More On Supplements

Dov Michaeli

Posted 1o/16/11 on The Doctor Weighs In

I know when I tread on people’s cherished beliefs when I get pushback from readers, some of it ,let’s say, quite emotional. But that’s good.

It is important that we challenge our beliefs, and if the sacred cows don’t stand up to scrutiny, we should slaughter them (to our Hindu readers – I meant it as a metaphor, honestly).

The October 14 of MedPage Today had an interesting article on the issue of vitamins and other food supplements. Highly recommended. Here are a few choice quotes:

“As the dust begins to settle, physicians interviewed by MedPage Today and ABC News agreed on a bit of simple wisdom –a healthy diet is more important than a fistful of supplements”.

“I had already asked my patients to stop their vitamin supplements four to five years ago, with the exception of those with a deficiency of vitamin D, …pregnant patients [who should get] folate and prenatal multivitamins, or those with cognitive impairment, when I would recommend vitamin B complex”, Albert Levy, MD, a primary care physician in New York, said in an email to MedPage Today and ABC News.”

“And there is sure to be pushback from the largely unregulated dietary supplements market –estimated to be a $20 billion industry – which has already launched multiple critiques of the latest evidence.”

David Katz, MD, of Yale’s prevention research center told MedPage Today in an interview:

“What we had was a notion that this was an insurance policy. Many people don’t eat the way they ought to, so they are not getting the optimal doses of nutrients from foods. Instead, we can rely on on a pill that ought to do some good, and certainly couldn’t do you harm. That was the thinking. But more studies suggested that health outcomes in patients taking multivitamins appear to be slightly worse”.

“Considering the weak basis for recommending multivitamins in the first place”, Dr Katz said, “when you combine that with evidence that
maybe it could hurt, the rationale for making routine use of multivitamins goes away”.

Which Supplements are Supported?

“That’s not to say supplements shouldn’t be used at all,” Katz said. He recommends omega-3 fatty acids and vitamin D for most of his patients, plus calcium for women. Prenatal vitamins and folic acid supplementation are also on the list. There is evidence behind those supplementations, he said. The GISSI trial found cardiovascular benefits for omega-3. Study after study has shown that the majority of Americans are deficient in vitamin D, and the supplement study included more positive finding for folic supplementation around the time of conception. As for the rest of supplement lot- give them only in the face of deficiencies, Katz said.”

Why don’t they Work?

“It’s not clear why these vitamins don’t do why they’re expected to do, and researchers are actively looking into why. [Patients] should
stop trying to look for health in a pill, Lee Green, MD, of the University of Michigan, said in an email. Health is not found in pills. It’s found in good food and regular exercise. There is something in our psyche that makes us want to believe in magic, and that desire to believe has focused on vitamins.”

So far for MedPage Today.

The politics of dietary supplements

So with all this evidence, how is it that this industry is unregulated? How could they mislead the public for so many years without a peep from the FDA? Chalk this one up to our peculiar form of democracy.

The state of Utah is the home for the multibillion dollar industry, and they own the influential senator from Utah, Orrin Hatch. They funnel millions of dollar to the coffers of his PAC, ensuring that their guardian angel stays on duty in Washington D.C. When the evidence mounted that certain supplements are not just useless, but outright toxic, certain senators’ onsciences began to bother them; they proposed to put the supplements under the FDA jurisdiction. Hatch’s son, a lobbyist for the industry,”worked” the Congress, but failed to derail the bill coming before the senate. So Hatch Senior pulled the ultimate senatorial weapon: he promised to filibuster to death the FDA authorization bill if the supplement industry is not exempted from any future regulation. And this is why we are where are today.  Shouldn’t the “occupy Wall Street” protesters widen it to “Occupy D.C.” as well?

Final thoughts

So will all this evidence change minds? Will there be a massive desertion of the multivitamin cult by consumers? I doubt it. We are behaviorally addicted to our multivitamin pills. We fear that we are exposing ourselves to disease, or at least to sub optimal health. I found myself reaching for the multivitamins this morning, and had to argue with myself that it’s time to kick the habit. I was successful; I am sure tomorrow is going to be a lot easier. Just like any going-clean process. Try it.

Dov Michaeli MD PhD is a basic scientist. He writes at The Doctor Weighs In.