Daily Vitamins Recommended

The Journal of the American Medical Association (JAMA) has issued a recommendation that all American adults take a multivitamin every day in order to supplement a healthy diet, keep their immune systems strong, and help stave off disease.

Since almost 80 per cent of Americans do not receive the recommended five daily servings of fruit and vegetables that would provide sufficient amounts of key vitamins and minerals needed for a healthy diet, supplementation has become extremely important, prompting the unusual move of the Journal recommending supplements on a daily basis.

In the article, the authors reviewed the association between inadequate intake of several vitamins and their association with a number of chronic illnesses. Their review of nine vitamins showed that elderly people, vegans (vegetarians who do not eat eggs), alcohol-dependent individuals, and patients with malabsorption are at higher risk of inadequate intake or absorption of several vitamins. Malabsorption, or an inability digestive tract of the body to derive all the nutrients from foods, is not uncommon in people with pancreatic cysts and tumors.

It is important to emphasize that the recommendation is to supplement to get to the optimal levels. Too much of a good thing is also not good. Excessive doses of vitamin A during early pregnancy, and too much of the fat-soluble vitamins taken anytime, may result in adverse outcomes. B vitamins are best taken as a group, in foods (liver, brewer’s yeast, or wheat germ) or in a balance multivitamin.

Folic acid is essential for normal cell duplication, and may help prevent formation of tumors. Too little folic acid has been implicated as a cause of spinal bifida in babies whose mothers had insufficient levels of folic acid in the first months of pregnancy. Folic acid dissolves in water and is not stored in the body, so a sufficient quantity must be taken each day. Now that breakfast cereals and bread are supplemented with folic acid in the United States, the incidence of spina bifida has decreased significantly. Folic acid and vitamins B6 and B12 are required for metabolism of homocysteine, and can the risk of cardio-vascular disease. Vitamin E and lycopene (the red pigment found in tomatoes, strawberries and watermelon) may decrease the risk of prostate cancer. Vitamin D is associated with decreased occurrence of fractures when taken with calcium. Calcium is essential to reduce the risk of osteoporosis.

Some groups of patients are at higher risk for vitamin deficiency and less than optimal vitamin status. Many physicians may be unaware of common food sources of vitamins or unsure which vitamins they should recommend for their patients. It is possible to get too much of a good thing, especially of the fat-soluble vitamins. But the greater risk is having too little of the essential vitamins needed to reduce the risk of chronic diseases, including coronary heart disease, cancer, and osteoporosis.

Best of all, be sure to eat your veggies! Include in your diet at least five servings of fruits and vegetables every day.

Reporting "Vitamins for Chronic Disease Prevention in Adults," by Kathleen M. Fairfield, MD, DrPH; Robert H. Fletcher, MD, MSc, JAMA 2002, 287:3116-3126