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Beyond a Backup Plan: Why a multi may be more important than you think.

Recommending a daily multivitamin and mineral supplement may be part of your standard practice, as an insurance policy to fill in nutritional gaps. But a multi might be more than a backup plan: a skillfully designed formula that includes a comprehensive array of supportive antioxidants can offer an added layer of protection for patients. Here’s why a multi may be more important than you think.


Overfed and undernourished.

It’s no secret that Americans are overfed and undernourished. In the United States, the primary dietary sources of energy are high in carbohydrates and fats, low in micronutrients—energy-dense and nutrient-poor. Even those who consume a near-perfect diet are likely to be missing essential micronutrients. National Health and Nutrition Examination Surveys (NHANES) have consistently revealed nutrient deficiencies and inadequacies in the U.S. population, and some data suggests almost 90 percent of the adult population is lacking in certain nutrients. Vitamins A, C, D and E, magnesium and calcium are the most prevalent micronutrient insufficiencies across all population groups, and zinc deficiencies are common in older adults.

Because the U.S. food supply is fortified, deficiencies that lead to clinically overt symptoms are infrequent. But even in the absence of critical deficiencies, micronutrient shortfalls—above levels associated with deficiency but below dietary intake recommendations—impair physiological functions and processes at a cellular level. Covert symptoms linked with insufficient micronutrient intake, like fatigue, weakness or diminished cognitive function, are often vague and difficult to clinically diagnose. Marginal nutrient deficiencies also have a significant impact on immunity, and inadequacies in zinc, selenium, iron, copper, folic acid and vitamins A, B6, C, D and E have been shown to alter immune response.

Over time, consistent shortfalls in vitamins and minerals heighten the risk for disease. Micronutrient inadequacies and deficiencies may accelerate mitochondrial decay and increase the likelihood of age-related degenerative diseases, including cardiovascular disease, diabetes, osteoporosis, cancer and macular degeneration. Insufficient micronutrient intake has been implicated in the development and progression of several types of cancer: in earlier studies, vitamin D deficiency was linked with increased rates of breast and colon cancer, and recent research shows that deficiencies of iron, zinc, folate and vitamins B6, B12 and C may cause DNA damage and lead to cancer.

Micronutrient deficiencies are also strongly implicated in the development and progression of heart failure, along with higher rates of cardiac-related morbidity and mortality.  More than 20 percent of adults with heart failure have a low intake of vitamin A, magnesium and selenium, and up to 75 percent have a low intake of vitamin D. Higher circulating magnesium levels are associated with lower incidence of coronary heart disease, hypertension, and type 2 diabetes, and studies continue to demonstrate the link between decreased vitamin D levels and increased risk for cardiovascular diseases and all-cause mortality.

Nutrient deficiencies: from stress to soil.

The reasons for widespread micronutrient shortfalls are varied and numerous, ranging from substandard diets to soil depletion. Only 10 percent of Americans eat the recommended daily servings of vegetables, and less than 13 percent consume the recommended amount of fruit. Meanwhile, diets rich in fat and sugar increase the prevalence of micronutrient deficiencies, and higher consumption of added sugars is associated with lower consumption of micronutrients, especially vitamins A, D and E, calcium and magnesium.

Additionally, certain foods interfere with absorption and decrease bioavailability of some nutrients. Tea is known to be a potent inhibitor of iron absorption. Other tannin-rich foods (nuts, coffee, grains, legumes) also hamper the uptake of nutrients. Oxalates in leafy greens, beets, nuts and legumes can bind to calcium and limit availability. Phytic acid in legumes, grains and nuts impairs the uptake of iron, zinc, calcium and magnesium. Because plant-based diets are abundant in legumes and nuts, vegans and vegetarians are particularly at risk. Vitamin B12 deficiencies are also common on plant-based diets, and reduced bioconversion of carotenoids may lead to insufficient vitamin A.

Even a balanced, whole-foods diet that limits anti-nutrients isn’t a guarantee. Diminished soil quality is linked with nutrient depletion in plants, and increasing evidence shows that many of today’s fruits, vegetables and grains are significantly lower in micronutrients than they were 70 years ago. A landmark study in 2004 noted drops in 13 vitamins and minerals—including calcium, phosphorus, iron, riboflavin, vitamin C—among 43 different crops ranging from chard and kale to cucumbers and asparagus. More recent research confirms these results, also demonstrating marked declines in nutrients found in grains, especially, iron, zinc, magnesium and manganese.

Besides diet, other factors—age, pregnancy, nursing, hormonal influences, medications and various genetic polymorphisms—can increase the risk of specific micronutrient deficiencies. Celiac disease, inflammatory bowel disease and other disorders impact nutrient digestion and absorption, and disruptions in gut microbiota are implicated in micronutrient deficiencies. Common lifestyle factors, like heavy drinking, sleep deprivation and ongoing physical or mental stress, can also lead to micronutrient shortfalls. Ethanol has an inhibitory effect on intestinal nutrient absorption, and excessive alcohol consumption is linked with insufficient thiamine, riboflavin, folate, vitamin C, selenium, iron and zinc. Lack of sleep is significantly associated with inadequacies of vitamins A, C, D, E and zinc. Psychological and physical stress may affect concentrations of micronutrients, and research demonstrates stress-induced depletion of magnesium, zinc, iron, calcium and vitamin B3.

Multis: more than a backup plan.

In a society where processed foods diets, stress and lack of sleep are the norm, digestive disorders are on the rise, and soil quality continues to decline, a daily multi should do more than fill in the gaps. Considering the weighty implications of micronutrient deficits on long-term health, immune function and overall well-being, a comprehensive multivitamin and mineral supplement is an essential part of a treatment protocol.

Research shows taking a daily multi can quickly correct deficiencies for most micronutrients. In one study, multivitamin and mineral supplement use at any frequency was associated with a lower prevalence of inadequacy for 15 out of 17 nutrients examined and an increased prevalence of intakes for seven nutrients. Regular use virtually eliminated inadequacies of most of the nutrients examined.

While date on the efficacy of supplements in reducing chronic disease risk is limited and conflicting, evidence supports possible benefits of multivitamin and mineral supplementation in cancer and cataract prevention, cognitive performance and other conditions. A recent study found that a daily multi could improve cognition in older adults and/or protect cognitive health with age. In another study, a multivitamin supplement in older adults boosted memory performance above placebo by the equivalent of 3.1 years of age-related memory change.

Research also highlights the therapeutic potential of antioxidants—including resveratrol, lutein, zeaxanthin, astaxanthin and lycopene—for the prevention or treatment of cardiovascular disease, cancer and neurodegenerative disorders. In a meta-analysis of 43 randomized controlled trials, a combination of selenium and antioxidants decreased cardiovascular disease mortality risk by 23 percent. Other data points to antioxidant supplementation as a possible strategy for decreasing cancer incidence by reducing oxidative stress and attenuating DNA damage and deleterious cellular changes.

The bottom line: it may be time to rethink the importance of a daily multivitamin and mineral. A well-formulated multi that includes antioxidants with proven benefits should be an integral part of comprehensive patient protocol—and not just a backup plan.



  1. McKeag NA et al. Dietary micronutrient intake and micronutrient status in patients with chronic stable heart failure: an observational study. J Cardiovasc Nurs. 2017; 32:148–155.
  2. Cascino TM et al. Nutrient deficiencies in heart failure: a micro problem with macro effects? J Am Heart Assoc. 2018;7(17):e010447.
  3. Wu J et al. Circulating magnesium levels and incidence of coronary heart diseases, hypertension, and type 2 diabetes mellitus: a meta-analysis of prospective cohort studies. Nutr J. 2017;16(1):60.
  4. Kheiri B et al. Vitamin D deficiency and risk of cardiovascular diseases: a narrative review. Clin Hypertens. 2018;24:9.
  5. Lee SH et al. Adults Meeting Fruit and Vegetable Intake Recommendations — United States, 2019. MMWR Morb Mortal Wkly Rep 2022;71:1–9.
  6. Bradley M et al. Obesity and malnutrition in children and adults: a clinical review. Obesity Pillars. 2023; 8:100087.
  7. Fulgoni VL 3rd et al. Association of added sugars intake with micronutrient adequacy in us children and adolescents: NHANES 2009-2014. Curr Dev Nutr. 2019 Nov 7;3(12):nzz126.
  8. Eberl E et al. Temporal change in iron content of vegetables and legumes in Australia: a scoping review. Foods. 2021 Dec 27;11(1):56.
  9. Mariem SB et al. Assessing the evolution of wheat grain traits during the last 166 years using archived samples. Sci Rep. 2020; 10, 21828.
  10. Butts M et al. The influence of alcohol consumption on intestinal nutrient absorption: a comprehensive review. Nutrients. 2023 Mar 24;15(7):1571.
  11. Ikonte CJ et al. Micronutrient inadequacy in short sleep: analysis of the NHANES 2005–2016. Nutrients. 2019;11:2335.
  12. Lopresti AL. The effects of psychological and environmental stress on micronutrient concentrations in the body: a review of the evidence. Adv Nutr. 2020 Jan 1;11(1):103-112.
  13. Blumberg JB et al. Impact of frequency of multi-vitamin/multi-mineral supplement intake on nutritional adequacy and nutrient deficiencies in U.S. adults. Nutrients. 2017 Aug 9;9(8):849.
  14. Baker LD et al. Effects of cocoa extract and a multivitamin on cognitive function: A randomized clinical trial. Alzheimers & Dementia. 2022. Epub Sept. 14.
  15. Yeung LK et al. Multivitamin supplementation improves memory in older adults: a randomized clinical trial. Am J Clin Nutr. 2023 Jul;118(1):273-282.
  16. Bohara RA et al. Recent overview of resveratrol’s beneficial effects and its nano-delivery systems. Molecules. 2022 Aug 12;27(16):5154.
  17. Mrowicka M et al. Lutein and zeaxanthin and their roles in age-related macular degeneration-neurodegenerative disease. Nutrients. 2022 Feb 16;14(4):827.
  18. Yoshida K et al. Effects of astaxanthin, lutein, and zeaxanthin on eye-hand coordination and smooth-pursuit eye movement after visual display terminal operation in healthy subjects: a randomized, double-blind placebo-controlled intergroup trial. Nutrients. 2023 Mar 17;15(6):1459.
  19. Davinelli S et al. Astaxanthin in skin health, repair, and disease: a comprehensive review. Nutrients. 2018 Apr 22;10(4):522.
  20. Przybylska S et al. Lycopene in the prevention of cardiovascular diseases. Int J Mol Sci. 2022 Feb 10;23(4):1957.
  21. Donoso A et al. Therapeutic uses of natural astaxanthin: An evidence-based review focused on human clinical trials. Pharmacol Res. 2021 Apr;166:105479.
  22. Jenkins DJA et al. Selenium, antioxidants, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2020;112(6):1642-1652.
  23. Angelo G et al. Efficacy of multivitamin/mineral supplementation to reduce chronic disease risk: a critical review of the evidence from observational studies and randomized controlled trials. Crit Rev Food Sci Nutr. 2015;55(14):1968-91.
  24. Didier AJ et al. Antioxidant and anti-tumor effects of dietary vitamins A, C, and E. Antioxidants (Basel). 2023 Mar 3;12(3):632.


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