Multivitamins

[Fotheringay-Phipps]

So the Annals of Internal Medicine has made a lot of recent headlines with an editorial arguing that multivitamins are a waste of money. From CNN:

The editorial, “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements,” is based on three studies looking at the effects of multivitamins on preventing heart attacks and cancer, as well as improving cognitive function in men older than 65. All three studies were also published in this week’s Annals of Internal Medicine.

The first study was a meta-analysis of 27 studies that covered more than 450,000 participants and found that multivitamins had no beneficial effect on preventing cardiovascular disease or cancer.

In addition, taking vitamins didn’t prevent mortality in any way.

However, there is also a counterargument presented:

However, Gladys Block, a professor of nutrition and epidemiology at University of California Berkeley, pointed out that the group of men followed in the cognitive study were all physicians with no health problems.

“These are very well-nourished, very health-conscious people,” she said.

In fact, she says none of the studies accurately represents the American population.

Block has spent her life studying the role of Vitamin C, in particular, on disease risk factors and says that most Americans are undernourished. She says that most Americans don’t have a healthy diet, and therefore don’t get the vitamins and minerals they need.

The argument against multivitamins is nothing new. I remember my HS science teacher making this same point 30 years ago. But I tend to be sympathetic to this counterargument. Most of those who argue against multivitamins also hasten to add that people should make sure to get enough fruits and vegetables. Which is great. But most people don’t do that, and are not going to do that. So the question then is: if you know that as a practical matter you’re not going to get your recommended amounts of F&V anyway, does it then make sense to take a multi? I don’t know, and these contra arguers don’t address this clearly enough IMO.

One additional point that my father has told me over the years - which I’ve not seen addressed in any recent article covering this editorial - is that the absorbtion rates for multivitamins is very poorly understood. He says to cover for this, the multis are loaded with doses of vitamins that go well beyond any possible necessary requirements, in the hopes that enough will be absorbed even at low rates. But conversely, he says, scientists have become increasingly aware that overdosing on vitamins also has harmful effects, so that the multi approach risks both being too low and too high for any of these vitamins. (Despite this - and a sickeningly healthy diet and lifestyle generally - I believe he does take some supplements as well, what do you know. Maybe his stuff is very narrowly focused.)

[newcomer]

@Fotheringay-Phipps

However, there is also a counterargument presented

Not only a counterargument but quite embarrassing property of a pool under observation. Did they hope no one would notice?

:rolleyes:

[ITR_champion]

Yeah, that’s a very common problem in a lot of published research. In high school statistics, one learns (or certainly should learn) that you can’t take a result from a sample of folks with certain characteristics and extend the results to everyone. Yet somehow, this piece of wisdom gets lost in reports.

Also, of course, people don’t take multi-vitamins only to prevent heart attacks and cancer. I’d assume to boosting the immune system to fight off common cold, flu, &c… is the most common reason people take them. So there need to be some studies on where multi-vitamins help there before we dismiss them entirely.

[Fotheringay-Phipps]

To be fair, that claim about the cognitive study referred specifically to the third of three studies, and not the one I quoted. The first study (the one I quoted) was a meta-analysis of 27 other studies covering 450K people. (I didn’t want to quote too much of the article, and was intending to illustrate the general argument rather than to claim that it specifically undermined these particular studies).

[x-ray_vision]

@Fotheringay-Phipps

So the question then is: if you know that as a practical matter you’re not going to get your recommended amounts of F&V anyway, does it then make sense to take a multi?

There seems to be plenty of evidence that vitamin supplements may not only be worthless, but harmful. Some of the links below are relevant for doses higher than in a multi, but still scary info.

‘‘The vitamin C in supplements mobilizes harmless ferric iron stored in the body and converts it to harmful ferrous iron, which induces damage to the heart and other organs,’’ Dr. Herbert said in an interview.

‘‘Unlike the vitamin C naturally present in foods like orange juice, vitamin C as a supplement is not an antioxidant,’’ Dr. Herbert said. ‘‘It’s a redox agent – an antioxidant in some circumstances and a pro-oxidant in others.’’

In contrast, vitamin C naturally present in food, he said, has no oxidizing effects.

Taking Too Much Vitamin C Can Be Dangerous, Study Finds (Published 1998)

Multi-vitamins alone or in combination with vitamin A, C, or E were associated more often with slightly increased mortality from all cancers combined and from cancers of the lung (both sexes) and colorectum (men) and other cancers (men) than was use of vitamin A, C, or E without multivitamins.

http://aje.oxfordjournals.org/content/152/2/149.long

Dietary supplementation with vitamin E significantly increased the risk of prostate cancer among healthy men.

http://jama.jamanetwork.com/article.aspx?articleid=1104493

Researchers at Johns Hopkins report that use of high-dose vitamin E supplements, in excess of 400 IU (international units), is associated with a higher overall risk of dying. These results should be of concern to the millions of Americans who take vitamin E supplements for perceived health benefits.

http://www.healthcentral.com/drdean/408/60985.html

Treatment with beta carotene, vitamin A, and vitamin E may increase mortality. The potential roles of vitamin C and selenium on mortality need further study.

http://jama.jamanetwork.com/article.aspx?articleid=205797

Antioxidants increasingly have been praised for their benefits against disease and aging, but recent studies at Kansas State University show that they also can cause harm.

Researchers in K-State’s Cardiorespiratory Exercise Laboratory have been studying how to improve oxygen delivery to the skeletal muscle during physical activity by using antioxidants, which are nutrients in foods that can prevent or slow the oxidative damage to the body. Their findings show that sometimes antioxidants can impair muscle function.

“Antioxidant is one of those buzz words right now,” said Steven Copp, a doctoral student in anatomy and physiology from Manhattan and a researcher in the lab. “Walking around grocery stores you see things advertised that are loaded with antioxidants. I think what a lot of people don’t realize is that the antioxidant and pro-oxidant balance is really delicate. One of the things we’ve seen in our research is that you can’t just give a larger dose of antioxidants and presume that there will be some sort of beneficial effect. In fact, you can actually make a problem worse.”

K-State study finds that antioxidants aren't always beneficial to your health...

After a median follow-up of 8.0 and 7.9 years in the clinical trial and observational study cohorts, respectively, the Women’s Health Initiative study provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in postmenopausal women.

Multivitamin use and risk of cancer and cardiovascular disease in the Women's...

Do vitamin supplements really do any good?

[XT]

The argument against multivitamins is nothing new. I remember my HS science teacher making this same point 30 years ago. But I tend to be sympathetic to this counterargument. Most of those who argue against multivitamins also hasten to add that people should make sure to get enough fruits and vegetables. Which is great. But most people don’t do that, and are not going to do that. So the question then is: if you know that as a practical matter you’re not going to get your recommended amounts of F&V anyway, does it then make sense to take a multi? I don’t know, and these contra arguers don’t address this clearly enough IMO.

And this is where I’m at. I’m probably the consummate example of an anti-Vegan…I basically eat almost exclusively meat, cheese and bread (with lots and lots of gluten :p). The only time I eat anything remotely resembling a fruit or vegetable its processed…as in the sauce on my pizza is sort of kind of a fruit, as is the chili peppers in my salsa (or the myriad other things I eat with green or red chili), or the french fries I have with my cheese burger (extra cheese, catchup and mustard). I also take a multivitamin every day and have for decades. I don’t do it to thwart cancer or prevent heart attacks, I do it because I know that I don’t eat a balanced diet.

Presumably SOMETHING is preventing my teeth from falling out or me getting rickets or scurvy, and I’m guessing it’s either the vitamins added to the foods I eat or the multivitamin…or both. Clearly, however, even with as bad a diet as I eat, it’s working well enough to do the job I’m looking for it to do, which is to allow me to eat my meat and cheese without having to give up valuable stomach space to nasty fruits and vegetables.

[Ambivalid]

One issue i have with supplementing with mutis is that it can serve to worsen a person’s already poor diet with the assumption that the multivitamins will “make up” for their poor dietary choices and basically serve as a license to eat even worse than they already were.

[monstro]

I experience chronic anemia. I don’t say that I suffer from it because am not aware of any ill effects. I am not easily fatigued or irritable. The only inconvenience is that I usually can’t donate blood due to low hemoglobin. Since I am O negative and I like feeling useful, this kinda bothers me.

So for the past six months I’ve been taking a multivitamin (Flintstones). I’ve been able to give blood the last two times the Red Cross has held drives at work. After being turned away for years, this is a big deal. So I know that extra iron has done something.

But as far as my physical health goes, I haven’t noticed a difference.

[DSeid]

Bottom line - iron for iron deficiency anemia works; treating true vitamin deficiency usually works; supplementing the general population has no evidence that it works in any meaningful way and in many cases has strong evidence of harm.

Diets high in real foods that contain vitamins (veggies, fruits, whole grains) are associated with lower rates of heart disease and cancer, and less risk of cognitive decline. Studies of similar populations studying vitamin use find no such decreases.

The meat cheese and bread diet of some will be enough to stave off gross deficiencies like scurvey and rickets. The broader documented benefits of having fruits and veggies as well are not obtained by adding in a multi.

No boosting of the immune system is documented anywhere.

It is a multibillion dollar industry exploiting the worried well (but not so worried that they’ll actually bother to do things like eat right and exercise, not when they think this shortcut will suffice).

[RickJay]

@Ambivalid

One issue i have with supplementing with mutis is that it can serve to worsen a person’s already poor diet with the assumption that the multivitamins will “make up” for their poor dietary choices and basically serve as a license to eat even worse than they already were.

I’ve always found it especially stunning that they make multivitamins for children for this very reason. Your child shouldn’t have to take Flintstone vitamins if you feed them a reasonably balanced diet.

I’m no food Nazi when it comes to my kid and she can be picky sometimes, but it’s not THAT hard to get nutrients into her with just food.

[Measure_for_Measure]

Pro multi-vitamin study: Study: Multivitamins Reduce Cancer Among Men – Mother Jones

[DSeid]

MfM here is the actual study being referred to and it is interesting. This one found a small but apparently statistically significant impact of taking Centrum Silver on cancer diagnosis in middle-aged and older men with no impact on deaths from cancer: “incidence of total cancer (multivitamin and placebo groups, 17.0 and 18.3 events, respectively, per 1000 person-years … no significant difference in the risk of cancer mortality …”

The article discusses that other larger studies have found no impact on cancer mortality either and if anything a negative effect on breast cancer in women:

In the Cancer Prevention Study II, which followed up more than 1 million US adults beginning in the early 1980s, multivitamin use was not associated with cancer mortality.27 The Women’s Health Initiative found that multivitamins had little or no relationship with the risk of breast, colon, or other cancers in more than 160 000 women followed up for a mean of 8 years.9 Among 35 000 Swedish women, however, multivitamin use was associated with a 19% increased risk of breast cancer (95% CI, 1.04-1.37) during a 10-year period compared with women not using these vitamins.8

Interpret at your own risk.

[Jackmannii]

@DSeid

No boosting of the immune system is documented anywhere (from multivitamins).

Worth repeating.

I’m also unaware of good evidence for any herb or supplement reliably boosting immune response in a beneficial way (and that includes Echinacea)).*

*"Every part of your body, including your immune system, functions better when protected from environmental assaults and bolstered by healthy-living strategies such as these:

Don’t smoke.

Eat a diet high in fruits, vegetables, and whole grains, and low in saturated fat.

Exercise regularly.

Maintain a healthy weight.

Control your blood pressure.

If you drink alcohol, drink only in moderation.

Get adequate sleep.

Take steps to avoid infection, such as washing your hands frequently and cooking meats thoroughly."*

*I eat a lot of garlic, which has been touted (again without convincing documentation) as an immune booster. But I eat it because it’s tasty.

**Fans of supplements often dismiss research studies that debunk supplement claims as being geared to benefit Big Pharma. What this ignores is 1) Big Pharma increasingly has gotten into the supplement business, buying up smaller companies (or starting their own operations), and 2) recommending healthy eating instead of popping pills does not boost pharma profits.

[Nava]

@x-ray_vision

There seems to be plenty of evidence that vitamin supplements may not only be worthless, but harmful. Some of the links below are relevant for doses higher than in a multi, but still scary info.
http://www.nytimes.com/1998/04/09/us/taking-too-much-vitamin-c-can-be-dangerous-study-finds.html?pagewanted=1

…‘‘Unlike the vitamin C naturally present in foods like orange juice, vitamin C as a supplement is not an antioxidant,’’ Dr. Herbert said. ‘‘It’s a redox agent – an antioxidant in some circumstances and a pro-oxidant in others.’’…

If the Vitamin C present in pills is not chemically equal to that in oranges, it’s not Vitamin C.

Vitamin C is a redox agent whether it comes from a pill or an orange (mind you, so are the majority of organic molecules). Let’s take a look at the molecule and flip a bit through any organic chemistry book, shall we? I give to thee L-ascorbic acid:

OK, so this thing has, without going into much detail:

• two alcohol groups (plus a third which is usually sterified with its own acid group), which can be reducing agents as well as acids or bases;
• a double enol (the two OH with the double bond in the middle), which can be both a reducing and an oxidizing agent (anybody interested in the redox properties of enols, check out aldehydes - enols are aldehyde automers)
• and an acid group, which, while preferring to act as, well, an acid (to wit, “sterification with its own comfortably-reachable alcohol”) can also be an oxydizer.

The same wiki article has parts about its oxy and red metabolic roles, but those go beyond what one can get from undergraduate Orgo 1.

I suspect the doctor in question would have problems writing the correct formula for hydrogen monoxide. While I’m not fond of multivitamins for my own reasons (the “minerals” part tends to include combinations which are insoluble when combined), people like this guy do not make science any favors.

[SerafinaPekala]

They’ll have to pry the bottle of fish oil from my cold dead fingers.

[kayaker]

Steven Novella’s take on the topic.

[Pleonast]

No idea where I read it (so no cite), but there was at least one study of prison inmates being given vitamin supplements. The supplements substantially reduced violence among the inmates who took them compared to the controls. So at least some populations can benefit from supplements.

[DSeid]

Found itfor you.

They gave both a multivitamin AND a sizable essential fatty acid (EFA) supplement. Interestingly there is some work on EFAs in mental illness.

[SerafinaPekala]

^^ that study is interesting. Thx for posting. My sister and I were also given orange juice and cod liver oil as wee bairns. Wonder where my parents got that idea ???

[DSeid]

Were you (or either of your parents) in the U.K. during WW2?