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.
http://annals.org/article.aspx?articleid=1767855
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
