The Best Multivitamins? Answers to Your Health Questions.

By Marcus Laux: ND

Dr. Marcus Laux is a licensed naturopathic physician and a member of both the Enzymatic Therapy and PhytoPharmica Scientific Advisory Boards. He received his doctorate from the National College of Naturopathic Medicine (NCNM) in Portland, where he serves on staff as a clinical professor. Dr. Laux is the co-author of “Natural Woman, Natural Menopause” (Harper Collins, 1997), a complete plan for staying naturally well through menopause and beyond. He has been seen by millions on his network television series “The Natural Health Show” in Europe, “Wellness Watch” a daily news segment in Canada, and currently on Fox News’s “MD TV” in the United States.

Multivitamin Quick Menu

There are many vitamin and mineral supplements from which to choose. Finding the right multivitamin may take a little time and require some effort. You need to ask questions, read labels, and compare products. You also need to choose wisely and use multivitamins to complement good nutrition, not replace it. Once you find the right formula for your gender and age, you will have a stronger nutritional foundation.

Selecting a daily multivitamin - What exactly are vitamins?

A vitamin is an organic substance or chemical found in food that is absolutely necessary for life. We now know that even though vitamins each have their own specific jobs, they also work together as a team. A deficiency in even one vitamin can make us very sick.1 Vitamins are either fat or water-soluble. Vitamins A, D, E, and K are fat-soluble and can be stored for awhile in our fat and in the liver. The water soluble vitamins, vitamin C and the B vitamins, can’t be stored, and must be taken more than once a day for optimum nutrition.2

What does RDA mean?

The RDA, or Recommended Dietary Allowance, is defined as “the average daily dietary intake level that is sufficient to meet the nutrient requirement of nearly all healthy individuals in a group.” This means that RDA amounts of vitamins and minerals are the standard amounts that healthy people need to consume each day to prevent dietary deficiencies. A good example is vitamin C. The RDA for this hard working vitamin is the level of vitamin C you need to prevent scurvy, not the amount you need for superior health.3

The RDA does not account for people who are teenagers, elderly, past the age of 45, taking oral contraceptives, pregnant, nursing, dieting, engaging in intense physical activity, drinking alcohol, taking prescription medications, eating processed food, eating prepared food, stressed at work or at home, smoking, or exposed to secondhand smoke or air pollution.4-12

My diet high is very high in whole grains and I eat at least 9 servings of fruits and vegetables every day. Do I still need to take a multivitamin?

This question gets easier to answer as more and more diet and multivitamin studies are completed. Recent studies have shown that, even in individuals who were eating a very healthy diet, taking a multivitamin improved their nutritional status.13,14

There are so many different multivitamin formulas on the shelves. What vitamins should be in the supplement I buy?

It depends on many things. Men and women have different nutritional needs and therefore, need different multivitamin formulas. Your age also determines the amount and type of vitamins and minerals you should take. In the case of multivitamins, “one size” most definitely does not fit all!

However, men and women of all ages require some similar vitamins. Let’s start with those vitamins.

What minerals do we need to stay healthy?

There are many minerals we need each day to keep us healthy. Minerals provide rigidity and strength to our teeth and bones that form our skeleton, help with nerve and muscle function, are vitally important in biochemical interactions and the normal clotting of blood, and for everyday tissue repair and growth.31

Make sure the multivitamin supplement you buy contains calcium, iodine, magnesium, zinc, selenium, copper, manganese, chromium, molybdenum, sodium, potassium, boron, and vanadium.32 Iron should only be in formulas designed for women who are still menstruating. Other adults can easily meet their iron needs from food, and excess can be unhealthy.33

Do women need certain minerals more than men?

Yes, women need silica to help keep their bones healthy.34 Compared to men, women of any age also need more boron and calcium.35 However, women going through or past menopause need even more calcium to protect their bones.36

What can destroy or interfere with vitamins and minerals?

Researchers believe that while food may, in fact, contain all the good things we need, many factors can destroy or interfere with many vitamins and minerals. Vitamins are easily wiped out by light, air, heat, and water. Cooking many foods actually destroys their vitamins. Eating other foods raw is less nutritious than cooking them.37 Drinking alcohol will deprive you of several vitamins.38 Oral contraceptives interfere with B12 and folic acid in women who take them.39 When you eat a meal at a restaurant, don’t count on getting any vitamins from your food as the use of heating lamps destroys many nutrients.37 Many prescription medications can rob you of several vitamins and minerals.40 Smoking cigarettes and exposure to secondhand smoke destroys vitamin C.41

Fortunately, taking a quality multivitamin will provide you with dietary insurance against all these losses.13,14 And, the good news gets even better. Studies have also shown that the longer you use supplemental multivitamins, the more substantial the benefits are to your health.42,43

Is it possible for me to get all the vitamins, minerals, and herbs I need in one pill taken once a day?

No, you can’t. For vitamins, minerals, and herbs to be effective they need to be in amounts that could not possibly fit into a single tablet or capsule in a size small enough to be swallowed. Many vitamins are only active in the body for a short period of time and need to be replenished every 6 to 8 hours. You need a formula designed to be taken at intervals during the day (3 times a day, just like meals). This will provide you with superior benefits.

What else should be in multivitamin formulas?

Both men and women can benefit from a combination of lutein/ zeaxanthin, grape seed, bilberry, black tea, and cherry fruit.

Lutein and zeaxanthin are found in high concentrations in the macula–the back of the eye where the retina is located. Both are excellent antioxidants.44 Anyone who spends time outdoors in the sun may be exposed to harmful ultraviolet radiation, which is very damaging to our eyesight. Lutein and zeaxanthin help protect us from this radiation, help filter out other harmful light, help prevent age-related macular degeneration (the most common form of blindness for older people), and help prevent glaucoma and cataracts.45-47

Grape seed is a potent antioxidant that helps strengthen our capillaries, veins, and arteries; helps our heart stay healthy; helps decrease bruising, reduce varicose veins, and leg swelling. Grape seed also helps our immune systems and helps reduce allergic responses.48,49

Bilberry is another antioxidant that helps prevent hardening of the arteries, cataracts, and macular degeneration.50 Studies show that people who drink black tea have less cancer and lower chances of stroke.51,52 And, cherry fruit is another powerful antioxidant that can help reduce the risk of death from heart attack. Flavonoids found in cherries are also natural anti-inflammatory compounds. Flavonoids also strengthen collagen, tendons, and cartilage. Extracts of cherries are used frequently in Europe for treatment of varicose veins.53

Are there other ingredients that should be in multivitamin formulas for men?

If you are purchasing a multivitamin for a man, make sure lycopene is in the formul Lycopene is the pigment that makes tomatoes red. The redder the tomato, the more lycopene is present. Numerous studies suggest that lycopene levels in the blood may be associated with reduced incidence of prostate cancer as well as heart disease and agerelated macular degeneratioin.54,55

What should be in multivitamin formulas for women?

All women can benefit from cranberry, nature’s antibiotic. Women have used this excellent antioxidant for many years to help reduce urinary tract infections.56,57 Women of all ages are concerned about supporting bone health. Phosphorus is an important bone building nutrient.58,59 Women who are still menstruating should look for chaste tree berry extract in their multivitamin formulas. This herb can reduce the symptoms of premenstrual syndrome
(PMS).60 Women going through meno-pause or past it need soy extract. Soy protects women against heart attacks and keeps bones from becoming brittle and breaking.61,62

What else should I look for in a multivitamin supplement?

Make sure the manufacturer is reputable. Ask the people working in the store for brands they recommend or personally take. Read the labels of any multivitamin supplement you are considering purchasing. They should be protected from light, since light can destroy these fragile substances. That means they should be in an opaque (non-transparent) package, and the tablets should be coated with a light resistant shield (usually white or ivory). Besides vitamins, minerals, and herbs it should contain, some things shouldn’t be in your multivitamin. The best multi-vitamins contain no sugar, artificial coloring, or artificial flavoring.

Conclusion

While it’s difficult to keep up with the latest nutrition developments, finding a multiple that can help you achieve optimum health may be easier than you think. The right blend for you depends on your gender, age, and additional health concerns. Knowing the vitamins, minerals, and herbs that you need will help you when choosing a multivitamin. Life is too short to spend it saddled with chronic illness and or poor energy. High quality multivitamins will protect you with powerful dietary insurance for superior health.

Vitamin A

Helps prevent certain types of cancer; helps reduce harmful cholesterol levels and the risk of heart attacks. Prevents night blindness; helps improve our vision; aids our immune system; helps keeps our skin, teeth, bones, hair, and gums healthy and strong; helps reduce age spots.15,16

Vitamin C:

Strengthens the immune system; helps prevent chronic illness, cataracts, assists in lowering cholesterol, helps make collagen; repairs damaged cells, bones and teeth. Helps heal wounds, burns, and bleeding gums. Helps healing after surgery, prevents colds and flu, protects us against cancer, and helps our bodies absorb iron.17

Vitamin D:

Without vitamin D, the minerals phosphorus and calcium cannot build strong bones and teeth. With vitamins C and A, vitamin D helps prevent colds; helps absorb calcium and vitamin 18

Vitamin E:

Vitamin E helps keep our skin young looking, helps oxygen get around our bodies; prevents and helps dissolve blood clots; helps burns heal faster; helps lower blood pressure; helps nerves convey messages faster; stops leg cramps and helps boost our energy levels.19

Vitamin K:

Vitamin K is essential to the activation of osteocalcin, a protein that helps prevent bone loss.20 Additionally, without vitamin K, our bodies couldn’t make prothrombin, a blood-clotting chemical, and our blood simply would not clot.21

The B Vitamins:

The B vitamins are an important complex of vitamins. Like a group of good friends, the B vitamins do their best when they are all together.

Thiamin:

Also called vitamin B1, thiamin helps keep our nerves and muscles, including the heart, working well. It can help prevent seasickness; tooth pain that happens after dental work; helps treat herpes zoster (shingles); and helps the digestion of carbohydrates. Thiamin prevents beriberi.22

Riboflavin:

Also known as vitamin B2 and vitamin G, riboflavin is easily harmed by light. Deficiency in riboflavin is the most common vitamin deficiency in Americ Riboflavin helps our vision; supports reproduction; helps eliminate sore mouths, lips, and tongues; and helps metabolize fats, proteins, and carbohydrates.23

Niacin:

Niacin helps lower total cholesterol, raises HDL (the good) cholesterol, improves circulation, helps make our skin healthy looking, helps to eliminate bad breath, helps to reduce migraine headaches and dizziness, and reduces our cravings for sweets.24

Vitamin B6:

Also referred to as pyridoxine HCl, this B vitamin can only work in our bodies for eight hours. Then we must get more. Deficiencies of vitamin B6 are noted in many diseases. Vitamin B6 helps us make antibodies, helps stop nausea, reduces morning sickness, relieves mouth dryness caused by certain medications, helps reduce leg cramps, numbness in the hands, helps us use protein and fats, and helps make niacin. With folic acid, B6 can reduce harmful levels of homocysteine, an amino acid implicated in heart disease and Alzheimer’s disease.25

Vitamin B12:

Possibly the most complex of all the vitamins, B12 is sometimes called “nature’s most beautiful cofactor” because of its striking deep red color. With folic acid, B12 helps make DNA, the molecule that carries our genetic code. Vitamin B12 helps our nerve cells spark and communicate, helps burn fat, and keeps us energized. Deficiencies of B12 can result in a serious type of anemia and potentially harmful nerve damage.26

Folic Acid:

Also called folate, this B vitamin has made huge headlines recently for its powerful ability to prevent spina bifida, a serious birth defect.27 A recent study determined that folic acid reduces the risk of breast cancer in women who drink alcohol.28 Folic acid can also help milk production in nursing mothers; reduce pain; make our skin look healthier; kill the germs that cause food poisoning; help cells grow and divide; and help make DN27

Biotin:

Our intestines can make biotin, but only if we have an adequate amount of beneficial flor Biotin is a natural beauty product. It helps delay gray hair and baldness. Biotin also helps heal eczema and inflammation of the skin. It can also help aching muscles.29 Pantothenic Acid: This B vitamin helps us make antibodies to fight infection. Pantothenic acid converts sugar and fat into energy and reduces fatigue. Our adrenal glands depend on pantothenic acid to function well.30

Pantothenic Acid:

This B vitamin helps us make antibodies to fight infection. Pantothenic acid converts sugar and fat into energy and reduces fatigue. Our adrenal glands depend on pantothenic acid to function well.30

References

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2. Vitamin categories. Ibid. 173-174. 3. National Research Council. Summary. In: Recommended Daily Allowance. 10th ed. Washington, DC: Author; 1989: 1-9.

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14. McKay DL, Perrone G, Rasmussen H, et al. The effects of a multivitamin/mineral supplement on micronutrient status, antioxidant capacity and cytokine production in healthy older adults consuming a fortified diet. J Am Coll Nutr. 2000;19:613-621.

15. Ross AC. Vitamin A and retinols: functions. In: Shils ME, Olson JA, Shine M, Ross AC, Eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999: 317-318.

16. Grodner M, Anderson SL, DeYoung S. Vitamin In: Foundations and Clinical Applications of Nutrition: A Nursing Approach. St. Louis, Mo: Mosby; 2000: 188-194.

17. Jacobs R Vitamin C: Biochemical functions. In: Shils ME, Olson JA, Shine M, Ross AC, Eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999:470-473.

18. Grodner M, Anderson SL, DeYoung S. Vitamin D. In: Foundations and Clinical Applications of Nutrition: A Nursing Approach. St. Louis, Mo: Mosby; 2000: 194-198.

19. Traber MG. Vitamin E: Biologic function. In: Shils ME, Olson JA, Shine M, Ross AC, Eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999:348-350.

20. Schaafsma A, de Vries PJ, Saris WH. Delay of natural bone loss by higher intakes of specific minerals and vitamins. Crit Rev Food Sci Nutr. 2001;41(4):225-49.

21. Grodner M, Anderson SL, DeYoung S. Vitamin K. In: Foundations and Clinical Applications of Nutrition: A Nursing Approach. St. Louis, Mo: Mosby; 2000: 198-199.

22. Tanphaichitr V. Thiamin. In: Shils ME, Olson JA, Shine M, Ross AC, Eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999: 381-389.

23. Mindell E. Riboflavin. In: Vitamin Bible. New York, NY: Warner Books;1991:31-32.

24. Cervantes-Laurean D, McElvaney NG, Moss J. Niacin. In: Shils ME, Olson JA, Shine M, Ross AC, Eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999: 401-411.

25. Leklem JE. Vitamin B6. In: Shils ME, Olson JA, Shine M, Ross AC, Eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999:413-421.

26. Fleming T., ed. Vitamin B12. In: PDR® for Nutritional Supplements. Montvale, NJ: Medical Economics Company; 2001: 477-487.

27. Herbert V. Folic acid. In: Shils ME, Olson JA, Shine M, Ross AC, Eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999: 433-458.

28. Zhang S, Hunter DJ, Hankinson SE, et al. A prospective study of folate intake and the risk of breast cancer. JAM 1999;281:1632-1637.

29. Mock DM. Biotin. In: Shils ME, Olson JA, Shine M, Ross AC, Eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999:459-466.

30. Plekovsky-Vig N. Pantothenic acid. In: Shils ME, Olson JA, Shine M, Ross AC, Eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999: 423-432.

31. Grodner M, Anderson SL, DeYoung S. Minerals. In: Foundations and Clinical Applications of Nutrition: A Nursing Approach. St. Louis, Mo: Mosby; 2000: 215-225.

32. Corti MC, Guralnik JM, Salive ME, et al. Serum iron level, coronary artery disease, and all-cause mortality in older men and women. Am J Cardiol. 1997;79:120-127.

33. Kang JO. Chronic iron overload and toxicity: clinical chemistry perspective. Clin Lab Sci. 2001;14:209-19.

34. Rico H, Gallego-Lago JL, Hernandez ER, et al. Effect of silicon supplement on osteopenia induced by ovariectomy in rats. Calcif Tissue Int. 2000;66:53-55.

35. Bunker VW. The role of nutrition in osteoporosis. Br J Biomed Sci. 1994;51:228-240.

36. Kenny AM, Prestwood KM. Osteoporosis. Pathogenesis, diagnosis, and treatment in older adults. Rheum Dis Clin North Am. 2000;26:569-591.

37. Grodner M, Anderson SL, DeYoung S. Vegetable victories. In:
Foundations and Clinical Applications of Nutrition: A Nursing Approach. St. Louis, Mo: Mosby; 2000: 190.

38. Leo MA, Lieber CS. Alcohol, vitamin A, and ß-carotene: adverse interactions, including hepatotoxicity and carcinogenicity. Am J Clin Nutr 1999; 69:1071-1085.

39. Shojania AM. Oral contraceptives: effect of folate and vitamin B12 metabolism. Can Med Assoc J. 1982;126:244-247.

40. Heins JR. Interactions between vitamins and drugs. S D J Med. 2002;55:69-70.

41. Harkins R, Bratman S. Introduction. In: The Drug, Herb, Vitamin Interactions Bible. St. Louis, Mo: Prima Publishing;2000: xi-xiv.

42. Lykkesfeldt J, Loft S, Nielsen JB, Poulsen HE. Ascorbic acid and dehydroascorbic acid as biomarkers of oxidative stress caused by smoking. Am J Clin Nutr. 1997;65:959-963.

43. Giovannucci E, Stampfer MJ, Colditz GA, et al. Multivitamin use, folate, and colon cancer in women in the Nurses' Health Study. Ann Intern Med. 1998;129:517-524.

44. Fleming T., ed. Lutein and zeaxanthin. In: PDR® for Nutritional Supplements. Montvale, NJ: Medical Economics Company; 2001: 281-284.

45. Jacques PF, Chylack LT Jr, Hankinson SE, et al. Long-term nutrient use and early age-related nuclear lens opacities. Arch Opthalmol. 2001;119:1009-1019.

46. Junghans A, Sies H, Stahl W. Macular pigments lutein and zeaxanthin as blue light filters studied in liposomes. Arch Biochem Biophys. 2001;391:160-164.

47. Sujak A, Gabrielska J, Grudzinski W, Borc R, Mazurek P, Gruszecki WI. Lutein and zeaxanthin as protectors of lipid membranes against oxidative damage: the structural aspects. Arch Biochem Biophys. 1999;371:301-307.

48. Sato M, Bagchi D, Tosaki A, Das DK. Grape seed proanthocyanidin reduces cardiomyocyte apoptosis by inhibiting ischemia/reperfusion-induced activation of JNK-1 and C-JUN. Free Radic Biol Med. 2001;31:729-737.

49. Joshi SS, Kuszynski CA, Bagchi D. The cellular and molecular basis of health benefits of grape seed proanthocyanidin extract. Curr Pharm Biotechnol. 2001;2:187-200.

50. Monograph. Vaccinium myrtillus (bilberry). Altern Med Rev. 2001;6:500-504.

51. Wiseman S, Mulder T, Rietveld Tea flavonoids: bioavailability in vivo and effects on cell signaling pathways in vitro. Antioxid Redox Signal. 2001;3:1009-1021.

52. Warden BA, Smith LS, Beecher GR, Balentine DA, Clevidence B Catechins are bioavailable in men and women drinking black tea throughout the day. J Nutr. 2001;131:1731-1737.

53. Seeram NP, Bourquin LD, Nair MG. Degradation products of cyanidin glycosides from tart cherries and their bioactivities. J Agric Food Chem. 2001;49:4924-4929.

54. Kucuk O, Sarkar FH, Sakr W, et al. Phase II randomized clinical trial of lycopene supplementation before radical prostatectomy. Cancer Epidemiol Biomarkers Prev. 2001;10:861-868.

55. Lu QY, Hung JC, Heber D, et al. Inverse associations between plasma lycopene and other carotenoids and prostate cancer. Cancer Epidemiol Biomarkers Prev. 2001;10:749-756.

56. Foo LY, Lu Y, Howell AB, Vorsa N. The structure of cranberry proanthocyanidins which inhibit adherence of uropathogenic P-fimbriated Escherichia coli in vitro. Phytochemistry. 2000;54:173-181.

57. Jackson B, Hicks LE. Effect of cranberry juice on urinary pH in older adults. Home Healthc Nurse. 1997;15:198-202. Review.

58. Knochel JP. Functions of phosphorus. In: Shils ME, Olson JA, Shine M, Ross AC, Eds. Modern Nutrition in Health and Disease, 9th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999: 159.

59. Gur A, Colpan L, Nas K, et al. The role of trace minerals in the pathogenesis of postmenopausal osteoporosis and a new effect of calcitonin. J Bone Miner Metab. 2002;20:39-43.

60. Fleming T, ed. Chaste tree berry. In: PDR® for Herbal Medicines. Montvale, NJ: Medical Economics Company; 2000:176-177.

61. Vigna GB, Pansini F, Bonaccorsi G, et al. Plasma lipoproteins in soy-treated postmenopausal women: a double-blind, placebo-controlled trial. Nutr Metab Cardiovasc Dis. 2000;10:315-322.

62. Kritz-Silverstein D, Goodman-Gruen DL. Usual dietary isoflavone intake, bone mineral density, and bone metabolism in postmenopausal women. J Womens Health Gend Based Med. 2002;11:69-78.

HEALTH FACT: Studies have shown that the longer you use supplemental multivitamins, the more substantial the benefits are to your health. 42,43

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Multivitamins During Pregnancy and After Birth Delay Progression of HIV In Women

By the NICHD, biomedical research arm of the National Institute of Health

The study appears in the July 1, 2004 New England Journal of Medicine.

Multivitamin supplements containing high doses of the vitamin B complex, as well as vitamins C and E, given to HIV-infected women during pregnancy and for more than 5 years after they gave birth reduced the symptoms of AIDS, according to a study of Tanzanian women supported by the National Institute of Child Health and Human Development (NICHD) and the John E. Fogarty International Center (FIC) for Advanced Study in the Health Sciences, both of the National Institutes of Health. The supplements also bolstered counts of disease-fighting immune cells, and modestly lowered HIV levels in the blood.

"This study provides evidence that multivitamin supplements may allow women in developing countries who are infected with the AIDS virus to go for longer than they otherwise would before needing anti-AIDS drugs," said NICHD Director Duane Alexander, M.D.

"By keeping women healthier longer, multivitamin therapy can help to assure that anti-HIV drugs can be directed to those who need them most," said FIC Acting Director Sharon Hrynkow, Ph.D.

The first author of the study was Wafaie Fawzi, associate professor of nutrition and epidemiology at the Harvard School of Public Health. Other authors of the study also were from the Harvard School of Public Health as well as from the Muhimbili University College of Health Sciences in Dar es Salaam, Tanzania.

The authors conducted the study from 1995 to 2003, a time when the antiretroviral drugs were not available to most women in Tanzania, including those who took part in the study.

The researchers enrolled 1,078 HIV-infected pregnant women in Dar es Salaam, Tanzania. Women were assigned to one of four groups and received either a placebo, vitamin A, vitamin A in combination with a multivitamin preparation or a multivitamin preparation alone. The women took the vitamins during pregnancy and continued taking them for as long as they participated in the study — more than 5 years, in many cases. The multivitamin preparation contained high doses of vitamins C, E, and folic acid, as well as the vitamins in the B complex group (B1, B2, B6, B12, and niacin). All of the women received folic acid and an iron supplement during pregnancy, whether they were in the placebo group or the vitamin groups.

All the women received periodic checkups for at least 4 years after giving birth, and about half of the women received checkups for more than 5 years after giving birth. The researchers charted the women's progress to determine whether the supplements had an effect on the progression of HIV disease to severe symptoms, to AIDS, or death; or on the levels of certain immune cells (CD4+ and CD8+ cells); and on levels of HIV in the blood.

In all, 18 of 271 (7 percent) of the women who took multivitamins progressed to AIDS during the course of the study, compared with 31 among 267 (12 percent) of the women in the placebo group, a 50 percent reduction in the risk of progression to AIDS. Of the 271, 52 (19 percent) of the women who took multivitamins died, compared with 66 of 267 women (25 percent) in the placebo group. Although the number of deaths were lower in women receiving multivitamins, this was not a statistically significant difference. The effect of multivitamins was strongest in the first 2 years of follow-up.

Fewer HIV Symptoms With The Use of Multivitamins

The women taking multivitamins also had fewer symptoms of later stage HIV infection, such as mouth infections, mouth ulcers, or diarrheal diseases, than did women in the other group. Similarly, the women in the multivitamin group also had significantly higher CD4+ cell counts than did women in the other groups: overall, the average CD4+ cell count was 48 cells higher in women who received multivitamins compared to those who received placebo. The HIV virus level in the blood was also modestly but significantly lower in women who received multivitamins.

The women who took vitamin A alone did not show any pronounced differences from the women in the placebo group, and adding vitamin A to the multivitamin preparation did not appear to offer any significant added benefit compared with multivitamins alone.

The benefits noted in the Tanzania trial are modest compared to the effects of combination antiretroviral therapy, the authors wrote. In the United States, physicians routinely prescribe multivitamins to pregnant women. Moreover, in developed countries like the United States, pregnant women infected with HIV are routinely given a combination of three or more anti-HIV drugs during pregnancy to prevent the spread of the virus to their infants.

However, in developing countries, vitamin supplementation during pregnancy is not routine and is not provided following pregnancy, explained Lynne Mofenson, M.D., Chief of NICHD's Pediatric, Adolescent and Maternal AIDS branch, which provided funding for the study.

Low Cost Multivitamins: Alternative To Antiretoviral Therapy

"These results suggest that use of multivitamins by HIV-infected women during and after pregnancy can slow the course of HIV disease, and could provide a low-cost treatment to prolong the time before they need antiretroviral therapy," Dr. Mofenson said. She added that multivitamin therapy could result in significant cost savings for developing countries.

The researchers wrote that the retail costs of a year's supply of the multivitamins used in this trial is about $15, and that wholesale prices are substantially lower. "Our findings should encourage the use of multivitamin supplements as supportive care to those infected with HIV in developing countries," Dr. Fawzi said.

Dr. Mofenson noted that more studies are needed to define the minimum dose of multivitamins needed to produce a health benefit and to determine whether the multivitamins might provide similar benefits if given to persons already receiving antiretroviral therapy.

The NICHD is part of the National Institutes of Health (NIH), the biomedical research arm of the federal government. NIH is an agency of the U.S. Department of Health and Human Services. The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. NICHD publications, as well as information about the Institute, are available from the NICHD Web site, http://www.nichd.nih.gov, or from the NICHD Information Resource Center, 1-800-370-2943; e-mail NICHDInformation
ResourceCenter@mail.nih.gov.

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