Sorting Out Supplements

In December 2013, the Annals of Internal Medicine amassed 2 original research articles, 1 review, and 1 editorial analyzing and supporting the hypothesis that vitamin and mineral supplementation may not be beneficial for many facets of total health. One study assessed daily multivitamin efficacy in older adults for prevention of cognitive decline (Ann Intern Med. 2013;159:806-814); one evaluated high-dosage daily multivitamin in myocardial infarction patients for prevention of repeated cardiovascular events (Ann Intern Med. 2013;159:797-805); and the systematic review reported all-cause mortality, cardiovascular disease, and cancer in multivitamin users (Ann Intern Med. 2013;159:824-834). All 3 concluded that there was no significant benefit, and the editorial asked that we close the book on this question (Ann Intern Med. 2013;159:850-851).

What’s the issue?

In dermatology, patients often inquire about supplements, dietary changes, and natural methods for aiding in their recovery and for preventing disease. This set of publications attempts to steer us to summarily discourage widespread multivitamin and supplement use. However, there are certainly instances in which dogma from medical school training, smaller patient cohorts, and anecdotal cases compel us to continue them. The first things to come to mind in dermatology (and beyond) are biotin for hair and nail growth, folic acid for preconception and pregnancy prevention of fetal neural defects, and vitamin D for bone health.

Should everyone be on a multivitamin? For which diagnoses do you routinely recommend vitamin or mineral supplementation? In fact, in which instances do you take supplementation yourself? Do you feel comfortable with the evidence that supports it? Which references do you trust in this facet?

We want to know your views. Tell us what you think.