A response published today in the Annals of Internal Medicine by four well-known nutrition researchers takes strident issue with an editorial published in the same journal that multivitamins are not useful. The authors of the first paper “ignored decades of nutrition research and diet monitoring of the U.S. population to reach this misleading conclusion,” the researchers wrote.
The researchers reasoned that multivitamins help fill nutritional gaps, improve general health, will cause no harm and are easily worth the few cents a day they cost.
To “call the case closed” is wrong and “misinforms the public and the medical community,” the researchers wrote. Their statements were a response to the editorial that ran in the same publication in December of last year that argued that such supplements are unnecessary. The editorial received widespread publicity.
The statement was authored by four nutrition experts: Balz Frei PhD, chairman of the Linus Pauling Institute at Oregon State University, Bruce Ames, PhD, of the Children’s Hospital Oakland Research Institute, Jeffrey Blumberg PhD, of Tufts University and Walter Willett MD, of the Harvard School of Public Health.
Critical shortfalls in nutrients
“The editorial focused on chronic disease,” Frei told NutraIngredients-USA. “The authors selected trials that they said proved their point that multivitamins don’t prevent chronic disease. They basically argued that there is no need for them and they may actually cause some harm.
“But they ignored all the beneficial effects. The primary benefit is that you make sure you meet the recommended dietary intake of each vitamin and essential mineral,” Frei said.
The researchers quoted public health statistics that outline what they characterized as critical shortfalls in the typical American’s nutrient intake. For example, 92% of Americans do not consume the recommended amount of either vitamin D or E; 61% don’t consume enough magnesium and 50% don’t take in enough calcium or vitamin A.
“Why don’t we get enough? I wouldn't say that it’s because foods now are nutrient deficient. It’s because we are not eating what we are supposed to eat. There are these dietary guidelines and they are very nice but no one is following them,” Frei said.
“To assume that everyone is on an ideal diet is naive and I think in fact irresponsible,” he said.
Large trial data
The researchers cited data for the efficacy of multivitamins in reducing the risk of certain diseases that was gathered the largest and longest RCT using a multivitamin and mineral supplement, the PHS II (Physicians’ Health Study II). That study found an 8% reduction in total cancer incidence in male physicians who used a multivitamin. The incidence for total and nuclear cataracts was cut by 9% and 13% respectively.
“The medical community argues that 8% was not a big effect,” Frei said. “Well, it was statistically significant and should be accepted as a positive result. The medical community argues we should repeat the trial. Well, that’s not going to happen. NIH (the National Institutes of Health) is not going to spend another $35 million on a new trial.”
Bottom line: cheap insurance on essential nutrients
Frei said the important point to keep in mind that the discussion is not about a pharmaceutical that might or might not have the advertised effect on a certain disease process. Vitamins and minerals have essential roles in the body’s functioning, and to cite the dangers of possible overdosing is obfuscating the issue. The authors of the editorial cautioned about the dangers of vitamin A and E, but those worries are based on extremely high doses.
“They are talking about doses that exceed the tolerable upper intake level. We are discussing here levels in the vicinity of the RDA. We clearly state that vitamin A, for example, should not be consumed long term in excess of the recommended levels,” he said.
“It’s irresponsible to ignore decades of nutrition research and tell the people of the United States they have no need for a supplement that could be so helpful, and costs as little as $1 a month,” Frei concluded.