Health: Vitamin hope or hype?
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“Stop wasting your money on vitamins” and “enough is enough” when it comes to vitamins, declare recent headlines. Many of our readers take supplemental vitamins in an effort to prevent disease and should be alarmed by these proclamations that expunge vitamins. As usual, the devil is in the details, particularly with supplement studies, and these devilish headlines deserve a more critical look.
Vitamins are in the news this week because of a study titled “Oral High-Dose Multivitamins and Minerals After Myocardial Infarction.” It was published in the Annals of Internal Medicine by lead author and cardiologist Gervasio Lamas, M.D. I was particularly interested in the outcome as our office was one of the study sites for this National Institute of Health sponsored trial. Moreover, the vitamin used in the study, the Ultra-Preventive from Douglas Labs, just happens to be the very one that I have personally taken for many years.
The study involved 1,708 patients aged 50 and older with pre-existing heart disease. They were followed for almost five years. The treatment group received the vitamin supplement and the control group took a placebo. The primary end point was time to total death, recurrent heart attack, stroke, coronary revascularization, or hospitalization for angina.
About 46 percent of the study participants quit taking the vitamins; amongst the ones that did continue them, 75 percent took the vitamins for one year and about 50 percent took them for three years. The results showed the treatment group had an 11-percent reduction in end-point events, which was not considered significant as the study was powered to have a positive result only if there was a 25 percent or more reduction in events.
First of all, this was a “secondary prevention” study that looked only at cardiovascular events in patients that already had cardiovascular disease. A “primary prevention” study is when the participants don’t yet have the disease in question. So the study did not address whether or not vitamins lower heart-disease risk in people who don’t yet have heart disease.
Second, the study had a huge dropout rate of 46 percent. Almost half of the patients in the treatment group did not take the vitamins, so any positive benefits would be diluted. Perhaps the 11-percent reduction in events might have made the “significant” 25-percent level if all participants actually took the vitamin.
Third, a 25-percent reduction is setting the bar very high to show significance. There are hardly any drug studies that set effect thresholds for significance this high. If a new drug lowers risk even 10 percent, it is typically hailed as a great success. By setting the event threshold so high, it would seem this vitamin study was designed to fail.
Last, is the relatively short length of time for analysis of the outcomes. The evidence of benefit increased as time went by, so a longer study period may well have led to a significant reduction in events. Expecting vitamins to make much difference over a period of a few years is perhaps a bit unrealistic.
Despite the generalizations and negative opines about vitamins, there are numerous studies that do show significant benefits of vitamins in disease prevention.
The “Antioxidant vitamins and coronary heart disease risk” study analyzed nine studies that totaled 293,000 people who were observed over a 10-year period, and found a 25-percent reduction in heart disease in people supplementing more than 700 mg per day of vitamin C (Knekt, 2004).
The “Multivitamins in the prevention of cancer in men: the Physicians’ Health Study II randomized controlled trial” showed “daily multivitamin supplementation modestly but significantly reduced the risk of total cancer” (Gaziano, 2012).
The “Supplementation of Vitamins and Mineral Antioxidants” study was a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals which showed “after 7.5 years, low-dose antioxidant supplementation lowered total cancer incidence and all-cause mortality in men but not in women. Supplementation may be effective in men only because of their lower baseline status of certain antioxidants, especially of beta carotene” (Hercberg, 2004).
BE WARY OF VITAMIN STUDIES?
Truly, most studies do not show much benefit from vitamin supplements. But to be honest, most vitamin studies seem to be designed by those who know little about nutrition or vitamins. Many studies rely on less reliable questionnaires about vitamin intake, with little or no specifics as to compliance or exactly what vitamins were taken.
To simply consider just any “multivitamin” as worthy is foolish. Most multivitamins on the grocery store shelves are either fraudulent or contain ingredients closer to limestone than something found in our diet.
Also, many studies, such as the infamous “Selenium and Vitamin E Cancer Prevention Trial” use only one form of a vitamin instead of the full spectrum found in nature. In this study, vitamin E was found to cause an increase in prostate cancer risk, but only one of the eight naturally occurring forms of vitamin E was used. We know from other research that by doing this it causes a deficiency in the anti-inflammatory vitamin E form called gamma-tocopherol, which clearly could skew results.
Very few vitamin studies use a high quality, comprehensive vitamin, in a randomized controlled fashion. Our feature study did just that, and the results were positive, despite the limitations.
During my regular seminar on how to choose vitamin supplements, I spend the first 20 minutes or so talking about diet and nutrition. That is to emphasize supplements are just that, a supplement to a healthy diet. Our first and most important medicine is nutrition, and our primary source is food. So don’t think of vitamins as an excuse for a lousy diet.
I’d love to see a study that used a high-quality vitamin such as the Ultra-Preventive in a randomized, placebo-controlled trial that extended out 10 years or more. Still, until the evidence convinces me otherwise, I’m going to keep taking my daily multivitamin.
GJ Free Press health columnist Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call 970-245-6911 for appointments or more information.
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