It’s time for the rank-list no one asked for: an entirely subjective ranking of the essential vitamins from worst to best. I hope you enjoy my completely unscientific and non-rigorous ranking. Agree or disagree? Please vote for your favorite and least favorite vitamin here: https://forms.gle/RaDePynSYdztwtVU8
If people care about this ranking enough to respond, I’ll do another rank list or similarly capricious article and include the results from the poll!
Top 10:
- Vitamin B2
Riboflavin has potential. Like iron, B12, and calcium, nutritional deficiencies of this vitamin are more commonly seen in vegetarians, but the aforementioned nutrients far overshadow riboflavin. Plus, angular cheilosis is fairly nonspecific as far as vitamin deficiency symptoms go.
- Vitamin B3
Dermatitis, diarrhea, and dementia, the triple-D sequelae of niacin deficiency make for some interesting test questions. Niacin strangely is included in the list of medications for dyslipidemia. Flushing and diarrhea as side effects can limit its use, so it’s damned if you do, damned if you don’t with niacin.
- Vitamin B6
Pyridoxine is important but ultimately boring. Not quite as associated with anemias or neuropathies as other vitamins, at least it has a fun connection with isoniazid use. Another redeeming factor is its possible use as a safe and effective monotherapy for morning sickness in pregnancy [1]!
- Vitamin B1
Thiamine will always stay dear in our hearts due to the association with Wernicke’s encephalopathy in people with significant alcohol use. This exam-favorite fact haunts many providers giving glucose to those with nutritional deficiencies, but fortunately so much of our food is fortified with thiamine, making true deficiencies rare.
- Vitamin B5
Super underrated in medicine, vitamin B5 is a crucial component of coenzyme-A. Even though it’s required for glucose and lipid metabolism, you would be hard-pressed to find someone with a deficiency. Low risk and high reward, super valuable qualities of a vitamin.
- Vitamin D
Converting cholesterol to vitamin D precursors simply from ultraviolet B radiation from the sun is about as close to photosynthesis as we get! While this is enough for it to crack the top five, vitamin D is held back by being part of an annoying concept that test writers love: calcium metabolism. Struggling to keep PTH, calcitonin, calcium, phosphate, and vitamin D levels straight in those dizzying arrays of arrows straight will likely always haunt me.
- Vitamin A
Next time you’re wandering around the Arctic Circle and successfully track down a polar bear for sustenance, please be sure not to eat the liver. Other organs are fair game, because they probably won’t give you hypervitaminosis A. Even back in 1943 scientists were figuring out that polar bear liver has impressively high concentrations of vitamin A, around 18,000 IU/gram, with lethal doses reached around 300 grams of liver [2]. Pretty hardcore for a vitamin whose derivatives also contribute to vision and acne mitigation.
- Vitamin C
This vitamin’s true strength is due to its inclusion in famous formulations such as Emergen-C or Airborne for cold-like symptoms. I’ll admit to taking my emergency vitamin C any time I feel the slightest tickle in my throat or cough, but I always assumed it was a placebo effect. Turns out I may not have been simply tricking myself, since a Cochrane review found that vitamin C reduces symptom duration and severity for the common cold in adults [3]. As a bonus, vitamin C deficiencies are associated with scurvy and old-time pirates. What more could you want from a vitamin?
- Vitamin B12
You’re taking a test, and your patient has symptomatic anemia. You glance at the MCV, already dreading the fact you’ll have to remember how to interpret ferritin, TIBC, or reticulocyte counts… but the MCV is 106! Hallelujah, macrocytic anemias are so much easier. Even better? One of the answer choices is “vitamin deficiency”. You take your free point and move on. Plus, if you ever need to distinguish B9 from B12, neurological effects and methylmalonic acid elevations only belong to B12 deficiency.
- Vitamin B9
Just like vitamin B12, folic acid deficiencies cause macrocytic anemia which can be blessings on tests. But this vitamin wins the crown over B12 by being the only vitamin recommended by the USPSTF [4]. It even has a coveted “A” rating for its role in preventing fetal neural tube defects among women who may become pregnant. Granted, this recommendation does not apply to more than half the population, but I won’t change my mind until another vitamin steps it up and earns that “A” rating from the USPSTF, an organization with incredibly high standards for recommending that providers do anything [5]!
Honorable Mentions:
- Vitamin K: Entangled in the coagulation cascade, the bane of a medical student’s existence.
- Vitamin E: Purported to prevent cancer, but it generally doesn’t [6]. Plus, interaction between vitamins E and K make supplementation of vitamin E pesky for surgeons hoping to prevent postoperative bleeding.
- Vitamin B7: Egg white overconsumption causing biotin deficiency is not interesting enough to make up for the fact that it’s so hard to remember which reactions in biochemistry even use this vitamin.
- NIH. Vitamin B6: Fact Sheet for Health Professionals. Accessed November 2, 2020 from https://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/.
- Rodahl K, Moore T. The vitamin A content and toxicity of bear and seal liver. Biochem J. 1943;37(2):166-168. doi:10.1042/bj0370166
- Padayatty SJ, Levine M. Vitamin C: the known and the unknown and Goldilocks. Oral Dis. 2016;22(6):463-493. doi:10.1111/odi.12446
- USPSTF. Folic Acid for the Prevention of Neural Tube Defects: Preventative Medication. Accessed October 31, 2020 from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/folic-acid-for-the-prevention-of-neural-tube-defects-preventive-medication.
- USPSTF. Intimate Partner Violence, Elder Abuse, and Abuse of Older Adults: Screening. Accessed October 31, 2020 from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/intimate-partner-violence-and-abuse-of-elderly-and-vulnerable-adults-screening.
- USPSTF. Vitamin Supplementation to Prevent Cancer and CVD: Preventive Medication. Accessed November 2, 2020 from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/vitamin-supplementation-to-prevent-cancer-and-cvd-counseling.
Luke Wohlford is a medical student in the University of Arizona College of Medicine - Phoenix, Class of 2022. He graduated from the University of Arizona in 2018 with a Bachelor of Science in physiology. Luke plans to go into emergency medicine has special interests in public health and EMS. He spends most of his free time hanging out with his dogs Kanye and Kelso or feeling guilty about not exercising.