Are Multivitamins A Waste Of Money?

Don’t Throw Your Vitamins Away Yet

Author: Dr. Stephen Chaney

ProfessorThe Professor is annoyed. Two things really irritate me:

  • Charlatans who cherry pick studies to “prove” that their snake oil supplements will cure what ails you.
  • Doctors who proclaim that vitamins are a waste of money without understanding the science behind the studies they are quoting.

Are Multivitamins A Waste Of Money?

You’ve seen the headlines telling you that “the experts” have concluded that multivitamins are a waste of money. You might be wondering “What’s behind these headlines? Who are these experts, and what is their evidence?”

Let’s start at the beginning. The article (Gualler et al., Annals of Internal Medicine, 159: 850-851, 2013) that generated all of the headlines was an editorial, which means it is an opinion piece, not a scientific study. It represents the opinion of five very prominent doctors, but it is, at the end of the day, just their opinion. Many other well respected experts disagree with their opinion.

They based their editorial on three recently published studies:

  • The first study reported that vitamin and mineral supplements did not decrease the risk of heart disease and cancer in healthy individuals (Fortmann et al., Annals of Internal Medicine, 159, doi: 10.7326/003-4815-159-12-201312170-00729)
  • The second study reported that multivitamins did not affect cognitive function in healthy male physicians aged 65 and older (Gradstein et al, Annals of Internal Medicine, 159, 806-814, 2013)
  • The third study concluded that multivitamins did not reduce the risk of a second heart attack in patients who had previously had a heart attack and were receiving appropriate medical therapy.

These were all large, well designed studies, so it would be tempting to conclude that the headlines were right. Maybe vitamins are a waste of money.

But, what if the whole underlying premise of these studies was flawed? Let’s examine that possibility by examining the flawed premises behind these and other studies.

What’s Wrong With These Studies?

#1) These studies were too narrowly focused.

MultivitaminsMultivitamins and individual vitamins and minerals are not magic bullets. They are not drugs. They are meant to fill nutritional gaps in our diet – not prevent or cure disease. We should be asking whether holistic approaches can prevent or cure disease – not whether individual nutrients can do so.

One of the examples that I love to use, because it really made an impression on me as a young scientist, occurred at an International Cancer Symposium I attended more than 30 years ago. I attended a session in which an internally renowned expert was giving his talk on colon cancer. He said, “I can show you, unequivocally, that colon cancer risk is significantly decreased by a lifestyle that includes a high-fiber diet, a low-fat diet, adequate calcium, adequate B-vitamins, exercise and weight control. But I can’t show you that any one of them, by themselves, is effective.”

The question that came to me as I heard him speak was: “What’s the message that a responsible scientist or responsible health professional should be giving to their patients or the people that they’re advising?” You’ve probably heard experts saying:

  • “Don’t worry about the fat content of your diet. It can’t be shown to increase the risk of colon cancer.”
  • “Don’t worry about calcium. It doesn’t decrease the risk of colon cancer”
  • “Don’t worry about B-vitamins. They don’t decrease the risk”
  • “Don’t worry about fiber. It can’t be shown to decrease the risk either”

But, is that the message that we should be giving people – that nothing matters? Shouldn’t we really be saying what that doctor said many years ago – that a lifestyle that includes all of those things significantly decreases the risk of colon cancer?

#2) These studies were destined to fail.

It’s almost impossible to prove that any single intervention prevents disease when you are starting with a healthy population (something we scientists refer to as a primary prevention study).

For example, in “Health Tips From the Professor” just a couple of weeks ago I shared with you that even when you combine all of the published studies with tens of thousands of patients, it is impossible to prove that stain drugs prevent heart attacks in healthy individuals.

If you can’t show that statins prevent heart disease in healthy people, why would you expect to be able to show that vitamins or minerals prevent heart attacks in healthy people?

I can’t resist pointing out that this perfectly illustrates the pro-drug, anti-supplement bias that is so prevalent among many of my medical colleagues. I haven’t seen a single editorial or headline suggesting that statin drugs might be a waste of money for healthy individuals.

#3) These studies simply asked the wrong questions.

For example, the third study described in the editorial was asking whether multivitamins reduced the risk of a second heart attack in patients who were receiving “appropriate medical therapy”. What does “appropriate medical therapy” mean, you might ask? It means that those patients were on 4 or 5 drugs, with all of their side effects.

In reality the study was not asking whether multivitamins reduced the risk of a second heart attack. The study asked whether multivitamins had any additional benefits for individuals who were taking 4 or 5 drugs to reduce their risk of a second heart attack. That’s a totally different question.

There are lots of examples of this paradigm. For example, 17 years ago the Cambridge Heart Antioxidant Study showed that vitamin E significant decreased heart attack risk in patients with severe cardiovascular disease (Stephens et al, The Lancet, 347: 781-786, 1996). Patients in that study were taking one or two medications. However, in today’s world that would be considered unethical. The standard medical treatment for high risk heart disease patients today is 4 or 5 drugs, and when patients are receiving that many medications it is no longer possible to demonstrate a benefit of vitamin E. The story is similar for omega-3 fatty acids.

That poses a dilemma. What recent studies show is that individual nutrients don’t reduce the risk of a second heart attack in someone who is receiving “standard of care” medical treatment.

But that’s not the question I am interested in. I’d like to know whether natural approaches might be just as effective as the drugs or whether natural approaches might allow one to use fewer drugs or lower doses. I’d like to avoid all of the side effects of those drugs if I could.

What about you? What questions would you like answered? Do these studies answer those questions?

What Was Overlooked In Those Studies

The studies did show conclusively that there were no harmful effects from supplementing except for high dose beta-carotene in smokers. Somehow that information never made it into the headlines.

The Bottom Line

  • Don’t pay much attention to the reports that supplements don’t work and are a waste of money. Those studies are fundamentally flawed.
  • Don’t pay much attention to the reports claiming that vitamins will hurt you. Except for beta-carotene in smokers the latest studies showed no evidence of harm.
  • On the other hand, don’t expect miracles from your vitamins. If you spend your time sitting in front of the TV set eating pizza & drinking sodas, popping a vitamin pill won’t prevent much of anything.
  • Finally, holistic approaches are often as effective as drug therapy – without the side effects. Your vitamins can be an important part of a holistic approach to better health that includes weight control, a good diet and exercise.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Use of Sports Supplements By Young Athletes

Are Sports Supplements Effective? Are They Safe?

Author: Dr. Pierre DuBois

plate-of-pills-200-300In recent years, the use of sports supplements by young athletes has increased dramatically. The most commonly used sports supplements among teenagers of all ages were vitamins and minerals, though “ergogenic aids” are used by some teen athletes specifically to enhance performance. Among these performance-enhancing supplements  are substances such as caffeine, creatine, ephedra and other stimulants, human growth hormone (HGH) and anabolic steroids.

Of the vitamin and mineral supplements, mutivitamins, vitamin C, calcium and iron were reported as being taken most often. While the risks of taking vitamin supplements is relatively low, there is some concern that young athletes may then progress to taking more dangerous substances under the impression that they are as harmless as vitamins and minerals. And while the risk of overdose with vitamins and minerals is low, it is not nonexistent, and some vitamins can be toxic when too much is taken (such as iron and vitamin A) or may interact with other vitamins or drugs.

Although many performance-enhancing supplements are advertised as being safe – especially those made from natural compounds –  a great number of them have not been tested by any regulatory agency, so their actual safety is not known. In addition, there are no formal guidelines for dosage in many cases, so there could be adverse side effects if too much is inadvertently taken.

The pressure to excel at sports is greater than ever, and there is increasing competition to get into elite sports programs where they have a better chance of being discovered by professional sports scouts looking for the next big star. The possibility of fame and fortune can be a strong enticement to young athletes to try performance-enhancing supplements to give them an edge over their competition. And often it is their coach that suggests or encourages this practice.

According to studies done on high school athletes, they report taking supplements to not only enhance performance, but also to encourage growth and muscle development, prevent illness and reduce fatigue. Supplement use was greatest among athletes who practiced two or more different sports and those who were required to “bulk up”, such as wrestlers and weight lifters.

While the opinions of friends, teammates and coaches were a big influence on the decision of young football players to take supplements (particularly creatine), it was their parents who had the greatest amount of influence on their decision. So it is incredibly important for parents to be educated as to the benefits and drawbacks of each of these supplements for young athletes.

The Bottom Line:

  • There is tremendous pressure on teenage athletes to qualify for elite programs that will increase their chances of being selected for the top college teams and eventually getting onto professional teams. Because of that, the use of sports supplements by teenage athletes is commonplace.
  • Vitamin and mineral supplements are generally harmless unless taken in excessive amounts.
  • Performance-enhancing sports supplements, on the other hand, are poorly regulated. Many are useless and others are potentially harmful. In next week’s “Health Tips From The Professor”, I’ll give you some examples of sports supplements you might want to avoid.
  • If you are the parent of a teen athlete, have a conversation with your child about supplements. Don’t lecture, but involve them in the process of doing research. You may be surprised what you both find.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Multivitamin Supplements May Reduce Breast Cancer Mortality

Can A Multivitamin A Day Keep Breast Cancer At Bay?

 Author: Dr. Stephen Chaney

3d rendered illustration - breast cancerA few weeks ago I wrote about soy and breast cancer survival. You’ve probably seen the latest headlines: “Multivitamin Supplements May Reduce Breast Cancer Mortality” and are wondering if they could possibly be true. After all, wasn’t it just a short time ago that the headlines said “Multivitamin supplements have no effect on breast cancer mortality” or that “Multivitamins may increase your risk of death”?

With all the conflicting headlines, you have every right to be skeptical about the latest news. So perhaps we should start with looking at the previous studies and discussing why they disagree.

What do we know about multivitamin use and breast cancer survival?

 Three very large studies have reported no correlation between multivitamin use and breast cancer incidence. So it is pretty clear that multivitamins don’t prevent breast cancer.

However, breast cancer incidence and breast cancer survival are two different things. In the first case you are starting with healthy women and asking how many of them develop cancer. That is what we scientists call a primary prevention study. It is very difficult to prove the effectiveness of any intervention in a primary prevention study. In the second case you are starting with a sick population and asking if an intervention provides a benefit. It is much easier to prove whether or not an intervention is effective in this kind of study.

There, have been several small studies looking at the effect of vitamin supplementation in women who already had breast cancer. While the results have been mixed, the majority of the studies showed that vitamin supplementation did appear to reduce breast cancer recurrence and mortality.

What makes this study different?

The women in this study were part of 161,608 women enrolled the Women’s Health Initiative (WHI) study to investigate the effects of multivitamin use in post-menopausal women. In fact, this was one of the studies to report no effect of multivitamin use on the incidence of breast cancer (Neuhouser et al, Arch. Intern. Med., 169: 294-304, 2009).

What the present study did was to look at the those women in the WHI who did develop breast cancer during the previous study and followed them for an additional 7.9 years to see if multivitamin use affected breast cancer survival (Wasserthiel-Smoller et al, Breast Cancer Res. Treat., 141: 495-505, 3013).

This is the largest study of its kind (7,728 women). It started with an older and sicker group of women than previous studies.  All of the women were 50-79 years old at the time the study began, and all of them had invasive breast cancer at the time of enrollment into the study.

The results were quite impressive. Multivitamin use improved survival by 30%, and the results were highly significant.

Strengths of the Study:

  • This was a large and very well controlled study. The authors did an excellent job of controlling for confounding variables that might have affected the outcome.
  • Multivitamin use was measured at multiple time points. It was assessed at enrollment into the original WHI study and at each subsequent doctor visit. The multivitamin usage for the purpose of data analysis was the usage at the time of breast cancer diagnosis, but the authors also corrected for any change in vitamin use post-diagnosis.
  • The study was in agreement with the majority of previous studies, further strengthening the conclusion that multivitamin use in women with breast cancer improves the likelihood of survival.

Weaknesses of the Study:

  • Because previous studies have been mixed with respect to the effect of multivitamins on breast cancer survival, further placebo controlled intervention studies will be required before multivitamin use becomes part of the standard of treatment for breast cancer patients.
  • Most of the women in the study were post-menopausal. It is unclear if multivitamins will provide the same benefit to pre-menopausal women with breast cancer.
  • This study measured consistent multivitamin use before and after the diagnosis of breast cancer. It did not look at women who began multivitamin use after diagnosis. So we have no idea whether starting multivitamin use after diagnosis would have also been beneficial.

The Bottom Line:

1)    This study strongly suggests that multivitamin use may help improve your chances of survival if you are unlucky enough to develop breast cancer.  While more studies are still needed, this study certainly strengthens the argument for multivitamin use.

2)    The rap on multivitamins has always been that they aren’t needed by healthy people who have a good diet. However, multivitamins are important for assuring good nutritional status if your diet is not optimal or if you have increased nutritional needs – either because of your genetic makeup or because of illness.

3)    The difficulty is that you usually don’t know if your genetics increases your vitamin needs, and once your disease has progressed far enough to be diagnosed it may be too late to improve disease outcome.  That’s why many experts consider a multivitamin supplement as an inexpensive form of nutritional and health insurance. I concur.

4)    As for the fear that multivitamins might just kill you, that hypothesis has been disproven by several subsequent studies including one published just a couple of weeks ago (Macpherson et al, Am. J. Clin. Nutr., doi: 10.3945/ajcn.112.o49304).

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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