Supplements will kill you !?!?!?

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.

Headlines went from: Are supplements killing you? to milder ones like: Bad week for dietary supplements

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. You have to be really careful if you are getting iron supplements, particularly if you do them through injections. You need to be aware that there may be an iron infusion reaction, which might happen if your body rejects the treatment.

Pertinent quick facts:

About 69% of Americans take some form of dietary supplement – SOURCE LINK

According to a recent UK based group pharmaceutical drugs are:

• 62,000 times more likely to kill you than food supplements
• 7,750 times more likely to kill you than herbal remedies – SOURCE LINK

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.

• In the new study, multivitamins cut the chance of developing cancer by 8 percent.
• The study included a clinical trial which consisted of nearly 15,000 older males
• Doctors monitored the men for more then 10 years and found that those who took a multivitamin daily reduced their risk of cancer by 8 percent over those that took a placebo.
• This study did not show any specific benefit for prostate cancer patients with the consumption of one daily multi-vitamin

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. Of course, depending on which exogenous ketones you should take, as well as the structure of your own body, different supplements will have different effects.

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.

References:

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.