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Dueling Docs -- the Vitamin Wars

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The Issue
Vitamins

The Facts
There's been such a flurry of disappointing news about vitamins you'd think Whole Foods would stop selling them. Just last week, the huge Women's' Health Initiative, a nearly decade-long study that tracks the health of 161,800 women, found that the staple of the vitamin aisle -- the multivitamin -- does nothing to prevent heart disease or cancer in older women. Only a few months earlier, the long-term Physicians Health Study on nearly 15,000 male doctors found that Vitamins C and E do not lower the risk of heart disease, while another report found they play no role in reducing overall cancer risk. Before that, a study on 35,000 men was halted when it showed that selenium and Vitamin E not only do nothing to prevent prostate cancer, but also might increase both cancer and diabetes risk.

Should the 50% of Americans who fork over $20 billion a year for supplements just kick the habit? Two doctors debate the issue: Jeffrey Blumberg, Professor at the Friedman School of Nutrition Science and Policy at Tufts University and Christine Gerbstadt, MD, spokesperson for the American Dietetic association and registered dietician.

The Debate

Dr. Blumberg:

"If you walk away from these studies saying you don't need to take vitamins, you're taking away the wrong message. You shouldn't be taking vitamins to prevent cancer. You take them because you're not eating well. That's why they're called dietary supplements. They're for people who aren't getting the recommended dietary allowance from their diet."

And that's a lot of people, says Blumberg. "One half of the population isn't even getting ½ of their requirement of Vitamin C, E, A, calcium, potassium, magnesium and fiber."
"The reason," says Blumberg, "is that Americans don't eat right. Only 4% of the population is following the USDA Guidelines which stipulate, for example, that you should consumer 5 servings of fruits and veggies a day. Who's going to do that? Well, 96% of the population doesn't and they need vitamins to function optimally."

Blumberg explains "Vitamins help your gut, your vision, your muscles, bones, liver and brain. You name any physiological system and it needs nutrients to make it work. If you're not getting those nutrients from your diet, then get them from vitamins."

Meantime, he takes issue with the way many vitamin studies are conducted, particularly the most recent Women's Health Initiative on multivitamins. "This study has flaws. The researchers lumped together people who took one vitamin a day with those who took one a week and called them vitamin users. That's like testing whether antibiotics are efficacious by comparing people who took them for one day versus those who took it for the full 10 days treatment. Most vitamin bottles tell you to take a vitamin once a day -- not once a week.

"Moreover, across the board, all the women who used supplements were leaner, better educated, smoked less, and were more physically active. They also took vitamins. What the researchers are telling people is that it's really good to eat veggies and get exercise, but hey, you don't need those vitamins! Taking vitamins is an integral part of their profile, but now the researchers tell us that part isn't important."

In Blumberg's view, "you're not wasting your money taking supplements. Unless you're going to routinely get a blood test to figure out what nutrients you're not getting from food, you should spend the nickel a day to take a multivitamin. That way you've got your bases covered."

Dr. Christine Gerbstadt:

"So many people talk about taking vitamins to cover themselves, 'just in case.' Those are usually the very same people who don't need vitamins. They tend to be doing the right thing with their diet in the first place. I tell them that if they want to do more, don't spend money on vitamins. Take a brisk walk instead.

"To me Women's Health Inititiative's findings on multivitamins are fantastic news. This is what the American Dietetic Association has been telling people all along and we've been right. You should get your nutrients from a variety of foods not vitamins. "

Gerbstadt says there are exceptions: "If you're on a restrictive diet, like someone who's a vegan or a fruititarian and is excluding food groups you'll need extra calcium, vitamin D, iron and other supplements. But for the rest of us, if you choose less refined foods, like real vegetables instead of veggie chips, it's easy to get a balanced diet. Think food first, not vitamins.

Gerbstadt insists that vitamins are just not worth it. "Why pay for a product that won't help you? If you have bad bones, then yes, you can take calcium and Vitamin D, but that's a specialty nutrient for a specific population.

"Too many people think they can eat French fires, a hamburger and a pastry and then take a vitamin and be healthy. The nutrients found in food all need to work together so that the body can absorb and utilize them properly to fuel the body, to build it and to repair it. You're not going to find that in a pill. If all you eat is 2,000 calories of donuts a day and a vitamin, you won't get what you need. No vitamin is going to fix your poor eating habits."

She says that getting proper nutrition isn't all that hard. "If you eat just 1,200 calories from healthy food, you don't need a vitamin. Health can be achieved in just 1,200 a day. After that, go have a glass of wine or a pastry."

What about the design of the multivitamin study? "Look, no research is perfect. The researchers were drawing conclusions from data they already had and they can't rearrange that data. This is one of the only sources of information we have from such a large population over a long period of time. No study will ever be designed to perfectly answer every question. These studies are expensive and if they're trying to get more data out of this study, fine."

"We now know that no vitamin has those powers to prevent disease. Most people are probably relieved to know that they don't have to spend that money on these vitamins anymore."

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