The recent news media came out with many stories blasting the use of multivitamins based on what a handful of doctors reported of their “findings” in the Annals of Internal Medicine

First of all, the original report came from medical doctors, which always makes me suspicious because they are experts on drugs, not supplements. In fact, most of the time spent in medical school is on the study of drugs. It’s no coincidence that the pharmacological industry is the largest financial supporter of medical schools. Big Pharma wants doctors to be their sales people, so they make sure to fund those schools enough to gain influence over what those schools teach.

This is why when you go to most medical doctors, they spent most of the time talking to you about what drugs they can prescribe for you to treat the symptoms and spend little (if any) time talking about the root cause of your condition and what to do about it. They have been brainwashed to think that treating symptoms with drugs is the same as curing, but we all know that isn’t the case.

Besides, Doctors tend to like to be in the press too, because it helps promote them and their practice. Writing a controversial article like this is pretty much a guarantee to get in the press. As you can see, this time it worked quite well. When one news organization gets a story like this, it spreads fast among the other news organizations and pretty soon these doctors are guests on TV and radio talk shows, which then opens up the door to things like book deals and more patients who they can prescribe more drugs for, making big Pharma happy and perpetuating the mad cycle of money.

The rest can be said better than me by Lee Swanson, who put out a great commentary on this recent news. Here is his report from his website:

Are the millions of Americans who take a daily multivitamin just throwing their money away? That’s the question raised by news outlets across the nation echoing the opinion expressed by five doctors in a recent editorial published in the Annals of Internal Medicine. The title of their editorial, “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements,”1 pretty much sums up what they have to say about the matter, an opinion that they claim is based upon the latest research, including three articles appearing in the same publication. However, when we look more closely at the articles in question, they don’t appear to support the strident conclusions espoused by the editorial, which appears to be the type of hatchet piece one might expect from someone with an ax to grind.

At the heart of the issue lie some basic problems with the way scientific studies are designed and how they are reported in the news media. Most studies are very specific in what they are attempting to evaluate and, as tempting as it may be, should not be used to draw conclusions beyond their purview. In this instance, one study cited by the editorial authors involved 1,708 patients aged 50 years and older who had all suffered heart attacks.2 The study found that multivitamin use did not produce statistically significant reductions in further heart attacks within this population. Obviously this is a study population with severe cardiovascular disease, and it would be irresponsible to extrapolate data from this study and apply it to the general population. An additional limitation of this study, as noted by its authors, is that “there was considerable non-adherence and withdrawal, limiting the ability to draw firm conclusions,” but that does not stop the editorial writers from doing just that.

One of the other studies cited in the editorial involved 5,947 male physicians aged 65 years and older, a population that could hardly be considered a representative cross-section of the general population. This study found that multivitamin use was not associated with any cognitive benefit in this group, although the authors note that the “doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin.”3 While the study authors obviously believed this limitation was significant enough to mention it specifically, the doctors who penned the editorial hit-piece apparently did not share their concerns.

The remaining article cited by the editorial authors in their condemnation of multivitamins was a review that included 26 studies of various individual vitamins and vitamin combinations, only five of which evaluated multivitamins specifically.4 Evaluation of these five studies found multivitamin use was not associated with any significant benefit in the prevention of cardiovascular disease, but was associated with a possible benefit for cancer prevention in men. Among the study limitations noted by the authors, the “studies were conducted in older individuals and included various supplements and doses” and the “duration of most studies was less than 10 years.” Once again, the authors of the study demonstrate an appreciation for the limitations of their findings not shared by the authors of the editorial.

To sum it up, the research clearly does not support the sweeping condemnation of multivitamins expressed in the editorial. Moreover, the doctors who wrote the unfortunate piece appear to have little understanding of why roughly 40% of men and women in the US take a multivitamin every day: to fill the nutritional gaps in their regular diet. If everyone ate a diet loaded with fresh fruits and vegetables every day, they might be able to get all the nutrients they need without a daily multivitamin (although, with our mineral-depleted soil, that is certainly questionable), but even those of us with the healthiest diets can fall short some days. Millions of Americans already know this, but apparently there are five doctors who do not.     

1. Guallar E, et al. Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Ann Intern Med. 2013;159(12): 850. Retrieved 19 Dec 2013 from http://annals.org/article.aspx?articleid=1789253

2. Lamas GA, et al. Oral High-Dose Multivitamins and Minerals After Myocardial Infarction: A Randomized Trial. Ann Intern Med. 2013;159(12):797-805-805. doi: 10.7326/0003-4819-159-12-201312170-00004

3. Grodstein F, et al. Long-Term Multivitamin Supplementation and Cognitive Function in Men: A Randomized Trial. Ann Intern Med. 2013;159(12):806-814-814. doi: 10.7326/0003-4819-159-12-201312170-00006

4. Fortmann SP, et al. Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;159(12):824-834-834. doi: 10.7326/0003-4819-159-12-201312170-00729

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And Betsy, one of my clients at X Gym, printed some great additional points in her blog:

Dr. Jamie McManus, suggests taking the 30,000 mile high view on this subject.  Vitamins are meant to supplement a diet that does not provide optimal nutrition.  They are not intended to substitute for a healthy diet rich in vegetables, lean protein and fresh fruit. Ninety-seven percent of us do not get adequate nutrition every day.  Vitamin supplements help bridge that gap.

So what do these three studies in the Annals of Internal Medicine say about preventing chronic disease?

Perhaps we should be begin by questioning the premise of the studies: that multivitamins can prevent chronic disease.  Do you believe you take your vitamins for that express purpose and leave everything else to chance?

Dr. McManus says “Prevention of any disease is a multi-factorial process that has to include diet, weight management, and lifestyle. To expect to see disease prevention accomplished by virtue of taking a daily multivitamin is a flawed premise. So, why are these large-scale (and very expensive) studies undertaken? It is simply the model of research that scientists and physicians understand – studying a single drug to determine what effect it may have on a single disease. Studying nutrition is far more complex.

These studies were conducted the way scientists study specific drugs.  Let us question that approach.

While a drug has a primary effect (usually something positive), they also have a myriad of side effects (which are usually negative and even life threatening). Every year pharmaceuticals are removed from the market because of these serious side effects. A study published in JAMA in 1998 showed that as many as 125,000 Americans die each year of properly prescribed pharmaceuticals – wow! When was the last time a vitamin was removed from the market?

Have you ever played around with stopping your vitamin intake for a week or so and then going back to them?  Could you tell the difference in how you felt with and without the supplementary nutrition?

Vitamins and minerals all have multiple positive functional roles to play in our bodies – which is why so many Americans pop a multi each day. People simply feel better when they take a multi because they are filling in those all too common nutrition gaps.

All three of these studies showed that multivitamins have an excellent safety profile. Well, of course they do! The only “potential harm” that continues to be mentioned every time we have a study such as this published is the slight increased risk of lung cancer in smokers who took beta carotene. My response to that is – smokers: stop smoking!

Let me quickly summarize these studies. The largest one is another report from the Physician Health Study – previous publications of data from this large government funded study did show an association of reduced cancer associated with multivitamin usage.

The next study looked at cognitive decline in physicians – who are at the upper end of the intelligence scale and pretty well nourished. Showing a significant change in cognitive decline in this population is going to take some intervention beyond a multi – as this population is most likely doing lots of the right things to protect their brain function.  

In other words, the presence or absence of a multivitamin can not be the deciding factor in declining brain function.

The third study tried to show that higher doses of specific vitamins decrease the likelihood of a second heart attack in folks who have already had a heart attack. Hmmm. Maybe we should look at weight reduction, cholesterol, blood pressure lowering, and blood sugar management as opposed to putting the burden of prevention of a second heart attack in someone with heart disease on vitamins!

I have been recommending a multivitamin (and beyond) to my patients, and consumers in general, for my entire 30 years as a physician – and nothing in these studies changes my mind. The statistics on inadequacies in our American diet are clear – most everyone is deficient in multiple nutrients. Here at Shaklee, we have the Landmark Study,published in the journal Nutrition in 2007 that showed a nice correlation of better health with multiple supplement usage, starting with a multivitamin. We have over 100 published studies that validate the connection of nutrition and health. 

 

 

Thanks for reading and caring enough about your own health and fitness to stay informed!