Is this article saying my pain is caused by stress or emotions?

No. This article describes how emotional state amplifies or dampens pain signals that originate from a real physical source. The pain generator, whether it is a joint, a nerve, or inflamed tissue, is still there. Emotional state acts on the volume control for that signal through specific circuits like the periaqueductal gray and RVM. Addressing the emotional and inflammatory layer does not mean the physical layer is being dismissed.

Why does my pain feel worse on some days even when nothing physically changed?

Two mechanisms drive this. Increased connectivity between the default mode network and salience network can pull pain-related threat signals into your ongoing self-focused thinking, and glucocorticoid receptor resistance can leave cortisol circulating without effectively shutting down inflammation. Both of these fluctuate with your stress load, which is why identical days on paper can feel physically different.

Does this mean medication won't work for me if my pain has an emotional component?

Medication still works on the target it was designed for. Anti-inflammatories still reduce inflammation in tissue, and nerve-targeting medications still reduce nerve signal transmission. What they were not designed to do is reach brainstem circuitry, glial activation in the central nervous system, or brain network connectivity. That is why addressing the emotional and inflammatory layer alongside your current medication, rather than instead of it, tends to produce a more complete result.

What can I actually do to influence this brainstem pain circuit?

Structured mindfulness training, consistent breathwork, cognitive behavioral therapy, and consistent sleep have measurable effects on amygdala reactivity, prefrontal regulation, cortisol output, and glucocorticoid receptor sensitivity. These are not generic wellness suggestions. Each one targets a specific mechanism described above, and each requires consistency rather than a single session to produce a measurable shift.

How do positive emotions actually reduce pain, not just distract from it?

Genuine positive emotion activates the ventral tegmental area and increases dopamine signaling, which triggers release of your body's own opioid molecules, beta-endorphins and enkephalins. Those molecules bind to the same mu and delta opioid receptors that prescription opioids target, in the same PAG and RVM circuit described earlier in this article. This is a direct neurochemical effect, not a psychological distraction from the sensation of pain.

Should I Be Taking a Multivitamin?

Jason Winkelmann

2 days ago

5 min read

Yes, I Think Everyone Should Take a Multivitamin

Here's a take that will get me in trouble: I believe everyone should be taking a quality multivitamin.

I know. You've seen the headlines saying multivitamins don't do anything. I'm going to walk through those studies head on, because they deserve a real answer. But first, let's talk about the food on your plate, because that's where this starts.

Your Food Isn't What It Used To Be

Nobody eats a perfect diet every day. Life gets busy, travel happens, and the drive-thru is right there.

But here's the part that surprises people. Even a great diet isn't delivering what it used to. When researchers compared USDA data on 43 garden crops from 1950 and 1999, they found median drops of about 15% in iron, 16% in calcium, 15% in vitamin C, and 38% in riboflavin (vitamin B2). Other analyses of food tables going back decades found lower levels of minerals like magnesium and copper too.

Why? A few things are at play:

Depleted soil. Intensive farming, heavy tilling, and synthetic fertilizer wear down soil life, including the fungi that help plants pull trace minerals out of the ground.
Bigger, faster-growing crops. Varieties bred for yield get larger, so the same minerals are spread across more water and bulk.
Time and travel. Vitamins like vitamin C start breaking down after harvest, and produce can spend days or weeks in transit and storage.

To be fair, scientists still debate how much of the decline comes from soil versus plant breeding, and some of the older comparisons have limits. But the direction is consistent: even your best meal likely carries less than the same meal would have decades ago. A multivitamin is how I make up the difference.

But What About the Studies?

Let's look at them honestly.

The U.S. Preventive Services Task Force concluded in 2022 that there isn't enough evidence that multivitamins prevent heart disease or cancer in healthy adults.
A 2024 National Institutes of Health study followed nearly 400,000 healthy adults for over 20 years and found that daily multivitamin users did not live longer than non-users.
The COSMOS trial found a small memory benefit in older adults, but no reduction in heart disease or cancer.

I'm not going to spin those. A multivitamin is not a magic pill that prevents cancer or adds years to your life. But look at what these studies actually asked.

They asked a pill to do a lifestyle's job. Preventing heart disease, cancer, and early death takes a lot more than a multivitamin: movement, sleep, stress management, a healthy weight, not smoking, limited alcohol, steady blood sugar, and good food. No single pill can overcome the rest of the picture.
They lump every multivitamin together. A cheap, low-dose formula with poorly absorbed nutrients counts the same as a high-quality one. The studies don't tell you what happens with a well-made product.
They ask the wrong question. A multivitamin's job is to fill nutrient gaps so your body has what it needs to function. That's a different goal from "prevents cancer."
Many of them just track who takes a pill. Large observational studies usually ask about supplement use at the start and follow people for years. They can't tell how consistently people took it, what was in it, or how it affected nutrient levels.

So the honest conclusion isn't "multivitamins prevent disease." It's "multivitamins are inexpensive nutritional support that cover the gaps, and gaps matter."

Why the Typical Multivitamin Falls Short

This is where I agree with the critics. Most of what's on the shelf isn't very good.

There's no standard formula. Two bottles that both say "multivitamin" can contain completely different nutrients in completely different amounts.
The doses are often tiny. A capsule can only be so big, otherwise you wouldn't be able to swallow it. Therefore, only a certain amount of a nutrient can fit in. This dose may be enough to supplement your healthy diet, but not enough to fill a true nutrient deficiency on its own.
Cheap forms, poor absorption. Vitamins and minerals come in many different forms, and that form determines how well your body absorbs and uses that nutrient. Low-cost formulas lean on nutrient forms that your body has to convert or can barely absorb.
Fillers and sugar. Dyes, sweeteners, and fillers are common, especially in gummies, and can contribute to the problems the multivitamin is trying to fix.
It creates false confidence. "I take a multivitamin" shouldn't become the reason we skip the vegetables.

Who Benefits the Most

I recommend one for everyone, but some people get an even bigger payoff:

Women who are pregnant or trying to conceive. Folate before and during early pregnancy lowers the risk of neural tube defects. This is one of the best-proven uses of a supplement.
Vegans and some vegetarians. Vitamin B12 is found almost only in animal foods.
Older adults. Absorption of B12 drops with age, and many older adults run low on vitamin D.
People on certain medications. Many common medications, like metformin, and antacids can cause nutrient depletions and impair absorption.
People with poor absorption or restricted diets. Gut conditions, weight-loss surgery, and heavy dieting can all create real gaps.
Busy, stressed, or picky eaters. In other words, most of us.

What To Look For in a Multivitamin

So what does a good one look like?

Third-party testing
- What: Independent verification that the bottle contains what the label says, and isn't contaminated with things undeclared.
- How: Supplement companies that actually third party test their products are not shy about it. It is either advertised on the label, or a certificate of analysis (COA) can easily be found on their website.
Effective dosing
- What: Meaningful amounts of each nutrient, not a pinch of everything. A quality formula often takes two to four capsules a day because the real doses won't fit in one pill.
- How: Check the percent daily value on the label and be wary of formulas that are mostly "proprietary blends." Skip iron unless you need it, which is usually the case for menstruating women and not for most men or postmenopausal women.
Bioavailable forms (the form your body can actually use)
- B12: methylcobalamin or adenosylcobalamin, rather than cyanocobalamin.
- Folate: methylfolate (5-MTHF) rather than synthetic folic acid.
- Magnesium: glycinate or citrate, rather than oxide.
- Zinc: picolinate or bisglycinate.
- Vitamin D: D3 rather than D2.
- Vitamin K: K2 (MK-7).
- Vitamin E: mixed tocopherols rather than synthetic dl-alpha-tocopherol.
When and how to take it: With a meal that has some fat, which helps absorb vitamins A, D, E, and K.

Let's Bust a Few Myths

"I eat healthy, so I don't need one." Eating well is the foundation, and I'm all for it. But the nutrient content of that produce isn't what it was, so a multivitamin is a smart backup.
"The studies prove they're useless." The studies show a pill alone doesn't prevent major diseases. They don't show that filling nutrient gaps is pointless.
"More is better." Not with vitamins. Extra water-soluble vitamins are mostly flushed out, and fat-soluble vitamins (A, D, E, K) can build up in the body. Mega-doses need a reason and a provider.
"Gummies are just as good." Gummies are candy with a vitamin label. They tend to have fewer nutrients and more sugar.
"Expensive means better." Price tells you about marketing, not quality. Third-party testing and nutrient forms tell you far more.

The Bottom Line

A multivitamin won't cancel out a poor lifestyle, and it isn't going to single-handedly prevent heart disease or cancer. What it does is cover the gaps in a diet that is rarely perfect and grown in soil that isn't what it used to be. Pick a quality one with third-party testing, real doses, and bioavailable forms, and let the rest of your habits do the heavy lifting.

Don't leave your nutrition to chance, because quality matters and so does what's right for your body. If you'd like help choosing the right formula and finding out if you need more of anything, a naturopathic medicine visit with us is a great place to start.

Written By:

Dr. Jason Winkelmann

Naturopathic doctor, Chiropractor, Chronic Pain Specialist, and Educator

Acute Pain

Chronic Pain

Systemic / Metabolic