This newspaper’s publisher, Leonard Woolsey, recently sent me an inquiry from a reader asking that I write on the topic of vitamins and supplements. Apparently, his wife takes a number of these over-the-counter products while he doesn’t take any. He wondered if he should.

My answer is, “It depends.”

Vitamins and dietary supplements are used for a broad variety of reasons but mainly for deficiency, prevention and therapy.

If you’re deficient in a certain vitamin, for example vitamin C, you need supplemental amounts in your diet or from a pill form to avoid the effects of the deficiency, which is scurvy. Likewise, too low of a level of vitamin B1 can lead to beriberi, heart failure, mental problems and more. Such frank nutritional deficiencies are relatively rare in developed countries.

The consensus by most clinicians and nutritionists is that the foundation of good health is from our diet. Supplements are rarely necessary in the presence of a healthy, balanced diet. A Mediterranean or anti-inflammatory diet are examples of diets providing adequate amounts of what our bodies need.

The emphasis on diet is crucial as people can live healthy, long and productive lives without ever taking a vitamin, mineral or other supplement. My grandparents raised their own vegetables, fruits, milk cows and chickens. They ate straight off the farm. Their food was wholesome, fresh, and I doubt they ever took a multivitamin. Similarly, consider locally grown and sourced foods for the healthiest choices.

Our spectrum of individual nutritional needs, genetics, metabolism, coupled with what’s often a nutrient-depleted diet because of food choices, farming practices, storage and processing of food may leave us with many trace deficiencies in our micronutrients. These may not show up in grossly clinical conditions like scurvy or beriberi but may affect our health in other ways. So, maybe a multivitamin is good insurance.

A recent example was during the COVID pandemic, associations were found with low vitamin D levels and worse clinical outcomes. Zinc supplementation may improve immunity and wound healing and was in short supply on shelves. Vitamin C has maintained its rugged reputation for helping prevent or shorten the common cold. Probiotics can help a gut microbiome depleted by antibiotics to recover its natural resilience.

The role of vitamins and supplements over the years has often been questioned as many studies reflected limited or no benefits. Such studies, however, are difficult to do given the long-time course of impacts of diet on health and individual variability. Micronutrients in foods are there in concert with an entire orchestra of others that interact with each other affecting absorption and bioconversion.

Many of my patients interested in a holistic approach come in with a list of half a dozen to a full page of supplements. I often counsel them to reduce but not eliminate some as unnecessary, costly or redundant, or to avoid potential interactions with prescriptions. Those who have a poor diet or lifestyle, high stress or family history of early disease also might consider well-chosen supplementation.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.

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