Nutrition & supplements
Vitamins & minerals, food first
Do you need a vitamin pill if you eat reasonably well?
Most people get what they need from a varied diet. Some groups need a specific supplement, multivitamins do little for heart disease, and too much of some vitamins causes real harm. Here is how to tell the difference.
In 30 seconds
The short answer
Your body needs 13 essential vitamins,1 and a varied diet of fruits, vegetables, beans, lentils and whole grains is the foundation.3 Multivitamins cannot replace food4 and appear to have little or no effect on heart disease risk.5 Some people do need a specific supplement, such as B12 after 50 or folic acid before pregnancy.1011 And too much of some vitamins causes harm.1415
Who may need a supplement
| Who | What to ask about |
|---|---|
| Adults over 50 | Vitamin B12 from fortified foods or a supplement.10 |
| Vegans and strict vegetarians | Vitamin B12; only animal foods contain it naturally.9 |
| Planning a pregnancy | Folic acid before and in early pregnancy.11 |
| Older adults | Vitamin D, because skin makes less with age.12 |
Iron deficiency is not uncommon in young children, women under 50 and pregnant women.13 Ask before starting iron.
When more is harmful
| Nutrient | What too much can do |
|---|---|
| Vitamin A | Severe headache, blurred vision, nausea, dizziness.14 |
| Vitamin B6 | Severe nerve damage after a year or more of high doses.15 |
| Iron | Stomach upset, constipation, nausea, vomiting.16 |
| Folic acid | Stay under the upper limit unless a provider advises otherwise.17 |
Multivitamins can raise the chance of getting too much of some nutrients.6
The clinic's approach
The Pakistan Institute of Medical Advancement in Karachi, whose documents inform this site, pairs multivitamins with chelation in its heart note. Here is what it says, and what independent evidence shows.
The clinic's multivitamin protocol, and the evidence
The clinic's heart note first, then independent evidence.
Oral multivitamins and multiminerals given alongside EDTA chelation infusions for heart disease
Listed in the clinic's treatment notesEvidence points the other way- Where the clinic says this
- "HEART DISEASES" note.20
- The clinic's stated rationale
- The note cites the NIH chelation trial, which gave EDTA infusions together with oral multivitamins and multiminerals.20
- Evidence and limitations
- Multivitamins appear to have little or no effect on the risk of heart disease and stroke.5 The trial evidence on chelation itself is on the coronary-heart-disease page. Multivitamins can also raise the chance of getting too much of some nutrients.6
- What this means for you
- A multivitamin is not a heart treatment. Keep taking prescribed heart medicines and ask before adding supplements.19
From the Dr. Majid Ali archive
A historical perspective
“Vitamins are oxygen’s darlings.”— Dr. Majid Ali, 2014-06-01Dr. Ali wrote often about vitamins, describing them within his own oxygen model, and he was sceptical of the official recommended amounts.
One part is consistent with current sources: vitamins are essential, and the body needs 13 of them to work properly.1
Where ProperHealth stops. The sources used here do not support his oxygen framework for vitamins or high-dose vitamin protocols. Too much vitamin A or B6 can cause real harm,1415 and upper limits apply.17
Supplements, medicines and safety
A pharmacist can check your supplements against your medicines and upper limits, and help you prepare questions. A pharmacist does not diagnose deficiencies; a blood test ordered by your clinician does.
Compared
Conventional and integrative care, compared
Where a vitamin is a real treatment, where supplements cause harm, what the body actually needs, and what the multivitamin evidence shows.
Where a vitamin is a treatment
- Where a vitamin is a treatment it is specific: folic acid before and in early pregnancy helps prevent spine and brain birth defects;11 people over 50 should get most of their B12 from fortified foods or supplements;10 a specific vitamin and mineral combination can slow vision loss from age-related macular degeneration.8 Iron deficiency is not uncommon, especially in young children, women under 50 and pregnant women.13
Limits and adverse effects
- Too much vitamin A from supplements can cause severe headache, blurred vision, nausea and dizziness;14 high-dose vitamin B6 for a year or more can cause severe nerve damage;15 high-dose iron can cause stomach upset, constipation, nausea and vomiting.16 Do not take folic acid above the upper limit unless a provider recommends it.17
- Some supplements interact with medicines, interfere with lab tests or cause problems during surgery,19 and the FDA does not approve supplements for safety and effectiveness before they are sold.18
What the body needs, and why people fall short
- There are 13 essential vitamins;1 A, D, E and K are fat-soluble and stored in the body, while vitamin C and the B vitamins are not stored.2 As you age, your skin makes less vitamin D from sunlight;12 B12 deficiency affects 3% to 43% of older adults, and only animal foods contain B12 naturally.9 Not eating enough fruits, vegetables, beans, lentils, whole grains and fortified dairy may raise the risk of heart disease, cancer and weak bones.3
Integrative and naturopathic approaches, by evidence
Evidence levels: EstablishedEmergingHypothesisNot supported
- Established
Food first: multivitamins cannot replace a varied diet, because foods provide more than vitamins and minerals.4
- Not supported
Multivitamins appear to have little or no effect on the risk of heart disease and stroke,5 taking one can raise the chance of getting too much of some nutrients,6 and there is no standard multivitamin — ingredients vary by product.7
- Hypothesis
The clinic's heart note describes EDTA infusions given with oral multivitamins and multiminerals, citing the NIH chelation trial;20 that trial's result is set out on the coronary heart disease page.
A child who has swallowed iron tablets or adult vitamins is a Poison Control call, 1-800-222-1222, or 911.21
When to get help now
Each warning sign cites the official guidance behind it. The wording still needs pharmacist sign-off.
- A child has swallowed iron tablets or adult vitamins — call Poison Control at 1-800-222-1222 or 911.2122
- Severe headache, blurred vision, dizziness or problems with coordination while taking high-dose vitamin A — stop the supplement and contact your provider.2324
- New numbness, tingling or unsteadiness while taking vitamin B6 — stop it and see a provider.2526
- Black, tarry stools with stomach pain while taking iron — contact your provider right away. Iron can darken stools, but black, tarry stools can also be a sign of bleeding.2728
- Tiredness, pale skin or a racing heart that is new — ask about a blood test for anemia.293031