Beware ‘Big Vitamin’

Dr. Harriet Hall of Science-Based Medicine has an excellent post about whether people should routinely take vitamins.

The short answer from the American Association of Family Physicians: In general, multivitamins are unnecessary. Certain populations (such as women planning pregnancy or infants) can benefit from taking certain supplements. However, as a general rule, the need for vitamins and their dose should be tailored to the patient, as large doses of certain vitamins can also cause harm.

A point to consider:

Critics of medicine often pick on Big Pharma for its profit motives. How much money do you think Big Vitamin makes (According to various sources, $20-40 billion a year~Estherar)? How much money is being spent on unnecessary vitamins that provide no real benefit? Any excess is promptly eliminated. Are we just producing expensive urine? Are our toilets getting the benefit? Are all those vitamins in our sewage good for the environment?

One could argue that multivitamins are good for healthy sewage bacteria and healthy profits for manufacturers. But I’d rather support my own health than theirs.

In my practice, I give multivitamins only to people on a very restrictive diet (e.g, children who ‘eat nothing’, or nothing but 3 kinds of food). Otherwise, supplements are tailored to the person’s needs – fertile women get folic acid, those with vitamin B12 defiviency get vitamin B12, postmenopausal women or those who don’t eat/drink milk products get calcium with or without vitamin D. And of course, vitamin D and iron drops for babies under a year old. I also find myself providing education about how vitamins are not a ‘tonic’ – e.g, if there is no iron deficiency, giving a 5-year-old child iron won’t perk him up, so let’s check for it before pushing the iron. Ditto for vitamins in general.

Another important point made in the article:

There is no convincing evidence that taking supplements of vitamin C prevents any disease except scurvy.

Though the tree-huggers at recommend it to cure everything from the common cold to cancer…

Actually, there is something I use vitamin C for other than scurvy: because any extra vitamin C (ascorbic acid) is excreted in the urine, women who suffer from recurrent UTIs can take it to acidify their urine as a precautionary measure. Cheaper than cranberry extract, too.

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11 Responses

  1. In this neck of the woods, parents are up in arms about doctors saying to give *-Vi-Sol to babies starting at 2 months. They claim because it’s made by a formula company (Enfamil) it’s EVIL.

    I try to stay out of that mess, but I do wonder if they make JUST vitamin D drops. Some don’t want to give their kids A, some don’t want their kids to get any iron that isn’t breast milk iron (or some such, I wasn’t listening). So, considering that Vitamin D supplementation can be beneficial at best and harmless at worst, do they make JUST D?

    I for one welcome the vitamin A and I expect him to be shooting lasers out his perfect 20/20 vision any day now. Kidding.

  2. We have vitamin D-only drops here, which is what I prescribe. Until about a year ago the recommendation was A+D drops. I understand Tri-Vi-Sol is A,D &C, but in Canada they have D-Vi-Sol and D-drops.

  3. I’ve never given my babies vitamins; I thought I’d have a third spigot for that if it were really necessary. I usually forget to give the older kids vitamins more than once a week, anyway; or I wait until they see the sugary gummies and beg for their vitamin treat.

  4. This post reminds me of a recent Cochrane review which said that vitamin supplements are of no use in primary and secondary prevention.

    Cochrane Review

  5. Fixed the link for you, Rural Physician. Thank you for it!

    I remember attending a lecture at a medical conference a couple of years ago which, essentially, came to the same conclusion. It made quite an impression on me at the time – I was pretty much in the “No Harm, No Foul” school before that regarding multivitamins.

  6. Should you take them on general principle if trying to conceive?

  7. can i bother you with a question about vitamins for infants?
    when my daughter was about 7 months old, i started giving her poly vi sol (i can’t even remember everything in it, but it had iron and D and some others). the first night after she had it, she woke up screaming. she’d also scrunch her legs up. when i held her, it felt like she was trying to climb right up my body. it seemed like pain was coming in waves, because she’d calm down in between them.

    we called the pediatrician (we were this close to just dashing her off to the ER, it was so scary and so unlike anything that had ever happened). finally, we checked her diaper and she had had a very funny looking, diarrhea-ish BM, which was very unusual, as she’d stopped pooping in her sleep months before.

    anyway, it stopped after about an hour, while we were on the phone with the pediatrician, and we never figured out what caused it. the pediatrician didn’t think it could be the vitamins, but i never gave them to her again.

    so, my question is, have you ever seen this happen with iron or other supplements? i’m scared to start giving my 7 week old vitamins.

    thanks, sorry if this is out of place, i’m not up on blog-etiquette.

  8. You can ask, but always refer to your own pediatrician for medical advice. In this case I happen to agree with your pedi – one episode of diarrhea (or any other minor complant) that follows the administration of a medicine doesn’t mean that the two events are connected. In such a case, I would recommend trying the drops again in a week and seeing what happens. If the stomach pains or diarrhea recurs, there’s a much better chance it IS the drops and an alternative should be sought (if they have several different iron and vitamin preparations here, surely the US does).

    BTW, Iron drops more often cause constipation than diarrhea, though either may happen.

  9. Have you got any evidence for the use of Vitamin C to cut UTI risk? (If so, I’d certainly like to recommend it to patients!)

  10. It’s more of a ‘received wisdom’ than an EBM sort of thing that is sometimes used here, as an adjunct, not as a replacement for antibiotic prophylaxis. Acidification of urine seems to have a bacteriostatic effect. Actual evidence seems to be mixed, however. So if it works for a particular woman, great.

    Here’s some literature on the subject:

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