According to USA Today (2/25, Painter), “Most vitamin and mineral supplements, alone or in combination, have not been proved to help or hurt when it comes to preventing cancer or heart disease, says a new report from the…US Preventive Services Task Force.” In the majority of “cases, more research is needed, but there are two exceptions, the panel says: Consumers should not take beta-carotene or vitamin E to prevent heart disease or cancer because vitamin E doesn’t work and beta-carotene increases the risk for lung cancer in people at high risk for the disease.”
Blogfinger Medical Commentary: By Paul Goldfinger, MD, FACC
In 2011 when we finalized the current edition of our book “Prevention Does Work–A Guide to a Healthy Heart” we reviewed all the current data on vitamins and came up with this summary, “Vitamins used to be recommended as preventive therapy due to their anti-oxidant actions. In recent years, however, large trials have shown no benefit with vitamins, so these supplements can no longer be considered part of a prevention regimen. This conclusion does not apply to vitamins found in fruits and vegetables “
The AMA summary above brings us to 2014 on the subject of vitamin supplements. There was a 2012 trial of Centrum Silver which suggested that daily multivitamin use in men might reduce the risk of cancer, but the proof was iffy. The article below from Forbes is a brief and excellent review of the whole topic.
A huge number of people take vitamins regularly, but unless they have a vitamin deficiency, they are just engaging in wishful thinking. As a practicing doctor, some patients did confess that they took vitamin supplements. My reaction was to say that there was no good evidence as to benefit, and I reminded them that supplements are not always safe.
Do I take daily vitamins? No. But after the 2012 study, I hopefully bought a bottle of Centrum Silver, however, it still is sitting in a closet, with about 14 tabs missing—my personal two week trial.
EDITOR’S NOTE: I call your attention to the comment below where David Seres, MD, a genuine expert in nutrition and Associate Professor of Medicine at NY Presbyterian Hospital in NYC, has offered us a superb and erudite discussion of the roll of vitamin supplements in preventing disease.
David is also a Grover, one of many highly accomplished individuals who call Ocean Grove home. So, you see, you never know who might be in line with you at Days. —PG
Ken: We have covered the subjects of salt, processed foods and vitamins on Blogfinger. Each of those subjects has some controversy attached. Processed food is the current popular target of hip nutrition experts, especially a pediatric endocrinologist named Lustig who first got famous attacking sugar and now has a new book targeting processed foods. If he keeps it up, what will be left to eat? We will all look like Somali pirates.
I recently read a book called “Salt, Sugar and Fat” by Michael Moss. I enjoyed it very much. It attacks all the things we like to eat and get addicted to. But as addictions go, I choose chocolate (i.e. sugar). It is safer than drugs, tobacco and sex, and probably has some redeeming qualities for health—especially the dark kind. (60-70% cacao)
Of all the fields of medical science, it is nutrition where you find the most controversy and the least solid science. I don’t believe any nutritionist you find on the radio, except Dr. Nestle from NYU on NPR. And don’t believe any doctor you find on TV if their segment is under 5 minutes or any doctor you find on Blogfinger who quotes less than 2 randomized trials.—-Paul
Blogfinger , What is so controversial about vitamins, salt, processed foods?
Complicated??
Sorry John but our topic now is vitamin therapy. Everything you mention is controversial and is worthy of discussion, but they are all complicated. —–Paul
Ocean Grove is so fortunate to have blogfinger for nutritional info straight talk. I suspect very few ever read the AJM.
ken
What about CoQ 10 tablets, resveratrol, digestive enzymes, fish oil–are they germane to this study? Your opinion, please, of this and naturopathic practitioners.
Dear Paul,
I am so glad to see you commenting objectively on the data that there is no benefit for vitamin supplementation. Certainly, where a deficiency exists, supplementation will improve health. But as study after study has shown, wholesale supplementation to the general well-nourished population has no benefit. But I would speak of these with far more caution than has the AMA. Harm has been pretty well demonstrated in well-designed studies.
People complain to me that they are confused about what to do with nutrition. I am, too, and I am supposed to be an expert. The reasons for confusion are likely two. First is the size and expense of good nutrition studies. The recently published study, relating supplementation of selenium and vitamin E (both putative antioxidants) to a significant increase in the risk of prostate cancer, required 35,000 participants. The second is the Dietary Supplement Health and Education Act of 1994, which effectively says that if a product is brought to market labeled as a dietary supplement (at the discretion of the manufacturer), there can be no oversight by the FDA of the product. This has resulted in multiple pharmacologically active substances, such as hormones, to be allowed unregulated on to the market. In a study now 15 years old, 50% of patients coming for elective surgery in Denver, CO, were taking supplements that had an effect on blood clotting. Not a good thing.
The other confusing thing is the way we do research. To do a proper study, one that determines cause and effect, we must use prospective randomization. This is very difficult to do with the large numbers we would need. So, instead, we rely on epidemiological observation. In the latter, we look for things that occur concurrently, and guess as to causality. But we have a very high probability of guessing wrong. To illustrate, when I give talks I pretend I don’t know why everyone is there, and conclude that it is the fact that 100% of the people in the room are wearing shoes that caused them to be there. As ridiculous as that is, it is even more reasonable than some of our leaps to conclusion from observation have been.
My advice: eat a varied diet with as few processed foods as possible. Go easy on salt and saturated fat (note: I did not say never eat any). And only take vitamin supplements if there is a good medical indication.
The best in health,
David
David S. Seres, MD, ScM, PNS
Associate Professor of Medicine in the Institute of Human Nutrition
Director, Medical Nutrition
Department of Medicine, Division of Preventive Medicine and Nutrition
Columbia University Medical Center, NYPresbyterian Hospital