Dec 19 2013

OK – But Should I Take a Vitamin

In a follow up to my post earlier this week, I have received (in the comments and elsewhere) multiple questions about whether or not it is still reasonable, in some circumstances, to take a multivitamin. This is ultimately an issue of how to apply scientific evidence to specific individuals – something which physicians have to do every day.

What studies of vitamin supplementation have generally found is that taking a multivitamin does not reduce the risk of cancer, reduce the risk of vascular disease, or prolong survival overall. The question is – can we generalize from the populations in these studies to the general population – to you? Perhaps you are in a subgroup that would benefit from vitamins.

Another common question is whether or not it is reasonable to take a vitamin for “nutritional insurance” in case your diet is lacking in one or more vitamins.

The scientific evidence we have is imperfect and incomplete, otherwise we would have a definitive answer to any such questions. Scientific evidence in medicine is always incomplete – we cannot study every possible permutation of physical conditions and interventions.

At this point, however, the evidence is robust and we can make fairly confident statements about some basic conclusions. If you are a member of the general population, which means you have no diseases or conditions which result in a restricted diet, poor absorption of nutrients, or greater than usual nutritional needs, despite many studies there is no evidence of any health benefit from routine supplementation.

This does not rule out a small benefit, or a subgroup benefit, but it does mean that any possible benefit is highly likely to be minimal. Further, the subgroup argument is not helpful, because you won’t know whether or not you are in a subgroup that may benefit (by definition, otherwise you wouldn’t be considered part of the general population. In other words, known subgroups have already been identified and removed.)

You can make the subgroup argument about any failed clinical trial. This generally does not pan out as a way of rescuing a failed treatment. It’s mostly not worth considering (it’s mostly special pleading) unless you have a good reason to suspect that a specific subgroup might benefit, in which case you should study the subgroup.

The nutritional insurance argument also does not fly – this is exactly what the studies have looked at. Taking a vitamin routinely as nutritional insurance is of no benefit.

A number of studies have compared dietary changes to vitamin supplementation for the prevention of cancer or vascular disease. These studies generally find that dietary changes are helpful, while supplements are not.

Often critics of these negative studies argue that the control group had a good diet, and this obscured any benefit from the vitamins. But that is exactly the point – if you have a good diet, you don’t need vitamins. And – if you have a bad diet, taking vitamins does not make up for it. You need to improve your diet.

The evidence shows that, either way, you are better off improving your diet, and taking vitamins does not help.

Yesterday on Science Based Medicine I wrote about a recent analysis showing that just recommending that people eat an apple a day – essentially adding a portion of fruit to their diet (without increasing their overall caloric intake) could save 8,500 lives a year in the UK, about as many as would be saved from taking a statin.

The same basic power and type of clinical and observational studies that show no benefit to vitamins do show that adding a portion of fruits and vegetables to your diet has a measurable health benefit.

Therefore, if you want some nutritional insurance, eat an apple.

What are the known subgroups that could benefit from some supplementation? I cannot give an exhaustive list, as there are many specific conditions, but here are a few common ones:

- Woman who are trying to get pregnant should take prenatal vitamins

- Recovering from surgery or injury

- Any malabsorption disorder

- Older patients may have a decreased ability to absorb vitamin B12, and should have their level checked periodically.

- Anyone on a restrictive diet should be familiar with which nutrients their diet may lack.

- Certain medications may deplete specific vitamins, in which case your physician will likely give you a supplement to take with the medication.

Dieting for weight loss may be a situation where it is reasonable to take a supplement. However, you should not be restricting to the point that you cannot get adequate nutrition through your food. Further, adding lots of vegetables to your diet is a good way to both lose weight and get your vitamins.

What about growing children? Here again it is optimal to encourage a well rounded diet. However, I admit to being on the fence here. If a child is going through a picky phase, and has a narrow diet despite your best efforts, a multivitamin may be reasonable as they are growing.

But – do not fall into the trap of thinking this is adequate and relieves you of the need to encourage a well-rounded diet. That would still be better.

If your child is not having a problem with obesity, then fruit is usually a good solution. My daughters love strawberries and apples, so we make sure there are always plenty of both in the house, and they can eat as much as they want. Strawberries in particular are packed with vitamins. And yes, you have to nag them to eat their vegetables.

You are better off giving them good eating habits for life, rather than just giving them a supplement.

Conclusion

I wish it were not the case. I really do wish that I could stave off disease and prolong life – in my patients, my loved-ones, and myself – simply by taking a supplement. The evidence, unfortunately, just doesn’t show it.

The good news is that, for most people, the best advice is actually quite simple. Eat a well-rounded diet with 5 portions a day of fruits and vegetables and exercise regularly. When it comes to vitamins and supplements – save your money. Spend it on food or a stationary bike.

If you have reason to suspect that your nutritional needs may be special, then consult your physician. It is easy enough to check your vitamin levels.

Also, the one vitamin that is perhaps the exception to the above is vitamin D. Research on this is still preliminary, but vitamin D insufficiency (if not outright deficiency) may be very common. The darker your skin and the further from the equator you live, the greater the chance you may need to supplement your vitamin D, since we get most of it from the sun. The consistent use of sunscreen, while good for preventing skin cancer, also decreases vitamin D levels.

But again – get your levels checked and supplement accordingly. Primary care doctors are doing this routinely now.

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43 responses so far

43 Responses to “OK – But Should I Take a Vitamin”

  1. Kawarthajonon 19 Dec 2013 at 9:18 am

    Ha! The kid comment made me laugh because I have the opposite problem. My kids love fruit and veggies, but have to be nagged to eat food with healthy calories in them – “Ok, no more veggies until you eat your pizza/sandwich/spaghetti/quesadilla!”

  2. Cow_Cookieon 19 Dec 2013 at 9:19 am

    I loved this post. It really helped me apply the studies to my life. Thanks for doing this.

  3. Kieselguhr Kidon 19 Dec 2013 at 9:43 am

    Yeah, I was pretty unhappy with the tone of the previous post and this one makes me happier. I was at a conference where Bruce Ames showed a lot of great data on good effects of vitamin B supplements and I thought his statistics and analysis were good. But he was outraged over the idea that medical associations were discouraging multivitamin use on the basis that a well-rounded diet is preferable. His take was, yes a well-rounded diet is vastly preferable, but don’t let the perfect be the enemy of the good: the multivitamin is a good backstop and you aren’t ecouraging people to take megadoses. It sounds like Dr. Novella is ending up in a similar place.

  4. Steven Novellaon 19 Dec 2013 at 9:56 am

    It’s not just that a well-rounded diet is preferable. A well-rounded diet works, while taking supplements routinely does not work. The perfect is not the enemy of the good here – routine vitamins are not good, they are useless. They may even be bad – taking resources away from other interventions, causing a false sense of security, and maybe even direct harm (not clear, but hasn’t been ruled out).

    Regarding B vitamins, there is evidence for specific benefits in specific conditions, and it is certainly reasonable to screen for levels, but the evidence does not support routine supplementation.

  5. ccbowerson 19 Dec 2013 at 11:46 am

    I’m actually a little surprised at the reactions to the multivitamin posts. I guess I’m a bit out of touch, because this is not really new. It is just more evidence supporting what had been apparent for some time. I think that some people are still confusing routine multivitamin supplementation of the general population with targeted supplementation under specific circumstances. This is a very good follow up post overall, and I think it did help to correct the misunderstandings of readers of the previous post.

    I don’t want to overemphasize this, but it seems people are still assuming that there is no harm. The data is/are messy, but there are associations between some supplements and harm, including: copper and dementia, vitamin E and heart failure, beta carotene in smokers and lung cancer, etc etc. When we are talking about broad recommendations to otherwise healthy people, these types of associations become more concerning without demonstrated benefit.

    Steve did a good job explaining why appealing to possible subgroup benefits doesn’t work (unless we know what those groups are), because there is the flipside of subgroups that may benefit- subgroups that may be harmed. The bottom line to me is that any intervention should have evidence for benefit first. It’s really that simple.

  6. Bruceon 19 Dec 2013 at 1:42 pm

    “What’s the harm” is all I have seen from one poster on Facebook after posting the previous blog entry and now this one.

    I often suspect those who comment on my Facebook links often don’t actually read the posts.

  7. LittleBoyBrewon 19 Dec 2013 at 3:19 pm

    The company I work for is one division of a larger organization who has another division that manufactures and sells possibly the most well known daily vitamin in existence, at least in the US. As a result I have been able to buy said vitamins at a very significant discount for over 20 years. Even with that I gave up taking them a number of years ago (probably not long after I started listening to SGU…).

  8. Will Nitschkeon 19 Dec 2013 at 8:23 pm

    “Further, the subgroup argument is not helpful, because you won’t know whether or not you are in a subgroup that may benefit (by definition, otherwise you wouldn’t be considered part of the general population. In other words, known subgroups have already been identified and removed.)”

    That’s not the issue Steve. Supplementation is common practice via food fortification and other methods. I.e., the addition of folic acid in foods is common in the US. It’s not implausible to survey the population via a sample to identify the % who have nutritional deficiencies that might, in principle, still benefit from untargeted general supplementation. Then estimate the potential benefit for those groups, if any. Then determine statistically how many who take multivitamins in the general healthy population that fall into those sub groups.

    That way you’re expressing a point of view regarding usage that’s evidence based.

    My other concern is that you need to qualify this sort of nutritional advice very carefully. I think the unstated assumption is you’re talking of first world countries such as the US, not other parts of the world where there are nutritional deficiencies. In those cases it’s not practical to just tell people to eat a “balance diet”. Now, that doesn’t automatically imply that distributing multivitamins to disadvantaged groups is actually a good use of limited resources or of improving health outcomes. But there is nothing insurmountable in being able to find an answer to such a question.

    Hypothetically, I’d be concerned if an amateur sceptic in a position of authority, kills off a vitamin supplementation program targeted at say, Chinese school children in Xieng Khouang Province, because “multivitamins do nothing” becomes the take home message.

  9. Bruceon 20 Dec 2013 at 2:51 am

    @Will,

    It is almost like you don’t read most of the blog post. Selective commenting, and many words to say nothing about what was not said.

  10. Kostason 20 Dec 2013 at 4:28 am

    I dont get this and its been bugging me for a long time. One time I entered (to the best of my ability) all the foods I consumed in a single (in my opinion, mostly average) day into wolframalpha to see what I ate and compare them to the recommended daily intake values. The results were horrific. I didnt manage to get 100% on any of the micronutrients. Many of them were lower than 50%. I repeated this process with similar results. I do recognize the huge margin of error of my results but thats the best I can do. Besides, it could just as well swing in the other direction. The funny thing is up until then I never considered my diet terrible in any way. Mediocre maybe but not terrible.

    Why would supplementation not help me in this case? Whats the usefulness of recommended daily intake guidelines if my results are somehow “not a biggie”? And all that “eat healthy” type of advise is in my opinion useless. We all know fruits and vegetables are healthy. Its the same with weight loss. Lots of people are trying to lose weight even though the answer is plain and simple: eat less and exercise. For a multitude of reasons some people just cant fit all this into their lifestlyle. Its the same with me. I just dont eat fruit. I buy apples and I watch them rot in the fridge. For a number of reasons I only eat when I get really hungry and I get this craving so I go for a pizza instead of a salad or fruit. Its not that I dont like fruits and salads, its just that given how I live I find it impossible to do all the right things. I just cant take care of myself properly. That sucks but I dont understand why supplements (not megadoses) wouldnt help me ameliorate the situation.

  11. emustrangleron 20 Dec 2013 at 4:44 am

    So if extra vitamins aren’t useful, by what mechanism does eating an apple help one’s health? I went to the SBM article, but it didn’t really explain why an apple was supposed to help cardio-vascular health, only that a model showed that it did.

    I think this is where a large amount of the faith in nurtional supplements comes from. Dr’s tell their patients to eat more fruits and veggies, and a lot of people assume the reason is because they have necessary vitamins and minerals they aren’t getting, and thus, taking a pill seems an obvious way to get the same benefit.

    So if this understanding is wrong, it would probably behoove Drs to advertize the fact more widely.

  12. proteinnerdon 20 Dec 2013 at 5:08 am

    I’m curious, do we know if very active people have a higher requirement of vitamins and minerals than a more sedentary person? I do resistance training and martial arts for approx 5 sessions per week…all relatively high intensity. Would someone like me have a higher requirement of vitamins and minerals than someone who doesn’t really workout much?

  13. BillyJoe7on 20 Dec 2013 at 6:22 am

    Kostas,

    To some extent, it’s probably a waste of time wondering why on earth vitamin supplementation wouldn’t work. You can’t make it work just because you would like it to work, because your diet sucks. The fact is that the evidence is that it does not work.

    We can probably speculate about why it doesn’t work and some have. For example, metabolism is very complicated. There are numerous nutrients, and countless overlapping and interacting metabolic pathways. At this point in time, scientists have only scratched the surface of this complex and complicated field of study. The vitamins we have so far discovered to be essential are probably only a bucketful out of a pond. It would be remarkable, then, that these few supplements would make any difference. It’s would also be a good reason why eating actual food would work better.

    I have never wondered if I eat the RDI of vitamins and minerals and I certainly have never tried to calculate how much of them I consume. I’m too busy enjoying my food. But I have wondered how anyone could eat two fruits and five vegetables each and every day. What to do? As someone else said above, when there isn’t good evidence that it is worthwhile to do something, don’t bother.

  14. BillyJoe7on 20 Dec 2013 at 6:29 am

    My thoughts on Will Nitschke is that he’s just a slippery eel not worth spending any more time on.
    Each to his own though.

  15. Bruceon 20 Dec 2013 at 7:37 am

    BillyJoe,

    I agree, that is why that is the only comment I have made against his screeds of almost unintelligible wandering prattle.

  16. emustrangleron 20 Dec 2013 at 9:09 am

    Also: if apples are good for you, but extra vitamins aren’t, why don’t they just take the active compounds from the apple, shove it in a pill and sell that in place of a multivitamin?

  17. ccbowerson 20 Dec 2013 at 9:54 am

    “Whats the usefulness of recommended daily intake guidelines if my results are somehow ‘not a biggie’?”

    Good question. Many people have wondered the same thing, and there are many knowledgeable people who disagree about this I think. My take is that the RDI exists because the RDA existed, which was based on WWII data/science, and that needed serious updating. My answer is that it probably isn’t that useful for most people, but may be somewhat useful in circumstances in which a person’s diet may be contributing to their health… people with significant dietary restrictions (for whatever reason – self imposed or otherwise).

    “And all that ‘eat healthy’ type of advise is in my opinion useless. We all know fruits and vegetables are healthy.”

    Umm… not really useless. Apparently some people think that multivitamins can “make up” for a lack of healthy diet, which, unless targetted with a specific indication, is untrue. Correcting this is important to avoid the rationalization one can make for a poor diet.

    I agree that dietary changes are difficult, as they are habits that we live develop throughout our lives, and they are hard to change like many other aspects of our lives that become routine and comforting. That is why it is important to develop healthy habits for our children. I find it a heck of a lot easier to give them healthy options than to stick to that for myself. To do that you do need that knowledge and realize the importance of diet, and that there currently no working shortcuts (such as a multivitamin or supplement).

  18. ccbowerson 20 Dec 2013 at 10:01 am

    Slight but important correction of what I wrote regarding things like the RDI:

    “My answer is that it probably isn’t that useful for most (otherwise healthy) people”

  19. Steven Novellaon 20 Dec 2013 at 10:44 am

    Will – all the studies are in the general population, which means no malnutrition. “Routine supplementation” does not refer to those who are malnourished for whatever reason. For example, about the cognitive function study I discussed I specifically stated – “the study population (physicians) have good baseline nutrition.”

    I also carefully carved out an exception for targeted supplementation. This includes population based supplementation of specific nutrients known to be generally lacking in our food chain – iodine in salt, calcium in milk, vitamin A in developing nations, etc.

    The question of why multivitamins do not work is interesting. Here are some possibilities:
    - baseline nutrition in these study populations (Western nations mostly) is adequate
    - homeostasis – we get enough from our food, and more is not better, it’s just wasted
    - A poor diet (not necessarily malnourished, but not a well-rounded diet) has downsides that are not compensated for by taking vitamins (too little fiber, too much fat)
    - There may be micronutrients that are yet to be discovered or not adequately accounted for in supplements.

    Regarding 5 portions of fruits and vegetable, these are small portions, and it isn’t that hard. Keep in mind, this is a daily average, you don’t necessary have to get each and every day.

    Snack on fruit or veggies. There are good fruit and vegetable drinks (even diluted in water, can give one or more portions a day). Have a salad with lunch or dinner, or for a meal occasionally. Have a side veggie or two with your meals. Have lettuce, pickles, and onions on that hamburger. Put corn in your chili, or peppers on your pizza. It’s not that hard, actually, to get plenty of plant-based food in your diet. In the West we actually have an embarrassment of food options.

  20. ccbowerson 20 Dec 2013 at 11:03 am

    I would add that people are not great at evaluating their own diets. It does help to have a knowledgeable person point-out areas of a diet that can use improvement. Often these are pretty simple changes.

    One common misconception that peope have is that their diet is lacking in some very important nutrients, and that a supplements can help counter that. Much more common in countries like the US is not a lack of nutrients, but a problem of excess calories. Eating less but emphasizing fruits and vegetables is probably the most simple and reasonable advice.

    The problem is doing that when that is not prioritized on daily basis. We tend to have busy lives, prioritize other things, and fall back on our bad habits

  21. Kostason 20 Dec 2013 at 11:40 am

    BillyJoe7,

    That all sounds very reasonable. The truth is I dont worry about it too much. Also, I dont take any supplements and I am not planning to. But as I said in the beginning, it bugs me and theres always an element of guilt when I reach for that pizza…

    ccbowers,

    I understand. I guess it makes sense to give a ballpark estimate to some people who have no idea what these things are (such as myself, for the most part).

    Also, what I should have said was that this type of advice is useless to me. The truth is though that my whole point is a slightly more sophisticated version of the “I dont need to eat healthy because I take supplements” argument, only in reverse. It just makes so much sense!

    Anyway I quit trying to get exact results when I realized the more nutrients you include in your study, the harder it is to get a balance. Sometimes even getting the carb/fat/protein ratio to come up right can be quite a chore!

  22. Steven Novellaon 20 Dec 2013 at 11:55 am

    emu – I believe I covered your questions above. Let me know if you still do not understand.

  23. ccbowerson 20 Dec 2013 at 12:58 pm

    emustrangler-

    One counter to your question could also be: why take an apple and put it into a pill to replicate what is good about the apple, when apples already exist and are edible? If you don’t like apples, pick another option that you do like. I’ve never had a tablet that tasted as good as fruit.

    I think the direct answer is that there doesn’t appear to be a shortcut that works. Its not that just an apple is healthy, but entire diets are healthy. You would have to replicate what is good about entire diets (and our knowledge of the ins-and-outs of that are still limited), and we will probably find that the easiest and best way to do this (at least at this point in time) is through food and eating a healthy diet.

  24. SimonWon 20 Dec 2013 at 7:22 pm

    For once Steve ducked the hard question.

    Regular chocolate consumption – good or bad?

    Can Nestle Research labs be trusted to be better than the pharmaceutical industry at publishing bad news?

    The published evidence looks good, but most of the studies are looking at the 20g to 40g a day range of dark chocolate, and really I don’t have that much self control once a 100g bar is open. A lot also correct for factors you might think chocolate consumption might affect, how does that work?

    Some skeptics will have to do some serious research on this topic.

  25. tmac57on 20 Dec 2013 at 7:37 pm

    ccbower- ” If you don’t like apples, pick another option that you do like. I’ve never had a tablet that tasted as good as fruit.”

    Not only that, but the Apple tablet is just impossible to swallow…even if you go with the mini ;)

  26. rocken1844on 21 Dec 2013 at 9:04 pm

    The NYT reports: “Dietary supplements account for nearly 20 percent of drug-related liver injuries that turn up in hospitals…”
    http://www.nytimes.com/2013/12/22/us/spike-in-harm-to-liver-is-tied-to-dietary-aids.html?hp&_r=0

  27. DGAon 22 Dec 2013 at 4:07 am

    I saw this story today about NAD+ reversing aging in mice; “Declining NAD+ Induces a Pseudohypoxic State Disrupting Nuclear-Mitochondrial Communication during Aging ” http://www.cell.com/retrieve/pii/S0092867413015213?cc=y. Have you seen the study and, if so, how do you rate the method and reliability of the results. In looking it up further I found the following which seems to support the study above and this http://www.ncbi.nlm.nih.gov/pubmed/7782898

  28. Mlemaon 22 Dec 2013 at 4:08 am

    ccbowers:
    “You would have to replicate what is good about entire diets (and our knowledge of the ins-and-outs of that are still limited)…”

    thank you for making this critical point, that is too often overlooked as we try to deconstruct nutrition and then replicate it in supplement form

  29. Will Nitschkeon 22 Dec 2013 at 5:41 pm

    @ Steven Novella

    My objection is that your advice is wrong. What the studies tell us is that multivitamin supplements for the general population will probably have no effect. We don’t know if there is a benefit for certain individuals that outweighs the negatives for the population overall. Working out if there is a net benefit is not impossible. Until that’s established the advice should read: If you’re a normal/average healthy individual living in a first world country on a balanced diet who gets periodic health checks, multivitamin supplementation is of no benefit. But that’s not what you actually wrote.

  30. BillyJoe7on 23 Dec 2013 at 2:48 am

    So, Will, when you’re instructing your trainee shoe shiners how to shine shoes, remember to tell them explicitly that the shoes will need be leather….

    There’s a good fella. (;

  31. Bruceon 23 Dec 2013 at 6:07 am

    BJ,

    I usually give most people consideration, but when they start writing multiple long posts on more than one topic it turns me off as it more often than not indicates someone who is trying to either score points against Steve and his commentors or has another ulterior motive.

  32. BillyJoe7on 23 Dec 2013 at 7:47 am

    Well, he’s a legend in his own mind if he thinks he’s scored any points off Steven Novella…or any one else here for that matter. Maybe one day he’ll realise that his hubris is the result of rank ignorance.

  33. ccbowerson 23 Dec 2013 at 10:56 am

    BillyJoe7-

    You are wrong. You must first assess that they have shoes, and you are not shining their feet.

    Actually what Will is doing is a bit worse than that. He is nitpicking where there are no nits. Steve has addressed this topic well, and if you look at Will’s objections over time shift. He appears to have a primary goal of objecting to something, but he’s not quite sure what that something is.

  34. BillyJoe7on 23 Dec 2013 at 3:53 pm

    :)

    “Will’s objections over time shift”

    Yes, which is what I meant when I referred to him as a “slippery eel”.
    And I believe he’s slithered right out of the place now.

  35. Rikki-Tikki-Tavion 27 Dec 2013 at 5:55 pm

    Wow?

    I don’t know what to say. You could copy some of the statements made in this tread by ccbowers and, I opine, even Steve to naturalnews and no one would notice.

    ccbowers: “Why eat a pill when you can eat an apple”

    … seriously? Why take an Aspirin when you can chew on bark? Apples rot. Not everyone has a grocery store right around the corner. It would take me more than an hour to buy one. If I buy a kilo and then don’t feel like apples for a couple of days, they will go bad. In winter they have to be transported over vast distances to get to the store in the first place, which contributes to global warming. You have no idea about the dosage of “Applein” in any particular apple. Et cetera, et cetera.

    And you, Steve? Since when do you extrapolate wildly from a study that shows only that well-nourished people do not benefit from Vitamins, that not-so-well-nourished won’t either? Where is the data for that? Are you supposing that apples work by some unknown undetectable (possibly magical) substance, when the effect of vitamins is well established? Is it fiber? You can have that as a supplement, too.

    As much as I like good cooking, there are weeks when I have no time for anything but ready-to-eat foods, which commonly contain very little of some vitamins that are destroyed by cooking (which is necessary for their preservation). There are heaps of evidence that lack of vitamins causes all kinds of fuckups in your body (short and long term). Supplements replenish those vitamins. Does that make Ramen+Vitamin pills a healthy diet? No. Does it prevent scurvy? You betcha.

  36. BillyJoe7on 28 Dec 2013 at 8:26 pm

    Wow, what a ridiculous comment!
    Have you even read the two articles and the comments?

    So what if natural news promotes fruit and vegetables ahead of supplements (do they?).
    Does that mean that SBM should automatically oppose it? Even if it’s science based?
    And do you really think that eating apples is like chewing on bark? Seriously?

    I’m sorry you find is so hard to get your apples and keep them fresh. Fortunately I live on the outskirts of suburbia and there’s a strawberry farm about five minutes drive away with an “honesty” cart full of fruit and vegetables. Their apples remain fresh for up to a week. Do I know how much “applein” in each apple? No. Do I care? No. I love apples. And strawberries. Apparently they’re loaded with more vitamin and minerals than any other fruit!

    And where exactly, in your rapid scanning of the article in order to get your rant off, did you see SN extrapolate wildly from people with adequate diets to those with inadequate diets?

  37. hUMBerton 28 Dec 2013 at 11:18 pm

    Thank you most sincerely, Dr. Novella, for this fine piece. Vitamins and their efficacy are one of the most frequently discussed medical topics online, but your summary elegantly cuts right to the general heart of the matter.

    You speak briefly about picky-eating kids, but recently there has been a significant increase of research interest in similarly picky adults (i.e., adults who are averse to a great many foods, typically for psychological reasons that are very difficult to treat), a subgroup of which I must, alas, count myself a member. (In my own case, during a very long hospitalization in permanent traction as a young child, I became extremely averse to the horrible food that was literally forced by the nurses’ thumbs into my unwilling mouth). It turns out we’re more common than previously suspected.

    In a hypothetical Venn diagram of eating pathologies, I’m also in the intersection with those who struggle daily to eat anything at all (along with many elderly people). I’m sure you can imagine the overwhelming difficulty we face in even fantasizing about the ideal of a healthy, balanced diet, for who wants to go through the tribulations of cooking something they absolutely loathe eating?

    As you can readily grasp, we look to processed foods and vitamin supplementation as a last gasp of hope. No cooking or eating something literally nauseating required.

    But with all the enormous quantity of often vitriolic contempt hurled at both of these (please do not imagine I’m including yourself or any other genuinely scientific mind in that categorization!), even that tiny hope seems to be dashed. Previously, I thought a product like Ensure drinks (in the US) were a good answer, but milk-based Ensure drinks are difficult for me to force down (but not because I was lactose-intolerant, which I’m not, but only because they’re very unappealing). So when a non-milk-based version of Ensure (Ensure Clear) came out, I was delirious. However, they’re all stock full of vitamins, and now that I’ve read your article (and others like it), I realize that these drinks have little benefit either!

    Oh, well.

  38. tmac57on 29 Dec 2013 at 9:59 am

    Point of fact: Apples will keep well for weeks in a refrigerator.They like potatoes and onions are especially easy to store for long periods if kept cold.

  39. Fitness Health Rxon 29 Dec 2013 at 5:25 pm

    Interesting article, I do believe there are some vitamins that have a positive impact towards your health and there is some studies to prove. Some are junk, some deliver as promised.

    Great article, thank your for sharing.

  40. Mlemaon 30 Dec 2013 at 3:38 am

    tmac57 – that is a good point. And here are what I hope are helpful hints for storing for anyone interested:

    potatoes should be kept cool, dry and in the dark (not fridge, which will cause their flavor to change and they will turn dark)
    onions also dry and dark (until cut, then they can go in the fridge – but not forever)
    don’t store onions and potatoes together – they’ll rot faster
    tomatoes: room temp until cut

    mostly cool and dry (think root cellar)

    also, with carrots and celery I’ve found that they will stay firm for a very long time if they are wet. If I want to store them, I don’t clean them, but instead rinse them and wrap a bounty towel around them and then saran wrap. i have been shocked at how long they’ll stay firm (I hate it when I take a carrot out of the fridge and can bend it in half.) :P

  41. ccbowerson 30 Dec 2013 at 10:08 am

    “… seriously? Why take an Aspirin when you can chew on bark? Apples rot. Not everyone has a grocery store right around the corner.”

    Umm, apples are food, and we are talking about supplements NOT being a substitute for a healthy diet for the population studied. That is the point of this, and that had nothing to do with the Natural News (‘nice’ nonsequitur), because this is not ideologically motivated, and is based on the best evidence available. If you like bark, then eat it, but most bark is not delicious. Also, aspirin is not a vitamin or supplement- it is a medicine, so your analogy doesn’t apply. You are all over the place and it really doesn’t make much sense.

    “As much as I like good cooking, there are weeks when I have no time for anything but ready-to-eat foods, which commonly contain very little of some vitamins that are destroyed by cooking (which is necessary for their preservation).”

    It looks like you might be the one motivated to deny what the data indicate. You don’t have time to eat healthy food for weeks? As other people pointed out, there are many foods (ironically, including the apples you mentioned ) that keep for weeks if stored properly, and take no more time than Ramen and beef jerky.

    But apparently you prefer to believe that multivitamins are making up for your dietary choices. OK. Yes, it will prevent scurvy or beri beri, but that is not the bar most of us are setting for our diets.

  42. ccbowerson 30 Dec 2013 at 10:16 am

    Mlema-

    For good information on produce storage, Cook’s Illustrated has a nice 2 page guide. It’s pretty basic, and they have more detailed information elsewhere, but it is pretty good overview.

    Unfortunately, most of their content is not free (I am a subscriber), but I did find a website that has the PDF. The good thing about CI is that they often test various methods of storage (a test kitchen approach) and recommend the ones that work best.

    http://www.rifoodcouncil.org/sites/default/files/Cooks-Illustrated-Produce-Storage.pdf

  43. Mlemaon 30 Dec 2013 at 7:10 pm

    ccbowers – thanks – What a convenient guide! I forgot about squash – you can pretty much throw squash in the closet with your boots and whenever you find it there again you can still eat it :)

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