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Guest editorial: Steve Mister, President & CEO, CRN

Multivitamins – They Won’t Wash the Windows or Change the Oil Either!

13-Nov-2012

Positive results of the Physicians’ Health Study II show that supplement users - usually more likely to have healthier lifestyles than non-users - may gain potential additional benefits from a daily multivitamin. In this special guest article, Steve Mister, President & CEO for the Council for Responsible Nutrition (CRN), welcomes the results but cautions on understanding the limitations of supplements - 'we shouldn’t expect vitamins to perform miracles'.

"This week, JAMA published the results of the second supplement arm of the Physicians’ Health Study II. Last month, the first arm was released, indicating that multivitamin use had a modest but significant reduction on the risk of cancer among the middle-aged and older, healthy, predominantly white male physician population taking a daily multivitamin in the study.

That is certainly good news for the 42% of American adults who regularly use a multivitamin for better health.

Now comes this new aspect of the study which indicates that, among that same group of physicians, the multivitamin apparently did not reduce their risk of major cardiovascular events .

Disappointing news for consumers? Yes. But reason to throw out your multivitamins? Hardly. It sure would have been nice if the study gave us one more reason to recommend multivitamins, but perhaps this is a good wake-up call too: We shouldn’t expect vitamins to perform miracles.  

Multivitamins supplement a healthy diet by providing a range of nutritional benefits, but they are not a magic bullet. They don’t wash the windows, clean dust bunnies out of the corners, or change the oil in our cars either.

But before discounting the multivitamin too quickly, it’s also critical to understand the limitations of the study. The study’s authors noted that “…several behavioral…and pharmacological…interventions are available to effectively lower CVD risk. This may make it difficult for vitamin supplements such as a multivitamin to meaningfully contribute toward risk reduction.”

In other words, these middle-aged and older, mostly white male doctors already had relatively healthy diets, healthy BMIs, they exercised, very few smoked, and the majority was on a daily aspirin regimen.

All of these healthy behaviors lower the risk factors for heart disease.  It would have been nothing short of amazing if, in this population that was already doing everything right to prevent heart trouble, the participants had seen even further risk reduction simply by adding a multivitamin. 

As CRN’s head scientist put it, “The floor in this population may have been too close to the ceiling for a multivitamin to have demonstrated additional benefit.”

"Vitamins and other unproven supplements"?

But then things get weird, and quite frankly, disappointing for a journal of JAMA’s stature. JAMA published a commentary (by a separate author) that accompanied the PHS II study. She wrote, “Many individuals and societies as a whole resort to the use of vitamins and other dietary supplements as a simple and miraculous escape from the difficult and complex task of implementing effective prevention strategies.”

She suggests the regular use of vitamins and other dietary supplements in the “hope that this approach will prevent a future myocardial infarction or stroke” is a “distraction  from effective CVD prevention [and] is the main hazard of using vitamins and other unproven supplements.”

She chides that sedentary lifestyles, processed or fast foods, continuing to smoke, and failing to adhere to one’s regimen of lifesaving prescription medications are the real causes for cardiovascular disease. Then she criticizes multivitamins as a culprit under the assertion that consumers will somehow believe that vitamins supposedly give us a “free pass” to continue those behaviors. REALLY? 

Tell that to all the supplement users who are more likely than their non-supplement-using counterparts to exercise, visit their docs, take their prescription meds, maintain a healthy BMI, and not smoke.  

To the contrary, numerous studies show that supplement users are more likely to be leaner and more physically active than non-supplement users, more likely than non-users to try to eat a healthy diet, more likely to engage in regular physical activity, and see a doctor regularly. The behavioral data directly refutes her assertion.

And then she opines that, “Robust data from multiple trials clearly confirm that CVD cannot be prevented or treated with vitamins.”  This, despite the fact that in the secondary analysis of PHS II there were fewer heart attack deaths among multivitamin users compared to placebo, which was even more prominent in participants with no baseline history of heart disease.

Because there were so few heart attack deaths during the study  – remember, this was a relatively healthy population – and this morsel was only discovered in the secondary analysis, I don’t want to overplay these findings, but it hardly slams shut the door as a “confirmation” that a multivitamin does not play a role in heart health. And I can’t help but wonder what effect the multivitamin may have had in a less healthy population.

Beyond multivitamins

Lastly, I can’t help but notice that the typical multivitamins—although they absolutely round out the recognized essential nutrients we may miss in our diets—are hardly formulated specifically for heart health. Nor are multivitamins usually advertised for that purpose.

There are other supplements that have demonstrated benefits for heart health—omega-3 fatty acids to help reduce triglycerides; plant sterols and stanols to help reduce cholesterol; vitamin B, niacin or magnesium (all at doses much higher than the RDA levels typically found in a multivitamin) for reducing homocysteine, cholesterol and blood pressure, respectively.

While these supplements are very effective for heart health, I would doubt most healthcare practitioners would recommend a multivitamin for that purpose. Like I said earlier, the earnest multivitamin is not a magic bullet.

Thank goodness most consumers seem to know that. The truth is that practicing a variety of healthy behaviors collectively contributes to better health. It may be impossible to “tease out” just one as the pivotal one. 

That’s what makes the earlier cancer-prevention aspect of the PHS II study that much more remarkable – in that case, the addition of the multivitamin did show a modest but significant reduction of cancer incidence, on top of everything else.

I’ve heard critics of the vitamin industry say things like, “you should act like the typical supplement user, just leave out the supplements.” However, it seems to me the PHS II studies refute that dogma.  Even among that healthy population, multivitamins seem to add a protective benefit, at least with cancer risk reduction, and maybe even with regard to heart health among a less healthy population.

So go ahead and act like the supplement user and practice a healthy lifestyle, but don’t forget to take your supplements."

Steve Mister, President & CEO, CRN

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