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MOST people do not need multivitamins and should be warned they are flushing away their money, say Australian experts commenting on the latest study showing little evidence vitamin products do any good.
“Australians are probably second only to Americans in having expensive urine,” said Professor Colin Binns, professor of public health at Curtin University in Perth.
“I guess people want to take a pill to solve all of their ills rather than looking after their lifestyle ― diet, exercise, etcetera.”
Professor Ric Day, professor of clinical pharmacology at the University of New South Wales and St Vincent’s Hospital, Sydney, said toxicity had been described with excessive dosages of registered vitamin products and it was always important that patients not exceed recommended doses found on the labels.
“If individuals are well, eating a balanced diet, getting adequate sun exposure and not abusing alcohol, tobacco or other recreational drugs then they usually do not need vitamins,” he said.
An annual check with the GP was a good screen for an individual’s health and diagnosis of any vitamin deficiencies. Patients with chronic illness might need vitamin supplementation.
“Being on the look out for vitamin C, B group and D deficiency in the elderly is important,” Professor Day said. “(They are) much more prone to deficiency.”
The latest study on multivitamin use, reported in the American Journal of Epidemiology, found no clear decrease or increase in mortality from all causes, cardiovascular disease, or cancer and in morbidity from overall or major cancers among multivitamin supplement users. (1)
The findings did not vary across subgroups by ethnicity, age, body mass index, pre-existing illness, single vitamin/mineral supplement use, hormone replacement therapy use, and smoking status.
There was also no evidence indicating that multivitamin use was associated with risk of cancer, overall or at major sites, such as lung, colorectum, prostate and breast.
Professor Ian Caterson, professor of human nutrition at the University of Sydney, said, in general, healthy adults and children in Australia did not need vitamins and, in some cases, vitamins could do harm.
There were some situations when supplements could be given, such as folate for pregnant women, and in cases of specific deficiency situations, but these were rare in Australia, he said.
Professor Binns said the problem with most nutrition effects was that there was a U-shaped curve. “If we are deficient in vitamin A then it has severe effects (but) too much vitamin A is dangerous too,” he said.
National Health and Medical Research Council guidelines recommended calcium for women, vitamin D for people aged over 65, folate, iodine and usually iron for pregnancy, and iodine for breastfeeding, he said.
Professor Alastair MacLennan, of the University of Adelaide and head of a research group in South Australia that has monitored the use of complementary and alternative medicines (CAMs) for almost two decades, said their surveys showed that 60% of women and 44% of men used CAMs, with women using significantly more vitamins and other products that were not prescribed than men.
Professor MacLennan said vitamins should be prescribed only to the very few Australians who were shown to be vitamin deficient by validated tests.
“The reasons for their use are mostly due to the marketing of these products and a wish to self-medicate,” he said.
“In Australia, the public spends four times as much on CAMs as their contribution to all registered pharmaceuticals, some of which are subsidised,” Professor MacLennan said. (2)
The experts agreed that clever and forceful marketing was largely responsible for the exponential increase in the use of vitamins that were not prescribed.
In a recent article in the Brisbane Times, the founder of an American charity that provides vitamins for children in the developing world said they were an “essential” part of every modern diet. (3)
Vitamin Angels founder Howard Schiffer said people critical of using vitamin supplements were “naive”.
Professor Binns said several studies supported the findings of the latest study, including a Cochrane review in 2008 of 67 randomised controlled trials that found no evidence to support antioxidant supplements — beta-carotene, vitamin A, vitamin C, vitamin E, and selenium ― to prevent mortality in healthy people or patients with various diseases. (4)
“Antioxidant supplements need to be considered medicinal products and should undergo sufficient evaluation before marketing,” the authors said.
– Cathy Saunders
1. American Journal of Epidemiology 2011; DOI: 10.1093/aje/kwq447
2. Prev Med, 2002; 35 (2):166-173
3. Brisbane Times, 22 March 2011
4. Cochrane Database of Systematic Reviews 2008
Posted 28 March 2011
I am curious as to what proof there is that a vitamin is what it is says on the label! Is a Vitamin E capsule really E – similarly any other letter!!! Multivitamins – does that mean whatever the manufacture decides to include? What about cost – is a bottle of Vitamin E for $5.00 the same as one for, say $15.00? Curious – I like to know if I am wasting money, and taking what I think I might be!!
Surely both the extent to which vitamin supplements are actually absorbed by the body, as well as any deficiencies that are actually present, will determine if they are effective or not.
I have some empirical evidence that vitamin E in sufficient doses is quite effective in helping to reduce the severity of seizures in patients with epilepsy. In addition certain natural vitamins and other supplements have helped enormously in bolstering the immune systems of post chemotherapy cancer patients. Is it a placebo effect? Perhaps but given the size of the market and potential benefits, surely more research is warranted.
I think that persons – and surely those over 45 years – should have AFFORDABLE, thorough blood tests done yearly to get some history and track record on their wellbeing, to establish any deficiencies or other known shortcomings that need a specific vitamin or corrective agent. Then people won’t fall around trying everything.
Excuse me saying that as a practitioner of conventional medicine, I may not advise multi-vitamins/multi-mineral supplements to my patients (quackish), however, I will not stop taking certain selected types myself; when one reads about the functions of these micro-nutrients, one is convinced of their need, regardless of what is put out in ‘studies’.
I looked at the paper cited by Dr Maxwell in Annals of Internal Medicine. They reported their findings thus:
“A multivitamin and mineral supplement reduced the incidence of participant-reported infection and related absenteeism in a sample of participants with type 2 diabetes mellitus and a high prevalence of subclinical micronutrient deficiency.” They did not find any benefit in the non-diabetic group.
It makes sense that there would be a benefit in people with micronurtient deficiency – that’s what supplements are for.
I disagree with Dr Maxwell that current food crops are degraded and nutritionally deficient – we now have a greater year-round range of fresh produce available than ever before. Studies comparing “organically grown” produce with non-organically grown show no difference in nutritional value. Snap-freezing has been shown to conserve vitamins and other nutrients – much better than the old canning mjethods that were the only methods available for preserving seasonal crops in the past.
Our discussion in this area should be based on evidence, not ideology.
Nutritional deficiencies are very common
Manipulation of our food by commercial interests has caused untold disease and suffering, and the direct result has been a massive increase in cardiovascular disease, cancer, adult onset diabetes, liver and kidney disease, obesity, dementia, arthritis and osteopareosis. Crops grown on chemical fertilisers containing nitrogen, phosphorus and potassium, do not contain the essential minerals, and therefore the human body is mineral deficient. Foods are further degraded by mass production methods of ripening, storing, dry-cooking, freezing, etc. Optimal body function cannot occur without the daily ingestion of 90 nutrients, including elements, vitamins, co-factors, essential amino acids and essential fatty acids. Most of these nutrients are deficient or entirely absent from our food supply.
Doctors have little faith in the use of multivitamin or mineral supplements by healthy adults, but some persuasive evidence now supports the supplement believers. A year-long study in two primary care clinics in the United States (Annals of Internal Medicine 2003;138:365-71) found that the volunteers who took active supplements had fewer infections and took less sick leave than those who took a placebo. The effect was most substantial in patients with diabetes but was also apparent in the people in normal health.
75% of all Australian deaths are a result of lifestyle factors. This includes poor diet and the resulting nutritional deficiencies. Drugs are mostly synthetic chemicals. There are many drugs that are life saving and beneficial when prescribed responsibly. But the massive proliferation of drugs has given rise to a statistic, whichthe multi-national pharmaceutical industry attempts to hide.
Inappropriate pharmaceutical drug and medical treatments have now become the third leading cause of death.
In Australia alone the increasing popularity of natural products hasdeprived the global pharmaceutical market of 2 billion dollars annually.
What about an increase in the vitamin D deficiency in the general population?
Research tells us that approximately 40% of all healing is through the placebo effect. It would be interesting to see a research asking people who take those vitamins if they feel that they are helping them. If consumers are willing to pay for a placebo benefit that is working for them, I say great! Let us keep quiet about this research, or is there an underlying reason for such a research – who funded it?
Would it make more sense to look at the labeling of both drugs and vitamins so that consumers can make a more informed choice?
We have to ask ourselves, why do people decide to medicate themselves?
One article showing the association of marketing for pharmaceutical drugs can be found here: http://www.sciencedaily.com/releases/2011/03/110315192707.htm
Agressive marketing by pharmaceutical companies is no lesser a problem than marketing by vitamin companies, other than possibly a higher extent of toxic side effects from the first.
An inexpensive type 2 diabetes drug that has been around for more than 15 years works just as well and has fewer side effects than a half-dozen other, mostly newer and more expensive classes of medication used to control the chronic disease… Details of this article can be found here: http://www.sciencedaily.com/releases/2011/03/110314172314.htm.
Could it be the reason for the aggressive marketing by pharmaceuticals for newer drugs is because the older patents are running out and could cause a cheaper generic drug to come on the market, or am I just being cynical?
Could it be that the below might have an influence on my wanting to take my own wellbeing into my own hands?
My mother was given long-term prescriptions for Valium back in the ’50s or ’60s. Researched as safe, and a common household prescribed medicine. Prescribed by doctors on a regular basis despite government guidelines recommending only a maximum 4-week prescription period. I believe that this medication over a 30-year period of consuming was a major contribution to a total nervous breakdown. For further research see: Porrit D, Russell D, “The accidental Addict,” 1994, ISBN 0 330 35593 7
I was prescribed blood pressure medication – all three variations of available drugs prescribed caused me to cough, one caused swelling of my ankles and knees as well as the coughing. But as my doctor rightly informed me, I was allergic to the first two medications and if this one had fared better, then he could have given me another medication to take down the swelling. And if that caused another side effect – would I then be on 3 medications?
Now as it is, I am on no medication for blood pressure. As a responsible person looking out for my own wellbeing I did some research of my own. I found that some people suffer from white-coat hypertension. That before prescribing medication it would be prudent for a doctor to have monitored me for some days to see the consistency of my blood pressure, rather than put me on medication based on the one monitoring in his office. I went out and bought a blood pressure monitor and kept tabs on this myself. I made a lifestyle change of going to bed earlier – I don’t have a blood pressure problem anymore. How much value have I added to my life rather than now being a lifetime on medication for blood pressure, and possibly other medication as well?
And I could go on with other examples, but hopefully I have made a contribution to looking further into how best we can make changes to instill confidence and trust in our doctors. Taking vitamins off the market in the guise of keeping those few people that misuse these safe, would in my opinion cause an underground purchasing arena that would add to their unsafe use.
Patients on dialysis, where an obligatory loss of water soluble vitamins across the filter membrane during dialysis, are an exception and require supplementary return of their vitamin/mineral losses.
John Agar MBBS, FRACP, FRCP, OAM
Renal Services, Barwon Health