Mentioned previously in the article titled “Are Nutritional Supplements Necessary?”, nutritional supplements are intended to be supplemental to a nutritious diet, not a replacement or cure-all for any one particular condition or illness. A daily multivitamin and mineral (MVM) supplement may not be “necessary”, but it may indeed bolster the body’s various metabolic pathways that require these micronutrients as cofactors and coenzymes for the body to function optimally. Especially today with the exponential increase in toxin exposure, as well as the massive shift away from regularly eating locally-sourced, whole foods to processed food-like products, daily nutritional support via MVM supplementation may be a necessary tool for your patients’ overall health.

It is well-known in scientific literature and now in the media that the intestinal microbiome vitally influences the health and disease status of its host. As the soil quality decreases (from environmental toxins, chemical runoff, pesticide use, and monocropping), so do the microbial diversity and nutrient density within the foods we eat. The volume of ultra-processed food within the food supply in the U.S. and other high-income countries is displacing dietary patterns that are based on freshly prepared meals, causing rapid increases in energy intake that often results in weight gain, obesity, type 2 diabetes, cardiovascular disease, and nutritional deficiencies. Westernization of the diet has resulted in a significantly lower intake of dietary fiber, increased intake of saturated fats, sugars, artificial ingredients, food additives, and antibiotics which all play a significant role in nutritional status.

A prospective cohort study published this year in Current Developments in Nutrition shows that consumption of ultra-processed foods (e.g., cakes, pastries, packaged juices, instant cocoa) is strongly correlated with incident frailty risk among older adults. Severely selective diets, most often consisting of highly palatable carbohydrate-rich processed foods and very few vegetables and protein-rich foods can lead to fat-soluble vitamin deficiencies, B vitamin deficiencies, and mercury toxicity. Current estimates of nutrient status from NHANES found that 31% of the U.S. population is at risk for at least one vitamin/mineral deficiency or anemia, and that vitamins A, C, D, E, folate, B₆, B₁₂, calcium, zinc, iron and magnesium are often under-consumed relative to the dietary reference intake values.

Benefits of multivitamins for specific health conditions

In a previous article, we highlighted the benefits of MVM supplementation in children with ADHD. Researchers showed that supplementation improved levels of aggression, regulated emotions and moods, and improved attention span and general functioning in the children studied. Research shows a link between autism spectrum disorder (ASD), nutritional deficiencies, dietary factors (e.g., food dyes, food sensitivities), and chemical toxicities from heavy metal exposure and environmental pollution. A systematic review and meta-analysis published earlier this year in Nutrition Research showed that offspring whose mothers used multivitamin supplements during the prenatal period had a significantly reduced likelihood of ASD compared with offspring of mothers who did not supplement with multivitamins.

A narrative review published in the journal Nutrients illustrates how patients with inflammatory bowel diseases (e.g., Crohn’s disease, ulcerative colitis) have multiple vitamin and mineral deficiencies that are necessary for healthy mucous membranes and reduce intestinal microflora diversity. IBD patients showed low levels of folate, vitamin A and D, magnesium, zinc, and iron, and vitamin B₁₂, with 51% of the adolescents in the study having anemia. Nutritional deficiencies are also common following bariatric surgery such as the Roux-en-Y Gastric Bypass. According to a literature review in Current Drug Metabolism, following gastric bypass, iron, calcium, and vitamin D deficiency occur in up to 50% of patients, and that oral supplementation may be required indefinitely.

In a retrospective cohort study, multivitamin supplementation significantly reduced overall mortality risk, incident tuberculosis, and immunologic failure and appeared to be an effective and scalable program to improve survival and treatment outcomes in adult HIV patients.

Optimal nutrition is crucial for patients with these chronic conditions that often lead to multiple micronutrient deficiencies. Even in otherwise healthy patients, multivitamin supplementation is a simple, safe, and effective reinforcement to a nutrient-dense, minimally-processed diet.