The Multivitamin Myth: Debunking the "Expensive Urine" Theory

Are vitamins worth it? Personally, I have been taking vitamins since childhood, when my parents would slide me a Flintstone to take along with my breakfast cereal. Does it make a difference?  Some experts argue that this is not the case. For example, a group of researchers from Johns Hopkins wrote a 2013 editorial urging people to stop wasting money on vitamin and mineral supplements. And ample research evidence fails to show any tangible benefit of multivitamin supplementation on overall longevity.

But that isn’t necessarily the whole story. Good research data indicates some real benefits from multivitamin use. For example, multivitamin use is associated with a lower risk of injury during basic military training in Air Force recruits. Further, multivitamin use in the elderly has been found to improve cognition and memory to a degree equal to 2 years less of aging. So vitamins might not directly help you live longer, but they may exert a subtle beneficial effect on quality of life. 

One of the editorialists from Johns Hopkins, Dr. Larry Appel, stated that “Other [than multivitamin use] nutrition recommendations have much stronger evidence of benefits—eating a healthy diet, maintaining a healthy weight, and reducing the amount of saturated fat, trans fat, sodium, and sugar you eat.” And that is a sound, evidence-based opinion. As a counterpoint, I would offer that rather than an either/or approach, adding multivitamins to your best attempt at a healthy diet can offer some additional benefits. Additional benefits are good, and it may be worth it.

The Rise of Food Costs: Can Multivitamins Play a Role?

Anti-vitamin supplementation voices often state that our micronutrient needs can be obtained from a balanced diet with adequate fruit and vegetable intake. That is ideal, but we don’t live in an ideal world. Vitamin supplementation can be a helpful adjunct to a diet with occasional lapses in adequate produce consumption. Also, considering costs, vitamins are relatively cheap. The cost per serving for a multivitamin is around 10-15 cents. Looking at groceries online as I type this, I see a serving of pre-prepared salad is about $1.50-$2.00. So vitamin supplements shouldn’t break the bank. 

New Research and Targeted Multivitamins: A Personalized Approach

Customized multivitamins have emerged as a new product in the supplement world.  Companies that offer these personalized supplements with the goal of meeting each individual’s specific nutritional needs based on an assessment. The assessment consists of either a nutritional survey or blood/saliva testing. 

As you might anticipate, these services are more costly than standard vitamins purchased off the shelf. But are they worth it? There is some research supporting better delivery of micronutrients with customized multivitamins versus a standard multivitamin in bariatric patients, but whether this is worthwhile for people who don’t have an impaired ability to absorb nutrients from food is unclear.   

Finding the Right Multivitamin for You: Quality Matters

Dietary supplements, including multivitamins, are loosely regulated in the United States. For your health and safety, it is wise to look for products that have quality assurance through third-party testing. The US Pharmacopeial Convention (USP) or NSF International test supplements to ensure they contain the ingredients listed on the label and don't contain high levels of contaminants. You can check to see if a multivitamin is USP and or NSF-verified. 

1. _{Guallar, E., Stranges, S., Mulrow, C., Appel, L. J., & Miller, E. R., 3rd (2013). Enough is enough: Stop wasting money on vitamin and mineral supplements. Annals of internal medicine, 159(12), 850–851. https://doi.org/10.7326/0003-4819-159-12-201312170-00011}
2. _{Kasper, K. B., Cockerell, M., Escamilla, C., & Gonzalez, R. (2024). Multivitamin Compliance Reduces Injuries of Female Recruits at Air Force Basic Training: A Randomized Controlled Cohort Study. Military medicine, 189(Supplement_3), 93–98. https://doi.org/10.1093/milmed/usae044}
3. _{Kopittke, P. M., Menzies, N. W., Wang, P., McKenna, B. A., & Lombi, E. (2019). Soil and the intensification of agriculture for global food security. Environment international, 132, 105078. https://doi.org/10.1016/j.envint.2019.105078} 
4. _{Loftfield, E., O'Connell, C. P., Abnet, C. C., Graubard, B. I., Liao, L. M., Beane Freeman, L. E., Hofmann, J. N., Freedman, N. D., & Sinha, R. (2024). Multivitamin Use and Mortality Risk in 3 Prospective US Cohorts. JAMA network open, 7(6), e2418729. https://doi.org/10.1001/jamanetworkopen.2024.18729} 
5. _{Vyas, C. M., Manson, J. E., Sesso, H. D., Cook, N. R., Rist, P. M., Weinberg, A., Moorthy, M. V., Baker, L. D., Espeland, M. A., Yeung, L. K., Brickman, A. M., & Okereke, O. I. (2024). Effect of multivitamin-mineral supplementation versus placebo on cognitive function: results from the clinic subcohort of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial and meta-analysis of 3 cognitive studies within COSMOS. The American journal of clinical nutrition, 119(3), 692–701. https://doi.org/10.1016/j.ajcnut.2023.12.011}
6. _{Zayed, M. F., & Awis, R. R. (2024). A Comparison of the Health Benefits of Customized Multivitamins and Standard Supplementation Post-bariatric Surgery: A Systematic Review. Cureus, 16(6), e63253. https://doi.org/10.7759/cureus.63253}