Over half of all adults in the U.S. take multivitamins. A 2011 report from the National Center for Health Statistics estimated that 53% of American adults used some type of supplement in the years 2003 to 2006, with multivitamin/multimineral formulations being the most popular and U.S. consumers spent $28 billion on them in 2010 alone.
Why do they do it? Because the supplements make them feel better and hopefully live longer. Why do they believe that? Because years of published research that shows that vitamins and minerals significantly reduce the risk serious diseases, including heart disease, cancer, strokes, diabetes, arthritis, age related blindness, anxiety, depression, prostate disease, etc.
Suddenly, one biased editorial appears in one medical journal, written by five M.D.s, stating that using supplements and multivitamins to prevent chronic conditions is a waste of our money and could be harmful and the eager media looking for sensational headlines blindly runs away with the biased, or worse, intentionally deceptive conclusions.
Are we all that gullible or that ignorant? Are five M.D.s, that were virtually unheard of previously, so smart that their obviously biased interpretation of three admittedly narrow, flawed and limited studies, can suddenly “close the case” against vitamins.
Since when were vitamins on trial? Why are they on trial? Who is trying to get rid of them? Have they become too popular? Are they working so well that they are cutting too deeply into sales of pharmaceutical drugs? Does the FDA want to regulate vitamins as drugs to increase its revenues or to eliminate the competition for its primary client – Big Pharma?
Follow the money
Funding for the authors of the editorial and the research studies was provided by grants from the Agency for Healthcare Research and Quality (AHRQ), a government agency that provides substantial financial support and grants to the authors. Government influence for a desired outcome is a significant conflict of interest to the study authors. It appears that in order to acquire AHRQ grants the authors manipulate the conclusions to favor a government agenda or their own.
Here are the Headlines:
WebMD: Experts: Don’t Waste Your Money on Multivitamins
CBS News: Multivitamin researchers say “case is closed” after studies find no health benefits
Annals of Internal Medicine: Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements
The Annals of Internal Medicine editorial that spurred the Headlines states, “The (vitamin and supplement) industry is based on anecdote, people saying ‘I take this, and it makes me feel better,’ said Dr. Edgar Miller, professor of medicine and epidemiology at Johns Hopkins University School of Medicine and co-author of the editorial.
The results of the studies are so clear and consistent, the editorial writers said, that it’s time to stop wasting research money looking for evidence of a benefit. “The probability of a meaningful effect is so small that it’s not worth doing study after study and spending research dollars on these questions,” said Dr. Eliseo Guallar, MD, DrPH., who is the lead author of the editorial and professor of epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore.
“We believe that the case is closed – supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough.”
What does Dr. Hansen think of the editorial?
The editorial, which claims to be the final word on vitamins, 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, published on December 16, 2013, in Annals of Internal Medicine, are flawed by design, intentionally or unintentionally, and omit reporting of significant positive results in order to support their claims. In short this is a veiled attempt to discredit good science with bad science and replace safe, inexpensive multivitamins and other nutritional supplements with definitively more dangerous and exponentially more expensive drugs.
To be sure, there are many vitamin supplements that are poorly formulated with insufficient quantities of nutrients or proper nutrient combinations. There are some vitamin manufacturers that do not follow the FDAs required GMPs (Good Manufacturing Practices). However, the FDA does indeed regulate the Nutritional Supplement Industry and has the legal power and authority to pull harmful or misrepresented products from the market. However, nutritional supplements are not drugs and although they are not required to prove that they are safe or effective, abundant research has shown and continues to show that they are safer, less expensive and often more effective than many drugs.
Flawed Study Number 1
The editorial summary of the first study, which is a meta-analysis of 27 studies that covered more than 400,000 participants. The editorial authors claim that they found that multivitamins had no beneficial effect on preventing cardiovascular disease or cancer. In addition, they said that taking vitamins didn’t prevent mortality in any way.
Their negative conclusion can only mean that they did not investigate enough research studies, their scientific method and investigative skills are seriously lacking, or they chose to exclude or ignore hundreds of positive studies.
Curiously, the first study of the 27 that I fact checked “shows that a combined supplementation with reasonable doses of both vitamin E and slow-release vitamin C can retard the progression of common carotid atherosclerosis in men. The proportion of men with progression was reduced by 74% by supplementation with the formulation containing both vitamins, as compared with placebo. This may imply benefits with regard to other atherosclerosis-based events.”
This study, Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) study: a randomized trial of the effect of vitamins E and C on 3-year progression of carotid atherosclerosis, published in the Journal of Internal Medicine 2000 Nov; 248(5):377-86, conducted at the University of Copenhagen and the Research Institute of Public Health, University of Kuopio, Kuopio, Finland, was a Double-blind, randomization clinical trial that gave patients twice daily either 91 mg (136 IU) of natural, d-alpha-tocopherol, 250 mg of slow-release vitamin C, a combination of these or placebo for three years.
These are significant results from a combination of very low doses of Vitamin C and E over a very short time period. This study showed that no significant benefit occurred from each vitamin individually, but when combined, the results were very impressive and should have been acknowledged by the study authors.
Instead, “the editorial authors reported that there was no clear evidence of a beneficial effect of supplements on all-cause mortality, cardiovascular disease, or cancer. To come to this conclusion, they have to be biased and intentionally attempting to deceive the public and anyone who blindly accepts their word without reading the study themselves.
The data from the first study reviewed in the editorial, clearly shows that multivitamins do indeed lower the incidence of cancer in men by 0.93, which equals a 7 percent reduction:
Data Synthesis: “Two large trials (n = 27,658) reported lower cancer incidence in men taking a multivitamin for more than 10 years (pooled unadjusted relative risk, 0.93 [95% CI, 0.87 to 0.99]). The study that included women showed no effect in that group. High-quality studies (k = 24; n = 324,653) of single and paired nutrients (such as vitamins A, C, or D; folic acid; selenium; or calcium) were scant and heterogeneous and showed no clear evidence of benefit or harm. Neither vitamin E nor β-carotene prevented CVD or cancer, and β-carotene increased lung cancer risk in smokers. (They should have reported that one study found that a combination of vitamin E and vitamin C produced a 74% reduction in carotid artery atherosclerosis in men.)”
Limitations: “The analysis included only primary prevention studies in adults without known nutritional deficiencies. Studies were conducted in older individuals and included various supplements and doses under the set upper tolerable limits. Duration of most studies was less than 10 years.”
Conclusion: “Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only (7 percent reduction) and no effect on CVD.”
Although limited, the evidence revealed in these study does prove that multivitamins do significantly reduce cardiovascular disease and cancer, in spite of the flawed design of not including more studies that combined vitamin E and vitamin C and not reporting on the ones that they did include.
Flawed Study Number 2
For the second study, researchers randomly assigned 5974 male doctors aged 65 or older to take either a daily Centrum Silver multivitamin or a look-alike placebo pill. Every few years, the researchers gave the men a battery of tests over the telephone to check their memories.
After 12 years, there was no difference between the multivitamin and the placebo group in overall cognitive performance or verbal memory.
Here are the problems with this study and why it was flawed from the inception. The men were over age 65 at the outset of the study. By this age significant brain and nervous system degenerative changes have already begun, which are very difficult to reverse. More problematic is the multivitamin that was chosen. Centrum Silver is a one-a-day multivitamin with very low supplemental levels of nutrients. Even though, 84 percent of participants in the study said they faithfully took their pills each day, the multivitamin contains only 60IU of synthetic vitamin E (dl-alpha-tocopoheryl acetate), 100mcg of Selenium (the essential vitamin E co-factor) and 120mg of Vitamin C.
In spite of the insufficient quantities of the antioxidants C, E and Selenium, data from this same study, had previously found that this multivitamin could modestly reduce the risk of cancer and cataracts. Cancer risk was reduced by 8 percent, while the risk of cataracts dropped by 9 percent, compared to a placebo.
Natural versus synthetic vitamin E
Most studies have shown that synthetic vitamin E is only half as active in the body as the natural form. As it relates to the flawed study claiming that vitamin E does not prevent heart attack, the 60 IU of synthetic dl-alpha tocopherol given every day equates to only 30 IU a day of the natural form.
We would not expect 30 IU of natural vitamin E a day by itself to reduce vascular disease risk.
Note: When checking vitamin labels, natural vitamin E is usually stated as the “d” form (for example d-alpha tocopheryl acetate, d-alpha tocopherol, and d-alpha tocopheryl succinate).
Synthetic vitamin E will have an “l” after the “d” (for example, dl-alpha tocopheryl acetate, dl-alpha tocopheryl succinate, dl-alpha tocopherol). Remember “dl” signifies synthetic vitamin E, whereas “d” signifies natural vitamin E. Remember that natural d-alpha tocopherol (d-alpha tocopheryl succinate or acetate) is equal to about 1.5-2.0 times more antioxidant activity than the synthetic dl-tocopherol (dl-alpha tocopheryl acetate or succinate).
Vitamin C potencies too low
Published studies that document vascular benefits in response to vitamin C typically use doses of 1,000-6,000 mg each day. The authors of the flawed study should have know this since they reviewed 277 articles. “In a pooled analysis of 9 cohorts, vitamin C supplement use exceeding 700 mg/day was significantly associated with a 25% reduction in coronary heart disease risk.”
Since the doctors who designed the flawed study knew that vitamin C intakes exceeding 700 mg a day significantly reduce heart attack rates, why would they limit their subject’s daily dose to only 250 mg.
Two-time Nobel Prize laureate Linus Pauling and his associates advocated daily doses of vitamin C ranging from 10,000 to 20,000 mg to protect against heart attack. Linus Pauling’s theory was that atherosclerosis is primarily caused by insufficient vitamin C intake. Dr. Pauling compared the high amount of vitamin C naturally synthesized in the bodies of animals that don’t typically die of heart attacks. A 150 pound goat, for example will maintain an ascorbate blood concentration equivalent to ingesting 13,000 mg of vitamin C.
Unlike most animals, humans lack an internal enzyme needed to manufacture vitamin C in their body. If humans don’t obtain enough vitamin C from external sources, they die acutely from scurvy, or according to Linus Pauling…slowly suffer atherosclerotic occlusion. Dr. Pauling crusaded to educate humans about the need to take mega-doses of vitamin C.
Dr. Pauling and his associates published papers stating that when vitamin C levels are insufficient, the body uses cholesterol to repair the inner lining of arteries. Dr. Pauling believed that cholesterol’s involvement in atherosclerosis was a direct result of insufficient vitamin C.
Flawed Study Number 3
In the third study, researchers randomly assigned 1,708 heart attack survivors, previously enrolled in a trial of therapy known as intravenous EDTA chelation, to a daily regimen of high doses of vitamins and minerals (6 pills contain 1200mg of vitamin C, 400 IU of natural d-alpha-tocopheyl succinate and d-alpha-tocopheryl acetate, plus 200mcg of Selenium) or placebo pills.
Participants were asked to take six pills a day. Nearly half the participants in each part of the study stopped taking their medication before the end of the study three years later. The average time people stuck with it was about two and a half years. With such a high drop-out rate, “interpretation is very difficult,” said Miller.
After an average of 55 months, there was no significant difference between the two groups in a composite measure that counted the number of deaths, second heart attacks, strokes, episodes of serious chest pain and procedures to open blocked arteries.
Although this study included a multivitamin with significant quantities of cardiovascular disease preventing vitamin combinations, the study duration was prohibitively short. Definitive results require 15 to 20 years of diligent supplementation in order to demonstrate significant effectiveness.
Multivitamins Do Make a Significant Difference
The editorial authors should have looked back in time a little farther. In a 1998, the Annals of Internal Medicine reported that women who used multivitamins containing folic acid for at least 15 years had a 75% lower rate of colon cancer than non-users. The study concluded that using a multivitamin over multiple years could reduce the rate of colon cancer in women 55 to 69 years of age by 78%, from 68 cases per 10,000 to as few as 15 new cases per 10,000.
Dietary Magnesium Intake Is Inversely Associated with Mortality in Adults at High Cardiovascular Risk. Experts should also look at the endless release of new studies that continue to confirm that vitamins and minerals reduce the risk of disease and death as shown in this November 20, 2012, Journal of Nutrition study:, J Nutr. 2013 Nov 20. [Epub ahead of print], which shows that, “Compared with lower consumers, individuals in the highest tertile of magnesium intake had a 34% reduction in mortality risk.”
Cells of multivitamin users may have a younger biological age than cells from non-users, according to research in 2009, the. Researchers led by Honglei Chen, MD, PhD from National Institute of Environmental Health Sciences looked at the length of telomeres, DNA sequences at the end of chromosomes that shorten as cells replicate and age.
Compared to non-multivitamin users, the researchers noted that that telomeres were on average 5.1 per cent longer for daily multivitamin users. Source: American Journal of Clinical Nutrition
June 2009, Volume 89, Number 6, Pages 1857-1863, doi:10.3945/ajcn.2008.26986
“Multivitamin use and telomere length in women”
Prenatal Vitamins boost birth weight and infant health, Posted on April 11, 2010 by Clark Hansen N.M.D. Women who take daily multivitamins in and around the time of conception give birth to babies who weigh one pound more on average than women not taking the supplements, report researchers from Harvard and Boston University in the Annals of Epidemiology.
Vitamin Supplements vs Drugs, Posted on February 1, 2010 by Clark Hansen N.M.D.
Over half of the adults in the US use multivitamins. Why do they do it? Because the supplements make them feel better and hopefully live longer. Why do they believe that? Because years of research that shows that vitamins, minerals and herbs significantly reduce the risk serious diseases, including heart disease, cancer, strokes, diabetes, arthritis, age related blindness, anxiety, depression, benign prostate enlargement, etc. Now, however, recent headlines are turning everything upside down. Why the change?
According to Richard Smith, editor for the British Medical Journal for 25 years, the major medical journals read by doctors may be the culprits. “Major journals are just an extension of the marketing departments of major drug companies,” Smith said. He is not alone in this opinion. “Journals have devolved into information laundering operations for the pharmaceutical industry”, wrote Richard Horton, editor of the Lancet Medical Journal, in March 2004.
These are strong words from some of the most respected and prominent people inside the medical community who are disturbed by the powerful influence of big drug money. The drug industry is becoming “primarily a marketing machine,” says Marcia Angell, former editor of the New England Journal of Medicine. She criticizes the drug companies for deceiving the public.
HARVARD RESEARCHERS RECOMMENDING VITAMIN SUPPLEMENTS FOR ALL ADULTS
WASHINGTON, D.C., June 20, 2002 – Two Harvard researchers, Robert H. Fletcher, M.D., M.Sc., and Kathleen M. Fairfield, M.D., Dr.P.H., of Harvard Medical School and the Harvard School of Public Health, have joined a growing list of scientific experts who recognize the benefits of vitamins by stating in the June 19 issue of JAMA that “we recommend that all adults take one multivitamin daily.”
The researchers reviewed more than 30 years of English-language articles about vitamins in relation to chronic diseases and published their findings in two companion articles.
In the scientific review article, the two physicians found strong evidence that suboptimal levels of folic acid, along with suboptimal levels of vitamins B(6) and B(12), are a risk factor for cardiovascular disease, neural tube defects, as well as colon and breast cancer; low levels of vitamin D contribute to osteopenia and fractures; and low levels of the antioxidant vitamins (vitamins A, E, and C) may increase risk for several chronic diseases. Most people do not consume an optimal amount of all vitamins by diet alone.
The Harvard Medical School team of physicians stated that “low vitamin intake has been linked to so many illnesses, that everybody—regardless of age or health status— should start taking a daily multivitamin.
“Lead author of the study, Dr. Robert Fletcher, said, “It’s rare to find a health-promoter that offers such a substantial benefit with a relatively low cost and low risk of problems. And when you have such a thing,” he added, “you ought to jump on it.”
Annette Dickinson, Ph.D., Vice President, scientific and regulatory affairs, Council for Responsible Nutrition (CRN), and the author of The Benefits of Nutritional Supplements, states “There is no question that the amount of scientific evidence in favor of consistent use of vitamins, particularly multivitamins, is formidable and must be taken seriously, both by the medical community and by those who create public policy. Clearly, this is more good news for those consumers who already incorporate vitamins into their daily routine and should serve as a wake-up call for those who are still just thinking about it.”
Take a MultiVitamin: Boost Vitality and Longevity, Posted on January 27, 2011 by Clark Hansen, N.M.D. Research now confirms what you already knew-that you can prevent most of today’s chronic degenerative diseases and extend your life by taking a daily multi-vitamin. So, what are you waiting for?