About-Face: JAMA Recommends Multivitamins

After 20 years, the Journal of the American Medical Association has completely reversed its policy and is now encouraging all adults to take at least one multivitamin per day. A landmark article published in the Journal announced that all adults should take vitamin supplements to prevent chronic diseases.

"Most people do not consume an optimal amount of all vitamins by diet alone. It appears prudent for all adults to take vitamin supplements," state the articles by Robert H. Fletcher, MD, MSc, and Kathleen M. Fairfield, MD, DrPH, both affiliated with Harvard Medical School. The physicians reviewed studies published between 1966 and 2002 that investigate the links between vitamin intake and diseases such as cancer, osteoporosis, and coronary heart disease.

A large proportion of the population is at increased risk due to low vitamin levels. The high prevalence of these diseases indicates the standard diet in the U.S. fails to provide sufficient amounts of the vitamins studied. The authors examined the following nutrients: vitamins A, B6, B12, C, D, E, and K, folate, and the carotenoids including alpha- and beta-carotene, beta-cryptoxanthin, lycopene, lutein, and zeaxanthin.

They noted the association of low intakes of the B vitamins with elevated homocysteine levels and the increased risk of coronary heart disease; of low folate with neural tube defects, coronary heart disease, breast cancer, and colorectal cancer; of vitamin B6 deficiency with cheilosis, stomatitis, central nervous system effects, and neuropathy; of low B12 with macrocytic anemia and neurologic abnormalities; of low levels of vitamin E with prostate cancer; of low levels of various carotenoids with breast, prostate, and lung cancer; of low vitamin D with secondary hyperparathyroidism, bone loss, osteoporosis, and increased fracture risk; of low vitamin C with cancer; of low vitamin A with vision disorders and decreased immune function; and of low vitamin K with blood clotting disorders and with increased fracture risk.

Drs. Fletcher and Fairfield recommend that everybody, regardless of age or health status, take a daily multivitamin/mineral. The physicians go on to suggest that vegans, who may not get enough vitamins D and B12, also need to take a multivitamin. In addition, as people age, they become less able to absorb vitamins and minerals from their diet and should take a multiple vitamin, the physicians said.