For about a dime a day, you can enjoy the benefits of some pretty decent health insurance. It comes in pill form—as a multivitamin.
Vitamins used to be thought of as nutrients needed in small amounts to prevent diseases like scurvy and rickets. As those diseases became less common, people generally paid less attention to vitamins. But all that has changed in recent years as more and more research has pointed to the power of the vitamins and other nutrients found in a standard multivitamin to prevent heart disease, cancer, osteoporosis, and other chronic diseases.
Taking a vitamin supplement is, of course, not a replacement for healthy eating. As we discussed in Chapter 1, no pill could give you the vast array of healthful nutrients and natural chemicals found in foods—or the combinations of those nutrients that work in synergy to keep you healthy. But a vitamin supplement can be a reliable backup plan—a way to fill any nutrient gaps that can show up from time to time, even in a healthy diet.
Folic acid, and vitamins B6, B12, D, and E are the five vitamins most people don’t get enough of from their diets. Even the 21-Day Diet outlined in Chapter 12 can’t guarantee that you’ll get enough of them. Eating more fruits and vegetables, wonderful and healthful though they may be, won’t give you much vitamin D, for example. And adding more whole grains doesn’t gain you much vitamin B6. If you drink alcohol, as we discuss in Chapter 6, you should take some additional folic acid. In short, taking a multivitamin is a safe, easy, inexpensive way to complement healthy eating.
Some multivitamins also include minerals. If you follow the healthy eating guidelines outlined in the Eat, Drink, and Weigh Less program, you probably won’t need to buy a supplement with minerals, because you’re likely to get enough of them from your food. Of course, if you want that extra safety net, it’s fine. For menstruating women, especially those who don’t eat much red meat, we recommend a vitamin supplement with minerals that include iron, which will help replace iron lost in menstruation.
Don’t be taken in by fancy labels and promises of “megadoses” or “all natural” sources. Any RDA-level multivitamin—including a store brand—will give you most of what you need. One exception is likely to be vitamin D; the RDA is only 400 international units (IU) per day, but recent studies show that most people would be better off with at least 1,000 IU per day. At the moment, only a few multivitamins include this amount, but we hope more will do so soon.
Several large studies among patients with heart disease have shown that separate supplements of vitamin E that contain amounts well above the RDA are not beneficial and therefore not recommended. The jury is still out on the use of vitamin E for people without existing heart disease. In a recent study among healthy women, those who took vitamin E supplements had only a 10 percent lower risk of heart attacks than did those who took a placebo, and this did not prove statistically significant. There was, however, a 24 percent lower risk of dying from all forms of cardiovascular disease combined, which would be an important benefit.
The amount of vitamin E present in food or in multivitamins isn’t enough to reach the levels that may reduce cardiovascular disease, that is, 400 to 800 IU per day. Until further evidence is available, we suggest an extra vitamin E supplement for most men and post-menopausal women without existing heart disease, which means a separate pill, taken when you take your multivitamin. Because vitamin E can reduce the blood’s ability to clot, people on blood-thinners should consult their health-care providers before taking vitamin E supplements.
No one really knows how much calcium an adult needs each day, but the current recommended daily intakes of more than 1,000 milligrams are probably higher than necessary. An intake of 500 milligrams is probably enough, and the current English recommendation of 700 milligrams per day is likely to prove more than sufficient. If you feel you need to get more, keep in mind that a high consumption of dairy products is probably not the best source. Supplements are a better way to go, because they have no calories and saturated fat, and they’re far more convenient and less expensive than several servings of dairy products. If you do buy a calcium supplement, get a calcium plus vitamin D combination; the extra vitamin D is likely to fill a gap in your nutrient stores. Also, there is powerful evidence showing that weight-bearing activities such as brisk walking—and weight-training, for upper body bones—greatly reduce risk of fractures associated with osteoporosis. The bottom line: If you want to prevent bone fractures, forget the milk and take your cow for a walk.
Make a multivitamin part of your daily diet. Buy a compartmentalized pill reminder box and stock it with multivitamins and whatever other daily supplements you choose to take. Or set a nice-looking pillbox on the table and refill it on the same day every week. You can take supplements before, after, or during a meal, but establish a routine so you don’t forget altogether. We recommend drinking a glass of water before every meal (see Chapter 5), and that habit can dovetail nicely with this one.