From the WebMD Archives

Nov. 14, 2019 -- When 37-year-old Charlotte Carlito began using a personalized vitamin service in June, the company told her it found a higher chance of heart weakness in her DNA analysis. The service, Curos, suggested she take magnesium to offset it.

Two months later, her mother had to suddenly have heart surgery.

“She needed stents put in her heart. The doctors said it was a genetic condition,” says Carlito, who lives in Miami.

Carlito believes Curos’s suggestion will help her avoid surgery in the future.

Carlito is among a growing number of people using personalized vitamin services online. The companies create supplement plans for its customers based on lifestyle, health issues, and, for some services, genetic tests. Seventy-five percent of U.S. adults used dietary supplements in 2018, up from 65% in 2009, according to a survey commissioned by the Council for Responsible Nutrition.

According to the National Health and Nutrition Examination Survey, 31% of the U.S. population is at risk of at least one vitamin deficiency or anemia. Almost a quarter of all Americans are at risk of deficiency for at least one vitamin or anemia, the survey found, while millions more are close to deficient in multiple categories.

Doubts About Effectiveness

Despite the wide use of supplements, nutritionists aren’t sure they help. In fact, the jury is still out on whether vitamins are effective at all.

Jennifer Cholewka, a metabolic nutrition support specialist and registered dietitian at Mount Sinai Hospital, says there is very little evidence to suggest taking any type of oral supplement significantly improves health.

“If you are eating a balanced diet and living a relatively healthy lifestyle, there really is no definite need for a multivitamin,” she says. “No matter what, it's best to get as many of our nutrients as we can from food. It’s not a quick fix.”

It would be more effective, Cholewka says, to instead put money toward a gym membership or healthier groceries.

“If a patient is coming to see a dietitian, we'd first address eating more whole foods, eating healthier, incorporating more lifelong habits into their lives,” she says.

Many Options Already Exist

Still, vitamins remain a fixture in the daily lives of most Americans. But rather than entering the marketplace blindly, people are using services that cater to their specific needs. Carlito answered a Curos questionnaire and submitted raw DNA from a previous analysis before she began taking magnesium, omega-3, copper, and a Curos multivitamin. The process was free, she says, but she buys her vitamins exclusively from Curos now. The Curos multivitamin costs $30 for a monthly supply, which is comparable in price to other vitamins purchased online or in a store.

“Within a week, I noticed I needed less sleep and had more energy,” Carlito says. “I did definitely notice a difference.”

Not all services use DNA to create customized programs. For example, the company Persona gives users a survey that takes 5 to 10 minutes to complete. It asks questions like “What are your top three health concerns?” and “What is your fitness or activity level?” It also asks how many servings of calcium, vegetables, and other diet staples the user gets in a week, and what medications they take. It gives the option of submitting any previous DNA test results.

Its staff includes five doctors, a registered dietitian, a pharmacist, and a team of nutritionists.

“We don't hock pills, we provide education and information for free,” says Jason Brown, CEO and co-founder of Persona. “If an individual is interested in purchasing, they can buy with us. If they're not, we don't care.”

Persona has about 90 different vitamins and dietary supplements, according to the company. There are 5 trillion combinations, and Persona has a database of over 1,000 prescription medications that is checked for potentially harmful interactions.

Brown says more than 1 million people have taken the questionnaire but did not say how many bought supplements from Persona.

The company’s top users are men and women over 35, he says.

“We call it the ‘bifocal era,’ ” Brown says. “The goal is to make sure we as a company promote healthy aging. Let's face it, north of 70% of America is on medication.”

Incorporating a DNA test into the process allows these companies to assess whether there are certain vitamins that cannot be absorbed, says Golnoush Yazdani, marketing director at VitaminLab.

Conflicts, Benefits in Question

For example, those who have the MTHFR gene mutation cannot absorb folic acid or folate. This deficiency can lead to fatigue, weakness, shortness of breath, pale skin, and crankiness.

To get around the mutation, experts would likely recommend methylfolate, Yazdani says.

The cost of getting supplements from VitaminLab can average between $40 and $80, based on what is needed. Three months’ worth of vitamins are shipped at once.

Yazdani says its main audience is women ages 30-40, along with athletes.

“Because our soil is getting so depleted, we can’t get all of our nutrients from our food,” she says. “So supplements are getting more popular.”

According to a 2015 study published in the journal Nature, Earth’s soil is less nutrient-dense as a result of depletion from human activity. A 2004 study evaluated 43 crops from 1950 to 1999 and found declines for six nutrients -- protein, calcium, potassium, iron, and vitamins B2 and C.

But Cholewka says although there is probably some truth to this, the degree to which it would affect people’s health “would be negligible.”

On the other hand, if someone is going to take supplements, it is best if the vitamins are customized to fit their needs, says Angela Zivkovic, an assistant professor in the department of nutrition at the University of California, Davis.

“It is important to take only what is necessary, and take something if and when you need it,” she says.

More Information Needed

Though she likes the idea of personalized supplements in theory, the brief questionnaires likely do not cover enough ground for a full assessment, Zivkovic says.  

To really get a sense of what someone’s diet is like, an expert would need to see a log of what has been eaten over about a week.

The micronutrient world is a complex one, she says. For example, if someone has megaloblastic anemia -- which is linked to a lack of folate -- taking a folate supplement would make the anemia go away. But it could also mask the symptoms of a B12 deficiency, which can lead to loss of nerve function.

“I don’t think just asking someone questions through a 5-minute survey or giving a DNA test is enough,” she says. “It’s informative, but it won’t get you there on their own.”

Show Sources

Charlotte Carlito.

Council for Responsible Nutrition.

National Health and Nutrition Examination Survey.

Jason Brown, CEO and co-founder, Persona.

Golnoush Yazdani, marketing director, VitaminLab.

Nature: “Human security at risk as depletion of soil accelerates, scientists warn.”

Jennifer Cholewka, metabolic nutrition support specialist and registered dietitian, Mount Sinai Hospital.

Angela Zivkovic, assistant professor, department of nutrition,  University of California, Davis.


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