Multiple Choice: How to find the best multivitamin

This article comes from Nutrition Action. We don't accept any paid advertising or corporate or government donations. Any products we recommend have been vetted by our staff and are not advertisements by the manufacturers. 

“Feed your cells,” says Centrum. “Designed with your genetics in mind,” says Ritual. “The perfect women’s multi,” says Olly. “All clean, all the time,” says Sundown. “We’re so organic,” says VitaFusion.

Companies use any pitch that works to sell their multivitamins. But they dodge the $64,000 question: Do you need one? The short answer: We don’t know.

What the Physicians' Health Study found

When it comes to multivitamins, 2012 was a turning point. That’s when researchers reported the results of the Physicians’ Health Study II (PHS II), which had randomly assigned 14,641 male doctors aged 50 or older to take a typical multivitamin—Centrum Silver—or a placebo.¹

“After an average of about 11 years, men who were randomly assigned to take the daily multivitamin had a significant 8 percent reduction in total cancer,” says Howard Sesso, associate professor of medicine at Brigham and Women’s Hospital in Boston and co-author of the study, which was funded largely by the National Institutes of Health (NIH).

“We were both surprised and intrigued by the finding.”

The PHS II stood out because earlier studies were only designed to observe a lower—or higher—risk of disease in people who chose to take multivitamins on their own. But something else about people who choose to take a multi might explain their risk.

The PHS II results hinted that a multi might help some men in particular.

“In the 1,312 men who came into the trial with a previous history of any type of cancer, those randomized to the multivitamin had a significant 27 percent reduction in subsequent cancer risk compared to those taking the placebo,” says Sesso.

And among men aged 70 and older, those who were randomized to the multi had an 18 percent lower risk, whether or not they had a history of cancer.

“We were encouraged by those two findings, but we have to be cautious when we look at smaller groups,” notes Sesso. That’s because those results could be due to chance.

The PHS II didn’t find a lower risk of any one type of cancer, not even the most common type in men, non-aggressive prostate cancer.

“We’re still going through the data to see if there is evidence for aggressive forms of prostate cancer,” says Sesso.

And the number of cancers other than prostate was small. “Because prostate cancer comprised about 50 percent of the cancers, the study didn’t have strong statistical power to see a difference in other individual cancers,” explains Sesso.

The PHS II found no difference in heart attacks, strokes, memory, or other outcomes, with one exception.²

“There was a significant 9 percent reduction in cataracts in men taking the multivitamin versus placebo,” says Sesso.³

Put another way, roughly 80 men would have to take the multi for 11 years to prevent one of them from getting a cataract. That’s about the same number of men who would have to take the multi for 11 years to prevent one cancer.

But Sesso’s team is still uncertain about both cataracts and cancer.

“Because this was the only large-scale trial that had been done on multivitamins, and it was only done in middle-aged and older men, we were hesitant to assume that this was a real finding,” says Sesso.

That set the stage for COSMOS.

What the COSMOS Study is testing

The ongoing COSMOS (COcoa Supplement and Multivitamin Outcomes Study) randomly assigned 21,444 women and men to take Centrum Silver or a placebo every day for four years.

Participants are also taking either a placebo or cocoa extract containing 600 milligrams of cocoa flavanols a day—far more than you can get by eating dark chocolate.

The trial—which will look at cancer, heart disease, stroke, memory, and more—is funded by the scientific arm of the candymaker Mars and the NIH. Results are due in 2021.

Why might the COSMOS researchers see a difference in cancer rates after four years, when the PHS II found just an 8 percent difference in rates after 11 years?

“If you look at the data from the Physicians’ Health Study II, a separation between the multi-vitamin and placebo groups emerged after about two to three years,” says Sesso.

“Also, we specifically recruited an older population for COSMOS; the men are aged 60 and up and the women are aged 65 and up. And more than 3,500 of the participants began the trial with a history of cancer.”

The bottom line on multis

Until 2021, when the COSMOS results are in, it’s hard to know who should take a multi. But some groups, like older people, may have more reason to.

“As we age, we tend to eat fewer calories, so our intake of vitamins and minerals starts to go down,” says Sesso. “But they may not drop to levels that would cause a deficiency.”

And many older people can’t absorb the naturally occurring vitamin B-12 from foods because they have less stomach acid.

“Vitamin B-12 insufficiency does increase in prevalence in older populations,” says Sesso. That’s why anyone over 50 should take at least 2.4 micrograms a day from a supplement or fortified food, says the National Academy of Sciences.

If you do take a multi, Sesso suggests that you consult your doctor and offers these rules of thumb:

• Don’t get fancy. “Stick with the tried and true brands or the major generic brands. Many designer formulations mix in herbals and botanicals, but there’s no evidence that they’re better.”
• Think twice about gummies. “Gummies tend to be more expensive because you need at least two a day. Only consider them if you cannot swallow pills.” (Gummies are also less complete: see “High Potency Marketing Ploys.”)
• Don’t fall for pricey “personalized” formulas. “Some websites ask you a dozen or so health questions and give you personalized recommendations for vitamins, minerals, and herbals. But it is not necessarily based on solid scientific evidence.”

References

¹JAMA 308: 1871, 2012.
²JAMA 308: 1751, 2012.
³Ophthalmology 121: 525, 2014.

How to find the best multis

Here’s a selection of multivitamin-and-mineral supplements from some major brands that meet our criteria, in alphabetical order.

As for the criteria: our minimums match the RDA or DV, when feasible, and our maximums are at levels that are typically found in major brands and are below amounts that may pose a risk. We disqualified multis with herbs or botanicals. No gummies met our criteria.

What if your multi isn’t on our list?

Keep in mind that we didn’t look at every brand. You can check any label against our “What Your Multi Should Contain” criteria:

Some of the best multis for premenopausal women 

(These multis have enough iron and folic acid.)

• Centrum Adults
• Centrum Women
• CVS Spectravite Adults
• CVS Spectravite Women
• CVS Women’s Daily
• Nature’s Bounty Daily Multi
• Nature Made Multi Complete Softgels
• Target Up & Up for Women Under 50
• Walgreens Adults
• Walgreens Women
• Walmart Equate Complete Adults

Some of the best multis for men and postmenopausal women

(The multis that contain iron are italicized.)

• Centrum Silver Adults 50+
• Centrum Silver Men 50+
• Centrum Silver Women 50+
• CVS One Daily Women’s 50+ Advanced
• CVS Spectravite Adults 50+
• CVS Spectravite Men 50+
• CVS Spectravite Women 50+
• Nature Made Men’s Multi Softgels
• One A Day Men’s
• One A Day Women’s 50+ Healthy Advantage
• Target Up & Up Adults’ 50+
• Target Up & Up Women’s 50+
• Walgreens Adults 50+
• Walgreens Men 50+
• Walgreens Women 50+
• Walmart Equate Complete Adults 50+
• Walmart Equate Complete Men 50+
• Walmart Equate Complete Women 50+
• Walmart Equate One Daily Women’s 50+

— Best-multis ratings by Lindsay Moyer & Kaamilah Mitchell

High potency multivitamin marketing ploys

“Complete multivitamin,” says the VitaFusion Men’s Powerful Multi gummies label.

We found no complete gummies. Some make the claim, though, because the term has never been defined. But gummies are notably short on many nutrients. Among them:

• Iron and iodine. Many premenopausal women get too little of both.
• Other minerals. Expect little or no copper, magnesium, selenium, or zinc.
• Vitamins. A and C often fall short. And K is often missing. (So are B-1, B-2, and B-3, but they’re added to most flour, so we get plenty.)

What’s more, some gummies have far higher doses—that’s not good—than their labels claim, according to ConsumerLab.com.

Other undefined claims to ignore: “Active,” “Advanced,” “Beauty,” “Metabolism,” and “Vitality.” “High Potency” means higher doses, but not because you need more.

The take-away: Don’t assume that any multi is formulated to meet your needs. It’s all about marketing—what looks good on the label, what fits, and what’s hot.

Can’t swallow pills? Centrum Adults or Silver Chewables are your best bets.

Are multis a cure for everything?

Multivitamins—Centrum isn’t the only one—claim that their supplements can “support” nearly everything, from metabolism to brain health to energy. Those claims are usually backed by weak evidence:

Metabolism

• The claim: “B-vitamins aid in the metabolism of fats, carbohydrates and proteins.”
• The evidence: Sounds like B vitamins speed up your metabolism—that is, help you lose weight. They won’t.

Brain health

• The claim: ”Zinc and B-vitamins help support normal brain function.”
• The evidence: Vitamin B-12 deficiency can cause dementia. But taking extra B-12, other Bs, or zinc doesn’t help keep you sharp.

Muscle function

• The claim: “Vitamins D and B-6 help support muscle function.”
• The evidence: Vitamin D didn’t strengthen muscles in most good studies. And there’s no good evidence that B-6 helps muscles.

Immunity

• The claim: “Antioxidants to help support normal immune function.”
• The evidence: In clinical trials on a total of roughly 2,220 people, multivitamin takers were just as likely to get sick—or stay sick for just as long—as placebo takers.

Heart health

• The claim: ”B-vitamins help promote heart health.”
• The evidence: In a dozen good clinical trials, B vitamins didn’t reduce the risk of heart attacks.

Eye health

• The claim: “Vitamins A, C, and E and Lutein support healthy eyes.”
• The evidence: Those vitamins can slow macular degeneration if you already have an intermediate or advanced case. And a multivitamin may lower the risk of cataracts. A new trial is in progress.

Healthy appearance

• The claim: “Biotin, vitamins A, C and E help maintain healthy appearance.”
• The evidence: Unless you’re suffering from a rare, life-threatening nutrient deficiency like scurvy, there’s no good evidence that a multi will help your skin or hair.

Energy

• The claim: "B-vitamins and iron support daily energy needs.”
• The evidence: B vitamins won’t make you more energetic. Iron may fight fatigue only if you have low iron levels. Most people don’t.

Photos: luismolinero/stock.adobe.com (woman), Kaamilah Mitchell/CSPI (all others).