A recent editorial published in the Annals of Internal Medicine1 made the claim that, “Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.” This opinion was penned as a summary of three other articles published in the same journal, all of which concluded that multivitamins had no beneficial effect on specific health outcomes.
However, the conclusion drawn by the authors of the editorial is hasty at best. Here’s why:
The first article2 discussed in the Annals editorial piece was an assessment of several studies which looked at the use of supplements by adults at least 65 years of age with no known nutritional deficiencies and evaluated whether vitamin and mineral supplements worked as primary prevention of cardiovascular disease and cancer. This included subjects who took a single vitamin or mineral (like Vitamin C on its own), paired combinations (like a Calcium-Magnesium tablet), or “multivitamins” which they defined as a combination of three or more vitamins and minerals. In the marketplace, a typical multivitamin supplement contains dozens of vitamins and minerals; thus to lump comprehensive multivitamins in with simpler combinations like a B-Complex, is misleading. On the surface, it appears that the authors reviewed a large sample of studies – 28 in total. However, of those, only four included their definition of “multivitamin.” And of the remaining 24 studies of single or paired supplements, they found three or fewer studies of each nutrient. They also stated, “trials varied considerably in principal aims, study design, and recruitment criteria,” and, “for some supplements the evidence of no benefit was inconsistent. In one of two studies of selenium, for example, cancer risk decreased. Likewise, 1 of 2 studies of calcium plus vitamin D supplementation in women found a decreased cancer risk.” In short, this review compares too few apples to too few oranges, and ends up woefully short of a comprehensive fruit salad.
The second article3was a nutritional intervention within the Physicians’ Health Study II,4 which looked at the long-term effects of a daily multivitamin versus a placebo on cognitive function and memory later in life. The subjects were male physicians over the age of 65. They were given either a daily multivitamin or a placebo for twelve years starting in 1997; during that time they completed up to 4 repeated cognitive assessments by phone. The study found no significant difference in cognitive function between the participants who took the multivitamin and those who took the placebo. This is a well-designed study, but its use as evidence that multivitamins have no useful role in the health of the general public is limited. The subjects were male physicians over the age of 65; from that one may draw the conclusion that each likely led a relatively healthy lifestyle prior entering the study and had adequate financial means to maintain his health. The researchers themselves point out that, “doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin.”
Article number three5 was another study involving a multivitamin versus placebo. The subjects, in this case, were people with an average age of 65 who had already suffered one heart attack. The study’s purpose was to see if a daily multivitamin would reduce the incidence of a second cardiovascular event, including a second heart attack, stroke, heart surgery, or angina requiring hospitalization. The study was well-designed, but the rate of non-compliance was high with 46% of participants discontinuing the intervention and 17% withdrawing from the study. The researchers did not find a statistically significant difference between the study groups, but stated, “this conclusion is tempered by the nonadherence rate.”
Vitamin and mineral supplements are not the “be all, end all” in maintaining good health; it is also important to practice healthy dietary habits, get daily physical activity, and attend to your mental health. But supplements can help fill the ever-widening nutritional gaps in your diet attributed to factors like factory farming which depletes the soils (and the food it produces) of nutrients, free radicals caused by environmental pollution, chronic systemic inflammation brought on by consuming too much animal protein and processed foods.
Sadly, it is often the view of westernized medicine that supplements should be used and studied in the same way as prescription drugs: that they should be used as a magic bullet to treat a specific disease state. However, the actual objective of nutritional supplements is to improve and maintain one’s quality of life, not just to stave off a single disease state. Nutrients work together synergistically to re-establish homeostasis (balance) in the body over a period of time.
The authors of the Annals editorial are right, “Enough is Enough”. Health care workers and researchers must stop sensationalizing health claims and mislead the public with sound-bite-worthy article titles. The editorial published in the Annals acknowledges briefly that not all supplements are without value, but their title certainly does nothing to imply that.
1Eliseo Guallar, SaverioStranges, Cynthia Mulrow, Lawrence J. Appel, Edgar R. Miller, III; Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Annals of Internal Medicine. 2013 Dec;159(12):850-851.
2Stephen P. Fortmann, Brittany U. Burda, Caitlyn A. Senger, Jennifer S. Lin, Evelyn P. Whitlock; 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. Annals of Internal Medicine. 2013 Dec;159(12):824-834.
3Francine Grodstein, Jacqueline O’Brien, Jae Hee Kang, RimmaDushkes, Nancy R. Cook, Olivia Okereke, JoAnn E. Manson, Robert J. Glynn, Julie E. Buring, J. Michael Gaziano, Howard D. Sesso; Long-Term Multivitamin Supplementation and Cognitive Function in MenA Randomized Trial. Annals of Internal Medicine. 2013 Dec;159(12):806-814.
4Physicians’ Health Study II, Harvard University. November 5, 2012. http://phs.bwh.harvard.edu/index.html
5Gervasio A. Lamas, Robin Boineau, Christine Goertz, Daniel B. Mark, Yves Rosenberg, Mario Stylianou, Theodore Rozema, Richard L. Nahin, Lauren Lindblad, Eldrin F. Lewis, Jeanne Drisko, Kerry L. Lee, for the TACT (Trial to Assess Chelation Therapy) Investigators; Oral High-Dose Multivitamins and Minerals After Myocardial InfarctionA Randomized Trial. Annals of Internal Medicine. 2013 Dec;159(12):797-805.