Vitamin Researchers are Idiots! Vitamins ARE important!
How’s that for a headline? I really didn’t mean to insult anyone (scientist and all) but I find it interesting how not only the news media but also journal articles are sparking their titles to attract attention. I figured I’d join the party.
The Annals of Internal Medicine recently published an editorial with a less than the typical conservative title that you would normally find in such a journal:
How’s that for a sensational title from a historically conservative journal. Again, no offense to the authors I just figured I’d grab some of the attention as well with the title of this blog post. Seriously though, this scare tactic against the use of supplements is utterly ridiculous.
Last night (12/17/13) on CNN with Anderson Cooper
While writing this rebuttal I was watching Anderson Cooper interview Drs.Sanjay Gupta and Travis Stork about this recent multivitamin published article
Summary of Dr. Stork’s position on this: if a little is good a lot is not better. He will not discourage patients from taking multivitamins. Discuss with your doctor if you take dietary supplements.
Summary Dr. Gupta’s position on this: There is potential danger with mega-dosing. Prostate cancer rate went up with megadoses of vitamin E. Anybody with a good diet and not suffering from vitamin deficiency should get their vitamins from food. Antioxidant to pro-oxidant ratio maybe out of balance.
I uttered these thoughts under my breath as I watched CNN:
Your right Dr. Stork – if a little is good a lot is not better but no I would not discuss with my doctor on what supplements I take or on anything related with nutrition. Most doctors are not interested in having such conversation with patients. More importantly, they are not trained nor know anything about nutrition. HERE is the curriculum of the #1 medical school in the US, Harvard medical school. How many nutrition courses do you find? I found none.
Oh no. Not you too Dr. Gupta with the misunderstanding on how vitamin E works and how the studies associating vitamin E with prostate cancer and heart disease are flawed. I like Dr. Gupta’s work, a lot actually. I watch his programs and consider him an intelligent man. I assume he is just not abreast on all aspects of nutritional science. So he gets a pass from me. More on vitamin E and antioxidants below.
Back to the journal article in question
This Annals of internal medicine editorial, which has gotten so much media attention is essentially a rehash of three previous studies.
One is the Physicians Health Study (PHS) II that follow roughly 15,000 physician men and their dietary habits to evaluate if a certain diet or consumptions of dietary supplements had any influence in cognitive performance or memory. After a 12 years follow up the researchers found that there was no cognitive benefit.
Details of the PHS study and its Flaws
1. The multi consumed had a mere sprinkle of a variety of nutrients: 60 mg of vitamin C, 25 mcg of vitamin B12, and 20 mcg of selenium, for example.
2. The men studied in this trial were asked to recall how often they comsumed their supplement during the previous year. Do you remember what you ate for breakfast last Monday? How about 8 Monday’s ago? You get the point. A recollection based approach in adherence is naturally a flawed method of assessing for compliance
3. Even with a minute level of nutrients in the multi-vitamin, there was a bit of cognitive improvement in the experimental group after 2.5 years of consumption.
4. It turns out that those men in this study who consumed a multivitamin experienced a modest reduction in cancer compared to those who did not consume a multivitamin. (Gaziano et al. 2012) But you wouldn’t know that.
The Second one is a published article by the US Preventive Services Task Force (USPSTF). Remember this group? Yes, that’s right. This is the same group that suggests to abandon the use of PSA testing for prostate cancer before the existence of a better screening marker. The USPSTF concludes that there is no benefit with supplementation in the prevention of heart disease and cancer. Moreover, antioxidants can be harmful – highlighting vitamin E causing more harm than good, especially increasing the risk of prostate cancer.
On Vitamin E
The educated health consumer by now knows that the type of Vitamin E highlighted in the flawed SELECT study is not natural vitamin E. There is a big difference between the synthetic dl-alpha tocopheral version and the more protective mixed gamma-tocopherol version. Long story – short : 50 units of synthetic dl-alpha tocopherol IS protective against prostate cancer while 400 units ( 8 times the amount shown to be protective) may increase the risk of prostate cancer. More importantly, gamma-tocopherol is needed in the mix to be protective against prostate cancer one study showed after studying over 10,000 men with prostate cancer at Johns Hopkins, ( Helzlsouer et al. 2000) For more on this READ HERE
Gamma-tocopherol vitamin E is seemingly not only protective against prostate cancer but also heart disease. Numerous studies suggest that gamma-tocopherol is connect with a reduced risk of death from a heart problem. (Jiang et al. 2001) In a seven-year follow-up study of more than 334,000 postmenopausal women with no previous heart disease, greater intake of dietary vitamin E — consisting predominantly of gamma tocopherol — was strongly connected with a lower risk of death from cardiovascular disease. (Kushi et al. 1996)
Lastly, the third study highlighted in the Annals of internal medicine was by a team of scientist assessing the benefits of taking a high-dose multivitamin supplement or intravenous infusions of a chelating agent in subjects with a history of cardiovascular problems. The authors purported no adverse effects from the consumption of supplements but no cardiovascular benefit was found in the high-dose multivitamin group. First of all, the control group also consumed multi-vitamin nutrients, although at smaller amounts. So how can an accurate comparison be made? In addition, and perhaps most importantly, there was a large drop out rate of 46% in the high-dose supplement group which makes it impossible to conclusively assess benefit or lack thereof of the use of dietary supplements.
The authors of the Annals of Internal medicine “cherry picked” the studies that made sense to promote their prospective on supplements being waste. I have been asked on facebook and received emails of health conscious individuals wondering if Big Pharma is behind this study.
I have no evidence that this is the case – so I am not going to make any assumptions. Besides, Big Pharma is also in the supplement industry; i.e. Pfizer owns Centrum. But I don’t know for sure.
On Vitamin C
Paul Offit, MD in his attempt to debunk natural medicine wrote, Do you Believe in Magic?. In it he tries to make Linus Pauling look like he went senile in his sixties for promoting mega consumption of vitamin C to treat disease and promote health.
To continue to promote his skewed perspective he recently joined the supplement bashing party and wrote THIS piece in the New York Times.
Linus Pauling is arguably the father of vitamin C who promoted high dosages of vitamin C for prevention and even management of cancer along with its use for colds and flu’s and other conditions. While treating cancer with vitamin C alone is a stretch, there are protective benefits for its use.
One study, for example, looked a large group of people and found a significant reduced risk of cardiovascular mortality with vitamin C intake in Japanese women. (Kubota et al. 2011)
In another study vitamin C intake from diet and supplements again reduced cardiovascular risk. (Ye et al. 2008)
In 2004, a pooled analysis of nine prospective studies found that supplemental vitamin C intake (>400 mg/day for a average of 10 years), but not dietary vitamin C intake, reduced the risk of heart disease. (Knekt et al. 2004)
The oral intake of vitamin C and cancer research is murky at this time, as better-designed trials are needed. However, the addition of vitamin C as part of a nutritional regimen for someone with cancer might be a prudent approach since it help immune modulating benefits.
So, no, Linus Pauling, the only two-time Nobel Prize winner in history, was not losing it or demented in his sixties. In fact, vitamin C is even more intriguing and relevant today as a result of Dr. Pauling’s research.
On Vitamin D
This year a study of studies ( aka meta-analysis) showed a link between higher vitamin D levels and all cause reduced mortality rates amThis year a study of studies ( aka meta-analysis) showed a link between higher vitamin D levels and all cause reduced mortality rates among men and women followed between 6 to 13 years.
This study involved about 24,300 adults of varying ages. Over the studies’ follow-up periods of 6 to 13 years. , there was a 19% higher risk of dying from any cause among those with lower blood levels of vitamin D as compared to those with higher levels. (Rush et al. 2013)
Another German researcher found vitamin D deficiency being linked to a significant increase in all-cause mortality as well (Schöttker et al. 2013) while adequate levels was shown to reduce the risk of heart disease in women and reduce the risk of cancer in men (Rohrmann et al. 2013).
Vitamin D consumed from dietary supplementation is a better method to gain reasonable blood levels of vitamin D. Vitamin D from food or sun exposure is not reasonable since not too many foods contain enough vitamin D and we would have to be almost naked outdoor sun exposure to get enough of this vitamin. Additionally, some are too prone to skin cancer so sun exposure is not an option. Sun block lotion, by the way, interferes with the making of vitamin D from sun exposure.
There seems to be a big push to stop the progression of effective natural therapies. The argument is always that there isn’t enough evidence that supplements and natural therapies work and that it can kill you. I agree that there isn’t enough evidence. Is there enough evidence in mainstream medicine? No there isn’t. There is never enough evidence.
Prescription drugs kill over 40,000 people a year. How many people a year die from dietary supplements? Zero. So the safety argument does not hold and needs to end.
The argument of getting all the nutrients we need from food is also silly. Unless you eat 100% plant-based diet from local, organic food, animal derived foods from animals in their natural environment eating their natural diet – you cannot get everything you need from food.
Even those with the best dietary habits have no idea how contaminated their food is or where it comes from. Your lettuce may come from Chile. Your apples may come from New Zealand. By the time a food makes it to your mouth it has lost over 50% of you its nutrient content.So the argument anti-supplement groups pose to get all your nutrients from fruits and vegetables is disingenuous and impractical.
We should judiciously consume quality dietary supplements to fulfill the inadequacies of our food supply, to protect us from disease and promote health. There is good evidence that quality dietary supplements ARE protective. Of course more research is necessary and required in this area. But is there isn’t lack of evidence either.
Lastly, not to lose sight on the subject in question – are multivitamins necessary or a waste of money? A good multivitamin is a good start. We all have individualized needs. Nothing replaces the proper guidance of an expert doctor in the field of natural medicine like a licensed naturopathic doctor or integrative practitioner who are experts in this field. Such experts serve as a valuable resource in guiding people in consuming dietary supplements that are right for their specific needs, while eating right and encouraging physical activity.
Whew! Now do you want to know how I really feel? 😉
Links to other good reads on this:
Lippman et al. Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2009;301(1):39 -51.
Klein et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2011 Oct 12;306(14):1549-56.
Helzlsouer, K.J., Huang, H.Y., Alberg, A.J., Hoffman, S., Burke, A., & Norkus, E.P., et al. (2000). Association between alpha-tocopherol, gamma-tocopherol, selenium, and subsequent prostate cancer. Journal of National Cancer Institute, 92(24), 2018-2023.
Kubota Y, Iso H, Date C, et al. Dietary intakes of antioxidant vitamins and mortality from cardiovascular disease: the Japan Collaborative Cohort Study (JACC) study. Stroke. 2011;42(6):1665-1672.
Rush L, McCartney G, Walsh D, Mackay D. Vitamin D and subsequent all-age and premature mortality: a systematic review. BMC Public Health. 2013 Jul 24;13(1):679.
Schöttker B, Haug U, Schomburg L, Köhrle J, Perna L, Müller H, Holleczek B, Brenner H.Strong associations of 25-hydroxyvitamin D concentrations with all-cause, cardiovascular, cancer, and respiratory disease mortality in a large cohort study. Am J Clin Nutr. 2013 Apr;97(4):782-93.
Gaziano JM, Sesso HD, Christen WG, Bubes V, Smith JP, MacFadyen J, Schvartz M, Manson JE, Glynn RJ, Buring JE. Multivitamins in the prevention of cancer in men: the Physicians’ Health Study II randomized controlled trial. JAMA. 2012 Nov 14;308(18):1871-80.
Knekt P, Ritz J, Pereira MA, et al. Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts. Am J Clin Nutr. 2004;80(6):1508-1520.
Ye Z, Song H. Antioxidant vitamins intake and the risk of coronary heart disease: meta-analysis of cohort studies. Eur J Cardiovasc Prev Rehabil. 2008;15(1):26-34.
Jiang Q, Christen S, Shigenaga MK, Ames BN. gamma-tocopherol, the major form of vitamin E in the US diet, deserves more attention. The American Journal of Clinical Nutrition. Dec 2001;74(6):714-722.
Kushi LH, Folsom AR, Prineas RJ, Mink PJ, Wu Y, Bostick RM. Dietary antioxidant vitamins and death from coronary heart disease in postmenopausal women. The New England Journal of Medicine. May 2 1996;334(18):1156-1162.