If you took your multi-vitamin this morning or some extra vitamin-E, chances are you’ll kick the bucket sooner rather than later?! Wait, what?!…
Many of you have heard the breaking news about the University of Minnesota study published in the Archives of Internal Medicine (see ‘Background’ below) that found women taking multivitamins don’t live longer than those who get their nutrients from food alone and may appear to have slightly higher death rates. Nearly 39,000 older women completed questionnaires beginning in 1986. The survey asked about use of multivitamins, vitamins A, C, D and E as well as beta-carotene, B vitamins and minerals such as calcium, copper, magnesium, selenium and zinc. Here’s the thing: I believe the study has methodological short-falls.
Among other issues, specific doses of vitamins, minerals, and antioxidants looked at in the study are not in ‘therapeutic’ range. That is to say, they are not taken at a dose that represents need (neither based in deficiency nor in medicinal application). The doses referenced are not context appropriate for neither disease nor predisposition. For these reasons and others, I’m in fact NOT a strong advocate of the ‘multi’. I am however a strong advocate for functional testing and customizing individual supplement plans.
What I found almost amusing was that when you take what the study had to say along with what both Canadian and US federal guidelines have to say, you’re right back at the need to supplement. Here is what I mean. The study suggested that an exception to the findings was the need to take vitamin D, which many recent studies suggests may help women live longer (and with a higher quality of life I should add). And, if you live north of 32 degrees latitude – where most of us live – you’ll likely be low but not necessarily outright deficient in vitamin D. The study also showed that Calcium supplements were linked to a lower risk of death over 19 years of follow-up, with 37% of users dying compared to 43% of non users. The 2010 U.S. dietary guidelines recommend getting nutrients from food, not supplements. However, women of reproductive age are advised to get extra folic acid and those who are pregnant, menstruating, or anemic need iron supplements. The guidelines also urge people 50 and older to get extra vitamin B12 (new research also suggesting it sways the onset of dementia). So… hold on… get vitamins and minerals from food with the exception of Vitamin D, B12, Folic Acid, and Calcium?! Isn’t that pretty close to a multi? Maybe not.
Let me tangent for a moment while remaining on the topic of the need to supplement. We are a nation who may not have many overt “third world country deficiencies”. Or do we? North America is a place where food is high calorie and nutrient deficient. When it comes to fish oils for example, Health Canada, The United States Food and Drug Administration, World Health Organization, American Heart Association, and the UK Food Safety Agency are all recommending that you supplement beyond your diet to live longer. So, now your vitamin and supplement list grows to a minimum of 5 things daily.
Prof. Mursu, one of the study’s lead researchers, also cautioned that his study doesn’t prove supplements cause harm, saying “I would rather conclude that there is no evidence for benefits”. Professor Mursu, with all due respect, this isn’t just about life and death, it’s also about quality of life. Furthermore, it’s also about properly assessing who needs what and at what dose – but not exclusively based on deficiency. You can use vitamins, minerals, and antioxidants therapeutically if you (or more appropriately, your health care provider) know how.
This goes back to a main argument in my book “The Antioxidant Prescription”: take too much of what you DON’T need and you have higher chance of having problems. Conversely, take too little of what you DO need and you also have a higher chance of experiencing problems. It’s important to note that this study doesn’t suggest harm from taking a multi, but it also doesn’t suggest that there isn’t benefit for therapeutic doses of vitamins, minerals, or antioxidants when they are indicated. The problem is, nobody is really getting properly assessed. Ultimately, you need to test yourself to know your specific and very individual demands. And there are many accurate tests that can help you determine those needs. Are You Vitamin and Mineral Deficient? How do you know? I’ll answer that in a minute.
So, at nearly the same time – just days prior, along comes another study that shows evidence of Vitamin E contributing to an increased risk of Prostate Cancer! Apparently, men who regularly take vitamin E supplements eventually have a higher risk of developing prostate cancer, compared to other men of the same age and overall health who don’t. This was reported by researchers from the Cleveland Clinic in JAMA (Journal of the American Medical Association). The authors say their findings clash with what most people would have expected. I’ve been asked by many to comment on this study also and let you know I think. And perhaps contrary to what you imagine I’d say my opinion is that this study accurately represents what actually happens! You see, too much of a good thing – especially when you don’t need it – ain’t such a good thing. Granma’s pumpkin pie might be delicious, nutritious, and perhaps even 100% organic. That doesn’t mean eating too much of it won’t make you fat and cause diseases related to obesity.
This particular study makes a lot of sense to me and supports all available science. It is actually a reflection of what I’ve been saying for years. To clarify my position, here is a nice summary from my book "The Antioxidant Prescription: How to Use the Power of Antioxidants to Prevent Disease and Stay Healthy for Life", 2009
Dr. Lester Packer, a senior scientist at Lawrence Berkeley Laboratory, was among the first to describe the role of antioxidants in the health of organisms. He proposed that antioxidants function not singly but as a network to balance overall free radical activity. Packer demonstrated that antioxidants synergize with one another and, even more importantly, recycle one another. In order to neutralize free radicals, antioxidants need to work like a team of firemen putting out a fire: some man the pumper truck, some are up the ladder, some are at the hose. Some move right in close to the fire to put out the flames, where others help the victims of smoke inhalation back away from the fire. You can’t get away with sending only one antioxidant—say Vitamin E—into the fray: that would be like having all the firemen rush to the end of the hose, with no one left to turn on the water. As you’ll learn later in this book, using single antioxidants in high doses can actually do you more harm than good.
Dr. Packer has focused, rightly, on the synergy of antioxidants. He has described five pivotal antioxidants, which he calls network antioxidants: lipoic acid, coenzyme Q10, vitamin C, the naturally occurring forms of vitamin E, and glutathione. His conclusion: there’s a synergy between these antioxidants that slows aging and prevents and treats disease.
No one disputes the value of antioxidants in diet, where nature provides them in useful combinations. Recent studies have suggested that high doses of certain antioxidants (especially taken without their necessary “network”) may have marginally increased mortality in some studied groups. Packer’s seven hundred scientific papers and seventy books on every aspect of antioxidants and health have exposed the shortcomings of those studies and maintain the importance of the network effect. The clear message that emerges from Packer’s review of the literature and from his own work is that antioxidants should be taken as a balanced network and at doses specific to the individual case or condition.
A case in point. Acne often improves with a therapeutic dose of Vitamin A, somewhere in the range of 10,000 IU twice daily with food depending on an individual’s age and weight. However, the antioxidant vitamins C and E are also indicated for healthier skin and collagen formation and aid vitamin A in helping to get rid of the free radicals that are the cause and the result of acne formation. Cardiovascular disease, especially artherosclerosis (plaque formation), responds very well to vitamin E, but vitamin E works much better to sweep up the mess left from artery injury and plaque formation if vitamin C is also there to “recycle” its potency.
So, there you go. I’m not a strong advocate of the Multivitamin and I don’t believe that anyone should take a high, therapeutic dose of a certain vitamin unless supervised (and more importantly tested) by a professional health care provider. It’s almost that simple.
Background on the University of Minnesota study published in the Archives of Internal Medicine
Women taking multivitamins don’t live longer than those who get their nutrients from food alone, according to a U.S. study that found they in fact appear to have slightly higher death rates.
About half of adult U.S. residents take dietary supplements, and the industry now boasts of annual sales as high as US$20-billion. Yet research suggests that some of the largely unregulated substances, such as vitamins A and E, could be harmful in high doses, according to an editorial published with the study in the Archives of Internal Medicine.
“There is very little evidence showing that common dietary supplements would be beneficial in prevention of major chronic diseases,” said Jaakko Mursu of the University of Minnesota in Minneapolis, who worked on the study.
“Unless you are deficient, there is hardly any reason to take them,” he told Reuters Health.
Prof. Mursu and his colleagues used data from nearly 39,000 older women who participated in the Iowa Women’s Health Study and filled out questionnaires starting in 1986.
The survey asked about use of multivitamins, vitamins A, C, D and E as well as beta-carotene, B vitamins and minerals such as calcium, copper, magnesium, selenium and zinc.
During the study, supplements became increasingly popular. Between 1986 and 2004, the proportion of women who said they took one or more jumped from 63% to 85%.
Only calcium supplements were linked to a lower risk of death over 19 years of follow-up, with 37% of users dying compared to 43% of non users. That link held up even after considering that women taking supplements had a healthier lifestyle than the rest.
By contrast, women taking other supplements did not live longer. For instance, 41% of multivitamin users died versus 40% of non-users — and the gap became even wider when adjusting the numbers based on health problems like diabetes, high blood pressure and overweight in the two groups.
Prof. Mursu said he expects that his findings will be true for men as well, adding that they jibe with earlier research hinting that dietary supplements do little good in Western countries where vitamin deficiency is not common.
One possible exception is vitamin D, which one recent study suggests may help women live a little longer.
Prof. Mursu also cautioned that his study doesn’t prove supplements cause harm.
“I would rather conclude that there is no evidence for benefits,” he said.
The 2010 U.S. dietary guidelines recommend getting nutrients from food, not supplements. However, women of reproductive age are advised to get extra folic acid and those who are pregnant may want to take iron supplements if their doctor suggests it.
The guidelines also urge people 50 and older to get extra vitamin B12 from fortified foods or supplements.
Duffy MacKay of the Council for Responsible Nutrition, a trade association representing manufacturers and ingredient suppliers of dietary supplements, disagreed with the researchers’ conclusion that doctors should only recommend supplements to people with deficiencies.
He added that in the case of iron, women on high doses may have underlying conditions that could explain their higher death rates.
While Prof. Mursu acknowledged that shortcoming, he said it is unlikely to be relevant for multivitamins, which usually aren’t prescribed by a doctor.
Short of getting sick, he added that it’s hard to know if you are getting enough vitamins and minerals, and that screening everybody would be prohibitively expensive.
“Include as many vegetables and as much fruit as you can,” he said, by way of advice. “There is hardly any reason to limit those, and they contain a whole lot of vitamins and minerals."
© Thomson Reuters 2011