Will Multivitamins Help You Live Longer?

Here are the facts.

A new observational study suggests multivitamins might slightly decrease your lifespan.

Before taking a look, let’s put this into its appropriate context.

This is educational in nature and not medical or dietetic advice. See terms for additional and more complete disclaimers.

The Short Answer

But first, the short answer.

The best way to get all your micronutrients in is to have an average daily intake of one or two ounces of liver; one or two oysters; a tablespoon or two of unfortified nutritional yeast; several servings of something rich in vitamin C such as bell peppers or strawberries; two to three servings of a calcium-rich food like dairy, bones (but not bone broth), or three to five servings of dark greens (mainly napa cabbage, Chinese mustard greens, bok choy, kale, or broccoli); and a large volume of potassium-rich foods, such as the lean portions of meat, eggs, and milk; legumes, such as lentils, peas, and beans; or tubers such as potatoes; and fruits and vegetables. If you don’t follow these rules of thumb, track your diet in Cronometer (see How to Track Your Diet in Cronometer) to make sure you are hitting all the micronutrient targets. If you cannot meet your micronutrient targets with foods, use a high-quality multivitamin such as Adapt Naturals and Seeking Health Optimal Multivitamin Chewable. If you really want to optimize, run the Comprehensive Nutritional Screening and use the screening and Cronometer to keep tweaking till everything is fully on target.

If you have a loved one who is not motivated to do any of this, have them take a run-of-the-mill drugstore multivitamin. The data support it having almost no effect on lifespan, but being good for healthspan.

Multivitamins Are Far From Useless

Multivitamins are far from useless.

They reduce high blood pressure [1] and they provide a number of brain-boosting benefits, ranging from improvements in short-term memory [2] to reductions in stress, anxiety, fatigue, and confusion.[3] Older adults who take multivitamins spend 2.5 fewer weeks a year being sick than those who don’t,[4] and there’s some evidence that multivitamins can even reduce the risk of cataracts,[5] a common cause of cloudy vision. 

Multivitamins are especially important in pregnancy, when women are medically advised to take a special formulation known as a prenatal vitamin. Use of multivitamins during pregnancy reduces the risk of miscarriage[6] and birth defects,[7] and it may even reduce the risk of childhood cancers.[8] Multivitamins also seem to prevent preeclampsia,[9] a condition that causes nausea, vomiting, high blood pressure, and headache, and when left untreated can lead to seizures and even the death of the mother.

At this point, the benefits of multivitamins come to a screeching halt. 

Multis do nothing to reduce the risk of heart disease or cancer,[10] the leading causes of death,[11] and as a result they don’t make us live any longer.[12] Although most studies show that multivitamins are safe,[13] they appear to worsen the risk of age-related macular degeneration,[14] the leading cause of blindness in older adults. 

Multivitamins And Lifespan: Prior Evidence

The latest study on lifespan [15] is the largest prospective cohort study to date.

Let’s put it into context by looking at the prior studies on multivitamins and lifespan.

Randomized Controlled Trials

In 2022, a meta-analysis [16] of three randomized controlled trials with 51,945 subjects found a 6% lower risk of death in those randomized to use of a multivitamin that did not reach statistical significance (OR, 0.94 [95% CI, 0.87-1.01]). Nearly all the deaths in the included trials occurred in the COSMOS trial, where about 750 out of 21,442 people died over 3.6 years, and those taking a multivitamin seemed to die 7% more slowly but this did not reach statistical significance (hazard ratio [HR], 0.93 [95% CI, 0.81-1.08] [n = 21 442])

A 2013 meta-analysis [12] had included a broader number of smaller randomized trials, and had come to similar conclusions: no statistical significance. However, limiting the analysis to 13 primary prevention trials covering 60,967 people brought the all-cause mortality benefit just to the border of statistical significance (RR: 0.94; 95% CI: 0.89, 1.00). The primary prevention trials were those that tested the use of multivitamins in healthy people instead of those with existing cardiovascular disease or cancer.

Prospective Cohort Studies

The new study is a prospective cohort study, which does not randomize people to different interventions, but instead asks people what they are already doing and follows them over time. To my knowledge, there are no existing meta-analyses of prior prospective cohort studies assessing the association between multivitamin use and all-cause mortality.

A pubmed search suggests that this new study is one of only seven prospective cohort studies that have reported all-cause mortality, and four of the remaining six were specific to individuals diagnosed with diabetes or cancer. Of the two that remain:

• The German EPIC-Heidelberg Study [17] covered 23,943 and 1,101 deaths over 11 years. The use of any vitamin or mineral supplement, 83% of which was multivitamins, was associated with a statistically significant 14% lower risk of death when adjusted for sex and age alone, but adjusting for education level, physical activity, BMI, waist-to-hip ratio, smoking category, intake of meat and meat products, total energy intake, and baseline regular use of NSAIDs reduced the magnitude to a 9% benefit and caused the loss of statistical significance (95% confidence interval 0.8-1.4). Notably, those who did not use supplements at baseline and started using supplements during the study actually had a 58% increased risk of death, which is likely explained by “sick user bias,” where people changed their habits because they ran into health problems.
  

• In a Swedish study [18] of 38,994 men covering 3403 over 7.7 years, multivitamins accounted for a much lower 41% of supplement use. Whether adjusting for age alone or a full model of potential confounders, there was no statistically significant association between use of any supplements and all-cause mortality. Risk ratios seemed slightly favorable (0.96-0.97) for occasional use and completely flat (1.0) for regular use.

The Swedish paper lists a reference to a third study that did not turn up in the pubmed search for all-cause mortality:

• In this American study [19] of 47,967 men and women and 14,753 deaths over 7 years, adjusting for age alone led to no association in men or women, while a full adjustment model led to a significant 5% increased risk of death in men but not women, and this was exclusively driven by a ~10% increased risk of death in those who had only been using multivitamins for fewer than five years. In those using them longer than five years, the association was completely flat (0.99-1.00). The duration effect is hard to interpret: either multivitamins killed all the easy victims quickly and left the resilient ones alive (survivorship bias), or it’s another case of sick user bias: people who started fewer than five years before baseline were people who changed their habits because they ran into health problems.

Using a broader pubmed search that uses “mortality” instead of “all-cause mortality” or “total mortality” does turn up this last study, but perusing the titles suggests that no other studies on all-cause mortality were missed that were done in general populations rather than disease-specific populations.

The German finding of a 14% benefit to supplement use at baseline and a 58% increase in the risk of death in those that started later is strongly suggestive of sick user bias (sick people start using supplements). This makes it more likely that the American finding of increased risk of death only with short duration is explained in the same way, and not by survivorship bias (multivitamins kill the easy targets first).

Complete Lack of Clarity About The Validity of Statistical Adjustments

The Swedish study is the least specific to multivitamins, and the American study is the most specific. The German study is reasonably (83%) specific to multivitamins. In both the German and American studies, associations looked worse in fully adjusted models.

Adjustments are not valid if multivitamins mediate their impact on mortality through the factors being adjusted.

It is completely plausible that multivitamins could make people more physically active, improve their waist-to-hip ratio, help them quit smoking, change how much they eat, and impact their use of NSAIDs.

For example, you could fix a nutrient deficiency that is sapping your energy. This makes you feel more energetic. You exercise more. You lose body fat. You stop relying on crutches for your previously miserable life and you quit smoking. This all motivates you to eat better foods and to stop overeating. You live longer.

A statistician then comes and says yes but we have to subtract the life you gained from feeling more energetic, exercising more, losing body fat, stopping smoking, and eating better, and after we subtract that, you did not live longer.

Those adjustments just ruin the information rather than clarifying it.

As such we should never trust the fully adjusted models over the less fully adjusted ones.

Instead, we should look for the congruence with the randomized controlled trials. These are suggestive of a small longevity benefit to multivitamins that does not always reach statistical significance, and is easiest to see when looking at populations that are healthy at baseline.

There is better congruence between the randomized controlled trials and the prospective cohort findings that are only adjusted for age or for age and sex. The fully adjusted prospective cohort findings lose their congruence with the randomized trials.

Multivitamins And Lifespan: The New Study

The latest study on lifespan [15] covered 390,124 generally healthy American adults with more than 20 years of follow-up and 164 ,762 deaths.

Deaths accelerated in the second half of followup, so the two halves were analyzed separately, as followup periods 1 and 2 (FP1 and FP2).

Here are the results:

Daily use is almost completely flat when adjusted for age and sex alone.

Non-daily use looks bad in the first half and good in the second half.

The fully adjusted models included race and ethnicity, education, BMI, marital status, smoking status, alcohol consumption, physical activity level, coffee intake, family history of cancer, conformation to healthy eating patterns, and use of individual supplements.

Some of these are immutable characteristics, some are unlikely to be directly impacted by multivitamins (marital status, family history of cancer), and others as covered above could be impacted by multivitamin use (BMI, use of cigarettes, alcohol, and coffee, physical activity level, use of other supplements, dietary patterns).

In the fully adjusted models, daily use has a consistent 4% increase in risk across the time periods that is statistically significant in the first half and just loses significance in the second.

Whether you view this as a non-effect or a small negative effect all hinges on whether you trust all the adjustments.

I would maintain that the model adjusting only for age and sex is more consistent with the rest of the data, which suggests there is a very small longevity benefit to multivitamins that is often hard to show statistical significance for. That ultimately means there is very little impact of multivitamins at all on lifespan.

Why Do Multivitamins Help Healthspan More Than Lifespan?

If we assume that multivitamins represent the full force and effect of the entire collection of vitamins and minerals, these findings don’t look so great for the power of nutrients. Perhaps they simply mean that vitamins and minerals are great for our brains, our feeling of well being, our energy, and our immune system, but they’re useless for helping us live longer or survive any of the major causes of death, and they’re a gamble when it comes to our eyes. Maybe we should just be happy that nutrition helps prevent a few colds and helps us feel and think better, and leave it at that.

A much more compelling explanation is that, when it comes to getting good vitamin and mineral nutrition, multivitamins help a little bit but they can only go so far.

There are three big problems with multivitamins: many nutrients just don’t fit into their tiny tablets and capsules; the forms of nutrients within them are often inferior to those found in natural foods; and they are a one-size-fits-all solution, when the full power of nutrition can only be seen when we tailor our diets to our individual needs.

Let’s look at one example of each problem and how it could help explain why multivitamins don’t impact the risk of heart disease, a major leading cause of death.

Multivitamins: Some Nutrients Just Don’t Fit

Why do multivitamins reduce high blood pressure[1] yet do nothing to reduce the risk of heart disease [10] when high blood pressure itself is a major cause of heart disease?[20]

One of the nutrients most important to controlling blood pressure is potassium. The most popular multivitamins[21] either don’t have any potassium at all[22-25] or have tiny doses like 50-80 milligrams.[26,27] Yet many people need 4,700 milligrams per day to control their blood pressure.[28] This is about seven times more potassium than all the other nutrients in a multivitamin combined. Even if they wanted to give you all the potassium you need, they couldn’t. It just doesn’t fit!

Multivitamins provide other nutrients that lower blood pressure, but the effect is just too small to bite off a big chunk of heart disease risk. Getting enough potassium, by contrast, could have a much bigger impact on blood pressure that could bite off that chunk, but no one can get enough potassium just by taking a multivitamin. To get enough potassium, we need food. (If not food, it’s scoops of funny-tasting powders or mouthfuls of capsules.)

Other nutrients that are hard to stuff into a multivitamin include calcium, phosphorus, and sodium, a nutrient that gets a bad rap for its ability to raise blood pressure, but is still at the end of the day a nutrient and many people need more of it.

Multivitamins: Inferior Forms

Besides potassium, another nutrient important to heart disease prevention is vitamin K. Vitamin K comes in two forms. K1 is found mainly in unfermented plant foods, such as fresh kale or broccoli. K2 is found in fermented plant foods, such as sauerkraut, or natto, a strong-smelling gooey soybean paste popular in some parts of Japan. K2 is also found in animal foods, like cheese, egg yolks, and meat. K1 is primarily good at supporting blood clotting,[29] while K2 protects against heart disease by preventing calcium from getting stuck in the blood vessels that feed the heart.[30-33] 

Some of the most popular multivitamins don’t contain any vitamin K at all,[24] while most have K1 but not K2.[22,23,25-27] Multivitamins would be more likely to protect against cardiovascular disease if they had K2, the more heart-friendly form.

Unlike potassium, it is entirely possible to formulate a multivitamin with a sufficient dose of K2. In fact, there are plenty of examples on the market.[24-36] However, these higher-end supplements tend to be two to three times more expensive than the more popular brands with lower-quality ingredients.

Other nutrients that tend to be found in inferior forms within multivitamins include vitamin B3, B5, B6, B9, B12, choline, vitamin E, copper, and iron.

To an extent, it’s possible to make up for this problem by investing more of your money into a higher-quality multivitamin. But there are still nutrients like potassium, sodium, calcium, and phosphorus that will never fit in a multivitamin, and, as we will see below, multivitamins can’t be tailored to your unique needs as an individual.

Multivitamins: One Size Doesn’t Fit All

Besides potassium and vitamin K, another nutrient that protects against heart disease is selenium. Selenium helps protect cholesterol from damage, which helps prevent it from blocking arteries.

There’s just one problem: many of us get too little selenium, but just as many of us get too much.

One of selenium’s major roles is to protect against “oxidative stress,” which can best be thought of as the wear and tear that occurs to our tissues as we age. Selenium only protects against oxidative stress up to a certain point. Once we hit this sweet spot, extra selenium starts to undermine its own protective role. It actually starts making oxidative stress worse.

Oxidative stress is a major cause of heart disease[37], making heart disease an area where the two faces of selenium might reveal themselves. Indeed, that’s exactly what studies of selenium supplements have found. These supplements cut the risk of heart disease in half when they are given to people who don’t get enough selenium from food,[38] but for people who do get enough, they either do nothing or make heart disease worse.[38, 39]

This could add to our explanation of why multivitamins don’t help with heart disease: their selenium may be helping the people who need it and harming the people who don’t, and these conflicting effects may cancel each other out in the bigger picture.

Oxidative stress is also a major contributor to cancer[40] and age-related macular degeneration,[41] the other two areas where multivitamins seem either ineffective or harmful. Could the two faces of selenium help explain these results as well?

For cancer, studies on selenium supplements are relatively straightforward. They reduce the risk of cancer up to a certain sweet spot; after that, the effect wears off and the risk may even start to increase.[42]

The studies on age-related macular degeneration are harder to interpret. Selenium is an important component of a supplement known as PreserVision, which decreased the risk of this disease in one study,[43] yet it is also an important component of Centrum Silver, a multivitamin that increased the risk of this disease in a different study.[14] We don’t know why these supplements had opposite effects, but it’s possible that the people who took PreserVision in the first study needed its selenium, while the people who took Centrum Silver in the second study didn’t.

Overall, selenium offers a powerful example of how the one-size-fits-all approach of multivitamins could undermine their ability to protect against heart disease, cancer, and age-related macular degeneration. Since heart disease and cancer are the two leading causes of death, this also helps explain why multivitamins don’t do anything to help us live longer.

Although major supplement companies haven’t attempted to solve this problem by making multis with and without selenium, some companies do attempt to account for variable needs by making some multis for men, some for women; some for older adults, some for children; some with iron, and some without. 

Even if multivitamin manufacturers eventually develop options to allow people to better control their selenium intake, selenium is only the tip of the iceberg. There are far too many factors that contribute to variation in our needs for nutrients to make a different multivitamin for each one. Just a few few examples: a high-protein diet can triple your need for biotin, birth control can increase your need for B6 by ten- to twenty-fold, going vegetarian can increase your need for zinc and iron, and eating a high-carb diet can nearly double your need for thiamin. 

Multivitamins: The Verdict

It would be a huge mistake to say that multivitamins are useless. Overall, even the most run-of-the-mill multivitamins you would find in your local drug store, the kind tested in most scientific studies, do help with blood pressure, cognitive performance, and mental health; keep us from getting sick as often; and help promote healthy pregnancies.

Nevertheless, their inability to combat the leading causes of death, and their risky effects on eye health, should cause us to demand something better. We need an approach that can fit all the nutrients we need in the right amounts, that provides the right form of each nutrient, and is individualized to meet each of our unique needs.

Still, not all of us have access to this information or motivation to perfect our diet. Do you have a loved one that you know will do something simple, but who will never even think about thinking about weighing and recording their food or letting a slice of chopped liver touch their lips? One of the most simple things you can do for them is tell them to take a multivitamin.

The chances that this is going to give them better cognitive function, keep them from getting sick as often, and give a little boost to their energy and well being is quite high.

Whether there is a 4% chance this shortens their life by a tiny bit after statistically adjusting for 17 confounders if they take it for fewer than five years but not if they take it for more than five years and that it will hurt them for the first 15 years and help them for the next 15 years if they don’t take it every day and but will help them by 14% if they take it before they become ill and hurt them by 58% if they take it after they become ill is an open question, but such is the nature of observational studies.

The most likely effect on lifespan will be the one shown in randomized controlled trials: a barely detectable benefit.

If you are up to the challenge of getting optimized, you want to take a food-first approach. The best way to get all your micronutrients in is to have an average daily intake of one or two ounces of liver; one or two oysters; a tablespoon or two of unfortified nutritional yeast; several servings of something rich in vitamin C such as bell peppers or strawberries; two to three servings of a calcium-rich food like dairy, bones (but not bone broth), or three to five servings of dark greens (mainly napa cabbage, Chinese mustard greens, bok choy, kale, or broccoli); and a large volume of potassium-rich foods, such as the lean portions of meat, eggs, and milk; legumes, such as lentils, peas, and beans; or tubers such as potatoes; and fruits and vegetables.

My favorite way to include liver along with kidney and heart is US Wellness 75% Ground Beef With Heart, Kidney, and Liver, pan-cooked as crumbles with one pound in 20 grams of olive oil, 14 grams of taco seasoning, and 4 grams of salt. Any fresh organs from grass-fed animals are excellent. As a “good” rather than “excellent” option, Ancestral liver capsules can substitute. My favorite nutritional yeast is Sari. If fresh oysters won’t do it for you, try Oystermax.

Everyone should track their diet in Cronometer (see How to Track Your Diet in Cronometer) and run a Comprehensive Nutritional Screening at least once to check everything is in order. These can also become powerful tools to help individualize the details of your diet to your unique needs.

If you don’t follow the above rules of thumb, you need to track your diet in Cronometer to check whether you are missing important nutrients.

If you made it this far and getting optimized seems overwhelming, take a high-quality multivitamin. Some good examples include Adapt Naturals and Seeking Health Optimal Multivitamin Chewable.

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