Monday, February 10, 2014

To Vitamin or Not To Vitamin?

There has been a small firestorm since the publication on December 17, 2013 of an editorial in the Annals of Internal Medicine entitled “Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements”. This editorial concluded with the following statements; “we believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough.”

Let me cut to the chase, I’m going to continue recommending vitamin and mineral supplements for my patients, and continue taking supplements myself.

One of the tip-offs that the content of this editorial would be of questionable value is its use of the phrase, “the case is closed”. No “case” in science is ever closed. Science is always open to new evidence, new viewpoints, and even to rehashing the old. This comment is at best foolish and at worst, rude.

The title “Enough is enough”, even without an exclamation mark, sounds more like an emotional statement than scientific guidance.

In the course of its admonishments, the editorial advises against vitamin supplementation for “well-nourished” adults. But what is “well-nourished”. We have neither scientific agreement on what constitutes “well-nourished”, nor methodology for measuring it. These writers claim that the study subjects lacked for no vitamins, minerals, amino acids, nor essential fats, but, they never tell us how they proved this in the subjects studied.

To additionally explain why I will not follow the recommendations of the editorial, I will briefly comment on the first of the three studies referenced in the editorial. That study was titled, 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.

This study, as stated in its title, was looking at whether nutritional supplements alone would prevent a first occurrence of either cardiovascular disease (CVD) or cancer (CA). This is a fine study question, but would anyone really expect that vitamin and mineral supplements, particularly the one-size-fits-all supplements used in the reviewed studies, by themselves prevent CVD or CA? It is well established that diet, exercise, and other lifestyle factors are major factors in both diseases. We know that all disease-influencing and health-influencing factors blend together in the body and contribute to a net outcome. Importantly, if supplements, as utilized in these studies, do not by themselves protect against CVD and CA, it still cannot be concluded that the supplements were of no benefit. When combined with other appropriate lifestyle measures, supplements may well provide health benefits, and even reduce the incidence of disease and mortality.

Others who also appear not to have been convinced by the “Enough is Enough” editorial include:

Why You Should Not Stop Taking Your Vitamins  by Mark Hyman, MD

Vitamins Can Help Prevent Heart Attacks by Dr. Leo Galland

4 Supplements to Start Taking Today by Dr. Tom Sult

Why You Should Keep Taking Your Supplements by Ronald Hoffman, MD

A Vitamin & Supplement Cheat Sheet by Frank Lipman, MD