Vitamins – Fact or Fiction

Get the Facts

• We have outsourced responsibility for our health. We don’t want to change the way we live despite documentation that lifestyle is one of the most powerful determinants of health.
• The question isn’t whether people need vitamins. They do. The questions are how much do they need, and do they get enough in foods?
• I’m very sceptical of anyone who takes a pill to cure the man-made epidemics of our time (and you should be too).
• Nutrition experts argue that people need only the recommended daily allowance — the amount of vitamins found in a routine diet. “Routine” is not often well defined.
• Vitamin manufacturers argue that a “regular diet” doesn’t contain enough vitamins, and that more is better.
• Most people assume that, at the very least, excess vitamins can’t do any harm. It turns out, however, that scientists have known for years that large quantities of certain supplemental vitamins can be quite harmful. And most recently, the editors of Annals of Internal Medicine finally said that vitamins are a waste of money and offer no health benefits. That is pretty radical for medicos!
• Sales are good. One in three people take supplements. Which confirms my view people don’t trust science.

Understand the Science

Vitamins and supplements as a category includes a large range of ingestible products, from vitamins and calcium pills, to protein shakes, diet pills, and energy drinks. Derived from “vita,” meaning life in Latin, vitamins are necessary to convert food into energy. When people don’t get enough vitamins, they suffer diseases like scurvy and rickets. These diseases are now almost unknown in developed societies.

The vitamin market is also referred to by various names such as nutritional supplements, dietary supplements, and simply, supplements. By whatever the name, this is a lucrative market. The USA Market in 2013 is about $30b, with vitamin sales about $12b, and with 10% annual increases. Over 39% of adults take vitamins and 54% take supplements. Australia’s complementary and alternative medical industry is worth at least $4b, and the vitamins and supplement market size is estimated at over $1.8b and likewise growing at 12%.

According to Adams, Professor of Public Health and Director of the Australian Research Centre in Complementary and Integrative Medicine at UTS, the growing use of alternative medicine is part of the development of a “paradigm of wellness” in the community. “People are looking to improve their lot and are thinking more proactively and holistically about health and not just about responding to illness. It’s a message the healthcare system in general promotes, whether it’s about quitting smoking or having a good diet,” he said.

Adams says vitamins and supplements have become firmly entrenched in the way people think about their health, whether or not there is convincing evidence that the products work. “When you look at the data,” he said, “one of the most important things you notice is that it’s not just a middle-class phenomenon, or people who are wealthy, who are using complementary medicine. It’s men and women of all ages and socio-economic groups, right across the country.”

From 2002 and onwards, Bjelakovic and others from Copenhagen University reviewed a range of trials in meta-studies. In one review of 815 clinical trials, taking supplements had a detrimental effect on lifespan. You die earlier. Those who took beta-carotene had a 7% increased risk, and vitamins A and E incurred a 16% and a 4% increased risk, respectively. In another study, there was no benefit found of anti-oxidants on colorectal adenoma; a separate study found that older women increased their risk of cardiovascular or cancer death by taking a daily vitamin, especially an iron supplement.

Most recently, Edgar Miller from the Mayo Clinic, one of the Editorial Committee of the Annals of Internal Medicine, commented on three articles in the December 2013 issue and said, “These vitamins should not be used for chronic disease prevention. Enough is enough.”

One study analysed 24 previous trials involving 450,000 people and found no beneficial effect on mortality from taking vitamins. A second examined 6000 elderly men and found taking pills had no positive effect on cognitive decline after 12 years, and a third piece of research followed 1700 men and women with heart problems and discovered no benefit in those who had taken supplements.

The evidence is pretty clear. Multivitamins, β-carotene, antioxidants, Vitamin E, folic acid, B vitamins, and mineral supplements are harmful or ineffective for chronic disease prevention.

If you want to read dissenting views to Millers editorial, read the comments that were subsequently posted. There are many who say that nutrition is not optimal and vitamins should be taken especially during pregnancy. To my thinking this comes back to, “Eat Food. Not too much. Mostly plants.” If your diet is mostly a Western diet with high sugar and processed food products, vitamins might be necessary. Alternatively, just eat whole foods.It is not worth further trials. Vitamin D supplementation, however, is an open area of investigation, particularly in deficient persons. Clinical trials have been equivocal and sometimes contradictory.

Sometimes you see a study and you are left scratching your head. E.g. A study with 14,641 male doctors older than 50 for over 13 years (1997-2011) showed Centrum Silver multivitamins reduced the risk of cancer by about 8% but not site specific cancers such as prostate or colorectal. But what was the doctors’ diet? And what was their lifestyle? Why was this study done, without trying to get to some of the interactions between diet and supplements? We just don’t know. We are left with that vague feeling that vitamins might prevent some ills, but could also possibly do harm.

Buying vitamins can definitely do some harm to your wallet! Ditch the pills, buy whole food. Try an apple a day. That was as good as statins for mortality reduction.

Omega-3 Supplements

About eight years ago, I started taking fish oil supplements. A family member had said it was beneficial for mild depression, and there appeared to be some relationship with dementia onset from a couple of media articles. However, when I thought we had found a supplement with unquestionable benefit, our hopes of ensuring good health by religiously swallowing the right pill are dashed. There was a recent report that stated that taking fish oil increased prostate cancer risk. We will discuss this more in the next chapter. Health-minded consumers have propelled annual fish oil sales to more than $6b in products and fortified foods.

How did fish oil get on our medical radar and become a $6b industry? It can be very informative to trace the origins of any accepted health practice; especially the whole claim that dietary cholesterol increases heart attacks. Sometimes there is a small experiment or more likely an observation. It may prove to be wrong, but then research can go for years trying to prove there is an advantage. Consumers follow this like lemmings!

In the early 70s, Danish investigators noted a dramatically lower incidence of cardiovascular disease among 130 Greenland Inuit in a study. This is what they said in the abstract.

Most types of lipid were decreased, compared with Danish controls and Eskimos living in Denmark. The most remarkable finding was a much lower level of pre-β-lipoprotein and consequently of plasma-triglycerides in Greenlandic Eskimos than in Danish controls. These findings may explain the very low incidence of ischæmic heart-disease and the complete absence of diabetes mellitus in Greenlandic Eskimos.

I would suggest it might also be due to the lack of a Westernized diet with high sugars and carbohydrates. If these Inuit have high Omega-3 blood levels due to their diet, do they have a high prevalence of prostate cancer? Turns out the Inuit have an extraordinarily low prevalence of prostate cancer. Clearly the prostate-cancer Omega-3 story is more complicated. The Inuit data proved all the more interesting in light of the evolution of their health over the past 50 years. As so often happens, with the westernization/modernization of the Inuit lifestyle, the incidence of cancer has increased dramatically, except for one. Prostate cancer remains incredibly rare amongst the Inuit regardless of dietary fish oil or Omega-3 blood levels. This is not the first time a supplement has been embraced as a therapeutic agent, and subsequently found to have no effect or even a negative one. Vitamins A, C, and E, beta carotene, and selenium supplementation, in the absence of a deficiency, have all proven ineffective or something that increased mortality. It is another example of hype without substance.

There are two overarching reasons as to why this keeps happening.

• The reductive nature of Western science, as explained by Ahn lends itself to a certain kind of thinking. If a population is observed to have a particularly low incidence of a disease, we study them in an attempt to define the one factor that might explain it. We attempt to isolate the therapeutic agent. In this Inuit cash it was Omega-3s.
• The second cause of repeated disappointment in health supplements has to do with our unrealistic expectations. We have outsourced responsibility for our health. We don’t want to change the way we live (or eat) despite documentation that lifestyle is one of the most powerful determinants of health. In this regard, we collude with the reductive scientific thinking. We don’t want to go and change our lifestyle to that of the primitive Inuits, but if we pop a fish oil pill, that sounds easy!

We want to continue to do the same things and get a different result by swallowing a magic pill.

Commercial interests understand this proclivity very well. They have created a panoply of products (magic pills and potions) that are supposed to make you lose weight, put on muscle, and live longer, disease-free lives without any change in behaviour. In earlier times these products were called snake oil. And sales are good.

We are a tough species. Ten thousand generations of evolution have crafted humans that are remarkably effective at absorbing and using the essential nutrients from food. For better or worse, our body is programmed to work on food, not pills or powders. The “housing” of these nutrients and vitamins in food seems to be an important part of how they are adsorbed and utilised. Evolution has also wired us for lots of movement.

We have inadvertently conducted a global experiment on the consequences of sedentary behaviour and the consumption of huge caloric loads of processed foods. The results are in: an epidemic of obesity, diabetes, hypertension, and cardiovascular disease. As we understand more of our human biome, the bacteria that live in and on us, it seems they are healthier when we eat whole food.

Conclusion

We like simple stories that provide simple solutions and don’t ask us to change. Most like a solution of once a day taking a “natural supplement”. It seems more “scientific”, or so it says on the bottle, than eating whole food. “Proven by clinical trials.” Or “As used by a celebrity.” If we can appreciate the benefits of whole foods, we should be able to understand the need for thinking about whole people. Many variables determined the Inuit’s remarkable health, including lots of physical activity, clean air and water, a close community of supportive social connections, a relatively homogenous population with similar genetics, and yes, their diet too.

Anyone claiming to have a pill to cure the man-made epidemics of our time smells a little fishy to me. If you change to eating whole foods, and especially the complex carbohydrates, some fish, some meat then vitamins and supplements have no role.