent amount of lycopene.

BUT FOOD ALONE IS NOT ENOUGH

It seems axiomatic that we are best served by focusing upon food as our primary source of nutrients. However, a number of factors in our modern world make it next to impossible to obtain all of the nutrients we need to THRIVE from food alone:

1. Modern agricultural practices have led to soil depletion, resulting in lower nutrient content in crops. This phenomenon, known as agricultural soil erosion, has been studied extensively, revealing declines in essential nutrients like zinc, iron, and selenium in crops.

2. Chronic stress depletes micronutrient concentrations in the body while increasing the demand for them.

3. A shift toward dietary intake heavy in macronutrients but lacking in micronutrients due in part to the ubiquitous access to low-cost, but highly-processed, energy-dense, nutrient-poor food products (macronutrients are protein, fat, carbohydrates, whereas micronutrients are vitamins and minerals.) Food processing further strips nutrients.

4. Increased toxins levels in food like heavy metals and glyphosate interfere with assimilation by binding to nutrients, thereby decreasing bioavailability. These toxins also inhibit the production of nutrients within the growing plant.

5. Global food supply chain. Modern consumers have grown accustomed to having any food they choose regardless of whether it is in season. This, coupled with economic drivers, results in food being shipped thousands of miles before arriving on your plate. Local foods can contain nearly twice the density of certain fragile nutrients than those foods shipped from far away. 

6. Increase in chronic disease. Certain health conditions and medications can interfere with nutrient absorption and utilization. For example, individuals with gastrointestinal disorders may struggle to absorb nutrients effectively, leading to deficiencies even with a seemingly adequate diet. Furthermore, certain diseases increase the demand for nutrients.

7. Industrial agriculture methods reduce food nutrient density. Organic produce, pasture-raised meat, and wild-caught seafood tend to have higher nutrient density than conventional produce, CAFO (concentrated animal food operation) meat, and farmed seafood. For example, eating organic foods instead of conventional can increase antioxidant intake by 40% versus conventional foods. 

8. Pharmaceuticals like metformin can deplete nutrients or affect their bioavailability.

9. Restrictive diets and intermittent fasting limit nutrient intake. For example, a growing percentage of the population must follow an AIP (autoimmune protocol) diet and avoid triggering foods like legumes and nuts, which are nutrient-dense. Low FODMAP is another diet for those with IBS and SIBO that reduces nutrient intake.

While some of these challenges can be overcome by eating locally grown organic produce, and some apply only to certain populations, others affect us all. 

PREVALENCE OF NUTRIENT DEFICIENCIES

The following abridged table from the Linus Pauling Institute reveals just how prevalent nutrient deficiencies are in the U.S.  Note that despite the table including nutrients from enriched foods, a high percentage of the population receives less than the Estimated Average Requirement (EAR - a nutrient intake value that is estimated to meet the requirement of half the healthy individuals in a particular life stage and gender group). For example, less than half of the population acquires adequate magnesium from diet alone, and only 2% get adequate potassium!

National Health and Nutrition Examination Survey 2007-2010: Usual Micronutrient Intake from Food Sources and Prevalence of Micronutrient Inadequacies Among US Residents Ages ≥ 4 Years (PubMed)

* includes enriched and fortified food

# α-tocopherol

† % < Adequate Intake; DFE, dietary folate equivalents 

†† considered an essential nutrient but not strictly a micronutrient

As alarming as the figures are, they are almost certainly underestimated. The RDA was established during WWII to ensure soldiers would not develop acute diseases from nutrient deficiencies. Therefore, RDA numbers reflect bare minimum values rather than optimal ones. In addition, the RDA does not take into account higher nutrient needs for the obese and those with chronic disease, which negatively impact bioavailability. Nor does it factor in the effect of nutrient synergy. For example, magnesium is required for Vitamin D absorption, so if intake of one of these nutrients is insufficient, the other will not be absorbed adequately. 

According to Triage Theory, introduced by Dr. Bruce Ames,  professor of Biochemistry and Molecular Biology at UC Berkeley, proteins and enzymes in the body may be classified as either survival proteins or longevity proteins. Dr. Ames posits that

a modest deficiency of one of the nutrients/cofactors triggers a built-in rationing mechanism that favors the proteins needed for immediate survival and reproduction (survival proteins) while sacrificing those needed to protect against future damage (longevity proteins).

In other words, while modest nutrient inadequacies may not cause overt clinical symptoms, they may still contribute significantly to the aging process and to the development of chronic disease.

You may be asking, “How do I find out if these nutrient inadequacies are impacting ME and my family?” Unfortunately, that question is not so clear cut because testing for nutrient status is notoriously difficult and complex. For various reasons, it can cost thousands of dollars to accurately identify how shortfalls in our diets are impacting micronutrient levels, and some nutrient deficiencies simply cannot be accurately assessed.

99.5% of magnesium in our bodies is stored in the tissues. So, if we try to measure it in the serum or even inside of the red blood cell—which are the two commonly available ways of doing it—we’re not going to get a true picture of magnesium status. There’s a similar problem with calcium. Calcium has to be maintained within a very tight range in our blood, so if dietary intake of calcium falls, the body will remove it from the bone just to maintain the normal range in the blood. This means that even when someone is not consuming enough calcium in their diet, the blood test will be normal. It’s even worse for vitamin K2: we don’t have a way of measuring it in any body fluid or tissue. [1]

All of the foregoing realities of rampant rates of nutrient inadequacy, the serious impact of suboptimal intake of essential nutrients, and the difficulty in identifying the presence of these shortfalls make a strong case for micronutrient supplementation.

BENEFITS OF MULTIVITAMINS

It is beyond the scope of this article to detail the myriad proven health benefits of taking a multivitamin, but here are just a few:

• Vitamin B6 supplementation decreases anxiety and depression after only one month. 

• Magnesium supplementation improves glycemic control indicators in patients with type 2 diabetes. 

• Zinc supplementation improves antiviral immunity 

• Vitamin B12 supplementation prevents the onset and improves the prognosis of depression 

• Selenium supplementation significantly reduces thyroid antibody levels in patients with Hashimoto’s disease 

However, if you do your own research about multivitamins beyond that presented here (which I very much encourage), you will find conflicting information. Even Harvard Medical school, a source for health information that is respected by many, offers equivocal recommendations about multivitamins. One article states, “While the likelihood of harm is small, the likelihood of a clear health benefit is also very small—and also we have no clear proof yet of such benefit.”  A second article from Harvard Health cites several randomized double-blind placebo-controlled trials (the gold standard in research) that conclusively demonstrate the benefit of multivitamin supplementation. 

One possible explanation for these contradictory conclusions is that they were drawn from the findings of studies made with low quality generic supplements. The dramatically different response our bodies have to two different forms of vitamin E supports this notion. Alpha-tocopherol, the form of vitamin E most commonly found in low quality supplements, is 40-50 times less bioavailable than delta- and gamma-tocotrienol. The body is simply not able to utilize the tocopherol form.  To make matters worse, tocopherols have been shown to cause harm by increasing the risk of cancer and heart disease. In contrast, tocotrienols have been found to help maintain healthy lipid levels and cardiovascular health. They reduce the activity of the HMG-CoA reductase enzyme, which is also targeted by statin drugs. Tocotrienols have a more gentle effect on this enzyme however, so they do not typically cause the side effects that are associated with statins. 

Tocotrienols have a proven range of other benefits as well, including reducing blood sugar in diabetic patients, promoting healthy brain function, reducing inflammation, maintaining healthy bones and protecting against cancer. Unlike tocopherols, tocotrienols have no known contraindications or long-term adverse effects.

So, as you can see, ingesting the appropriate form of a nutrient can be the difference between causing significant harm and offering true health benefits. This reality begs the question, “How do I choose the right supplement?”

HOW TO CHOOSE

For the aforementioned reasons, one must be discerning when choosing which type and brand of supplement to take to reap maximum benefit and avoid harm. When choosing a multivitamin, ensure that it is:

• Free of impurities

• Suitable for the condition you are seeking to treat

• Includes the appropriate ingredients in the right ratios to support synergistic interaction

• The correct dosage

• In a bioavailable form

Vitamins that do not meet the above criteria are more the rule than the exception. Many are synthetic, rendering the body incapable of absorbing them. Even worse, many of these supplements end up accumulating in the body in places where they are harmful, rather than helpful. For example, low quality calcium supplements are poorly absorbed, resulting in the mineral accumulating in the soft tissue, rather than the bones. This bioaccumulation causes manifold health concerns, such as increased rates of prostate cancer, heart disease from calcification of arteries, and kidney stones from excess calcium being excreted in urine. 

It goes without saying that we want to ensure that the vitamin we choose provides all of the benefits without the hazards highlighted above. But a newly published study from the The American Journal of Clinical Nutrition concluded that taking even a low-quality generic multi daily multivitamin led to significant improvements in episodic memory and global cognition, equivalent to reducing the participants’ cognitive age by two years! Imagine how much more beneficial a whole food-based bioidentical vitamin that includes phytonutrients like quercetin, broccoli sprout extract, trans-resveratrol, lutein esters, lycopene and citrus bioflavonoids would be.

MY RECOMMENDATIONS

So which vitamins should you take? Adapt Naturals are the ones I take personally and recommend to clients, friends and family. Those of you who have known me for a long time know that I am quite circumspect when offering recommendations or endorsements of supplements. I make every effort to first assess the safety and efficacy of products through firsthand experience. Adapt Naturals, developed by Chris Kresser M.S., L.Ac., co-founder of the California Center for Functional Medicine, the founder of Kresser Institute, and the New York Times best-selling author of The Paleo Cure and Unconventional Medicine are the best I have found. Kresser is one of the most respected clinicians and educators in the fields of Functional Medicine and ancestral health and has trained over 2,000 clinicians and health coaches from over fifty countries.

My personal experience with Adapt Naturals products has been nothing short of miraculous. I was diagnosed with Hashimoto’s thyroiditis in the fall of 2023, an autoimmune condition in which the immune system destroys the thryroid gland. My thyroid peroxidase antibody (TPOAb) levels were at 220 IU/ml (normal is below 30) despite having been on a strict autoimmune protocol diet for months. My TSH levels were elevated. I felt terrible. I was depressed and exhausted. I was achey all over and had brain fog. My hair was coming out in clumps in the shower, and I had to shave my beard because I had developed alopecia barbae. I didn’t know where else to turn and was on the verge of starting pharmaceuticals.

I took a deep dive into researching Hashimoto’s. I learned that three factors needed to be present for it to take hold: a genetic predisposition, a leaky gut and a triggering event. Two of my brothers have Hashimoto’s, so I knew I was predisposed. In my case, I believe that having COVID concurrent with packing and moving across the country triggered the condition. I addressed the leaky gut but wasn’t feeling any better. Having read that dietary insufficiencies might prevent the body from having the building blocks necessary to keep the thyroid functioning optimally, I decided to give Adapt Naturals a try, given that nutrient deficiency was the only stone left unturned.

I started with the BioAvail Multi, and my energy levels increased within a month. Then, I added the BioAvail organ and BioAvail Mag and experienced a marked improvement in my mood and sleep. Next, I added BioAvail E+, which significantly reduced overall joint pain and acheyness. Finally, I added BioAvail Myco, a blend of eight superfood mushrooms, and have noticed an appreciable improvement in my mental acuity and focus. Over the span of a few months, my hair stopped falling out and my beard grew back in. My most recent blood work shows all of my thyroid levels in the normal range. My condition is in total remission! So, now I can say with supreme confidence from personal experience that multivitamins and other supplements can have a profound positive impact upon one's health and wellbeing, and I wholeheartedly endorse their use. 

If you make a purchase through a link I provide, I receive compensation, as I am an affiliate of Adapt Naturals. THRIVING is the discount code associated with my account, which entitles you to 15% off of your purchase when inputted at checkout.  You may want to bookmark this site so you are reminded each time to input the code: https://adaptnaturals.com/THRIVING. 

All of the supplements I mentioned above are available at a discount if purchased as the Core Plus Bundle, which is what I now have on autoship. If you are on the fence about whether you want to make this investment in your health, keep in mind that Adapt Naturals offers a 60-day money back guarantee. While I am confident that you will be more than satisfied, if these products don’t yield the results you are hoping for, nothing is lost. 

CONCLUSION

Whole food sources offer more potent therapeutic effects than isolated nutrient supplements. However, it is nearly impossible to obtain optimal nutrients levels from diet alone, and nutrient deficiencies are prevalent worldwide. When taken at the appropriate dosage and in a bioavailable form, multivitamins have proven benefits to help treat chronic disease and benefit one’s overall health and longevity. The supplement line I recommend and use personally is Adapt Naturals.