Multivitamins: To have or not to have

When I make a diagnosis and start treatment, many patients want to know “are there any vitamins I can take to support my getting better?” I love this question because it tells me that the patient wants to be an active participant in their recovery. They don’t just believe that medication will make it all right.

Multivitamins and other supplements are multimillion-rand industries. Just walk into any major pharmacy and view the confusing array of vitamins. Time magazine in 1992:


I have fallen for the hype too. My son can be a bit of a picky eater, I feel like a good mother by giving him a multivitamin to address the shortfalls. I have patients taking various vitamins in the hope of staying younger and stronger for longer. Sometimes people use vitamins as a sort of bargaining point for an unhealthy lifestyle: “I smoke, but it’s ok because I take antioxidants.”  Patients are excited because they have a way to cure all ills.

This way of thinking is encouraged by doctors. We want our patients to have better odds in the health lottery. Think of the vitamin D deficiency “epidemic” of the last decade. I too have been supplementing my Vit D levels, because my blood test reported low levels. Vit D deficiency has been linked to everything from cancer to dementia. While no-one is arguing that a serious deficiency causes serious illnesses like rickets, it now seems that the lab cut off values are arbitrary and not linked to clinical evidence. Further, supplementation has not been shown to be that much of a useful intervention. So, for now, I’m just making sure that I get outside more during the “safe sun” periods of early morning and evening.

The pendulum has swung. A recent meta-analysis suggests that there is not much evidence for the benefits of multivitamin supplementation. It seems as if regular multivitamin use might be associated with a shorter lifespan!

If doctors and scientists can’t get it right, what’s the average Joe supposed to make of this? A few guidelines I use when I think of multivitamin supplementation nowadays:

  • Is there a clinical deficiency that needs treatment?

If someone has symptoms of scurvy, rickets or any of the other deficiency illnesses, then restoring the deficiency is the treatment.

Sometimes it’s less obvious. There might not be an overt illness, but the patient is still not functioning at optimal health. All, literally all, my vegetarian patients have proven to have a Vit B12 deficiency. Patients who have been on the contraceptive pill or anticonvulsants might be folate deficient.

  • Is there a vulnerability in how the body absorbs and uses the vitamin?

We are living in the time of personalised medicine. Genetic tests can now comment on “low penetrance” genes.  These are genes we can influence by diet and behaviour. (In the past, we focussed on “high penetrance” genes, those genes which influence the risk for cancers and serious diseases). Maybe Banting diet is good for you but bad for me. Maybe salt intake will make you sick and have little effect on me. Knowing how your body deals with food and the environment means that you are in control of intelligent health choices.

When I advise patients on how to get vitamins, I focus on how to do so naturally. Feel a cold coming on?- up your naartjie consumption. Taking 4000mg of Vit C as is promoted in some flu remedies is equal to 60-70 oranges! At this dose Vit C is not a nutritional supplement, it’s a drug with potential side effects.

More and more I have come to realise that Granny was right. If it’s too good to be true, it’s probably too good to be true. You can’t take a vitamin to “neutralise” unhealthy choices.



  1. I am a vegetarian and so, I’m afraid that there is nowhere else that I can get my B12 from except as a supplement. I am also bipolar I and there are two supplements which are recommended by the most trusted authority on psychiatry, to be taken as adjuvant therapies, namely N-acetylcysteine (NAC) and Omega-3 fatty acids (typically Salmon or Flaxseed oil). Both have been demonstrated to be efficacious in double blind randomized control studies, though neither are recommended as monotherapies – you still have to take your regular meds.

  2. I forgot to mention what I call “anti-vitamins”. They are substances that create a vitamin deficiency in your body. Alcohol, lead, mercury, air-pollution and cigarette smoke are the most common culprits. Alcohol, for example creates a vitamin B1 deficiency which leads to some characteristic neurological problems. Drink hard enough and for long enough and your brain will develop lesions that will manifest as Korsakov’s psychosis.

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