Multivitamins: The Big Honest No

Multivitamins are the perfect research subject: taken by millions, easy to test, huge trials available. The result is correspondingly robust — and sobering. The Physicians' Health Study II, a randomised trial running over ten years with more than 14,000 male physicians, found no effect whatsoever on heart attacks, strokes or cardiovascular mortality. The systematic review for the US preventive services task force (Fortmann et al.) concluded: insufficient evidence of benefit from vitamin and mineral supplements for preventing cardiovascular disease or cancer in healthy adults. And the 2018 meta-analysis across two million participants confirmed: no association between multivitamin use and better cardiovascular outcomes. A 2026 rapid review of 19 meta-analyses still confirms this picture: no mortality or cardiovascular benefit.

The one honest footnote: in the Physicians' study, total cancer incidence among the older men was slightly lower on multivitamins — an interesting single finding that never consolidated into a purchase argument and is graded insufficient in the reviews. A second, more recent footnote carries real weight: the COSMOS trials (randomised, ≥ 60 years) found a measurable improvement in global cognition and episodic memory under a standard multivitamin — the first consistent RCT benefit for a multivitamin at all, though so far from a single US trial platform. We mention both footnotes, because honesty runs in both directions.

The warning that comes with the 2026 rapid review: alongside confirming the absence of mortality and cardiovascular benefit, the review reports a signal for INCREASED progression of age-related macular degeneration (AMD) under multivitamin use. Anyone with an AMD diagnosis should therefore discuss supplements with their ophthalmology practice rather than continuing them unprompted.

The reasoning error behind the multivitamin is the assumption that fruit and vegetables are essentially vitamin tablets with water around them. Real food delivers hundreds of accompanying compounds, fibres and structures whose interplay has so far refused to be pressed into a capsule — which explains why dietary patterns (plenty of vegetables, legumes, whole grains) are consistently linked with better health in studies, while the isolated vitamins extracted from them keep disappointing.

Add the dosing absurdity of the shotgun: a standard multi gives you nutrients you are not missing (wasted), at doses too low for genuine deficits (ineffective) — and for some compounds more than you need. It answers a hundred questions, of which yours are perhaps two — and answers those two badly.

• Vitamin D: the most plausible candidate at our latitudes, especially in winter — context and dosing in the vitamin D article.
• Vitamin B12: on a vegan diet not optional but mandatory — details here.
• Iron: only after a blood test and medical clarification of the cause — why that order is binding is explained in the iron deficiency dossier.
• Folic acid: officially recommended when planning pregnancy and in early pregnancy — a textbook example of targeted, justified supplementation (details with your gynaecologist).
• For training: if anything, the candidates with real evidence — above all creatine and sufficient protein.

The test for every supplement decision remains the same: which specific nutrient am I missing — and how do I know? If you can answer both, supplement specifically. If you cannot, the answer is usually the plate — and the multi-subscription money is better invested in good food. Consequently, we deliberately link no products in this article.