Talk about inconsistencies, eh? No, I am not talking about Romney and Obama, although there is much incongruities with those two. I’m referring to the flip-flop conclusions with the use of dietary supplements.
About a year ago there were headlines all over the internet highlighting the detrimental effects of dietary supplement consumption.
Two studies were published around that time that caused supplement consumers to panic and my inbox to be jammed with hundreds of emails from worried patients and subscribers: 1. Men’s prostate cancer SELECT trial. 2. Women’s Supplement health study.
The SELECT study attempted to determine whether vitamin E (in the form alpha-tocopherol) and selenium (in the form of L-selenomethionine) can prevent prostate cancer. The trial was called the SELECT trial (SELenium and vitamin E Cancer prevention Trial).
This trial is an example of GIGO (Garbage In, Garbage Out). It was set up to fail ( not intentionally, I don’t think).
There are eight forms of vitamin E and they all work together in nature, not separately : 4 tocopherols (alpha, beta, gamma, and delta), and 4 tocotrienols (alpha, beta, gamma, and delta).
The SELECT study used ONLY synthetic dl-alpha-tocopherol and left out the other tocopherols. Now, lets say you wanted to design a worse study, what would you do? Maybe magnify the dosage of the synthetic version of vitamin E to 8 times the amount that has shown to be protective (50units) vs. 400 units(harmful)).
Well, that’s exactly what was done. 400 units of synthetic dl-alpha-tocopherol was used in the SELECT study which showed a 17% higher risk of prostate cancer. More on SELECT HERE.
Of interest, 50 units has shown to decrease the development of prostate cancer among smokers by 30% (Albanes et al. 1996).
The Iowa Women’s Health Study
This study assessed the use of vitamin and mineral supplements in relation to total mortality in 38,772 older (post menopausal) women. The published study concluded: In older women, several commonly used dietary vitamin and mineral supplements may be associated with increased total mortality risk; this association is strongest with supplemental iron. In contrast to the findings of many studies, calcium is associated with decreased risk of mortality. (Mursu et al. 2011)
Why were post-menopausal women taking iron supplements? Iron supplementation is ONLY recommended in those with iron deficiency anemia and pre-menopausal women. In post-menopausal women (and in men) iron supplementation induces oxidative stress which leads to heart disease and more. This underscores the importance of obtaining the guidance of a nutritionally oriented physician for proper use of nutritional supplements.
Pertinent quick facts:
According to a recent UK based group pharmaceutical drugs are:
Use of prescription drugs contribute to more deaths ( about 15,000 a year) than motor vehicle accidents. Highest rates are among men. SOURCE LINK
Well, now, according to a recent study published in the Journal of American Medical Association (JAMA) dietary supplements reduces the risk of most cancers in men.
Duffy MacKay, naturopathic doctor and VP scientific and regulatory affairs for the Council for Responsible Nutrition has been quoted in saying:
“This study reinforces the value of long-term consistent use of a daily multivitamin as a convenient and affordable insurance policy for good health. Not only did this study provide good news for the supplement industry and its consumers, but it also provided another reminder that science should be viewed in the context of the full body of scientific literature.” – SOURCE LINK
My take on this
In order to determine if the use of dietary supplements are worth while studies need to be designed properly (use of all natural vitamin E, for example) and like Garziano el al., randomized in a placebo controlled trial and followed for a long period of time. The truth these types of well-designed studies will never happen. They are too expensive (millions of dollars) and very little interest to objectively research unpatentable products.
Vitamins and dietary supplements are not harmful or cause death in most cases. Certainly compared to prescription drugs, which contribute about 100,000 deaths a year.
Studies that connect dietary supplements to mortality are flawed in design. And, although they are great for headlines and sound bytes, they should not deter you from a smart supplementation regimen.
If you go to the Council for Responsible Nutrition website, you can download a well written free e-book on dietary supplements: The Benefits of Nutritional Supplements
Bottom line: dietary supplements are not deadly, they are often protective, they do not replace the consumption of good food and exercise, it is always smart to seek the help of a nutritionally oriented physician like naturopathic doctors.
Garziano et al. Multivitamins in the Prevention of Cancer in men The Physicians Health Study II Controlled Trial. JAMA 2012; 1-10.
Christen S, et al. gamma-tocopherol traps mutagenic electrophiles such as NO(X) and complements alpha–tocopherol: physiological implications. Proc Natl Acad Sci U S A 1997 Apr 1;94(7):3217-22
Jiang Q, et al. gamma-tocopherol, the major form of vitamin E in the US diet, deserves more attention. Am J Clin Nutr. 2001 Dec;74(6):714-22.)
Albanes et al., Alpha-Tocopherol and beta-carotene supplements and lung cancer incidence in the alpha-tocopherol, beta-carotene cancer prevention study: effects of base-line characteristics and study compliance. J Natl Cancer Inst. 1996 Nov 6;88(21):1560-70.
Mursu J, Robien K, Harnack LJ, Park K, Jacobs DR Jr. Dietary Supplements and Mortality Rate in Older Women: The Iowa Women’s Health Study. Arch Intern Med. 2011 Oct 10;171(18):1625
Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med. 2010 Nov 25;363(22):2124-34.