Vitamins have a powerful psychological hold over us. As precautionary health measures go, supplements are easy. Compare the two seconds required to swallow a pill with the constant vigilance necessary to exercise and eat right. And the fact that vitamins are available without a prescription makes them seem safe—even though it probably makes them less so, since they're not regulated by the FDA as drugs, and manufacturers are not required to prove that they're effective at treating disease. *
But the risk-benefit calculus has changed. We know more about the risks, and it's clear that there's also less potential benefit. During the early 20th century, diseases like scurvy and rickets were common until researchers began to isolate compounds in food—which became known as vitamins—that could altogether cure these ailments. It must have been remarkable to see devastating diseases alleviated with common foodstuffs.
During an era when many people legitimately had nutritional deficiencies, placing your bets on a multi might have been reasonable. But today, of course, actual deficiencies are much less common. Our salt, milk, flour, juice, cereal, and more are all fortified with extra nutrients, and a 2009 study published in the Archives of Pediatrics and Adolescent Medicine suggests that most of the kids who end up taking vitamins in the United States today don't actually need them.
If vitamins are useful for anything, it's probably for tapping into our old friend the placebo effect.In a 2008 survey, 38 percent of doctors confessed to recommending vitamins because they believed the pills could promote health purely through the power of positive expectations. Consider a famous 1975 study designed to probe whether vitamin C supplements alleviated colds better than a placebo, an inert lactose tablet. It turned out that it didn't matter much which pill the subjects were actually taking.What mattered was what they thought they were getting: Those who believed they were taking vitamin C had fewer and milder cases of the sniffles than those who believed they were just swallowing lactose.That would be reason enough to pop a supplement—there are worse things than deceiving yourself into better health—if it weren't for the emerging evidence that the pills might be capable of causing real harm.
That's not to say that vitamins aren't important. Vitamins are critical to all sorts of bodily functions, and we have to get them through diet because our bodies can't make them on their own. The Office of Dietary Supplements at the NIH recommends that we get certain levels of a variety of kinds of vitamins, and that recommendation is sound. But encouraging us to get a complete suite of vitamins is not the same as suggesting that we get them by popping a pill.
In fact, the reports littering the ODS site seem to converge upon the same point: There is some good news for supplements, but it's extremely limited.The 2006 NIH panel, for instance, concluded that postmenopausal women should probably take calcium and vitamin D to safeguard their bones; that pregnant women should keep taking folate; and that adults with age-related macular degeneration, an eye disease, should take a combination of antioxidants and zinc. But beyond that, the panel's strongest recommendation was that scientists conduct further research on the risks and benefits of vitamins.For every study that turns up disconcerting vitamin side effects, there seem to be two more that conclude that we simply don't know enough yet about supplements to make evidence-based recommendations.
Until we do, we should stop treating supplements like health candy and more like prescription meds, to be used only when there's a demonstrated need. Doctors should create individualized regimes, tailored to a particular patient's deficiencies. As for the rest of us, we can put the pills back on the shelf and save our cash for one of those martinis.
Correction, Jan. 8, 2010: This article originally and incorrectly stated that vitamin supplements are not regulated at all by the FDA. (Return to the corrected sentence.)
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