You have likely heard about a recent study, involving roughly 40,000 women over the age of 60, in which daily use of a multivitamin -- and several other nutrient supplements -- was associated with a higher rate of death. Along with the mix of shock, consternation, and disappointment is the very practical question: could a multivitamin kill you?
Almost certainly not! The current study -- like others before it that have hinted at much the same association -- is absolutely NOT cause for panic. For each such study, there is another showing no real harm. That vial of (now menacing) multivitamins in your medicine cabinet doesn't mean you need to fast track the preparation of your will and testament.
For starters, the study now making headlines, and the similar studies preceding it, are observational. A large group of people is simply followed and assessed over time, and the associations between what they do, and what happens to them, are analyzed.
In the current case, routine use of a multivitamin was associated with roughly a 2 percent greater chance of dying over a 20-year span for women over age 60. So, for starters, a 2 percent increased risk of dying over 20 years is not exactly cause for panic -- especially when one considers that dying in our early 80s is not entirely unexpected or untimely.
But even more important, these women were not assigned to a multivitamin or placebo; they made up their own minds. Some chose to take nutrient supplements, some did not. How did these two groups differ? Like all good observational studies, this one attempted to account for obvious differences -- in education, income, smoking status, general dietary pattern, and so on -- but the only honest answer is: we don't know! We can't possibly know all the ways women who opt to take nutrient supplements differ from those who don't. (That, by the way, is why randomized trials can be so important; they reliably correct for this limitation of observational studies.)
So, for instance: What if women more concerned about a family history of chronic disease were the ones to take supplements? What if women who were less confident in their ability to eat fruits and vegetables daily were the ones to take supplements? What if women who were just more anxious and pessimistic about their health were the ones to take supplements? Independent of all other factors, pessimism increases mortality, and optimism decreases it.
We don't know that any of these "what ifs" was true; but if any one of these, or another like them, was true, it might be the reason for the (minimally) higher death rate among supplement users, rather than the supplements per se.
But, the fact of the matter is that several large studies now suggest possible harm attached to the use of multivitamins and certain other supplements (including some B vitamins, and iron). Since we never had any clear evidence of benefit from multivitamin use, and since the "at least it couldn't hurt" rationale for using multis as an insurance policy is clearly not valid -- the day of the conventional multinutrient supplement is over. I used to take a multi, and no longer do; I used to recommend them to patients, and no longer do.
How could a mix of nutrients known to be essential cause harm? When we extract nutrients from their context in food, we are "guessing" about preparation, dose and combination. Errors in any of these could lead to trouble.
Imagine, for example, that you had all the essential construction material you needed to build a house -- but in the wrong proportion. Too many roofing shingles, but too little lumber. Or perhaps the beams were too short for the dimensions of the roof. We use nutrients to build cells and proteins and hormones every day, and having the right "stuff" but in the wrong form or supply could make a mess of things.
Or, consider a musical analogy. You love a jazz ensemble, a rock band and a symphony orchestra. Imagine the sax player from the one, the guitarist from the other, and the cellist from the third each playing her own music, all at the same time. Noise! Lovely on their own, a mess when combined badly.
This could be the case with how we have approached nutrient supplementation. Frankly, I don't know for sure -- nobody does -- but the potential for real, if modest, harm is plausible.
So what do we do now?
For one thing, we should recall that all along, the best-case scenario was "supplement," not substitute. There is no substitute for eating well, and that deserves our dedicated commitment.
At this point, unless you are likely to have a serious deficiency in overall nutrient intake -- or unless you have a specific indication for taking a multivitamin, such as pregnancy or the intent of pregnancy -- use of a multivitamin seems ill advised. You need a good reason to do it; "what the heck" is no longer sufficient.
Judicious use of select supplements still makes sense. We have convincing evidence of known or likely benefit from supplemental omega-3 oils and vitamin D for most men and women, and calcium for most women. For the most part, other supplements should be used for a specific reason, and with input from someone with genuine expertise. As an example, B12 supplementation is warranted for most vegans, and for all older adults with pernicious anemia. Let's not toss out the baby with the bathwater!
Another intriguing consideration is the use of whole food-based supplements (for example). Such products are "humble" in the sense that they don't presume to know how to combine nutrients -- they let nature do it. They simply compress the nutrients from healthful foods into pill form so that those who don't eat quite as they should -- including children -- can fill in the gaps. We need more science to prove the benefits of such supplements, but the approach makes sense to me, and may prove to be the new-age answer to the multivitamin/mineral supplement.
Independent of other factors, a multivitamin is very, very unlikely to kill anyone. If there is risk attached to the use of such supplements, it is very small. But there may be some risk -- and there is no reliable indication of benefit.
That's really all we need to know to conclude: it's probably time for us to kill the multivitamin.
- fin
Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org
Follow David Katz, M.D. on Twitter: www.twitter.com/DrDavidKatz
Julie Chen, M.D.: Should Women Take Calcium and Vitamin D or Not?
I'll try again:
It is common practice in Medicine to put patients on combinations of drugs. The vast majority of these combinations of drugs (especially where 3 or more drugs are involved) have never been studied at all, let alone in double-blind trials ( with the exception of Oncology/AIDS treatment, where the toxicity of the drugs demands study); yet it is frequent practice to prescribe these multiple-drug combinations.
It is well accepted in Pharmacology that it is scientifically impossible to accurately predict the side effects or clinical effects of a combination of drugs without studying that particular combination of drugs in test subjects. Knowledge of the pharmacologic profiles of the individual drugs in question does not in any way assure accurate prediction of the side effects of combinations of those drugs, especially when they have different mechanisms of action, which is very common because polypharmacy is most often prescribed to patients with "multiple illnesses". More than 100,000 patients in this country die from identified adverse drug reactions (perhaps the 4th to 6th leading cause of death in the U.S.) The number who die as a consequence of polypharmacy is, to my knowledge, unknown. The number of people who die from Vitamins and supplements, taken as directed, is miniscule.
And they worry about Vitamins and Herbs?!!
http://www.innateresponse.com/category-s/50.htm
http://www.organic-pharmacy.com/completelife.htm
http://www.newchapter.com/vitamins
http://www.megafood.com/vitamin-formulas
We get our vitamins from our local hippie health food store, so they have the least amount of garbage preservatives in them as you can get.
They may help you, they probably won't hurt you. Seems like decent enough insurance for your health for the cost involved.
The best thing you can do to get vitamins and minerals is eat a lot of fruits and vegetables, or juice fruits and veggies at home.
I like to take high quality supplements found at health food stores. Most vitamins and supplements that you find at high volume discount stores or your corner pharmacy lack the best manufacturing techniques so you in fact you are left with a far less dosage of nutrients that is on the label. It's kind of like going to a restaurant and the menu says 8oz steak before cooking. When a vitamin is manufactured (cooked), by using preconceives such as heat, the raw material is altered in a way that you lose some of it's nutritional value. Stick with brands such as Nature's Plus, Bluebonnet, Solgar, Country Life, etc.
As a child my mother used to say… let’s put it to the test. She was a science teacher.
I remember her buying two identical plants and placing them side by side.
Every week she would water both plants. But in one of the watering's (for the same plant) she would add a little plant nutrient (same as supplements). Guess which one over thrived?
After a few weeks, the difference became visibly obvious.
Although we’re talking about plants - we’re still talking about what nutrients/supplements can do.
They can make a healthy difference.
Take another example: If you give a plant direct sunlight for days on end, it will thrive. If you give a human the same exposure to direct sunlight, they will get sunburned (and possibly skin cancer)
Plants and humans are very different organisms, and they process vitamins and minerals differently too.
However using your own explanation… and I agree that for decades we have been inundated with the knowledge that over exposure can cause skin cancer. So we slap on the sunscreens! Which block the essence of sun light from the liver to create vitamin D. So wouldn’t a D supplement sound reasonable to take?
I haven’t heard anyone dieing from supplements (out side the “tainted” L-tryptophan).
One should take the responsibility to become well informed about vitamins, I really don’t see a problem with taking a supplement.
Why are we denying that supplements deliver no benefits or hold no value but want to defend this study – that other studies can prove other wise. The plant analogy was used for one to apply common sense. If plant nutrients show a plant can thrive… human nutrients can benefit human beings as well. Real simple.
The risk the study claims is very debatable. There are studies that can prove other wise. The fact is, We all fall short of the recommended daily amounts that require good nutrition. Many of us do not eat (have the time or have that kind of money) to eat like we should. However my personal experiences and common sense aided with being well informed about a supplement has proven other wise. So for me, I lean towards the benefits rather than the risk of dieing because I’ve added a supplement . Common sense.
I don’t think my mothers point was a bad one at all… you should have seen her green thumb skills – largely due to feeding them correctly with plant nutrients. Believe me you would have been impressed.
All this money and research should go towards researching the pharmaceutical companies that are using human beings as guinea pigs and are daily being sued for ruining lives with the all the "real dangerous" - after effects/side effects.
Vitamins? - Really!
Why We Must Eat at Least Five Vegetables and Fruit a Day
For many years in the U.S. it was highly suggested by the heads of nutrition that to meet our nutritional levels on a daily basis we should eat at least five fruits and vegetables.
http://www.associatedcontent.com/article/8140477/why_we_must_eat_at_least_five_vegetables.html
It is a bit like I was wearing this T-shirt when I went to Vegas and I won some money, so this T-shirt must be lucky.