An editorial panel of medical doctors (MDs) says the case is now closed for multivitamins: they don’t help well-nourished adults. But leading trade associations have defended the safety and efficacy of the products, calling the editorial, ‘close-minded, one-sided’ and ‘overblown’.
Writing in response to three articles on vitamin and mineral supplementation published in Annals of Internal Medicine, MDs from Johns Hopkins, the University of Warwick in the UK, and the American College of Physicians wrote: “Beta-carotene, vitamin E, and possibly high doses of vitamin A supplements are harmful. Other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases.
“Although available evidence does not rule out small benefits or harms or large benefits or harms in a small subgroup of the population, we believe that the case is closed – supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful. These vitamins should not be used for chronic disease prevention. Enough is enough.”
The editorial has led to headlines like Forbes’ Case Closed: Multivitamins Should Not Be Used , and CNN’s Are multivitamins a waste of money? Editorial in medical journal says yes .
Cara Welch, Sr VP of Scientific & Regulatory Affairs for Natural Products Association (NPA), told us that the case is not closed. “The intention of supplements is to supplement the diet. Don’t expect supplements to cure the common cold or prevent cancer, but they are part of the puzzle of a healthy lifestyle.”
Steve Mister, President and CEO of the Council for Responsible Nutrition (CRN), said: “The editorial demonstrates a close-minded, one-sided approach that attempts to dismiss even the proven benefits of vitamins and minerals. It’s a shame for consumers that the authors refuse to recognize the real-life need for vitamin and mineral supplementation, living in a fairy-tale world that makes the inaccurate assumption that we’re all eating healthy diets and getting everything we need from food alone.
“We would not suggest that vitamin supplements are a panacea for preventing chronic disease, but we hope the authors would agree that there is an appropriate place for supplements. Given that government research repeatedly demonstrates that the typical consumer diet is falling short on critical nutrients, vitamin supplements are an appropriate option to meet those needs.”
The editorial is based on results from a sub-study of a large, randomized, placebo-controlled trial (The Physicians’ Health Study II), a study of high dose multivitamins and minerals in heart attack survivors, and the previously published systematic review from the United States Preventive Services Task Force (USPSTF) .
The PHS II sub-study, an analysis of 5,947 male physicians aged 65 years or older found no difference in cognitive function between the multivitamin and placebo groups. It is important to note that data from the whole PHS II study, which included 15,000 men, has previously shown that low-dose vitamins and minerals may reduce the risk of cancer by a modest 8% , while another report from the PHS II indicated no reduction in cardiovascular disease risk .
In contrast to the PHS II regimen, with its emphasis on low doses of vitamins and minerals, another study in the Annals of Internal Medicine found that there was no difference between high doses of multivitamins and minerals and placebo for cardiovascular events in people who had suffered a heart attack.
“In stable patients with a history of myocardial infarction and receiving appropriate, evidence-based medical therapy, the use of high-dose oral multivitamins and multiminerals seemed safe but did not statistically significantly reduce cardiovascular events. These conclusions must be interpreted cautiously because of a high rate of non-adherence to the study regimen,” wrote the researchers.
In the editorial, the authors wrote: “The large body of accumulated evidence has important public health and clinical implications. Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action.
“The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries.”
In response to the editorial’s claims, John Shaw, CEO and Executive Director of the NPA, said: “It’s extremely unfortunate to see this overblown editorial that aims to misinform consumers and attack our industry. It’s no secret that many consumers in this country don’t get the recommended nutrients from their diet alone, and multivitamin and mineral supplements are an affordable alternative. For the medical professionals who authored this piece to claim that the use of supplements is not justified, is, quite frankly, baffling.
“Consumers should in no way be deterred from continuing to take the products that contribute to their improved health on a daily basis, and we encourage all consumers to discuss their dietary supplement regimen with their health care professional.”
Regarding the safety issues, CRN’s Mister said that the USPSTF draft recommendation, the basis for which comes from a study in the same issue of the Annals of Internal Medicine, did not identify safety concerns for vitamins at nutritional doses.
“Specifically, several scientific authorities have dismissed the concerns raised by the editorial for vitamin E, including this USPSTF report, which states ‘The USPSTF found adequate evidence that supplementation with vitamin E has little or no significant harm’.
“The concerns around beta carotene are isolated to high doses in smokers, and are not a concern for the majority of consumers taking a multivitamin; we would however recommend that smokers pay strict attention to their beta-carotene intake under the advice of their doctor. The evidence does not indicate any real health risk for multivitamin use.
“Further, the authors attempt to ignore the very real benefits for reducing the risk of cancer and cataracts found in the Physicians’ Health Study II. These findings are even more impressive by the fact that the benefits were found in a well-nourished population, and we haven’t yet begun to explore the potential benefits for most Americans who are not eating a healthy diet and have nutrient inadequacies.
“So we agree enough is enough,” said Mister. “Stop the reductionist approach to nutritional research. Stop insinuating there is evidence of harm. Stop ignoring the scientific evidence that demonstrates there is value to getting your essential nutrients. There is plenty of scientific evidence that recognizes that vitamin and mineral supplements have a role in good health for all Americans.”
Sources: Annals of Internal Medicine
“Long-Term Multivitamin Supplementation and Cognitive Function in Men: A Randomized Trial”
Volume 159, Number 12, Pages 806-814. doi:10.7326/0003-4819-159-12-201312170-00006
Authors: F. Grodstein, J. O’Brien, J.H. Kang, et al.
“Oral High-Dose Multivitamins and Minerals After Myocardial Infarction: A Randomized Trial”
Volume 159, Number 12, Pages 797-805. doi:10.7326/0003-4819-159-12-201312170-00004
Authors: G.A. Lamas, R. Boineau, C. Goertz, et al.
Editorial: Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements
Volume 159, Number 12, Pages 850-851. doi:10.7326/0003-4819-159-12-201312170-00011
Authors:E. Guallar, S. Stranges, C. Mulrow, L.J. Appel, E.R. Miller III