By Carolyn Sax, MD, a primary care physician with the Pediatric Physicians’ Organization at Boston Children’s and practices at Hyde Park Pediatrics in Hyde Park and Milton, Mass.
Parents often ask me whether I recommend multivitamins for their children, and in most situations I say no. This takes a lot of people by surprise. Vitamins sound like such a good thing, right?
The answer is actually somewhat complicated. Foods that are naturally rich in vitamins are definitely a good thing, and many scientific studies have shown the benefits of eating a diet rich in nutritious foods like fruits, vegetables, whole grains, fish, lean meats and milk. But the vitamins themselves, when taken in pill form, can actually be harmful. Our body is most effective at using nutrients when they enter us directly from their natural food source. The healthful advantages of these nutrients depend on their food “packaging” to give their full healthful benefits, like iron found in spinach or all the vitamin E packed into an avocado. But researchers have yet to find any benefit from most vitamins taken in pill form. None of the major medical associations, including the American Academy of Pediatrics, The American Medical Association, The American Institute of Nutrition, The American Society for Nutrition, or The Academy of Nutrition and Dietetics recommend routine use of multivitamins.
Too much of a good thing
Many vitamins are actually harmful if taken in too large a quantity. Too much vitamin A, for example, can cause birth defects, liver abnormalities and brain disorders, and can reduce bone mineral density. Too much vitamin B6 can lead to nerve damage in our arms and legs. Toxicity from these vitamins occurs almost exclusively as a result of taking vitamin supplements. Supplements of some vitamins and minerals can also block the body’s natural ability to absorb other essential nutrients from the foods we eat.
Many people give their children vitamins because they believe vitamins will prevent diseases, but they probably won’t be any help. In every careful scientific study looking at the effectiveness of vitamin C supplements, no benefit has ever been found. In February of 2014, the U.S. Preventive Services Task Force (USPSTF) published its official guidelines stating that there is no scientific evidence to support the use of vitamin supplements in the prevention of heart disease or cancer in adults. In fact, there is medical research showing that taking vitamin supplements can increase a person’s risk of getting cancer or dying from it. A study from the National Institute of Health found that men who took more than seven multivitamins per week significantly increased their risk of prostate cancer. Several studies of adults taking supplements of vitamin E, beta-carotene, selenium and vitamin A have shown an increased risk of developing cancer and an increased rate of death from all causes—without showing any overall health benefit.
And what exactly are in these vitamin supplements? Sadly, it’s hard to know for sure. Other than the manufacturer’s responsibility to ensure their products’ safety, there are no rules that limit a serving size or the amount of a nutrient packed into any form of dietary supplements. How much product information is shared with the consumer is decided by the manufacturer—who profits from sales—and doesn’t require approval or review by the Food and Drug Administration (FDA). What’s more, there’s no requirement that a vitamin manufacturer has to inform the FDA or consumers about the safety, or supposed benefits, of their products. According to a study in JAMA Pediatrics, many multivitamins marketed for children contain higher quantities of individual vitamins than are recommended and could possibly even be unhealthy.
A time and place for supplements
But that’s not to say vitamins are inherently bad—there are situations where vitamin supplements are a good thing. At birth, babies should receive a shot of vitamin K. Vitamin K deficiency, which is common in newborns, can cause severe, sometimes deadly bleeding. In fact, giving babies vitamin K at birth has eliminated this once common cause of newborn death. In addition, breastfed infants should receive vitamin D supplementation to help them develop strong bones. Since the dawn of time, humans have obtained vitamin D by absorbing it from sunlight. But since becoming more aware of the dangerous effects of sun exposure, we have greatly reduced our children’s exposure to the sun, which has caused children to get less naturally obtained vitamin D. As a result, vitamin D is now added to infant formula, but breastfed babies need to receive it as a supplement.
Children with serious intestinal tract diseases, such as inflammatory bowel disease, short gut syndrome, cystic fibrosis and others also need vitamin supplementation because their injured intestinal tracts prevent them from absorbing the vitamins that they need from food. Infants with a history of prematurity and children with iron deficiency need iron supplements. Children on a vegan diet need vitamin supplementation to get vitamins and nutrients that come only from animal-based foods like milk, eggs, meats and fish. Women in their child-bearing years need extra folic acid because it’s proven to reduce the risk of having a baby with spina bifida. And sadly, children in some of the more resource poor countries of the world may benefit from zinc and other supplements due to poor diets found there.
Encourage nutrients from plates, not pills
So what is a parent to do about the question of whether to give their child a multivitamin? In most cases, a multivitamin will not be helpful, but if you believe that your child is at risk of developing a vitamin deficiency, ask your pediatrician about whether she would benefit.
If vitamins are not the answer, there are plenty of ways to help keep your child healthy. From the start, give her only healthy food choices. Serve your child real food, not processed foods, with as many fruits and vegetables as possible. Most children have their super-picky phases and their “they-barely-ate-a-bite-all-day” phases, and that’s OK. (In fact, it’s to be expected!) Just keep offering healthy options and think of vitamin requirements as being met over the course of weeks, not days.
Leave the pills in the bottle. Teach your child that good health comes from a lifetime of healthy food choices. There are no shortcuts!
Dr. Sax is a member of Boston Children’s Hospital Community of Care Preferred Pediatric Practice and sees patients in both Hyde Park and Milton, Mass. To learn more please visit her profile page.