Don’t Believe the News

It is a sad reality that there is very little in-depth news reporting of news, especially of health news. So we get a one or two day headline like “Experts Say Don't Waste Your Money on Multivitamins”.

Before you believe any of that you have to ask yourself three key questions:

• What experts?

• What studies?

• What multivitamins?

. I am not going to review all the studies that show the efficacy of vitamin and mineral supplements. I have a whole book about them. You can find a very brief summary here (in a new window).
World-leading peer-reviewed medical journals have lots of reputable, duplicated studies demonstrating the efficacy of supplementation. So the weight of experts and studies clearly support supplementation. You will also discover at that link why all supplements are not created equal and how you can determine quality.

WebMD summarized one study in the news as follows: “For the first study (Guall and O’Brien Annals of Internal Medicine), researchers randomly assigned almost 6,000 male doctors over the age of 65 to take either a daily Centrum Silver multivitamin or a look-alike placebo pill. Every few years, the researchers gave the men a battery of tests over the telephone to check their memories.” A placebo is a pill or tablet that looks the same as the one being tested, but it has no active ingredients. The study can be found at Ann Intern Med. 2013;159(12):806-814.

Unfortunately Centrum Silver is a mediocre product. An independent third party rated over 1600 multi-vitamin products on a scale of 1 to 5 stars. (MacWilliam, Comparative Guide to Nutritional Supplements 2007: Fourth Edition) The Centrum Silver used in this study rated 0.5 star. That’s right ½ star. So that is really like testing a placebo against a placebo. There are products that have been shown in double-blind placebo-controlled studies to protect the brain against cognitive decline. Multi-vitamins sometimes contain some ingredients, especially certain antioxidants that help protect against endothelial (arterial wall lining) dysfunction, one of the first serious signs of cardio-vascular disease. That helps somewhat by maintaining more efficient flow of blood providing nutrients to and exiting wastes from the brain. The other way multi-vitamins can help is if they have enough folic acid, B₆ and B₁₂ to keep homocysteine at a safe level as covered in detail in the previous Newsletter on homocysteine (new window)

Elevated homocysteine has been shown in a number of studies to be associated with increased risk of cognitive impairment and of Alzheimer’s disease. Other studies have shown the advance of Alzheimer’s can be slowed in patients in early stages who have elevated homocysteine. The simple supplements noted above work. But because they do not contain the key active ingredients that help protect against cognitive decline when homocysteine is not elevated, good antioxidants alone are not the answer. And with a rating of ½ star you can be sure that Centrum silver was not providing good antioxidants; all the required ones in the right ratio to each other and in a form that the body can easily absorb. Centrum Silver today has 3 mg of B₆; 25 mcg of B₁₂; and 400 mcg of folic acid. We have known since about 1995 that you need 27 mg/day of B₆, 60 mcg/day of B₁₂ and 1000 mcg/day of folic acid to lower homocysteine levels to safe, normal levels. JAMA 1995; 1049-57) So you can see that this study is de facto testing one placebo against another placebo. No wonder they found a null effect. To their credit the authors did note in the limitations of the study “Doses of vitamins may be too low … to benefit from a multivitamin”.

The second study by Lamas, Boineau et al found at Ann Intern Med. 2013;159(12):797-805 set out to assess whether oral multivitamins reduce cardiovascular events after a preceding heart attack. The results are at best inconclusive and seriously limited by “considerable nonadherence and withdrawal, limiting the ability to draw firm conclusions”.

The third study, a literature review, by Fortmann, Burda et al sought to “to systematically review evidence for the benefit and harms of vitamin and mineral supplements in community-dwelling, nutrient-sufficient adults for the primary prevention of cardiovascular disease (CVD) and cancer”. A major limiting factor in this study is that the researchers only included studies in which “supplement doses [were] lower than the upper tolerable limit set by the U.S. Food and Nutrition Board”. That is the dose level had to be lower than the Dietary Reference Intake, which is way below the level for optimal health. The studies were also limited to “adults without known nutritional deficiencies… and studies were conducted in older individuals and included various supplements and doses.” Thus there is no recognition that the number of ingredients, the necessity for certain ingredients, their ratios, quality, purity, and bioavailability are all factors determining the efficacy of supplements. So we already have a number of confounding variables. To their credit the authors did note there were limitations to their report.

Given all these considerable limitations how could this issue of the Annals of Internal Medicine preface these studies with an editorial irresponsibly titled “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements” and to go on to say “The message is simple: most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.” The conclusion is not supported by the evidence.

I am saddened to see that this journal has allowed its standards to lapse to this extent. What do you think? Would you like to see a more detailed analysis of these three studies?

The Take-Away

Yours in health and wellness,