December 23rd, 2013

WOW – Editorial in Medical Journal Promotes Propaganda Against Multiple Vitamin Formulas

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Introduction
The latest issue (December 17, 2013) of the Annals of Internal Medicine featured a damning editorial titled: Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Wow, are they serious? Why are they ignoring all of the positive studies and instead focusing on studies fraught with issues? Obviously, the headline is designed to give the entire natural product industry a black eye instead of helping consumers make informed choices. It definitely accomplished its goal.

Garbage In Equals Garbage Out
The Editorial is largely based upon findings from three new studies, as well as examining review articles known as a meta-analysis. Let’s talk about the meta-analysis studies first. These sorts of analyses review the medical literature and then select published studies to include in their analysis based upon the studies meeting certain criteria. One of the biggest problems with these sorts of reviews is that they are often the collection of poorly designed studies. That is certainly the case in the studies cited by medical experts proclaiming vitamin supplements don’t work. It is the old adage “garbage in equals garbage out.

The Editorial is based once again primarily on rehashing previous studies fraught with BIG problems while ignoring all of the positive studies. It is obscene to cite only one side of the argument and ignore compelling data supporting nutritional supplementation. I have addressed the problems with some of the big studies using synthetic beta-carotene and vitamin E on numerous occasions in the past. The bottom line is that there are issues with the synthetic forms of these nutrients as well as supplementing them at extremely high dosages in the absence of other supportive antioxidants. For example, there are major issues with synthetic vitamin E and while studies showed that synthetic beta-carotene supplements given alone actually increased the risk of cancer in smokers, when beta-carotene was given along with vitamin E and selenium it reduced cancer deaths by a significant 13 percent.

Here was a BIG omission in the Editorial. Why did they not mention the results from the European Prospective Investigation into Cancer and Nutrition study? This large study on 23,943 subjects who took antioxidant vitamin supplements over an average of 11 years showed that individuals who used antioxidant multivitamins were 48% less likely to die from cancer and 42% less likely to die due to any cause compared to those who did not take antioxidant vitamins. Could it be that these results were contrary to their bias and agenda?

A Closer Look at the New Studies
Two new studies and a new review were cited in the Editorial and featured in the same issue. The review followed the same pattern as previous reviews described above.
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The first new study is based upon data from the Physicians Health Study (PHS) II. This study follows roughly 15,000 physician men. In the new analysis the researchers looked to see if the use of dietary supplements had any influence in cognitive performance or memory. Here is what is overlooked in most news reports:

  • The multiple vitamin formula used (Centrum Silver) is far from ideal and is one that would NOT be sold in a health food store because it is:
    • Poor quality sources of vitamins and woefully deficient in the levels of minerals (e.g., only provides 13% of the RDI for magnesium).
    • Packed full of synthetic forms of vitamins as well as food coloring agents. In addition to synthetic vitamin E, here is a list of other synthetic ingredients in the formula: FD&C blue #2 aluminum lake, FD&C red #40 aluminum lake, FD&C yellow #6 aluminum lake, and hydrogenated palm oil.
    • Though there was a small degree of cognitive improvement in the experimental group after 2.5 years of consumption, the researchers acknowledged “Doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin.”
    • A previous analysis of this study published in JAMA in 2012 concluded “daily multivitamin supplementation modestly but significantly reduced the risk of total cancer.” That is a big omission.

An Unreported Study
The Editorial failed to mention a new study from researchers from the University of Oxford showing that even modest supplementation with three key B vitamins can slow and possibly reverse the progression of Alzheimer’s symptoms along with cognitive impairment. The study involved with 156 elderly patients who had mild cognitive impairment and a high risk of dementia and Alzheimer’s disease. The patients were divided into two groups: one group took a daily supplement with 800 micrograms of folic acid, 20 milligrams of vitamin B6, and 500 micrograms of vitamin B12; the other group took a placebo supplement.

Before the trial and during the testing period, the researchers utilized magnetic resonance imaging (MRI) to measure the patients’ atrophy levels of grey matter in their brains. Atrophying (shrinking) grey matter is a sign of the progression of Alzheimer’s disease and other forms of dementia. Upon completion of the two-year study, researchers found that those given the B vitamin supplement had about seven times less grey matter shrinkage than did the placebo group.

The researchers also found that those whose grey matter shrunk fastest had higher levels of homocysteine, and those with higher homocysteine levels initially received the greatest benefit from the B vitamin supplements.

In their conclusion the researchers stated:

“Our results show that B-vitamin supplementation can slow the atrophy of specific brain regions that are a key component of the Alzheimer disease process and that are associated with cognitive decline.”

The Second Study Showed Benefits, but has Limitations
The second new study in the issue and cited in the Editorial looked at the impact of what was referred to as a high-dose multivitamin/mineral supplement in 1,708 patients aged 50 years or older who had a recent heart attack. The patients were randomly assigned to receive oral multivitamins/minerals and intravenous chelation infusions, oral placebo and intravenous chelation infusions, oral multivitamins/minerals and placebo intravenous infusions, and oral placebo and placebo intravenous infusions. That is a VERY complex study with a lot of variables. The primary outcomes were time to total death or vascular event (recurrent heart attack, stroke, coronary revascularization, or hospitalization for angina).

One of the big issues with the study was that the drop out rate was huge as 46% dropped out of the study because they did not want to take so many pills (6 per day). This huge dropout rate makes it impossible make any real conclusions for several reasons including that many people may not have actually taken the full dosage of the supplement, but said they did. That said, it is important to point out the key conclusion of the study “In stable patients with a history of MI (heart attack) receiving appropriate, evidence-based medical therapy, use of high-dose oral multivitamins and multiminerals did not statistically significantly reduce cardiovascular events.” Okay, let me interpret what this conclusion is saying. These patients were stable, they were receiving appropriate medical care and treatment, and taking a high potency multiple vitamin and mineral formula did not make a big enough difference.

That may be true, but it is also important to take a look at the limitations of the study. First, the dropout issue is big. Next, not to get too technical, but the statistical plan was based on achieving a 25% reduction in mortality or vascular events with high dosage supplementation. That treatment goal may have been way too optimistic. The dietary supplement used did show an 11% relative reduction in mortality or vascular events. That is significant, but it was judged as not being statistically significant because the difference was substantially smaller than the trial was powered to measure (11% vs. the expected 25% or greater). In other words, if the study was set up to show a 10% reduction in the primary endpoints of mortality or vascular events it would have shown statistical significance. It is also interesting to point out that there was a greater effect with the dietary supplement in patients not receiving a statin. This indicates that the use of statins may cloud the benefits of the dietary supplement.

A Naturopathic Perspective
While some experts say that you can theoretically meet all of your nutritional needs through diet alone, the reality is that most Americans do not. Beyond this argument is the difference in how some experts view “optimum” nutrition. If an expert believes optimum nutrition simply means no obvious signs of nutrient deficiency or disease, their answer to whether supplementation is necessary is going to be different from an expert who thinks of optimum nutrition as the level of nutrition that will allow a person to function at the highest degree possible. I believe in the latter.

Every day your body requires the necessary building blocks of nutrition. It is virtually impossible to get everything that your body requires from diet alone. In this era of modern living, people simply cannot afford not to take a high quality multiple vitamin and mineral formula. Stress, environmental pollution, second-hand cigarette smoke, and many other factors increase nutrient requirements, especially for antioxidant nutrients like vitamins C and E, selenium, and carotenes. Furthermore, there is evidence that when we take optimal levels of essential nutrients it enhances the body’s healing mechanisms and overall physiological functions.

Despite what this Editorial is saying and the media is reporting, there are definite studies showing the benefits of broad-spectrum nutritional supplementation. From these many unmentioned positive studies it is quite apparent that taking a multiple vitamin and mineral may offer significant health benefits including help boost immune function, enhance brain function, and prevent the development of chronic diseases like heart disease, cancer, and Alzheimer’s disease.

Taking a high quality multiple vitamin and mineral supplement provides the equivalent of a nutritional “insurance formula.” There is no question that the entire human body functions optimally when it has a steady supply of high quality nutrition. A deficiency of any single nutrient has profound effects on the human system because just like your car, the body is dependent upon the proper functioning of many interdependent parts. A high potency multiple vitamin and mineral formula is as important to your health as the key to the ignition and the spark plugs are to the functioning of your car.

The bottom line is that there are 13 vitamins and 14 minerals that you need to ingest in proper amounts each day for your tissues and organs to do their jobs.  Although needed only in relatively small amounts, these essential vitamins and minerals are crucial for the manufacture of body tissues as well as the activity of enzymes – molecules involved in speeding up chemical reactions necessary for human bodily function.

Some Practical Advice
The quality of a supplement is important and the best place to buy high quality natural products is your local health food store. Why? Because that is your best chance to find products from conscientious manufacturers that adhere to the highest standards in manufacturing. Many popular multiple vitamin and mineral formulas found in drug stores or supermarkets are woefully low in key essential nutrients and/or contain artificial coloring agents and other additives that actually interfere with the body’s ability to utilize some vitamins and minerals. Read labels carefully; make sure that the formula contains not only high levels of vitamins, but also minerals as well; and, if you have any questions, ask for help from knowledgeable sources at your local health food store.

Reference:
Guallar E, Stranges S, Mulrow C, et al.  Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Ann Intern Med. 2013;159(12):850-851.