Do You Need Vitamins? Fact or Fiction

Chapter summary

We have outsourced responsibility for our health. We do not want to change how we live, though lifestyle is one of the strongest determinants of health.
The question is not whether we need vitamins (we do). It is how much, and whether we get enough from food.
The author is sceptical of anyone selling a pill for the “man-made epidemics of our time”.
One in three people take supplements. The US market was about $30 billion in 2013, with vitamins around $12 billion and rising 10% a year.

Nutrition experts: You need only the recommended daily allowance, which a routine diet provides. “Routine” is not well defined.
Vitamin manufacturers: A regular diet does not supply enough, and more is better.
Complementary medicine researchers: Professor Jon Adams (UTS) says supplements are part of a “paradigm of wellness” and are entrenched in how people think about health, and not only among the middle class.

Bjelakovic (Copenhagen) reviewed 815 trials. Supplements had a detrimental effect on lifespan. Beta-carotene carried a 7% higher risk of death, and vitamins A and E also raised risk.
Edgar Miller of the Mayo Clinic, writing for the Annals of Internal Medicine: “These vitamins should not be used for chronic disease prevention. Enough is enough.”
One study analysed 24 trials with 450,000 people and found no mortality benefit. Another followed 6,000 elderly men for 12 years and found no help for cognitive decline.
The editorial concludes that multivitamins, beta-carotene, antioxidants, vitamin E, folic acid, B vitamins and minerals are ineffective or harmful for chronic disease prevention.
Vitamin D remains an open area.

A trial of 14,641 male doctors over 50, followed for 13 years (1997 to 2011), found Centrum Silver reduced cancer risk by about 8%, but not at specific sites such as prostate or colon.
Critics of the editorial argue that nutrition is not optimal for many people and that supplements, such as in pregnancy, serve a purpose.
The author asks about the doctors’ diets and lifestyles, and falls back on Pollan: “Eat food. Not too much. Mostly plants.”

Reductive science: If a population has low disease and a high intake of a nutrient, we isolate the nutrient and sell it, ignoring the whole food and the whole lifestyle.
Unrealistic expectations: We want to do the same things and get a different result from a magic pill. Commercial interests exploit this.
Evolution: Humans are built to absorb nutrients from food, not powders. Food packages them with fibre and other compounds.

The Inuit’s low heart disease was linked to fish oil, but they also had high activity, clean air, strong communities and a homogeneous population. Diet was only one variable.

Bjelakovic, G. et al. (2007) Mortality in randomized trials of antioxidant supplements for primary and secondary prevention. JAMA 297:842-857.
Bjelakovic, G. et al. (2004) Antioxidant supplements for prevention of gastrointestinal cancers. Lancet 364:1219-28.
Miller, E. et al. (2013) Enough is enough: stop wasting money on vitamin and mineral supplements. Ann Intern Med 159(12).
Bang, H., Dyerberg, J. and Nielsen, A. (1971) Plasma lipid and lipoprotein pattern in Greenlandic West Coast Eskimos. Lancet 297:1143-5.
Offit, P. (2013) Don’t take your vitamins. New York Times, 9 June.