As a family medicine physician, I often receive the following question from patients: “Are multivitamins actually worth my money, or are they just a waste?” The utility and effectiveness of multivitamins for general health purposes has long been a topic for debate. While physicians routinely recommend and prescribe specific vitamins for lab-documented vitamin deficiencies such as vitamin D, vitamin B12, and folate, among others, a consensus on multivitamins for the general health of patients does not exist. This practice can often fall to personal preference or opinion given the conflicting findings of past studies.
In searching for a concrete answer for my patients, I came across a meta-analysis of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS), that was published in the American Journal of Clinical Nutrition by Vyas et al. in 2024. In short, the findings of this article lent support to the notion that multivitamins are at least cognitively helpful, as participants taking multivitamins had improved episodic memory and global cognition after two years of daily multivitamin use compared with those taking placebo. One important caveat is that all individuals in the initial COSMOS study were 60 years of age or older.
Nevertheless, the studies on physical and mortality outcomes paint a different picture. The United States Preventive Services Task Force has a “Grade I” for insufficient evidence on the use of multivitamins to reduce cardiovascular disease or cancer. Additionally, a 2024 cohort study published in JAMA Network Open by Loftfield et al. that included multiple prospective cohorts showed there was no mortality benefit associated with the use of multivitamins. One pooled analysis actually showed a slightly higher mortality with multivitamin use (4%), while another found no difference. It is unclear if the increased mortality was due to confounding or other potential biases or if this was a real association, but it did not hold true in the second pooled analysis. Of course, limitations to every study exist regardless of the findings, and the conclusion was simply that multivitamins do not appear to be associated with improvement in mortality.
In theory, a consistent healthy and well-balanced diet that incorporates all of the recommended food groups in their ideal portions would likely result in optimal vitamin and mineral intake for patients. However, as we all know, theory gives way to practicality and reality in the exam room. While striving to have a well-balanced diet should always be the goal, it is my opinion that a daily multivitamin can help make up for the differences that separate the ideal from the actual when it comes to our diets. As humans, most of us don’t eat the precisely recommended amounts of varying food groups — and that’s OK; after all, we aren’t robots. This is where the consistent daily use of a multivitamin can help make up the difference.
Of course, in medicine nothing of benefit comes without inherent risks. As multivitamins are over-the-counter medications, they lack the rigorous standards and regulation that prescription medications undergo. A significant portion of this risk can be mitigated by selecting multivitamins with a third-party certification on their label. These certifications are provided by third-party organizations that routinely test the products to ensure they contain the elements they claim on their label. Additionally, multivitamins, while relatively cheap, do incur a cost to the patient which can be significant if they are used long-term. Lastly, specific components of multivitamins may influence the measurement of lab results, as in the case of biotin and thyroid function.
All in all, multivitamins are generally considered safe and low risk. My personal approach is to recommend multivitamins to patients 60 years of age or older, as there is data for cognitive benefit in this demographic. At the same time, I concede that no physical or mortality benefit will likely be incurred, but wouldn’t most of us hedge our bets for potential improved cognition as we age — for just a few bucks a month? Of course, shared decision-making with the patient is paramount in any medical situation, and that’s no different when discussing the use of multivitamins.
Do you take multivitamins? Share in the comments!
Dr. Del Carter is a family medicine resident physician in Tallahassee, FL. He enjoys traveling, watching sports, working on cars, and spending time with friends and family. Dr. Carter is a 2024–2025 Doximity Op-Med Fellow.
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