Dec 17 2013

Strike Three for Multivitamin Use

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32 Responses to “Strike Three for Multivitamin Use”

  1. Kawarthajonon 17 Dec 2013 at 9:43 am

    Problem is that people are increasingly turning to “naturopathic doctors” as their primary health care professional, at least in Canada (I have a number of friends and co-workers who have done this). These “professionals” often prescribe multivitamins or taking large doses of a certain vitamin, as they have with my friends and co-workers. According to these studies, this practice at the very least is a huge waste of money and will have little or no impact on their health. At worst, they could be making their patients sicker or turning healthy people into sick people.

  2. Steven Novellaon 17 Dec 2013 at 9:57 am

    I agree. Naturopaths generally massively overprescribe supplements. It’s what they do.

  3. KeithJMon 17 Dec 2013 at 10:25 am

    I think this line “While you can absolutely prove a null effect, ” should be ‘While you cannot absolutely prove a null effect, ”

    Interesting article. I wonder how many elderly people on fixed incomes are spending way too much money on vitamins while struggling to find money for healthy food, prescriptions or doctor’s appointments.

  4. tmac57on 17 Dec 2013 at 10:52 am

    Juicing has become quite the fad (again) especially among young people. On the face of it,it would seem to be a way to get more fruits and vegetables into your diet,but I wonder,since it removes all the fiber (a negative) ,and takes quite a lot of these to make a single serving (drink),could they be getting too many vitamins in this concentrated juice? Too much of a good thing?

  5. sciberdogon 17 Dec 2013 at 3:05 pm

    My wife and in-laws are educated and skeptical on nearly all topics, but they have a blind spot for vitamins and supplements, of which they take plenty. Their common argument is they can’t always tell how many vitamins they are getting daily from the foods they eat (or they can’t spend the time reading every label and doing the math every day), so it’s therefore best to take multivitamins to shore up any potential deficiencies.

    We are all generally healthy and don’t eat a lot of junk food or fast food, but I don’t honestly know if I get “enough” servings of fruits and vegetables each day, so they tell me I need vitamins. And we have a tough time getting our two children (ages 6 and 7) to eat their vegetables, as do all parents I’m sure, so do they need children’s vitamins?

    In most news reports on the recent article, I hear the “other side” complain that the studies use people with very healthy diets, so it doesn’t reflect most of the population. Even your article’s conclusion notes the answer is “a well-rounded diet with plenty of fruits and vegetables.”

    So where is the line in the sand? How many fruits and vegetables and vitamin-rich food do adults and children need to eat before they do not require vitamin supplements? Or maybe a better question is: how bad does one’s diet have to be before taking vitamins is a reasonable thing to do, or is it never reasonable unless you have clear signs of particular vitamin deficiencies?

    It’s that gap between eating super healthy foods and eating total junk where most Americans live and what many vitamin ads exploit as the reason additional vitamins are necessary. It seems like educating the population (and giving clear case studies) on the lack-of-value of vitamin supplements as it relates to their current diet, as opposed to their ideal diet, is the key to reducing unnecessary vitamin supplementation.

  6. Kawarthajonon 17 Dec 2013 at 3:18 pm

    sciberdog:

    I am not a doctor, but my understanding (someone please correct me if I’m wrong), but your diet has to be really atrocious to develop any kind of vitamin deficiency, with some exceptions. Most people in the Northern lattitudes develop a vitamin D deficiency and some people with medical conditions or other conditions (like severe drug/alcohol addictions) can develop other vitamin deficiencies. People who take excessive amounts of vitamins are stressing their bodies out, as their various cleansing organs are trying to get rid of the excess (i.e. kidneys, liver). I believe that excessive amounts of vitamins can actually poison you (i.e. too much vitamin A can lead to liver damage, too much vitamin C can harm your kidneys). Some studies on vitamin supplements have had to stop mid-way because of the increase in risk of developing diseases.

  7. Steven Novellaon 17 Dec 2013 at 3:27 pm

    Bottom line – even if your diet is poor, taking vitamins does not appear to make up for it. You need to improve your diet.

    Bad diet + vitamins does not equal healthy
    Good diet does not require vitamins

    The exception is those who have selectively removed things from their diet. For example, vegetarians can easily become B12 deficient and may need to supplement. So again, only targeted supplementation makes sense.

  8. sciberdogon 17 Dec 2013 at 3:47 pm

    I think it’s the “Bad diet + vitamins does not equal healthy” argument that isn’t reaching the masses. Or more specifically the supplement industry has successfully marketed the idea than if your diet isn’t 100% perfect then vitamins will help you make it 100% perfect. That’s what I hear the most and what I’d like to see refuted more often in the media.

    Until the masses are hit over the head that it’s all BS, that vitamin supplements are never the answer except for specific deficiencies, money will continue to be wasted and Big Suppla will continue to get Billions Bigger.

  9. Eric Tergersonon 17 Dec 2013 at 5:12 pm

    Is this idea that we need multivitamins and ‘supplements’ possibly helped along from the RDA percentages on our food labels? *anecdote incoming* I’ve heard people make the argument that you can’t get “100%” of all your vitamins and minerals from food alone by adding these numbers down to the minutiae.
    A daily recommendation doesn’t necessarily mean deficiency if it isn’t met every day, for every category. Also, can these values be misleading, when people can focus on non-caloric nutrients, while forgetting about or not noticing high calorie or sodium contents?

  10. TheFlyingPigon 17 Dec 2013 at 5:52 pm

    I’ve been taking a multivitamin semi-regularly since I was a kid… it just makes sense. However, in light of the evidence against them (some new, some old), I plan to throw away the remainder of my supply and never bother with multivitamins again.

    This is the second health practice I’ve dropped since starting with Neurologica and SBM. Thanks for the great content.

    TFP

  11. Will Nitschkeon 17 Dec 2013 at 10:08 pm

    Person A doesn’t get regular blood tests or medical check-ups, but has a vitamin deficiency. Will the multivitamin provide a benefit?

    Are these studies able to answer the above question?

    If the answer is yes, do the benefits outweigh the negative impacts to other members of the population?

    Are these studies able to answer the above question?

  12. Steven Novellaon 18 Dec 2013 at 8:27 am

    Will – the answers are: maybe, no, NA, and no

    The real question is – if you don’t know your vitamin status, what are the chances that taking a multivitamin will help you, vs having no health impact, vs hurting you (through wasted resources, false sense of security)?

    These studies do inform that question. The answer is – no benefit.

    Another question is – when do you seek medical evaluation for possible deficiency? I don’t know what the evidence-based algorithm would be, but some reasonable advice is:

    - Definitely if you are symptomatic (in which case you would likely seek medical attention anyway)
    - If you have some reason to be concerned about your vitamin absorption (some GI problem)
    - You have a restricted diet for some reason
    - You are in a high risk population (pregnant, extreme athlete, chronic illness, etc.)

    The question mark is – is there any benefit to routine nutritional screening for those who are young and healthy? I suspect the answer is probably not, but would need to review the evidence, if there is any.

  13. Gojira74on 18 Dec 2013 at 4:15 pm

    My parents are vitamin supplement believers. My father argued for years that “well, I’m taking lots of vitamins, and I have no health issues.” Then he had two heart attacks in a row and required 4 stints. My mother made the same argument, then she got uterine cancer and hemolytic anemia. They were healthy until they weren’t, and until that point they avoided medical check ups and proper diet on the logic of “vitamins will fix it.”

    “I think it’s the “Bad diet + vitamins does not equal healthy” argument that isn’t reaching the masses. ” – Yes.

  14. ccbowerson 18 Dec 2013 at 4:54 pm

    I’ve always had a problem with the way people frame the multivitamin question. It seems that people are starting with the intervention (taking vitamins) as a given, and then looking for the evidence to justify that intervention- instead of what should be done: starting with the evidence and then making use of the interventions that have support for their use.

    I think that is because people see vitamins as being in their own category – inherently good, not like medications. I think that if the general public viewed vitamins and supplements more like (or just like) medications, we would have a better perspective. Part of the problem is that even our healthcare system isn’t set up that way… vitamins and supplements get very different treatment than medications. The reasons for this are largely historical and/or political, and although as a whole they probably have less risk, as a whole they are also lacking in potential benefit. Without benefit, even small risks can become detrimental over a large population.

    TFP- I am glad to see someone making a decision based upon evidence. I am curious as to the other health practice you “dropped.”

  15. Will Nitschkeon 18 Dec 2013 at 5:38 pm

    Steven, the reason why I asked is that you’re offering the advice not to take multivitamins. If there is a sub population that might benefit, and on condition that the benefit outweighs the negative impacts overall, that might be bad advice. Unfortunately, these studies don’t answer such a question either way. In a perfect world people would periodically get blood tests and medical advice.

    Let me put this another way by using an analogy. I have perfect teeth and I’m not a spring chicken any more either. A dentist once characterised me as a ‘genetic freak’ who will probably die with perfect teeth. Fluoridation is not something that benefits me or people like me; it’s also a poison. So there is a possible negative impact on me, even if tiny. Nonetheless, there is a benefit to other portions of the population.

  16. Steven Novellaon 18 Dec 2013 at 6:11 pm

    Will – you don’t know if you are in the subpopulation. If you do, then that is targeted supplementation, not general.

    You also don’t know that benefits outweigh the negative impacts overall.

    My advice was not based upon having knowledge we don’t have, so that is really irrelevant.

    What the evidence shows is – unless you have a known reason to take vitamins, there is probably no benefit to taking them.

  17. Will Nitschkeon 18 Dec 2013 at 6:53 pm

    Steven, we don’t know if sub populations may benefit and if they benefit, to what degree. Potential harm seems negligible. Point taken about acting without evidence, but that doesn’t rule out the possibility that the general advice not to take them is still wrong. There are known benefits to supplementation nonetheless. Someone with an iron deficiency who doesn’t know they have an iron deficiency might benefit from a multivitamin/mineral supplement although obviously tailed supplementation would be better. “Stop taking multivitamins” should not be the conclusion. The conclusion should be, if you insist on taking them, also get a health check up/blood test, and see if you actually require supplementation. Most people don’t. If you’re one of a small sub population that does, advice to stop taking multivitamins on its own may result in worse health outcomes for certain individuals. Your advice may be correct in a statistical sense but not in an individual sense.

  18. ccbowerson 18 Dec 2013 at 7:02 pm

    “If there is a sub population that might benefit, and on condition that the benefit outweighs the negative impacts overall”

    This is not what this article is about. Steve mentions targeted supplementation in the article, which is very different than routine multivitamin use by the general public. There are many instances of targeted supplementation that are reasonable and have evidence (folic acid and pregnancy, B12 supplementation in some elderly patients, supplementation after weight loss surgery, etc.)

    The point is that you should know that you are in such a group before beginning supplemention, or else what are basing it upon? Applied arcoss a large population it is important to emphasize that it is not a risk free intervention, and billions of dollars are wasted.

  19. Will Nitschkeon 18 Dec 2013 at 7:40 pm

    @ccbowers

    Billions of dollars are ‘wasted’ on over priced running shoes. I see little point in being fixated on how other people should spend their money. The question is, is this advice doing more harm than good? Probably neither. But nonetheless it might not be good advice.

  20. loquaciousmusicon 18 Dec 2013 at 8:54 pm

    Dear Dr. Novella,

    I was grateful to come across your blog post. (As an aside, I see you work at Yale; it was your colleagues at the Newborn Intensive Care Unit who saved my life when, in 1979, I was born at 2.1 lbs!)

    I am fascinated by the back-and-forth on this issue, as it seems to get to the heart of many Americans’ concerns about their health and well-being. When I spoke to my mother tonight about this issue, she was aghast. She claimed that, while she tries to eat healthily, she is not 100% sure that she is getting 100% of her RDA and wants to make sure that she has the multivitamin to act as a “backup.” To me, this strikes me as a reasonable argument, but I’m also intrigued by the idea that perhaps many (or most?) of us ARE getting a healthy dose of vitamins in minerals through the food we eat.

    More troubling, however, is that I haven’t seen anything written about the fact that — at least as I understand it — most vitamin deficiency happens over the long term. I truly believe that people like my mom believe that, if they do not get 100% of every vitamin and mineral on Monday, they will be deficient on Tuesday. It is my understanding that, when vitamin and mineral deficiencies do occur, they are the result of a prolonged lack of a particular vitamin or mineral or an ongoing issue with the ways in which a particular individual’s body absorbs these nutrients.

    I currently take a three-tablet-a-day multivitamin that very obviously provides far more vitamins and minerals than I need, as someone who eats a balanced diet and who is going to continue to investigate the ways in which I can add more fresh fruits and vegetables to my meals. Instead of throwing the bottle out, I’m just going to take one pill per day—instead of three—so that I don’t waste the money I’ve already spent. Then, in consultation with my doctor, and with the usual caveats about D3 and B12, I’m going to lean away from my multi, as you suggest.

    I appreciate your thoughtful response and the care with which you have approached this issue. In the end, the argument for or against multivitamins isn’t really about the multivitamins at all. It is about us: the way we view our health, the way we view our lifestyles, and our concern — our real, honest, and well-intentioned concern — for our own futures.

  21. Eric Tergersonon 19 Dec 2013 at 3:42 am

    Will, when you break down this choice to a ‘commodity’ framework, then you can make any comparison you want. However, we are talking about medical interventions. The science does not hold up when it comes to how these multi-vitamins are marketed, and used. There is real harm in the dietary actions that are avoided by people using these, thinking they will be immune to the ill effects of poor diet and a lack of excercise (ie effective interventions)

  22. rezistnzisfutlon 19 Dec 2013 at 4:42 am

    I get what’s being suggested here, that if consumers want to blow a hole in their wallet on vitamins, what’s the harm? Let them waste their money if they want to. One of the problem is the misinformation about supplements that are being spread – consumers should be allowed the opportunity to be (correctly) informed. Many manufacturers and proponents make all sorts of claims about vitamin supplements that simply either aren’t true, or have no basis for them, that’s why.

    Dr. Novella already went over what a person does if they are deficient, and how they would know, and I don’t think many people would disagree that improving the diet by itself will facilitate our needs.

    As far as the running shoes analogy, I’m not sure where they are a waste of money. Sure, some people may buy really expensive ones that aren’t really much more functional that cheaper ones, but as far as I know running shoes are valuable as running shoes. As a lifelong runner, I like the padding and support for the soles of my feet, the mesh sides that allow for ventilation, their light weight, and extra traction for when I run on varying surfaces. They are far from useless buys, though there would certainly be a limit on how much I’d spend, sure.

  23. BillyJoe7on 19 Dec 2013 at 6:54 am

    Will,

    Steven Novella is not telling anyone to stop taking their vitamins.
    He is informing them that the evidence is that, unless you have a specific deficiency, taking vitamins is probably of no benefit.

    If someone who is taking vitamins, reads this information and decides to discontinue to take them, the most likely result is that he will be neither helped nor harmed. There is a small possibility that this person has an unrecognised deficiency and that he will be harmed by discontinuing to take them. But there is also a small possibility that he has a condition where he will be saved from harm by discontinuing to take them (eg haemochromatosis)

    (Similarly, if someone who is not taking vitamins, reads this information and decides to continue not to take them, the most likely result is that he will be neither helped nor harmed. There is a small possibility that he has an unrecognised deficiency and that he will be harmed by not taking them. But there is also a small possibility that he has a condition where he will be saved from harm by not taking them.)

    So, let everyone decide for themselves whether or not to start taking or to stop taking vitamins. But let us not hide the scientifically derived facts from them. After all, we want them to make an informed choice don’t we?

  24. TheFlyingPigon 19 Dec 2013 at 5:51 pm

    ccbowers,

    The other health intervention I dropped was taking Melatonin. I took it to try to pull on my circadian rhythm to help me wake up earlier. Also, I thought it helped me fall asleep more quickly. But according to what I’ve read around here (and other research spurred by these blogs), it’s very unlikely the melatonin was doing any good. I still try to maximize morning light exposure and minimize evening light exposure… it seems reasonable to conclude that doing so helps to keep me waking up early, which is convenient for me.

  25. Will Nitschkeon 19 Dec 2013 at 8:02 pm

    @BillyJoe7

    “Will,
    Steven Novella is not telling anyone to stop taking their vitamins.”

    Actually, he is.

  26. TheFlyingPigon 19 Dec 2013 at 11:01 pm

    Another thanks I should add… I’ve given up multivitamins and melatonin thanks to Neurologica and SBM, but I’ve also become more concerned with my blood pressure. I have about 2 months to go on my fitness plan… lots of exercise, and a weight target. But because of these blogs, I’m taking multiple daily readings of my blood pressure because Harriet Hall mentioned that variable blood pressure is a risk factor for health issues like stroke (and following comments mentioned success at maintaining stable levels with medication). And I’ve seen the devastating effects of strokes… frightening. My blood pressure in general has been on a townward trend with weight loss, but now its variability concerns me. I’ll present data to my doctor and accept the possibility that blood pressure drugs might be the right thing even at my target weight/fitness levels.

    My thanks and love go out to Dr. Novella and other MDs at SBM.

    Thank you and keep up the good work; you all make my life better.

    TFP

  27. Mlemaon 20 Dec 2013 at 3:44 am

    TheFlyingPig, if you have high blood pressure lower your salt (sodium) intake. Also, make sure you are getting enough potassium every day. (magnesium and calcium may help as well)
    foods with those minerals:
    http://www.nhlbi.nih.gov/hbp/prevent/factors/supls.htm

    If people want to ensure they get enough vitamins and minerals in their diet, there are good resources online. I guess you could find out what your RDA is and then try to match it to your foods. Once you knew better what to eat and how much it probably wouldn’t be too difficult to practice long term.

    Also, the more fruits and vegetables you eat, the more pesticides you eat. Please be careful everyone.

    Dr. Novella, apples and strawberries tend to be high in pesticide residue. Please consider organic as a way to reduce your daughters’ intake. Thank you.
    http://www.ams.usda.gov/AMSv1.0/getfile?dDocName=STELPRDC5091055

  28. rezistnzisfutlon 20 Dec 2013 at 4:55 am

    Mlema,

    Organic can have pesticides on them, as well as a higher risks of pathogens (the link you provided even indicates this in Appendix B). Going organic is no guarantee of safety or even increased safety. Furthermore, you’re making the massive assumption that the amount of pesticides on fruits and veggies is linked to harm. The advisory the USDA lists in the article does mention rinsing as a precautionary measure, but nowhere does it indicate a diet rich in fruits and veggies puts anyone at particular risk of harmful pesticide exposure. As usual, your conclusions about foods don’t match your premises.

  29. Mlemaon 20 Dec 2013 at 9:56 pm

    rezistnzisfutl, I’m allowed to voice my concern. Organics have much less pesticide residue. Apples and strawberries are high on the list of residue. Strawberries are difficult to wash. If you peel the apple you lose a lot of the nutrition. You can’t wash off that which has accumulated in the fruit. Small children and people who have certain health problems should avoid eating pesticides. In my opinion we should all avoid eating pesticides. This isn’t a statement about agriculture – it’s meant as a helpful suggestion.

  30. rezistnzisfutlon 21 Dec 2013 at 1:26 am

    ” Organics have much less pesticide residue”

    Where are you getting this from? Organics use just as much pesticides as conventional crops, and you have yet to back up any of your claims of pesticide residues linked to health issues with any sort of scientific evidence. What little pesticide residue found on fruits and veggies, especially if they’re rinsed off, is a far cry from downing a bottle of it, or showering in it.

    The only exceptions would be individual small farms that choose not to use any sort of chemical pesticides, but you won’t find that in most stores, and they can be found as certified organic or not.

    Yes, of course you’re allowed to voice your concern, just like I’m allowed to challenge you on your factual claims, of which you have made many. If you’re going to post claims on a skeptical forum, especially wild ones that have little, weak, or no evidence supporting them, then it’ll be pointed out. Honestly, I’m not trying to be mean or give you a hard time specifically, but you seem to be misled on some things.

  31. rezistnzisfutlon 21 Dec 2013 at 1:29 am

    I don’t think you’ll find many people who would disagree that, ultimately, reduced pesticide use is generally a positive thing. However, it would only be positive if the outcome didn’t result in greatly reduced crop yields and inferior produce. The “green revolution” included the use of chemical organic and inorganic pesticides and is largely responsible for the significantly improved yields.

  32. Mlemaon 22 Dec 2013 at 3:58 am

    rezistnzisfutl,

    “Organic can have pesticides on them, as well as a higher risks of pathogens (the link you provided even indicates this in Appendix B)”

    I don’t see where appendix b indicates either of these two things. The paper covers pesticides on fruits and vegetables without differentiation of organic. And no pathogens are discussed.

    Please provide your evidence for your claim that organic food has “a higher risks of pathogens”.
    From what i’ve read this seems to be based on a theory that using manure increases the risk of “pathogens”. In reality, organic food is safer because certified organic farms must follow rules on how they use manure. When applied, these practices reduce harmful bacteria.
    http://www.researchgate.net/publication/228028844_Produce_Safety_in_Organic_vs._Conventional_Crops
    Conventional farms use manure without restriction. Also, feeding nitrates to crops (As in conventional farming) makes plants more susceptible to fungal growth.
    Perhaps you can find some data to for us to examine regarding “pathogens”.

    Research and recall history indicate that organic food is safer than conventional (even allowing for the small % of food supply which is currently organic)
    and more nutritious:
    http://www.ph.ucla.edu/ehs/ehs100/Nutr%20quality%20Organic%20vs%20commercial%20grown%202011.pdf

    http://www.ncbi.nlm.nih.gov/pubmed/17297755

    There’s an overall 81% lower risk or incidence of one or more pesticide residues in organic food samples compared to the conventional samples.
    and
    most residues in organic food occur at much lower levels than in conventional food
    multiple residues in a single sample are rare in organic food but common in conventional produce
    high-­risk pesticides rarely appear as residues in organic food, and when they do, the levels are usually much lower than those found in conventional food
    and organic has:
    higher mineral content
    lower nitrate content
    less antibiotic-resistant bacteria
    higher Vit C
    higher flavonoids, phenols
    less mercury
    more dry matter (more nutrients per unit weight of food)

    I do agree with you that the “green revolution” has increased our food production, and we would be unable to continue to produce the amount of food that we do if we suddenly did away with pesticides and fertilizer. HOWEVER – as much as we apply them, we will benefit from directing resources toward more sustainable practices (all those that maximize our current knowledge of agricultural science: crop rotation, conservation tillage, pasture-based livestock husbandry, exploitation of natural biological cycles and controls, etc.)

    if you’re not happy with the links I’ve chosen – I will do my best to meet your standards. However, I would ask that you likewise provide support for your own statements. More than once you’ve aksed me “where do you get this from?” So, I will ask you the same.

    http://www.hsph.harvard.edu/news/hsph-in-the-news/buying-organic-food-is-worth-it-hsph-prof-says/

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