Podcast Episode 53 Transcript – Should You Take a Multivitamin?

Aidan

Hello and welcome back to The Ideal Nutrition Podcast. My name is Aidan Muir and I am here with my co-host Leah Higl, and this is episode 53. Today we’re going to be talking about multivitamins and whether you should take them. So we’re just going to cover a bit of background, whether you should take them, whether you should not take them, what would be the pros, what would be the cons and all of those kinds of things.

Leah

[00:00:30] I think the pro that always comes up for me is that a multivitamin can cover a lot of different gaps. So if there’s not a specific thing when I’m working with someone, like their iron intake is low, or a specific thing where you want to do it just individually, you go, oh, for whatever reason this person can’t meet their requirements as a whole so they’ve got a lot of nutrient gaps to fill. A multivitamin may actually be appropriate for them. We know that the average person has about 33% [00:01:00] of their calories coming from discretionary foods so processed, not super nutritious stuff. What if you are kind of below average in your dietary intake, for whatever reason, think about maybe low socioeconomic, can’t really afford a lot of healthy foods could be one.

You might have a lot of gaps that could be easily filled by a multivitamin, and that may benefit you. There’s also other situations like picky eaters, people with food [00:01:30] aversions or allergies, a range of intolerances, disordered eating maybe, when you’re in a large calorie deficit, that could be a reason to take a multivitamin. Then even like bariatric surgery, particularly in that first 12 months, post-surgery where the intake is relatively limited, a multivitamin is going to be pretty helpful there as well. So there’s a lot of reasons why you might want to take a multivitamin because it just does generally fill all these random gaps [00:02:00] that might be there.

Aidan

Yeah and all of that makes sense and doubling down on I guess two of those things there, the large calorie deficit thing and the 33% of calories coming from discretionary food, junk food, whatever you’d want to call it. There was one person I was listening to who made a pretty solid argument as to why multivitamins more likely to be beneficial during a calorie deficit and the argument he made was that, and he was using American data. We can’t fact check this, this [00:02:30] is something you’ll hear and you’ll be like, well, how do we prove this, but it does make sense to me, is that on average it takes about 80% of your calorie requirement to meet a hundred percent of the recommended daily intakes, unless you’re doing anything weird like having… Weird.

But unless you’re having really high vegetable intake or you have really nutrient dense food, like liver and stuff like that, just an average, she was just given a broad number, which is why we can’t fact check because this is kind of like, but it does make sense. I think that is pretty applicable in, it was using American data, but it would apply in Australia and everything like [00:03:00] that as well of course and the logic he was then using is being like, hang on, if it takes about 80% of our calorie requirements to meet the recommended daily intakes, what if you go into a calorie deficit? If you go into a 20% calorie deficit, suddenly it takes a hundred percent of your food to reach this unless you’re having those nutrient dense foods in large amounts.

What if you want flexibility in your diet, which is something we encourage doing, having some level of flexibility. You would then end up with a guarantee of not reaching [00:03:30] these recommended daily intakes, unless you, once again are doing anything that’s particularly nutrient dense. So being in a decent size calorie deficit, keeping in mind that in practice a lot of people do greater than 20% calorie deficits increases the likelihood of benefiting from a multivitamin because these gaps we’re talking about are more likely to be big, just like they are in all these other cases like picky eaters and stuff like that. It covers a lot of gaps.

Leah

Yeah and talking about calorie deficits is I personally recommend multivitamins to a lot of my clients in a calorie deficit [00:04:00] for that exact reason so it is part of my common practice and I think it makes a lot of sense just how you described it.

Aidan

Yeah, for sure and then leading into, I suppose the opposite, reasons not to take a multivitamin. Should everybody take a multivitamin, if that’s the case, just to cover gaps? I don’t recommend it for everybody actually. It’s not like something I recommend more frequently than I don’t. It’s rarer for me to recommend a multivitamin, even though I do recommend it to some people and reasons behind [00:04:30] that, one, if you have a great diet already, you could be meeting a hundred percent of your, you could have an appropriate amount of each micronutrient anyway. So it’s like, well there’s no need in that case. Two, the cost to benefit ratio. It’s like it still costs money to have a multivitamin. How much benefit are you getting out of it? And in some cases like those that we just talked about, you’re more likely to get benefit, but what if you’re not as likely to get benefit?

The next one is the potential for excessive supplementation of any individual nutrient. [00:05:00] If you just have a normal diet and you have a multivitamin that’s unlikely to happen, but if you take a lot of supplements, you could end up accidentally overdoing it. If you’re taking something for any particular reason in addition to a multivitamin that already has that you could have a higher than ideal intake of those nutrients. Then other stuff, nutrient interactions, it’s a bit of an inherent flaw and multivitamins is fine, but it’s something worth being aware of, is that nutrients compete for absorptions or [00:05:30] for absorption so even though it covers gaps, it can’t have enough of everything. An example of that is iron and calcium. They compete for absorption so if you look on the back of a multivitamin and just for context, if you look at the recommended daily intake for calcium, and it’s a thousand, look on the back of a multivitamin and it’s almost always under a hundred, because if they made it high calcium, it would reduce the effectiveness because then you’d absorb less iron, magnesium, zinc, and all these other nutrients that compete [00:06:00] for absorption.

Then the final thing as to why you wouldn’t want to solely rely on a multivitamin as well, is that it can’t cover everything. There’s so, so, so many things in food like this whole food matrix and everything that everybody talks about. One example of this is that there’s 8,000 different types of polyphenols. That’s like an estimate kind of thing, a rounded number, but in a manmade product we can’t include everything that’s naturally in food. I’m not one of those people who’s like [00:06:30] nature naturally made it perfect, but I am somebody who is pointing out that’s very clearly, we can only have so many ingredients and something we can’t cover every single thing.

Leah

Yeah. Not everything can be included and I think something from a multivitamin perspective in terms of reasons, I guess not to take it, but is that people that have the mindset of I’m taking a multivitamin so I don’t have to eat these particular kinds of nutritious foods. Whether it’s conscious or subconscious I think that is [00:07:00] a downside to taking a multivitamin or can be in that maybe you’re less likely to eat vegetables for dinner because you go, I had my multivitamin, when we know that it can’t cover a hundred percent of that stuff you’re going to be getting from food.

Aidan

Yeah and I guess that’s like the tail end of what I was talking about there. That’s exactly what I meant. The last stuff I was talking about is not a reason to not take a multivitamin, but if you’re using it to cover gaps in your diet that you would’ve covered, if you hadn’t had a multivitamin, that makes sense.

LeahOne study that I found really [00:07:30] interesting that you brought up a few months ago was this study where they actually found that people that were taking vitamin and mineral supplementation actually had increased mortality. We just want to talk about this because it a bit of an off the wall finding, it’s a bit random, but it was the Iowa Women’s Health Study and it included almost 40,000 women over 55 years old. They found this link here between vitamin and mineral [00:08:00] supplementation and increased mortality risk. The issue with this study, because I just find it interesting, but the issue with this study is that it was based on a food frequency questionnaire and they basically were like to people, what are you eating and what supplements are you taking?

It wasn’t a controlled study where they did this so there could be a lot of co-founding factors that add on. Maybe people that are taking these supplements are like we said, less likely to eat fruits and vegetables. Maybe [00:08:30] they’re more likely to do other things like eat more processed foods in place of more nutritious foods, but I just think it’s a very, yeah, interesting finding because, yeah, it’s not what you would think would be found from a study like that.

Aidan

Yeah and on that study in particular, because that was the first study that I’d seen on that topic and I headline read when I first heard of it obviously. I was like, that’s interesting. That’s an interesting finding, but because I think most people would automatically assume that actually if it was going to have any effect on longevity, [00:09:00] it would improve longevity-not reduce it.

In that study in particular, another point that was interesting in terms of people analyzing it and talking about why could this have been the case? The point that they made out with this whole food frequency questionnaire is that people are probably more likely to be sick to start off with and then start taking a multivitamin because they’re sick and they’re like, oh I need to start looking after my health or whatever. Even just that one variable out of all these hundreds of variables, it could be like, were they just measuring who was sicker to start [00:09:30] off with? There’s so many factors, but that is once again an issue with food frequency questionnaires.

Versus a controlled form where it’s let’s get 50% of them to not take a multivitamin and let’s get 50% to take a multivitamin and then see what happens. There’s the self-selection kind of thing that’s a bit of an issue.

Leah

Totally. I think that the better thing to look at is probably a review of multiple papers obviously. That’s always going to be a better thing to look at. So there is a review from 2019 that covered 277 [00:10:00] different studies on this particular topic and they found that vitamin and mineral supplementation wasn’t really linked with reduced mortality, but it wasn’t increased mortality either. So there was just this neutral effect.

So folate did have a small link between reduced mortality and folate supplementation, but that was found most strongly in China where the authors did highlight [00:10:30] that folate deficiency was far more common so it makes a little bit more sense. When we’re looking at the total of the research it seems like having this kind of supplementation has a fairly neutral effect overall.

Aidan

Yeah and that’s why I don’t necessarily go out on my way to recommend it to people who already have great diets and stuff like that in a bid to cover any potential gaps that might crop up on any individual day or whatever, because you would assume that it would increase longevity in [00:11:00] a very mild way in terms of like if some people happen to have deficiencies or whatever, and this happened to rectify, it should lead to some form of benefit. But the fact that it’s not really having any impact on that on average, keep in mind that there’s obviously individual cases or whatever is a reason why I wouldn’t be like, hey, if this person already has a great diet, probably no need for us to chuck this on top of that, just in case.

So an alternative approach that I personally do take more frequently with my clients outside of specific cases where there’s heaps [00:11:30] of inadequacies in their diet is supplementing each thing individually. So identifying what is the issue, like do they have a low intake of ion? Do they have a low intake of vitamin A? Do they have whatever it is, identifying that issue and then supplementing whatever the inadequacy is with that individual nutrient so that way I’m not chucking in a bunch of nutrients that they don’t necessarily need. The downside of this is very obvious though. It’s easy for me to identify this, but it’s hard for [00:12:00] an individual. So a way that I try to relate to this is sometimes I see exercise stuff on Instagram and coaches will be like, yeah, just strengthen what’s weak. It’s obvious. I’m like, how do I know what’s weak? What’s the criteria?

Leah

How do I know that?

Aidan

Yeah. And I’m like, I just want to hire this coach now. So it’s easy for me to say that, but that’s where I can look at it from another perspective and being like, well, that’s the appeal of a multivitamin. You don’t have to identify what do you specifically need even though it’s something that I would personally prefer to cover the individual thing. It’s also hard [00:12:30] to identify that without knowing everything.

Leah

Yeah. I totally understand why people are like, oh, I’m a bit lacking in energy or whatever. I’m just going to go get a multivitamin because where do you even start with identifying? So I get it. I get it.

Aidan

Yeah, for sure.

Leah

In terms of a practical takeaway from today is that a multivitamin can be great in a lot of situations where you know there may be quite a few gaps in your diet and a multivitamin’s probably not going to fix [00:13:00] all of them and replace all of them, but it could be useful when there’s going to be so many gaps. On the flip side of that it could just be a way to kind of waste your money if you already have a really nutritious diet, which is your prerogative at the end of the day. It is what it is. But there is a small risk that, especially if you’re taking multiple supplements that there may be a slight risk of having too much of certain vitamins and minerals, which could be to your detriment so something [00:13:30] to think about.

Aidan

This has been episode 53 of the Ideal Nutrition Podcast. Thank you to everybody who’s listening.