Four Good Reasons to Take a Multivitamin

I do not know how many times I have been asked the question "why should I take a multivitamin?" - but today I am going to share some of the answers with you. This blog post started off as one on immunity. I have had a lot of people asking me lately what they can do to boost their immunity. They seem surprised when I mention taking a daily multivitamin. The following list is by no means an exhaustive list of reasons why you should take a multivitamin, but I think it is some good reasons.

1. Experts agree that we don't get enough nutrition from our food. In the perfect world, all your essential vitamins and minerals would come from the foods you eat every day. You would eat a nutrient dense, modest calorie diet, not worry about weight gain, and feel confident that food was meeting your needs. That is not the world we live in. There is more data than I can cite that clearly shows our diets (even those of us who watch what we eat carefully) tend to be nutrient poor. More often, they are calorie rich AND nutrient poor, which is why we simultaneously have increasing obesity and poor nutrition. In 2001, researchers from the Harvard School of Public Health writing in the New England Journal of Medicine said the following:  "Given the greater likelihood of benefit than harm, and considering the low cost, we conclude that a daily multivitamin makes sense for most adults. Substantial data suggests that higher intakes of folic acid, vitamin B6, vitamin B12, and vitamin D will benefit many people, and a multivitamin will ensure adequate intake of other vitamins." (1)  The following year, researchers from Harvard Medical School, wrote in the Journal of the American Medical Association: "Most people do not consume an optimal amount of all vitamins by diet alone.  Pending strong evidence of effectiveness from randomized trials, it appears prudent for all adults to take vitamin supplements." (2)
2. Taking a multivitamin is good for immunity.  There has been a great deal of research looking at the the use of basic nutrition in the form of a multivitamin for preventing infection and improving immunity.  The vast majority of studies have been done in the over-65 population, because nutritional status tends to decrease and community acquired infections (like the flu and pneumonia) tend to increase and become more deadly as we age.  The findings are almost 100% positive.  Again, far too many studies to cite, but if you search Google Scholar for "multivitamin and immunity" you'll find plenty of good reading material.  What about in the non-elderly?  In a study published in 2003, researchers gave a daily multivitamin to adults aged 45-64 and found that the rates of infection and days of lost work were significantly less in those taking a multivitamin compared to those taking a placebo. (3)  
3. Taking a multivitamin may help you to control your appetite.  Two studies published in November 2007 in the British Journal of Nutrition indicate that taking a multivitamin and mineral supplement may assist in weight management. The first study reported on a survey of survey of 267 men and 320 women aged 20 to 65. (4) The survey found that in men regularly taking a dietary supplement weighed less, had less body fat, and lower BMI than those who did not. Women reported similar results, as well as generally reduced appetite.  In the second study, obese patients were placed on a low calorie diet and either given a multivitamin or placebo. (5) While both groups lost weight equally, those taking the multivitamin reported significantly reduced hunger both between and after meals.  What should this tell us? Our metabolism is driven by nutrients - vitamins and minerals are the cofactors that make all the reactions work. When we lack these nutrients, things just don’t work as well. Moreover, a basic reason we eat is to get the nutrients we need. When the body doesn’t get enough of what it needs, one thing it does is make you feel hungry so you will eat more to get those nutrients.
4. It might make your cells younger.  Let's face it, most of us either want to stay young or be younger.  Most of the focus these days on "anti-aging" is on cosmetic procedures.  You can lift, inject, color, and tighten whatever you want, but that does not change anything but what you see in the mirror.  Research published earlier this year from the National Institute of Environmental Health Sciences found that the cells of multivitamin users were biologically younger than those of non-users. (6) As we age, a piece of DNA called a telomere that resides at the end of your chromosomes gets shorter.  When the telomere is finally "consumed" the cell dies (a process called apoptosis).  Thus telomere length is often looked at a a measurement of cellular age.  This particular study looked at the cells of 586 women aged between 35 and 74.  Multivitamin users had, on average, telomeres that were 5% longer than those of non-users of the same age.

Even if you think you eat really well, taking a multivitamin is a sensible health insurance policy for most adults.  I also think it's a good idea for kids, but perhaps we will leave that for a separate blog post.  I think the hardest thing for most people who have never supplemented before is simply getting started and making this part of your routine.  Here are two ideas to help you get in the habit of taking a vitamin.  First, put them where you will see them every day.  Inside your medicine cabinet is usually not that place.  I suggest setting the bottle of multivitamins by your toothpaste or on the desk in your office (or one in each place).  Second, set a reminder for yourself.  Most of us carry a PDA or cell phone these days.  Set a daily alarm to chime at the time when you want to take your vitamins.  You probably won't need to do this forever, but it can be a great tool when you are trying to make this a new habit.

In Health,


Dr. Jacques


References:
(1) Willett WC, Stampfer MJ. Clinical practice. What vitamins should I be taking, doctor?  N Engl J Med. 2001 Dec 20;345(25):1819-24.

(2) Fletcher RH, Fairfield KM.  Vitamins for chronic disease prevention in adults.  JAMA 2002; 287:3127-312. 

(3) Barringer TA, Kirk JK, Santaniello AC, Foley KL, Michielutte R. Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial.  Ann Intern Med. 2003 Mar 4;138(5):365-71.

(4)(5) G.C. Major, E. Doucet, M. Jacqmain, M. St-Onge, C. Bouchard, and A. Tremblay. Multivitamin and dietary supplements, body weight and appetite: results from a cross-sectional and a randomised double-blind placebo-controlled study. Br J Nutr. 2007 Nov 1;:1-11

(6) Xu Q, Parks CG, DeRoo LA, Cawthorn LM, Sandler DP, Chen H.  Multivitamin use and telomere length in women. Am J Clin Nutr. 2009 Jun;89(6):1857-63.

Cholesterol Confusion

I believe that sometimes there can be too much of a good thing. People have been given so much nutrition information in the past 20 years that they no longer know what is good or bad. Are carbohydrates important for energy or will they make you obese and diabetic? Are fats bad for your heart or good for your brain? Should I eat fish because it's good for me, or will the mercury kill me? Part of the problem is that these questions are not simple yes or no issues, but the other part is that everyone now has a lot of information about food and diet, much of it conflicting, and for the average consumer the unending and rather confusing stream of messages can make every day diet decisions a serious challenge. I recently read a great book about decision making, that discusses the role of information overload in hampering our ability to chose. The book is called How We Decide, by Jonah Lehrer. It's a great read and I hope some of you choose to pick it up.

So I have received several questions along the lines of "what is really true about this food?" I can't answer them all in one post, so I am going to take this one:

Egg yolks- I am very confused. You hear that they raise cholesterol, but I also know much of the nutrition in the egg is in the yolk.

A lot of people are confused about eggs and cholesterol. I am going to try to keep this answer as simple as possible. For most healthy people, the amount of cholesterol they get in diet doesn't really have much to do with the cholesterol in your blood. Most of the cholesterol your doctor finds and measures on your blood test is manufactured by your liver from fats that you eat. A diet high in saturated fat or trans fats will do much more to elevate cholesterol in your blood than the amount of cholesterol you consume. Genetics, and conditions like insulin resistance also contribute. So, generally speaking if you are pretty healthy and have never had high cholesterol on a blood test, you should not get terribly concerned about consuming high cholesterol foods like egg yolks.

The story is a bit different if you have high cholesterol. If you have had high cholesterol on a blood test, studies have shown some benefit in keeping your dietary intake of cholesterol below 300 mg per day. Since a large egg with the yolk has about 200 mg of cholesterol, that still means that people with high cholesterol can enjoy eggs - but they should probably limit themselves to one per day, and try not to consume other high cholesterol foods like shrimp on the same day. If you have high cholesterol and you want to consume a big fluffy omelette, use one whole egg and one or two egg whites. This way you get all the great nutrition in the yolk. Just so you know I am not making this up, the data from the largest US population study of heart disease ever done (the Framingham Heart Study) has shown no correlation between egg eating, serum cholesterol and heart disease (click here to read).

As the questioner notes, while the white of the egg has the protein, the real nutrition is in the yolk. Egg yolk contains all the fat-soluble vitamins (A, D, E and K), lecithin, B1, B2, B5, folic acid, calcium, iron and zinc - I mean WOW!

Now I know once I post this there will be other questions, so here are a few of the answers:

1. Be careful of egg substitutes. If you are vegan and you have baking needs, there are some good products from companies like Ener-G, but if you are considering commercial liquid egg replacers, be careful. They are mostly egg white anyway, so just separating your eggs and using the whites is less expensive and healthier.
2. You can buy eggs now that are fortified with omega-3 fatty acids. I think this is great.
3. Buy organic. I am in general a fan of organic foods. But I think some foods are more important that others and eggs are one. Commercial non-organic eggs are produced with a lot of antibiotics and hormones. If you are going to enjoy the goodness of eggs, no need to spoil it with hormone and antibiotic residue. And truly - try for yourself if you need to - organic eggs taste a lot better than commercial eggs.

So I hope that clears up someone's confusion today! I will eventually try to tackle similar questions about sweeteners, fats, and more, so stay tuned.

In Health,

Dr. Jacques

Welcome

Welcome to my blog. Those who have known me throughout my life would never call me a person of small opinions, but I never thought I would feel inspired to share them in this way. Sometimes, however, something us moves us to action, and that happened to me recently. Let me explain.

I am a doctor of naturopathic medicine. I have had private practice, but have spent most of the past decade in the dietary supplement industry speaking, writing, formulating, and more. I have become very passionate about this industry, it's people, and the ability of good people and good products to affect change. Yet for all the good in this industry, there is ample bad. We have far too many examples of deceptive advertising, products laced with drugs, and other unsavory problems. For these reasons and more, I and others have championed continued industry improvements regulating advertising, labeling, and manufacturing.

So here is what happened to me recently. I got a "friend" request on Facebook from a medical school classmate. That's usually a very nice thing because I have lost track of many of my classmates and I generally like hearing about their lives and how they are doing. I accepted the request and left a nice note on my colleague's wall to say hello. The following day my own page was suddenly inundated with posts from this doctor promoting "miracle" weight loss products and denouncing bariatric surgery. Sigh. (Another thing to know about me is that I have spent the past eight years working in the bariatric surgery industry and serving on the board for the non-profit Obesity Action Coalition.) In a matter of moments my "friend" had managed to fill my page with deceptive advertising for products and offend all the weight loss surgery patients I am connected to at the same time.

So I lost a friend and gained some motivation. I know a lot about natural medicine. And I can use this knowledge for good. The driving force behind this blog is to talk about natural products, diets, and related subjects and look at them with a critical eye. If I can make one person healthier and one person safer, I'll feel pretty good about doing this. I think every consumer of natural products should be able to have a way to understand their safety, their efficacy, the reality behind the claims - good and bad. Because it's fun for me, I might also comment on current health topics and news as well. You may even get a recipe or a book review from time to time.

To get you started, here are a couple of other related pieces I have written:

1. Nutritional Mythology - this is a piece discussing false advertising claims for weight loss products in the dietary supplement industry. This was written for WLS Lifestyles Magazine.
2. Selecting a Weight Management Program - this is a nicely related piece on finding a good weight management program that recently appeared in the OAC Magazine.

Enjoy. Leave comments. Suggest topics.

In Health,

Dr. Jacques