Why you might need a multivitamin

Whether due to dietary preferences, medication, age or other factors, we can't always get the nutrients we need from our diet. Could a multivitamin help? Patsy Westcott investigates.

🕒 11 min read

The World Health Organization describes vitamins, minerals and other micronutrients (nutrients needed in tiny amounts) as 'magic wands' for growth and development. There is a growing mountain of evidence that certain nutrients, food groups, and patterns of eating can help us stay healthy throughout life, as well as helping to bolster us against disease as we get older.

It's always important to eat a diet rich in plant-based foods – think fresh veg, fruit, wholegrains, peas, beans and pulses and nuts and seeds – and lower in animal-based food, especially fatty and processed meats. Your diet should include five fruit and veg a day, together with two portions of fish a week, one of which should be oily.

But although a varied, nutritious diet is a key cornerstone of health, it's not always possible to get everything we need from food alone. If this is the case it could be time to consider a micronutrient supplement.

Are you deficient in micronutrients?

The Healthy Ireland Survey is a rolling study of the health of people living in the Republic of Ireland, and includes data on nutrition and eating habits. The latest findings from the survey show that significant numbers of adults of all ages are not getting the micronutrients they need from food.

In fact, according to the survey, a significant section of the population (72%) is not eating the recommended five or more portions of fruit and vegetables a day.

In addition, the National Adult Nutrition Survey (NANS) found that significant numbers of adults aged both 19-64 years and 65 years and over have inadequate intakes of vitamin C, folate (essential for healthy growth and development), calcium, zinc, vitamin B6, riboflavin, vitamin A and iron (particularly for females).

It also revealed that 61% of people had inadequate intakes of vitamin D; the sunshine vitamin created by the action of sunlight on skin in the summer months and also found in foods such as ox liver, egg yolks, cheese and some mushrooms.

The government recommends taking a 15 microgram (µg) vitamin D supplement daily between October and March; those over 65 should take a 15 µg vitamin D supplement all year round.

Even without outright deficiency, however, a suboptimal intake of nutrients can affect health and vitality, especially as we age.

You could be short of micronutrients if you:

• Are not eating enough (e.g. you're cutting calories to lose weight).
• Avoid whole food groups or certain nutrients because you are vegetarian, vegan or following a diet such as paleo, low-carb or keto (e.g. vegetarians and vegans are especially prone to deficiency of vitamin B12, as found in meat, fish, milk, eggs and other animal-derived foods).
• Often skip meals – either accidentally because of a busy lifestyle or deliberately due to intermittent fasting or time-restricted eating.
• Have food intolerances or sensitivities, or a medical condition that means you need to avoid certain food components, such as gluten.
• Have problems absorbing nutrients due to a medical condition such as coeliac disease or inflammatory bowel disease (IBD) or ageing (see below).
• Avoid certain foods for religious reasons.
• Have a poor diet with too many sweet and/or fatty foods and not enough vegetables, fruit and fibre.
• Are older (see below).

The vitamin and mineral needs of older people

Our nutrient needs and the way our bodies handle nutrients change as we go through life, and the Health Service Executive provides age-specific advice for those aged 65 and over.

Paying attention to your body's nutritional needs as you get older is important. A large systematic review and meta-analysis – a study of studies – concluded 'micronutrient deficiencies pose a considerable threat to independence and longevity'. The review included more than 28,000 people aged 65 or more. It analysed the intake of some 20 nutrients, highlighting six of special concern: vitamin D, vitamin B1 (thiamin), vitamin B2 (riboflavin), calcium, magnesium and selenium.

Why you may be short of micronutrients as you age

Factors that increase the risk of a shortage of micronutrients in later life include:

• Smaller appetite due to changes to the nervous system and the hormones that control appetite.
• Loss of taste and smell, making food less appealing.
• Changes to body composition such as more fat and less muscle, together with lower activity levels leading to fewer calories being consumed.
• Changes to the digestive system such as delays in stomach emptying (gastroparesis).
• Decline in the absorption of important micronutrients, such as calcium, vitamin D and vitamin B12.
• The effects of certain medications, such as for heart disease, nervous system diseases, gastric conditions and diabetes. These can dent absorption of nutrients, especially of vitamin B12, sodium and magnesium.
• Poor dental health leading to avoidance of hard-to-chew foods such as certain fruits, nuts and veg, chewy meat and some breads.
• Loss of interest in cooking and enjoyment of food and eating.
• Inflammageing (age-linked increase in inflammation). According to a 2021 study inflammation changes the profile of trace elements as we age (e.g. increases copper and decreases selenium and zinc).

Potential effect of lack of micronutrients in later life

Whatever the reasons, several studies highlight how a lack of micronutrients in later life can have adverse effects. In particular, it could:

Speed up the onset of physical frailty

• A 2022 preliminary review of 43 previously published articles revealed a link between low blood levels of vitamin D, albumin, and the antioxidants lutein and zeaxanthin, with physical frailty. Frailty is defined as unintentional weight loss, slowness, weakness, exhaustion, and low levels of activity leading to a lack of get-up-and-go and an increased risk of falls and fractures.

Hasten cognitive decline

• The same study highlighted an association between low levels of the B vitamins folate and vitamin B, vitamins A, D and E, and omega-3 fatty acids, with an increased risk of mild cognitive impairment.

Dent immunity

• A 2018 review points to the importance of vitamins A, C, D, E, B2, B6, and B12, folic acid, iron, selenium, and zinc for healthy immunity, and concludes that 'tailored supplementation based on the specific needs of each age group may help to provide an adequate basis for optimal immune function.'

Increase the risk of eyesight problems

Micronutrient deficiencies have a role in age-linked conditions such as cataracts (vitamins C and E are thought to be especially important) and age-related macular degeneration (lutein and zeaxanthin, found in green leafy veg, and omega-3 fatty acids, found in fatty fish, are linked with a decreased risk).

• A 2023 review highlighted the importance of vitamins A, B1 (thiamin), B12, vitamin C, vitamin D, vitamin E, zinc and folate for eye health. Its authors suggest 'Multivitamins designed for eye health can be a convenient way to ensure you receive a comprehensive spectrum of nutrients necessary for maintaining good vision and preventing eye conditions.'

Could a multivitamin supplement help?

More research is needed, but several studies suggest a multivitamin and mineral supplement could help:

Reverse physical frailty

A randomised controlled trial of frail older people living in Singapore published in 2015 found that taking a nutritional supplement, doing cognitive training, physical training or a combination of these helped reverse frailty. The supplement included iron, folate, calcium, and vitamins B6, B12 and D, and supplied around a third of the recommended daily allowances of these nutrients.

Maintain cognition

A 2023 US study of 3,562 older adults published in the prestigious American Journal of Clinical Nutrition, in which participants were randomly assigned to take a daily multivitamin supplement or a dummy pill for three years, found that those in the supplementation group had better memory as measured by an online test suite.

The researchers concluded that 'Multivitamin supplementation holds promise as a safe and accessible approach to maintaining cognitive health in older age.'

Improve immunity

A preliminary double-blind randomised controlled trial of 55-75-year-olds published in the journal Nutrients found that taking a multivitamin and mineral supplement for 12 weeks significantly increased zinc and vitamin C levels. It improved self-reported health, as well as the length and severity of illnesses.

The researchers concluded that taking a multivitamin and mineral supplement can improve 'immune outcomes' in older people.

Encourage healthier ageing

A small randomised controlled trial published in 2023 of 35 healthy men aged 67 and over found that a significant number had suboptimal blood vitamin levels. A multivitamin and mineral supplement improved or prevented a decline in blood vitamin levels.

It also helped prevent a decline in cellular energy metabolism. This is the total chemical change in cells needed for energy production, the synthesis of new molecules and breakdown of others. Specifically, it limited dwindling oxygen consumption in cells – a key characteristic of ageing.

What to look for in a supplement

Our nutrient needs change throughout life depending partly on our age and sex. Other factors that affect our need for certain nutrients include physical activity, pregnancy, breastfeeding, menopause, our diet and our genes. Choosing a supplement that takes these into account can help guide your choices.

Men

Go for… a broad-based supplement containing a variety of vitamins and minerals to support overall health and wellbeing. Considerations include:

• Selenium, which studies show to be important for sperm quality and prostate health.
• Zinc, which is essential for male fertility. It promotes maturation and release of sperm and helps balance testosterone.

Women

Go for… a broad-based supplement containing a variety of vitamins and minerals to support immunity, metabolism, hormones, bone health and energy levels. Considerations include:

• Iodine, vital for production of thyroid hormone, normal cognitive function throughout life and for development of the brain and nervous system in the unborn baby. Iodine requirements increase by half during pregnancy.
• Iron, needed for healthy levels of haemoglobin in the red blood cells that carry oxygen around the body. Iron deficiency is common in women who menstruate, especially in the third of women who have heavy periods.
• Vitamins B6, B12, folic acid and iron are all nutrients NANS highlights as being low in women in their 20s, 30s, 40s and 50s.

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Older people

Go for a broad-based supplement containing higher levels of vitamins, minerals and botanicals and other nutrients to support the brain, heart, nervous system, muscles, bones, teeth, and energy levels.

Consider an age-specific supplement such as one specially formulated for over-50s or over-70s. Other considerations include:

• Vitamin B12 and folic acid. Older people are prone to deficiencies of these nutrients, which in turn are linked to subtle changes in memory and attention.
• Chronic atrophic autoimmune gastritis (CAAG), an autoimmune condition that causes loss of cells in the stomach lining, leading to lack of stomach acid, is common in older people. It can lead to vitamin B12 deficiency and iron It's also been linked with deficiencies in calcium, vitamin D and vitamin C.
• We need less iron as we age. In fact some think iron may actually be involved in driving the ageing process.
• Calcium is especially important for strong bones and muscles, and the current recommendation of 700 milligrams a day is thought by some to be inadequate for older people, with 1,000 milligrams a day together with vitamin D thought to be more appropriate.
• Coenzyme Q10 could be especially important to help preserve cognition, according to a randomised controlled trial published in 2023 suggesting that 'a decline in cognitive capacities may be related to reduced antioxidant defenses, as reflected by low CoQ10 levels in older adults.'

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• B vitamins, iron and zinc contribute to cognitive health
• High levels of vitamin D3, vitamin K, magnesium and calcium help maintain normal bones
• Co-enzyme Q10 and vitamin B1 for normal heart function

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