According to the Centers for Disease Control and Prevention, one-third of Americans are obese, which implies that we have no shortage of calorie-dense food available. However, most diets lack a variety of nutrient-dense foods. Essentially, the Standard American Diet is a pattern of being over-fed and under-nourished and a trend that leaves many nutrient gaps.
Although severe vitamin and mineral deficiency to the point of disease is uncommon in the U.S., most of us do not meet general vitamin and mineral requirements. Since vitamins and minerals are essential for life this means you’re less resilient if you get sick, less able to recover when stressed, you’re making less energy and heal more slowly when injured. Why would you want your body functioning at 70% capacity?
What are vitamins and minerals?
The term "vitamin" comes from the words "vital" and "amine," because they were originally thought to be amines (nitrogen-based compounds) necessary for life. In truth, vitamins are required for life. A human deficient in vitamins will experience physical symptoms and eventually disease. Rickets, scurvy, night blindness, and even neuropathy that can result from severe vitamin deficiency. Our bodies can only make 4 of the 13 vitamins necessary for optimal health, and the remaining 9 need to come from our diet. Vitamins and minerals also work synergistically, and the 4 vitamins our bodies can make depends on the availability of vitamins minerals.
Minerals are elements (remember the periodic table from high school chemistry?) that come from the Earth and cannot be made by living organisms. Plants get minerals from the soil, and most of the minerals in our diets come directly from plants or indirectly from animal sources. We may also get minerals from the water we drink, depending on our geographic location. Minerals from plant sources may also vary from place to place, because soil mineral content and quality varies geographically. Like vitamins, mineral deficiencies can result in clinical symptoms and disease states.
When should I consider a multivitamin?
The best thing a person who wants to reach an optimal level of health can do is to consume more nutrient-dense foods in the diet. Nutrient dense foods give our bodies the most nutrients for the fewest number of calories. The next step is ensuring optimal nutrient intake from a therapeutic-grade high quality multivitamin. Nutrient depletion is rare to the point of disease in the US, but suboptimal intake that results in suboptimal metabolic function is actually more common when we consider the demands that are required for these specific circumstances that require more nutrients:
Most are not eating a nutrient-dense diet. Even with a trendy “healthy” diet most still have nutritional gaps. Vegan, vegetarian, Keto, Paleo, and calorie restriction diet plans do not cover all of our bases and leave out some nutrients. “According to data from the National Health and Nutrition Examination Survey (NHANES), 93% of the US population does not meet the estimated average requirement (EAR) for vitamin E, 56% for magnesium, 44% for vitamin A, 31% for vitamin C, 14% for vitamin B6, and 12% for zinc. Data from NHANES found that energy-dense, nutrient-poor foods comprise 27% of daily caloric intake in the American diet, and alcohol constituted an additional 4% of daily caloric intake.” (1)
Most foods lack the nutrient density it once had so supplementing with a high-quality multivitamin makes more sense than ever. Suboptimal farming practices and increase in CO2 have contributed to a decline in nutrient density in many crops. (2)
Most soil lacks the nutrient density it once had. While modern agriculture has been able to increase crop yield with faster-growing, and bug-resistant techniques, the cost has been that soil overuse has stripped more nutrients with each successive generation of crops. A study out of the University of Texas has confirmed this steady decline that has caused your veggies to be less nutritious than before. (3)
Medications can cause nutrient depletion. Many healthcare professionals don’t teach their patients about the most common side effect of medications, drug-induced nutrient depletions. Many Americans are on multiple medications and will be for a lifetime. While necessary for some, the loss of nutrients as a result can contribute to less drug effectiveness and a decline in the ability to battle the disease in the first place. (4)
Stress causes nutrient depletions in major minerals like magnesium, B vitamins, vitamin C and others. Short-term stress allows our bodies to recover and build back up nutrients stores, but repeated bouts of stress and chronic stress can deplete our nutrient stores, interfere with proper digestion and limit absorption of nutrients. Physical stressors like exercise can also increase the need for similar nutrients as well. (5)
Individual risk factors, stages of life, growth and development and disease states all have unique nutrient demands and can contribute to vitamin and mineral deficiency. While this list isn’t all inclusive the Linus Pauling Institute provided a list of unique situations where taking a multivitamin at is a good idea: (6-8)
Women of childbearing age (folate, vitamin D, iron)
Pregnant and lactating women (vitamin B6, folate, vitamin D, iron, DHA)
People who consume <1,200 cal/day (multiple micronutrients)
Obese individuals (multiple micronutrients)
Infants, children, and adolescents (vitamin D, DHA)
People with dark-colored skin (vitamin D)
Those who cover all exposed skin or using sunscreen whenever outside (vitamin D)
Older adults (vitamin B12, vitamin D, zinc)
Low socioeconomic status (multiple micronutrients)
Patients who have had bariatric surgery (multiple micronutrients)
Patients with fat malabsorption syndromes (fat-soluble vitamins A, D, E, and K)
Alcoholics (vitamin A, B vitamins)
Smokers (vitamins C and E)
Vegans and those with limited intake of animal products (vitamin B12, vitamin D, calcium)
People taking medications that interfere with the absorption and/or metabolism of certain micronutrients (e.g., proton pump inhibitors used to treat heartburn may impair vitamin B12 absorption; frequent aspirin use can lower vitamin C status).
Digestive and gut issues such as celiac, ulcerative colitis, cystic fibrosis, diarrhea and surgeries like a Whipple procedure can decrease the absorption of several nutrients.
The Bottom Line
The bottom line is most people are not following the basic USDA food plate recommendations and leave their health vulnerable as a result. Last but not least major health institutions like the American Medical Association and Harvard’s School of Public Health have recommended a basic measure of nutritional support in the form of a multivitamin, given the trend of a lack of nutrients in the average diet. (9,10) A high-quality multivitamin ensures you’re getting the exact amount of what is on the label and working with a trained clinician who can help guide lifestyle changes and offer superior quality products.
NHANES - National Health and Nutrition Examination Survey Homepage. (2020, February 27). Www.cdc.gov. http://www.cdc.gov/nchs/nhanes.htm
Zhu, C., et al. (2018). Carbon dioxide (CO2) levels this century will alter the protein, micronutrients, and vitamin content of rice grains with potential health consequences for the poorest rice-dependent countries. Science advances, 4(5), eaaq1012.
Davis, D. R., Epp, M. D., & Riordan, H. D. (2004). Changes in USDA food composition data for 43 garden crops, 1950 to 1999. Journal of the American College of Nutrition, 23(6), 669–682.
Common Drug Classes, Drug-Nutrient Depletions, & Drug-Nutrient Interactions. (2017). Https://Www.pharmavite.com/; Pharmavite LLC. https://www.aafp.org/dam/AAFP/documents/about_us/sponsored_resources/Nature%20Made%20Handout.pdf
Lopresti A. L. (2020). The Effects of Psychological and Environmental Stress on Micronutrient Concentrations in the Body: A Review of the Evidence. Advances in nutrition (Bethesda, Md.), 11(1), 103–112.
Malone M. Recommended nutritional supplements for bariatric surgery patients. Ann Pharmacother. 2008;42(12):1851-1858.
Halsted CH. Nutrition and alcoholic liver disease. Semin Liver Dis. 2004;24(3):289-304.
Craig WJ. Health effects of vegan diets. Am J Clin Nutr. 2009;89(5):1627S-1633S.
Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: scientific review. JAMA. 2002;287(23):3116-3126.
Nutrition Insurance Policy: A Daily Multivitamin. (2012, September 18). The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/multivitamin/