What vitamins support overall health?

Vitamins That Support Overall Health

For the general healthy population, obtain essential vitamins primarily through a balanced diet rich in fruits, vegetables, whole grains, and lean proteins rather than relying on supplements, as the evidence does not support routine multivitamin supplementation for disease prevention in well-nourished individuals. 1

Priority Vitamins for Overall Health Support

Vitamin D

• Vitamin D is the most critical vitamin requiring attention across all age groups, with mean intakes falling below the Estimated Average Requirement (EAR) in children (<8 µg/d), adolescents (<7 µg/d), and adults (<6 µg/d) 1
• Supports bone health, prevents rickets in children, and prevents osteoporosis in adults 1
• Supplementation with 3,000 IU/d is recommended to achieve normal concentrations of 30 ng/mL 1
• Particularly important for older adults at risk for falling 1

Vitamin E

• Over 80-95% of the population has intakes less than the EAR across all age groups 1
• Prevents vitamin E deficiency and H₂O₂-induced hemolysis 1
• The RDA is 15 mg/day α-tocopherol for adults 1

B Vitamins (B6, B12, Folate)

• Vitamin B12: RDA is 2.4 µg/day; critical for preventing developmental delays and cognitive impairments 1
• Vitamin B6: RDA is 1.3 mg/day; essential for normal metabolic function 1
• Folic acid: 400 µg/day of dietary folate equivalents is the RDA; 800-1,000 µg/day is mandatory for women planning pregnancy or capable of pregnancy to prevent neural tube defects 1

Vitamin C

• Over 25-40% of adolescents have intakes less than the EAR 1
• RDA is 75 mg/day for women and 90 mg/day for men 1
• Prevents vitamin C deficiency and provides antioxidant protection 1

Vitamin A

• Over 50% of adolescents have intakes less than the EAR 1
• Supports normal vision, gene expression, reproduction, growth, and immune function 1
• RDA is 700 µg/day for women and 900 µg/day for men 1
• Caution: Moderate doses may reduce bone mineral density, and high doses can be hepatotoxic or teratogenic 1

Essential Minerals for Health Support

Calcium

• RDA is 1,000 mg/day for adults under 50 years and 1,200 mg/day for adults over 50 years 1
• Supports bone health, vascular, neuromuscular, and glandular function; prevents osteoporosis 1
• Calcium citrate at 600 mg/day is the preferred supplemental form 1

Iron

• RDA is 8 mg/day for men and postmenopausal women; 18 mg/day for premenopausal women 1
• Over 15% of adolescent girls have intakes less than the EAR 1
• Prevents iron-deficiency anemia, developmental delays, and cognitive impairments 1

Magnesium

• RDA is 320 mg/day for women and 420 mg/day for men 1
• Over 70% of adolescents have intakes less than the EAR 1
• Maintains intracellular levels of potassium and calcium; supports bone health 1

Potassium

• Less than 3-6% of the population meets the Adequate Intake (AI) 1
• Counters excess sodium, supports healthy blood pressure, and prevents potassium deficiency 1

When Supplementation Is Appropriate

High-Risk Populations Requiring Supplementation

• Elderly individuals, pregnant or lactating women, strict vegetarians, and individuals on calorie-restricted diets should take a multivitamin preparation 1
• Patients with diabetes and uncontrolled disease often have micronutrient deficiencies requiring supplementation 1
• Post-bariatric surgery patients require two adult multivitamin-mineral supplements daily containing iron, folic acid, zinc, copper, selenium, and thiamin at 200% of the RDA 1

Specific Clinical Scenarios

• Vitamin A and iron supplementation in developing countries for women of reproductive age, infants, and children with deficiencies 2
• Vitamin D supplementation for infants and children 2
• Calcium and vitamin D for adults aged ≥65 years to ensure bone health 2

Critical Warnings About Supplementation

Supplements to Avoid

• β-carotene supplementation should be avoided, particularly in smokers and those with asbestos exposure, as it increases lung cancer incidence and all-cause mortality 1

Potential Harms of Excessive Supplementation

• Vitamins A and D have known harms at doses exceeding tolerable upper intake levels 1
• High-dose antioxidant supplementation (vitamin C, vitamin E, selenium) has not been demonstrated to protect against cardiovascular disease, diabetes, or cancer and may lead to health problems including diarrhea, bleeding, and toxic reactions 1
• Vitamin E has a tolerable upper intake level of 1,000 mg/day due to hemorrhage risk 1
• Vitamin C has a tolerable upper intake level of 2,000 mg/day due to gastrointestinal disturbances 1

Evidence-Based Approach to Vitamin Support

Primary Strategy

• Nutrients should come primarily from foods rather than supplements, with emphasis on a diet rich in fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood 1
• This dietary pattern has been associated with reduced risk for cardiovascular disease and cancer 1

When to Consider Supplementation

• Individuals should be educated about acquiring daily vitamin and mineral requirements from natural food sources and about the potential toxicity of megadoses 1
• Supplementation should be limited to the Dietary Reference Intake (DRI) ranges to prevent deficiency diseases 1
• Vitamin and mineral supplementation in pharmacological dosages should be viewed as a therapeutic intervention requiring placebo-controlled trials to demonstrate safety and efficacy 1

Quality Control Considerations

• The content and concentration of ingredients in commercially available formulations vary considerably 1
• Products with a U.S. Pharmacopeia seal provide a degree of quality control 1

Common Pitfalls to Avoid

• Do not assume that taking vitamins replaces the need for a healthy diet 1
• Do not exceed recommended dosages, as doses greatly exceeding the RDA or Adequate Intake may cause harm 1
• Do not use multivitamin supplements for primary prevention of cardiovascular disease or cancer in well-nourished adults, as evidence is insufficient or conflicting 1
• Do not overlook trace minerals (zinc, copper, selenium) when assessing for micronutrient deficiencies in patients with fatigue or significant weight loss 3