RFI #3: Vitamins

For about ten years now I’ve been taking a multivitamin pill each day — you know, the “Centrum Silver” type for Ye Olde Phartes — but I have to tell you all, I’m not convinced that it does anything.

Reason I’m pondering the topic now is because I just read somewhere that taking fish oil pills (for Omega-3 reasons) is a complete waste of time — the only way fish oil seems to do any good is if you get it from actual fish, which I eat about once a week anyway.

So I ask myself:  what about the multivitamin pill?  Is it too a waste of money?  The consensus around seem to be that at best, it doesn’t do you any harm — but that doesn’t seem to be enough reason to swallow the stuff every day.  Or is there any real value to it?  (I should point out that I eat a fairly balanced diet, and I’m not sure that I need any more.)

Serious / informed answers only in Comments, please.


  1. Have you ever been told you are deficient in any vites or minerals? If so, take whatever you need to correct any deficiencies. Everything else is an insurance policy. Most are water soluble, so the body will excrete what it can’t use. As an older gentleman, you might consider staying with a good multi, it only hurts the wallet, and if you’re taking centrum, you aren’t even approaching the ridiculous price some companies charge for their high-end, overpriced pills.

    Vitamin D does appear to have benefit and necessity as a supplement. Between 2000-5000 IU a day is recommended. I get tons of sun, eat eggs and meat, lots of veggies, and I’m still deficient, so I supplement that and the B spectrum, for some reason my body doesn’t use B vitamins well so I take extra. Both B and D are good for mood and energy.

    1. Never had issues with mineral deficiencies. I take the Centrum (and also a Vit D tablet) purely prophylactically.

      1. You’re doing exactly what you should do, which is defined as doing exactly what I do, minus my also taking an additional 500 mg of Vitamin C with breakfast and lunch. The idea for the Centrum is indeed prophylaxis, or insurance, against your diet not containing one of more of what the tablet has, you just don’t know, no matter how “actual” your food is. Like, how much selenium was in the soil that the wheat you ate today was grown in? Without knowing, taking such minimum quantities is wise as well as safe, and pretty cheap (I take the Walmart generic version of it, over 50 version, and of course no iron).

        I believe the concerns cited by Brad_in_IL on Vitamin D toxicity are overblown, based on what I read before I first started taking it. Most people in the US are seriously deficient, and at the time there were no known instances of toxicity outside of some people with rare genetic problems and those who got overdoses due to the manufacturer screwing up. But by all means get your level checked, I did before and after starting to take 5,000 IU, went from badly deficient to good.

    2. Exercise a bit of caution when taking things like D3 and other fat-soluble vitamins. They are not excreted through urine and can build up in your cells, causing a toxicity. I take a daily does of 2000 IUs & have my D3 level checked via blood test twice a year. With fat-soluble vitamins, too much of a good thing is harmful.

  2. You might not notice anything now, but stop taking them and you’ll feel… blah. Just blah. Like goingtothefields said, anything your body doesn’t use it just gets rid of, but I guarantee that your body is using the vitamin B, C and D that you’re putting in to it. You won’t die if you stop, but you’ll be more uncomfortable, and in the case of a vitamin D deficiency, you’ll be grumpy. Grumpier.

    As an aside, I also take vitamins, as well as glucosamine sulfate for my knees and back. If I stop taking the glucosamine, I can feel it normally within a week, and moving around becomes more painful.

  3. If you’re diet is rubbish in general (and you will know it is!) then take them as they give you what you’re not getting from food and/or drink. Better still, improve your diet then what you spend on popping pills can be put to those yummy veggies and fruit (irony alert). But better to get the vitamins and minerals any way you can, yes?

    If you drink a lot of alcohol (no names, no pack drill) then take B6 as a supplement, as alcohol leeches it from the body and B6 slows down, but does not prevent, the development of Korsakoffs’ psychosis. Let’s face it, if you’re drinking THAT much, you’re a gonner anyway.

    Pregnant women are recommended to take folic acid, prior to getting pregnant if they can, as it prevents nuchal tube defects.

    Lucky me had that special ‘lady time’ when I was 40. The incidence of cancers in the family meant a nix on the HRT, so I took homeopathic remedies (pause for the guffawing and tutting to stop). I took Dong Qwai and Starflower oil, once a day, every day. Three months, zero symptoms, all done and dusted.

    Guess at the end of the day ya pays ya money and ya takes ya choice.

  4. If you eat actual food, you don’t need a multi-vitamin. If you stuff yourself with blue boxes of macaroni and fast food, (which I strongly doubt) then you might need one.

    Best thing is (like other said) have your doctor do a workup at your next physical, and the vampires will tell you what you need. I need D3, but I’m good on everything else.

  5. For the past year and a half I’ve been taking first a men’s energy vitamin from Wal-Mart called Alive. I slowly dropped over 30 pounds before I kind of stalled for 3 months. Then I switched to one from a local health and herbal store and I’ve gone down another 10 pounds in the last 3 months. I drop another 10 and I’ve promised myself its time for new, smaller waistline pants. Hell, I’m about ready to drop an underwear size too if not shirts as well.

    In addition, I started on this after reading that drinking a half pint of cold water burns 50 calories and gives a brief metabolism boost. I was already doing that at work, I keep water in the break room fridge. But I started making sure I drank down that half pint twice before and after lunch, and since I bought a nice insulated thermos and a couple of trays of long, thin ice cubes that drop right in, now I drink 1 1/2 to 2 pints of icewater before and after lunch on any weekday. On the weekends, I chug my carbonated sugar water whenever I want to, on the weekdays, usually just at lunch and a can in the evening. That and on workdays, I fill up on lunch, eat a brownie and a glass of milk in the morning and call it breakfast, and often skip supper and just eat a snack instead.

    I haven’t been exercising, I’m on my feet all day at work, with the only break usually being if I need to go take a dump, so at the start or end of the day, going to walk a mile or two is not on my list, parking it in the comfy chair for a while has more priority. Though I have a pair of 10 pound weights I do a little bit with in the evening with my arms, and do some knee bends then and during work. My legs get stiff from all that standing at the counter and the knee bends help. But I figure all of that is just to keep even and the energy vitamins are what is tipping the scale. I’ve dropped weight and kept it off, people have noticed, etc.

    I take the vitamins every morning while heading out the door for work. And if I don’t, I notice it, the lack of energy throughout the day.

    Some years ago I also tried the fish oil pills. You are told to take so many of them you soon get sick of them. And for me anyway, it raised my good cholesterol by just one dang point after 3 months of eating the things like candy. Perhaps others get better effect from them, but not me as I found out.

  6. “Vitamin products are regulated by FDA as ‘Dietary Supplements.’ The law defines dietary supplements, in part, as products taken by mouth that contain a “dietary ingredient” intended to supplement the diet.”
    “In June 2007, FDA established dietary supplement ‘current Good Manufacturing Practice’ (cGMP) regulations requiring that manufacturers evaluate their products through testing identity, purity, strength, and composition.”
    Hmm! Oh, yes! Let the manufacturers evaluate their own products. Great!
    Nonetheless, I, too, take Centrum Silver 50+ and have for over 25 years, even though I maintain an (more than) adequate diet.
    Vitamin D:
    I donate some blood once a year in the dark basement of a hospital building and when the results come to light my Doc may recommend capsules until the next visit to the vampires’ den, when (amazingly) my levels have come back up to normal; he’s extraordinarily concerned about over-dosage and would prefer to let me seesaw; same with the rest of the oil-soluble vites.

  7. I’ve heard that if you take Vitamin D (D3 in my case), take a magnesium supplement as well, it aids in the uptake of the vitamin.

  8. I’ve almost never noticed any difference in how I felt when taking vitamins or not.

    The only time I noticed a difference was when my wife decided to try an MLM out that was doing one of those “superfood juices” and we had to buy the product monthly. That product actually made my sciatica dwindle noticeably. But not so much that I cared when she finally realized she sucked at MLM and we stopped participating and stopped getting the stuff either.

    As a result, I’m in the “I don’t think they really make a difference” camp.

  9. Kirkland (Costco) Mature Multi….
    Does it work? Well, I’m still around looking forward to Anno-77.
    Now, I have to go ride my Triumph.

  10. The isolated antioxidants in most multivitamin products are not good. As others here have noted, the foundation should be nutrition. You probably need to restrict purine intake, so consider the recommendation for fish oil below. You use your brain a lot; you might want to play with high DHA vs high EPA products and see if there’s any difference for you.

    Understanding that YMMV, this is a good start for someone with gout. Insulin resistance is a big player in gout, and managing that generally involves controlling carbohydrate intake.

    Look at the research on coffee cited below; note the need in the research to keep the amount of coffee consistent and not extreme and to maintain adequate hydration) and then keep your food consumption in a 6-10 hour window ending at least 3 hours before bed.

    More targeted lab work would include:
    Fasting insulin (ideally with a glucose challenge, but useful regardless.)
    Blood sugar two hours after a meal is much more useful than fasting blood sugar for ongoing monitoring of insulin resistance, and can help you fine tune your diet. GE makes a good, cheap meter with affordable supplies if your insurance doesn’t cover it.
    Get your vitamin D levels tested, and your parathyroid hormone levels as well. PTH is a good proxy for overall vitamin D metabolism, and intrinsically factors in your inflammatory state (increases D need) ability to conversion D from sunlight or supplements to the active form (varies with all kinds of stuff.) PTH should be in the lower half (ideally lower 1/3) of the reference range.

    Here’s the foundation, and the link:

    Gout researchers Saag and Choi have created a “food pyramid” to outline dietary recommendations for patients with gout, taking into consideration not only high purine foods, but also foods that exacerbate insulin resistance and contribute to metabolic syndrome.

    Saag and Choi have pointed out that following a “rigid purine restricted diet” (1) must be weighed against the fact that a low-purine diet is often high in refined carbohydrates and saturated fat, which may actually aggravate the underlying metabolic factors. In the long run, following a diet that promotes weight loss, improves insulin sensitivity and lipid levels, and lowers uric acid is also crucial in controlling gout symptoms as well as in managing cardiovascular risk. The resulting “food pyramid” incorporates both moderate restriction of purine intake, as well as strategies to improve insulin resistance that are characteristic of the diet used to control metabolic syndrome.(2) An adaptation of this pyramid is shown in Figure 1.

    There are some notable inclusions in this dietary plan, namely, moderate amounts of purine rich legumes and vegetables, as well as fish and poultry. Choi states that plant source purines do not increase risk of gout.(2) In a large observational study of over 47 thousand men, consumption of meat and seafood increased risk of gout by 40-50%, but intake of purine-rich vegetables and legumes did not.(3) Another inclusion is low fat dairy products; in the same study, intake of dairy products was associated with approximately 50% reduced risk of gout.(3) Fish is another inclusion that is recommended in moderate amounts considering its cardiovascular benefits,(2) however, given the high-purine content of fish, a fish oil supplement (no protein content) seems an even better strategy for patients with gout.

    Soft drinks and sweetened juices are discouraged since they contribute to insulin resistance and obesity, however regular consumption of coffee in moderate amounts is allowable. Caffeine is a natural xanthine oxidase inhibitor; this means that it slows down the conversion of purines to uric acid. Therefore as long as intake is consistent on a day-to-day basis, coffee may help lower uric acid levels.(4) If intake is variable, however, coffee may in theory worsen gout, since this pattern results in unstable changes in serum uric acid which may actually precipitate an attack.(2) Of course adequate water intake is necessary to ensure uric acid excretion.

    Finally, it is crucial to note that the base of the pyramid (the most important recommendation) is daily exercise.(2) This benefits metabolic parameters independently of weight loss, and when added to moderate weight loss and appropriate dietary strategies, the effect is even more powerful.

    1. Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Res Ther. 2006;8Suppl 1:S2.
    2. Choi HK. A prescription for lifestyle change in patients with hyperuricemia and gout.CurrOpinRheumatol. 2010;22(2):165-72.
    3. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004;350(11):1093-103.
    4. Choi HK, Willett W, Curhan G. Coffee consumption and risk of incident gout in men: a prospective study. Arthritis Rheum. 2007;56(6):2049-55.

  11. There’s a difference between taking multivitamins and targeted supplements, and they need to be addressed separately:


    The idea behind taking multivitamins lies in the so-called “Pauling hypothesis,” and was introduced in Linus Pauling’s justification for taking megadoses of vitamin C. It has to do with the idea that “minimum daily requirements” are based on distributions of effects in which “most” people do fine. But here’s the problem. Let’s say that you have a vitamin where the “average” requirement is 10, and taking 15 units will cover the standard 95% two standard deviation of a normal distribution (and assume,that this is a normal distribution). That means that if you take 10 units, then 50% of people will be getting enough, and if you take 15 units, then 97.5% of people will be getting enough (since the lower end of the 5% tail will be way overdosed). But that leaves 2.5% (the upper tail of the distribution) who aren’t getting enough.

    All the studies in the world will show that 15 units is plenty for “almost all” people. And it is likely that it will show little or no benefit in taking a supplement in the larger population. What they can’t tell you is whether or not *you* are in the 97.5% or the 2.5%. The *only* way for you to know is to take the vitamin and see if it makes you feel better. The chances are high that it won’t. Unless it does.

    This was the so-called “Pauling hypothesis” about vitamin C. He speculated that there is a range of requirements for vitamin C due to genetic variation on uptake, metabolism, etc. If you are somewhere near normal, then you are fine. But if you have a high requirement, than you will likely be in a constant state of mild deficit. And there’s no real way for you to know. So, what’s the answer? Pauling’s answer was that if the vitamin is a) cheap, and b) safe in the sense of having no downside for overdose, then you might as well spend the pennies a day and take the pill. You essentially have nothing to lose, and a small chance at a benefit for very little cost.

    Now, let’s expand this and use the same logic that was used to stop physicians from doing admit lab screens on patients. Back many years ago when I was in medical school, every patient admitted into the hospital was given a broad panel of lab tests, just to see what their status was. But it turned out that perfectly healthy people kept showing up with abnormal lab tests, and they ended up getting interventions they didn’t need. Why? For the same reason. “Normal” or “reference range” lab values are based on that 95% idea, which means that 5% of people will have “abnormal” results, but not be sick. So, let’s do 20 tests. The chance of being healthy but having an abnormal result on one test is 5%, or 1-0.95. The chance of being healthy but having an abnormal result after 2 tests is (1-.95^2), or about 9%. The chance of being healthy, but having an “abnormal” value after 20 tests will be (1-.95^20) or 64%. In other words, you only have a 64% chance of having “normal” values on every one of the tests. Now, in real world terms it’s not that bad because the distributions of lab values are not really bell curves, and the reference ranges are not constructed to exactly 95% and such, but the principle applies. So now you don’t tend to do these large panels just to do them — they are expensive, and they result in unneeded interventions to fix numbers that really aren’t all that bad.

    The dual of that applies to some of these vitamins. Let’s say that you have are in the group of 97.5% of people that don’t need the first vitamin in the multi vitamin. So, there’s a 2.5% chance you don’t need the first vitamin. There’s a 95% chance you would not benefit from first or the second. What is the chance that you won’t benefit from *any* of the vitamins? Well, if it’s a normal distribution, it would be 0.975^20, or about 60%. So there’s a 40% chance that you would benefit **in some way**. Again, the real numbers aren’t that good, since these really aren’t normal distributions, etc. But that’s the general justification.

    And general studies may not find any benefit for two reasons. The first is that small cohort effects are lost in big studies. Let’s say that you do a study of 100,000 people and there a small cohort of, say, 10 people who benefit greatly from the intervention and a small cohort of people who are *hurt* by the intervention. Neither cohort will likely be identified, and because just as many people are hurt as are helped, it will have *no* effect on the mean outcome. The second is that your benefit may not be measured by the outcomes measurement. If you look, for instance, at mortality only, then a benefit in quality of life will not be noted.

    So, should you take multivitamins? If this rationale is true, then you might try them and see if they help. The chances are they will not, and you can discontinue them. But, if you feel better or your labs in the next checkup get better, then you may be in one of those small cohorts that do better. The people who quote the large studies to tell you that the benefits you feel aren’t real are ignoring real effects in people who represent small cohorts that are lost in the large studies.

    The second area is that of directed supplements. There are a number of dietary supplements and vitamins that have well-documented effects, usually at high dosages. The classic example is niacin and lipids, where in many people niacin has a beneficial effect on cholesterol, etc. that is as good or better than statin drugs. This effect is seen only at high doses — usually 2 to 3 grams per day. For those who follow this, note that the AIM-HIGH studies did not use nicotinic acid, but instead a commercial slow-release version that should *not* have worked, and does not really constitute a counter study to the many that show significant benefit. Talking about “vitamins” when looking at these effects is nonsensical, since you are talking about specific effects of high doses of specific drugs.

    I have personally benefited both ways. Some years ago, I had a number of immune-mediated problems, including rosacea, hidradenitis suppurativa, a vasculitis, and recurrent pneumonia. I started taking high-dose vitamins and they all stopped. I stopped taking vitamins, and some of them came back. I started taking vitamins and they went away again. I’m not sure exactly which ones, but my suspicion is that it was some of the B complex vitamins. With respect to targeted stuff, I used to have a high risk lipid profile. I started taking high-dose niacin, and now have a very low-risk profile.

  12. The co-discoverer of DNA Jim Watson in his book The Double Helix said of Linus Pauling that he was insanely smart. That it would take Pauling 2 weeks to solve the DNA structure problem if he had the info Watson and Crick had. So much for establishing his cred…

    Pauling was firmly convinced of supplemental vitamins. Period, full stop. Done for me.

    We are so far away from our evolutionary diet and lifestyle that we eat ourselves to death. So supplements are good.

  13. Content warning: this is something I read years ago, probably by Theodore Dalrymple.

    Dalrymole was a psychiatrist in the British prison system. He noted that many of his patients were seriously malnourished. This was not because of poverty – they had money for booze, flashy clothing, jewelry, and of course drugs. Their problem was that they literally did not know how to eat, beyond tearing open a bag of potato chips or similar junk food. As children, they had been left to forage for themselves once they were old enough to open the refrigerator.

    IIRC, Dalrymple reported a study in which the inmates in a prison were all given omega-3 supplements. Omega-3 deficiency hampers neurological functions, especially judgment and impulse control. The prison saw a decline of about 50% in violence between prisoners. One prisoner said it didn’t feel like him.

    Or it may have been Clayton Cramer, whom you may remember as an amateur gun-rights scholar.

    In fact it was Cramer; the posting is partway down this page of the archive of his old blog,


  14. Vitamins are inexpensive, and essentially risk free in the doses you’re talking about.

    I take two multivitamins, 6000 IU of Vitamin-D, CoQ10, NAD+ and Vit C daily…also 4 horse tabs of Glucosamine.

    If I don’t I feel it.

  15. I’m taking Vitamin D and Iron pills daily based on advice from my Doctors based on results from regular blood work (at least every 6 months or so, usually more often as my semi-annual appointments from my 2 primary doctors don’t always mesh up).

    My GP also has me on a a multi-vitamin daily on couldn’t hurt, might help plan.

    So my recommendation is see what your Doc says, and go from there.

  16. I am a pharmacist, not that this makes me an expert, but I would like to offer an opinion. Multiple vitamins such as centrum contain only enough ingredients to prevent scurvy, beriberi and ricketts. Don’t waste your money. Instead look into vitamins in concentrations that might provide some real enhancement to your health. I take vit c to prevent infection and vit d to prevent cancer and osteoporosis and as a general immune booster. (Your skin is white because vit d is more important to our health than we currently inderstand.)

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