s, such as
vitamins and
dietary minerals.]]
A
multivitamin is a preparation intended to supplement a human diet with
vitamins,
dietary minerals and other nutritional elements. Such preparations are available in the form of tablets, capsules, pastilles, powders, liquids and injectable formulations. Other than injectable formulations, which are only available and administered under medical supervision, multivitamins are recognized by the
Codex Alimentarius Commission (the
United Nations' authority on food standards) as a category of
food. Multivitamin supplements are commonly provided in combination with
minerals. A multivitamin/mineral supplement is defined in the United States as a supplement containing 3 or more
vitamins and
minerals that does not include
herbs,
hormones, or
drugs, where each vitamin and mineral is included at a dose below the tolerable upper level, as determined by the Food and Drug Board, and does not present a risk of adverse health effects.
The terms multivitamin and multimineral are often used interchangeably. There is no scientific definition for either. Linguistically, the terms are compounded words of which meaning can be derived in that capacity.
History
Multivitamin-multimineral products providing more than vitamins A and D became available in the USA in 1915 when Dr. Forrest Shaklee developed Vitalized Minerals in liquid form. It wasn't until the mid-1930s however that multi-vitamins became available in pharmacies and grocery stores. In 1934
Nutrilite Company introduced the first multivitamin-multimineral tablets. These supplements were made from natural dried and compressed vegetable and fruit concentrates. In the early 1940s other brands started to produce synthetic tablets.
Multivitamin products and components
Many multivitamins are formulated and/or labeled to differentiate consumer sectors e.g. prenatal, children, mature or 50+, men's, women's, diabetic, stress or megavitamin. Consumer multivitamin formulas are available as tablets, capsules, bulk powder, or liquid. Once and twice per day multivitamin formulas dominate common usage, although some formulas are designed for consumption 3–7 times per day or even allow hourly use.
Compositional variation amongst brands and lines allows substantial consumer choices. Modern multivitamin products roughly classify into RDA (recommended dietary allowance) centric multivitamins with or without iron, RDA centric multivitamin/multimineral formulas with or without iron, higher potency formulas with mostly above RDA components with or without iron, and more specialized formulas by condition, such as for diabetics or by less common components, such as diversified antioxidants, herbal extracts or premium vitamin and mineral forms. Legally, the United States Food and Drug Administration allows a multivitamin to be called "high potency" if at least two-thirds of its nutrients have at least 100 percent of the DV. In practice, "high potency" usually means substantially increased vitamin C and Bs with some other enhanced vitamin and mineral levels, but some minerals may still be much less than DV.
Some components are typically much lower than RDA amounts, often for cost reasons, e.g. biotin, usually the most expensive vitamin component, at over $4000 per active pound, is typically added in at only 5%-30% of RDA in many one per day formulations. Biotin is required to be present at 100% of the value of the B-vitamins for they to be absorbed by the body. Any B-vitamins that cannot be absorbed due to a lack of biotin are eliminated by the body. Likewise, boron and magnesium are considered essential for the bioavailability and absorption of Vitamin D and calcium. Sometimes low content composition is for population subgroups, where the RDA would be inappropriate, such often occurs with iron, where the original population intake calculation was ca 12–13 mg iron per day by including menstruating females but some percentage of HFE variant gene bearing males with high iron retention, and others, may only need as little as ~1 mg iron per day including the normal dietary contribution.
Basic commercial multivitamin supplement products often contain the following ingredients:
vitamin C, B1, B2, B3, B6, folic acid (B9), B12, B5 (pantothenate), H (biotin), A, E, D3, K1, potassium iodide, cupric (sulfate anhydrous, picolinate, sulfate monohydrate, trioxide), selenomethionine, borate(s), zinc, calcium, magnesium, chromium, manganese, molybdenum, betacarotene, and iron. Other formulas may include additional ingredients such as other carotenes (e.g. lutein, lycopene), higher than RDA amounts of B, C or E vitamins including gamma-tocopherol, "near" B vitamins (inositol, choline, PABA), trimethylglycine (anhydrous betaine), betaine hydrochloride, vitamin K2 as menaquinone-7, lecithin, citrus bioflavinoids or nutrient forms variously described as more easily absorbable.
Uses
By supplementing the diet with additional vitamins and minerals, multivitamins can be a valuable tool for those with dietary imbalances or different nutritional needs. People with dietary imbalances may include those on restrictive diets and those who can't or won't eat a nutritious diet. Pregnant women and elderly adults have different nutritional needs than other adults, and a multivitamin may be indicated by their physicians.
The proponents of orthomolecular medicine recommend individually optimized vitamin intakes, usually at higher doses than standard recommendations (such as the US RDA). They also recommend more absorbable forms of vitamins and minerals, in inexpensive but higher potency formulas, spread across the day.
Manufacture
Precautions
While multivitamins can be a valuable tool to correct dietary imbalances, it is worth exercising basic caution before taking them, especially if any medical conditions exist. In particular, pregnant women should generally consult their doctors before taking any multivitamins: for example, either an excess or deficiency of
vitamin A can cause birth defects. Some analyses have suggested that long-term use of beta-carotene, vitamin A, and vitamin E supplements may shorten life rather than extend it, with the additional risk being particularly large in smokers.
Severe vitamin and mineral deficiencies require medical treatment and can be very difficult to treat with common over-the-counter multivitamins. In such situations, special vitamin or mineral forms with much higher potencies are available, either as individual components or as specialized formulations, sometimes requiring a prescription.
Multivitamins in large quantities may pose a risk of an acute overdose, due to the toxicity of some components, principally iron. However, in contrast to iron tablets, which can be lethal to children, toxicity from overdoses of multivitamins are very rare. There appears to be little risk to supplement users of experiencing acute side effects due to excessive intakes of micronutrients. There also are strict limits on the retinol content for vitamin A during pregnancies that are specifically addressed by prenatal formulas. Additionally, various medical conditions and medications may adversely interact with multivitamins.
Many common brand supplements in the United States contain levels above the DRI/RDA amounts for some vitamins or minerals.
Scientific assessment
Evidence in favor
In 2002, a paper by Robert H. Fletcher and Kathleen M. Fairfield from the Harvard School of Medicine, in the Journal of the American Medical Association stated that "it appears prudent for all adults to take vitamin supplements." In this article, which examined the clinical applications of vitamins for the prevention of chronic diseases in adults examined English-language articles about vitamins in relation to chronic diseases published between 1966 and 2002, and concluded that inadequate intake of several vitamins has been linked to the development of diseases including coronary heart disease, cancer, and osteoporosis.
Similarly, the April 9, 1998 issue of the New England Journal of Medicine featured an editorial entitled "Eat Right and Take a Multivitamin" that was based on studies that showed health benefits resulting from the consumption of supplemental folate to prevent birth defects and possibly decrease the incidence of cardiovascular disease.
A 2007 UC Berkeley School of Public Health study in collaboration with Shaklee Corporation determined that long-term vitamin and mineral supplement users showed markedly better health than people who took no supplements.
Bruce Ames, professor of Biochemistry and Molecular Biology at the University of California, Berkeley, and a senior scientist at Children's Hospital Oakland Research Institute (CHORI), suggests that "to maximize human health and lifespan, scientists must abandon outdated models of micronutrients" and that "a metabolic tune-up through an improved supply of micronutrients is likely to have great health benefits."
Evidence against
In 2006 the
National Institutes of Health convened an expert panel to examine the available evidence on nutrient supplements. However, the report noted that multivitamins have beneficial effects in people with poor nutritional status, vitamin D and calcium can help prevent fractures in older people, and that zinc and antioxidants can help prevent age-related
macular degeneration in people at a high risk of developing this disease.
In 2007 the United Kingdom Food Standards Agency published an updated set of recommendations for eating a healthy diet. The recommendations stated that pregnant women should take extra folic acid and iron and that older people might need extra vitamin D and iron. However, the report advised that "Vitamin and mineral supplements are not a replacement for good eating habits" and stated that supplements are unnecessary for healthy adults who eat a balanced diet.
In February 2009, a study conducted in 161,808 postmenopausal women from the Women's Health Initiative clinical trials concluded that after 8 years of follow-up "multivitamin use has little or no influence on the risk of common cancers, cardiovascular disease, or total mortality".
Regulations by governmental agencies
United States
Because of their categorization as a
dietary supplement by the
Food and Drug Administration (FDA), most multivitamins sold in the U.S. are not required to undergo the rigorous testing procedures typical of pharmaceutical drugs.
However, some multivitamins contain very high doses of one or several vitamins or minerals, or are specifically intended to treat, cure, or prevent disease, and therefore require a prescription or medicinal license in the U.S. Since such drugs contain no new substances, they do not require the same testing as would be required by a New Drug Application, but were allowed on the market as drugs due to the Drug Efficacy Study Implementation program.
See also
Bodybuilding supplement
Dietary supplement
Essential nutrient
Generic Multivitamin
Food supplements
Food additive
Food fortification
Functional food
Food processing
Health food
Megavitamin therapy
Orthomolecular medicine
Naturopathic medicine
Nutraceutical
Nutrification (a.k.a. food enrichment).
References
External links
Safe upper levels for vitamins and minerals - Report of the UK Food Standards Agency Expert Group on Vitamins and Minerals
Dietary Supplements: Health Information Office of Dietary Supplements, National Institutes of Health
The Landmark Dietary Supplement Study School of Public Health at UC Berkeley, published in Nutrition Journal
Category:Dietary supplements
Category:Vitamins
