Case Closed on Vitamin Supplementation?

VitamindA couple new studies came out recently looking at the effects of vitamin supplementation on heart disease. You can find one of the abstracts to the article here: http://annals.org/article.aspx?articleid=1789246

A second looking at cognitive function is here: http://annals.org/article.aspx?articleid=1789250

The third about cancer is here: http://annals.org/article.aspx?articleid=1767855

An article decrying their use can also be found here: http://annals.org/article.aspx?articleid=1789253

The authors in their title say, “Stop wasting money on vitamin and mineral supplements”. Pretty strong words. The question is though, do they have a point? Should we really stop taking all those supplements and give up on vitamins?

From reading only the abstract of the first linked study they gave a multivitamin w/minerals to people who had recently had a heart attack. They were followed for 5 years and then tallied up CV events to see what happened. The conclusion was that they didn’t do anything. They did mention adherence was poor in both vitamin and placebo group and was a limitation of the study. This is yet another study that is adding to a body of research condemning vitamins and minerals to scientific research death. At least that what the spin is that is being put on this.

The second looking at cognitive function. They sampled 5947 male physicians aged 65 years or older and gave them multivitamins or placebos. During the following years they assessed mental and cognitive function through phone calls. The observed no difference between the 2 groups. The authors noted,

“Doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin”.

I think this is a point worth discussing in a minute.

The third was pooled results from multiple studies looking at the incidence of heart disease and cancer with different vitamins and multivitamins. The only positive outcome was that there was a small decrease in cancer rates in the multivitamin group but only for men, not for women. Of note was that folic acid seemed to decrease mortality, albeit non significantly and increased cancer incidence. That is probably a post in and of itself.

So the conclusion of these studies is that vitamins don’t seem to do a whole lot other than put people’s money in the hands of companies that make them. I think there is some truth to this but we have to look at it in context.

Limitations

For starters, the first 2 studies were done in doctors. Socioeconomic status does seem to correlate very well with health. 1 Not to mention doctors have access to other doctors more readily and are able to pay for things that people who make less would be able to buy, like a monthly prescription every single month. I’m not trying to dog on doctors here, just pointing out that at looking at such a specific population you can’t infer those results to the rest of humanity.

The first team admitted that many of the subjects didn’t take the vitamins as prescribed. They state,

“Many people in both groups stopped taking the pills, did not take the pills as often as they were instructed, or stopped participating in the study before it was planned to end. Therefore, it is harder to draw firm conclusions about what high-dose multivitamins and minerals may do.”

This is kind of a big deal. If people aren’t adhering to the prescribed method of treatment the power to detect differences will crumble. This raises questions too. Did the doctors feel that the vitamins were worthless to begin with and had no confidence in their use as beneficial? Could the doctors detect if they were given placebo? Did the doctors feel that medicinal treatment was enough? I don’t of course know the answers but if the authors are will to list this as a limitation then we should be asking these questions and think about how they might affect the outcome.

The second study lists the following as a limitation,

Doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin.”

Are vitamin doses too low? Possibly. This is a common complaint of vitamin advocates. Is the claim founded? I don’t know. I don’t have access to the data. My guess is that if a common multi was used then many advocates will say that the doses were probably too small. Then there’s the question of synthetic vitamins vs naturally occurring vitamins. Again I can’t answer this. Many will say it doesn’t matter, that they are both equally useless, while advocates will claim there is a big difference.

The other part of this claim is that the population, doctors, may be too well nourished to receive a benefit, in essence that they weren’t deficient to begin with. This is a valid point. If you have no insufficiency then giving something you already have is like trying to reinforce concrete that’s already reinforced. You might make it a bit stronger, but not significantly.

Another question in this particular case is whether or not the nutrients found in typical multivitamins would affect cognition anyway. Specific fats and cholesterol are needed and not present in your regular multi. Plus there are other known factors such as heavy metals and inflammation that lead to cognitive decline. Are these addressed in a multi? No.

In both cases we know nothing of lifestyle of these doctors. Do they have a standard american diet? Do they exercise regularly? What is their intake of polyunsaturated fats and processed junk? I don’t know but they are relevant questions to both heart disease and cognitive decline. In some cases it’s possible to conclude that if there is a lot of other factors like inflammation that was accounted for both diseases, then using a multi would be like trying to rebuild a sandcastle while the tide is coming in. Every time you build up a wall the tide just washes it away. In this case no amount of any vitamin is going to stop the degradation of either the heart or the brain. In these cases the offender must be removed before healing can occur.

The opposite argument here is that if the doctors were all indeed in decent health or at least had sufficient raw material (good nutrition) then a multi also do nothing in this case. It’s the whole “if you’re not deficient then you don’t need more” argument against vitamins. This is a valid argument and one that I would argue as well. Food should be the primary source of nutrients for the body. Humans weren’t meant to live on crap and get nutrition from pills. Genetics and individual variation play a part in what one might need but overall it should be what type of food goes into the mouth that produces health. That leads to the next point which was brought out in the limitations.

veggiesNourishment

Are you well nourished? I can’t answer that but taking a multi may or may not take care of a deficiency. If a person is any kind of health conscious and have done some research they tend to find that eating whole unprocessed foods is ideally the way to go. But even when one is eating the best they can, depending on where they get their food or where it was grown, or depending on environmental factors or stress there may be a lack or overuse of one nutrient or more. Covering that with a multi is probably a little much and you may not even be covering the right one. Nutrition is also a growing science and we are understanding more and more as time goes on, especially the interplay between different nutrients and how those usually are packaged together in whole food. Eating the whole egg for example instead of just the white or eating a little liver from time to time with the meat. Cod liver oil has both vitamin D and A which need to go together. Plants have hundreds of phytonutrients that are beneficial and use each other in the body to produce health. Separating them out into a few constituent components like in a multivite is not necessarily going to produce good health.

On the flip side of that coin is the fact that sometimes it’s hard to get the nutrients you need. Living in the Pacific Northwest, I’m vitamin D deficient if I don’t use a supplement. Right now in December we’ve had some beautiful sunny days, but no matter how naked I am and no matter how long I stay in the sunlight right now, vitamin D just isn’t going to be produced. I have to get it some other way. Vitamin K2 is also in short supply in the western diet, unless you know where to find it. You can use a supplement or you can use butter oil and grass fed milk and butter and cheeses. CoQ10 levels drop as people age and unless you are eating a lot of heart from animals you probably aren’t getting any significant amount from your diet. Maybe you don’t have enough selenium or zinc because of dietary deficiency or  because of dietary choice, such as veganism or eating strictly a protein diet, neither of which I think are useful except in short periods of time and for a specific purpose.

Purpose

This is the crux of what supplements should be used for. When somebody asks me what multivitamin they should take I ask them what the purpose of using one is. I’d say in a great deal of people a multi probably isn’t needed. A lot of what is probably needed is to correct the deficiency. In some cases more may be needed. In others like in schizophrenia it may be a dependence on a vitamin that requires its continual use, in this case vitamin C and Niacin.  So ask yourself, what is the point of using a multi? Can I correct the problem with my diet? Is it a narrow problem that only needs a few nutrients acting in synch or it is more comprehensive then that?

The unadjusted numbers in the first study did show that there was a small reduction in cancer rates using the multi. Could this be done using better nutrition? I think so. Some people may need that multi to help prevent or treat problems, but I’m willing to bet that the majority should correct their life and their diet and then see what is needed. Vitamins have a purpose, I have no doubt about that, but they must be used with a specific purpose in mind. Throwing a whole bunch of synthetic vitamins at a vague problem probably wont’ solve anything, as evidenced by these studies. Remember that a “one pill to cure them all” mentality won’t do a whole lot but focusing down a problem and treating the problem or problems is a much better use of time and resources. I use some vitamins like Cod Liver Oil/Butter oil and I use it for a specific purpose along with some vitamin D. The rest I try to accomplish with food, covering other things as needed. What do you think?

CIAO

1.Adler, Nancy E., and Joan M. Ostrove. “Socioeconomic status and health: what we know and what we don’t.” Annals of the New York academy of Sciences 896.1 (1999): 3-15.

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