Yet another perspective on the vitamin controversy

[Guest guest]

From The Huffington Post 10/20/2011

By Mark Hyman, MD

Do vitamins kill people?

How many people have died from taking vitamins?

Should you stop your vitamins?

It depends. To be exact, it depends on the quality of the science,

and the very nature of scientific research. It is very hard to know

things exactly through science. The waste bin of science is full of

fallen heroes like Premarin, Vioxx and Avandia (which alone was responsible for

47,000 excess cardiac deaths since it was introduced in 1999).

That brings us to the latest apparent casualty, vitamins. The recent media hype

around vitamins is a classic case of drawing the wrong

conclusions from good science.

Remember how doctors thought that hormone replacement therapy was the best thing

since sliced bread and recommended it to every single

post-menopausal woman? These recommendations were predicated on studies

that found a correlation between using hormones and reduced risk of

heart attacks. But correlation does not prove cause and effect. It

wasn't until we had controlled experiments like the Women's Health Initiative

that we learned Premarin (hormone replacement therapy) was killing women, not

saving them.

A new study " proving " that vitamins kill people is hitting front

pages and news broadcasts across the country. This study does not prove

anything.

This latest study from the Archives of Internal Medicine of 38,772 women found

that " several commonly used dietary vitamin and

mineral supplements may be associated with increased total mortality " .

The greatest risk was from taking iron after menopause (which no doctor

would ever recommend in a non-menstruating human without anemia).

The word " may " is critical here, because science is squirrelly. You

only get the answers to the questions you ask. And in this case, they

asked if there was an association between taking vitamins and death in

older woman. This type of study is called an observational study or

epidemiological study. It is designed to look for or " observe "

correlations. Studies like these look for clues that should then lead to further

research. They are not designed to be used to guide clinical

medicine or public health recommendations. All doctors and scientists

know that this type of study does not prove cause and effect.

Why Scientists are Confused

At a recent medical conference, one of most respected scientists of this

generation, Bruce Ames, made a joke. He said that epidemiologists (people who

do

population-based observational studies) have a difficult time with their job and

are easily confused. Dr. Ames joked that in Miami

epidemiologists found everybody seems to be born Hispanic but dies

Jewish. Why? Because if you looked at population data in the absence of

the total history and culture of Florida during a given time, this would be the

conclusion you would draw. This joke brings home the point that

correlation does not equal causation.

Aside from the fact that it flies in the face of an overwhelming body of

research that proves Americans are nutrient deficient as a whole,

and that nutritional supplements can have significant impact in disease

prevention and health promotion, the recent study on vitamins is flawed

in similar ways.

How Vitamins Save Money and Save Lives

Overwhelming basic science and experimental data support the use of

nutritional supplements for the prevention of disease and the support of optimal

health. The Lewin Group estimated a $24 billion savings over five years if a

few basic nutritional supplements were used in the elderly. Extensive

literature reviews in the Journal of the American Medical Association and the

New England Journal of Medicine also support this view. Interventional trials

have proven benefit over and over again.

The concept that nutritional supplements " could be harmful " to women

flies in the face of all reasonable facts from both intervention trials

and outcome studies published over the past 40 years. Recent trials

published within the last two years indicate that modest nutritional

supplementation in middle age women found their telomeres didn't shorten.

Keeping your teleomeres (the little end caps on your DNA) long is the hallmark

of longevity and reduced risk of disease.

A plethora of experimental controlled studies -- which are the gold

standard for proving cause and effect -- over the last few years found

positive outcomes in many diseases. These include the use of calcium and vitamin

D in women with bone loss; folic acid in people with cervical

dysplasia (pre-cancerous lesions); iron for anemics, B-complex vitamins

to improve cognitive function, zinc; vitamin C, E, and carotenoids to

lower the risk of macular degeneration, and folate and vitamin B12 to treat

depression. This is but a handful of examples. There are many more.

Why Most Vitamin Studies are Flawed

There is another important thing to understand about clinical trials

that review the utility of vitamins in the treatment of disease. The

studies that show harm are often designed like drugs studies. For

example, a study may use a high dose of vitamin E and see what happens. This is

actually a prescient example also explored in recent media.

Studies recently found that high doses of vitamin E and selenium didn't

prevent prostate cancer and may increase risk. What this study didn't

explore properly was the true biochemical nature of vitamin E and

selenium. These nutrients work as antioxidants by donating an electron

to protect or repair a damaged molecule or DNA. Once this has happened

the molecules become oxidants that can cause more damage if not

supported by the complex family of antioxidants used in the human body.

It's sort of like passing a hot potato. If you don't keep passing it

you will get burned. This study simply failed to take this into account.

Nature doesn't work by giving you only one thing. We all agree that

broccoli is good for you, but if that were all you ate you would die in

short order. The same is true of vitamins. Nutrients are not drugs and they

can't be studied as drugs. They are part of a biological system where all

nutrients work as a team to support your biochemical processes.

Jordon may have been the best basketball player in history, but he

couldn't have won six NBA titles without a team.

Obesity is Linked to Malnutrition

The tragedy of media attention on poor studies like these is that

they undermine possible solutions to some of the modern health epidemics we are

facing today, and they point attention away from the real

drivers of disease.

Take the case of obesity for example. Paradoxically Americans are becoming both

more obese and more nutrient deficient at the same time. Obese children eating

processed foods are nutrient depleted and increasingly get scurvy and rickets,

diseases we thought were left behind in the 19th and 20th centuries.

After treating more than 15,000 patients and performing extensive

nutritional testing on them, it is clear Americans suffer from

widespread nutrient deficiencies including vitamin D, zinc, magnesium, folate

and omega 3 fats. This is supported by the government's National Health and

Nutrition Examination Survey (NHANES) data on our population. In fact 13 oercent

of our population is vitamin C deficient.

Scurvy in Americans in 2011? Really? But if all you eat is processed

food -- and many Americans do -- then you will be like the British

sailors of the 17th century and get scurvy.

Unfortunately negative studies on vitamins get huge media attention, while the

fact that over 100,000 Americans die and 2.2 million suffer serious adverse

reactions from medication use in hospitals when used as prescribed is quietly

ignored. Did you know that anti-inflammatories like aspirin and

ibuprofen kill more people every year than AIDS or asthma or leukemia?

Flaws with the " Vitamins Kill You " Study

So what's the bottom line on this study on vitamins in older white women in

Iowa?

After a careful reading of this new study a number of major flaws were

identified.

1. Hormone replacement was not taken into consideration. Overall the women who

took vitamins were a little healthier and

probably more proactive about their health, which led them to use

hormone replacement more often (based on recommendations in place when

this study was done). 13.5 percent of vitamin users also used hormones,

while 7.2 percent of non-vitamin users took hormones. Remember the

Women's Health Initiative Study I mentioned above? It was a randomized

controlled trial that found hormone therapy dramatically increases risk

of heart attack, stroke, breast cancer and death. In this Iowa women's

study on vitamins, the degree of the effect of harm noted from the

vitamins was mostly insignificant for all vitamins except iron (see

below) and calcium (which showed benefit contradicting many other

studies). In fact, the rates of death in this study were lower than

predicted for women using hormone therapy, so in fact the vitamins may

have been protective but the benefit of vitamins was drowned out because of the

harmful effects of hormones in the vitamin users.

2. Iron should not be given to older women. Older women should never take iron

unless they have anemia. Iron is a known oxidant and excess iron causes

oxidative stress and can lead to cardiovascular

disease and more. This is no surprise, and should not make you stop

taking a multivitamin. If you are an older woman, you simply need to

look for one without iron. Most women's vitamins do not contain it

anyway.

3. Patient background was ignored. In this

observational study it was not known why people started supplements.

Perhaps it was because of a decline in their health and thus they may

have had a higher risk of death or disease that wasn't associated with

the vitamins they were taking at all. If you had a heart attack or

cancer and then started taking vitamins, of course you are more likely

to die than people without heart attacks or cancer.

4. The population was not representative. The study

looked only at older white women -- clearly not representative of the

whole population. This makes it impossible to generalize the

conclusions. Especially if you are an obese young African American male eating

the average American diet.

5. Forms and quality of vitamins were not identified.

There was no accounting for the quality or forms or dosages of the

vitamins used. Taking vitamins that have biologically inactive or

potentially toxic forms of nutrients may limit any benefit observed.

For example synthetic folic acid can cause cancer, while natural folate is

protective.

6. A realistic comparison between vitamins and other medications as cause of

death was not made. 0ver 100,000 people die every year from properly prescribed

medication

in hospitals. These are not mistakes, but drugs taken as recommended.

And that doesn't include out of hospital deaths. The CDC recently released a

report that showed in 2009, the annual number of

deaths (37,485) caused by improper/overprescribing and poor to

non-existent monitoring of the use of tranquilizers, painkillers and

stimulant drugs by American physicians now exceeds both the number of

deaths from motor vehicle accidents (36,284) and firearms (31,228).

In short, this recent study confuses not clarifies, and it has only

served up a dose of media frenzy and superficial analysis. It has left

the consumer afraid, dazed, bewildered and reaching for their next

prescription drug.

Please, be smart, don't stop taking your vitamins. Every American

needs a good quality multivitamin, vitamin D and omega-3 fat supplement. It is

part of getting a metabolic tune up and keeping your telomeres long!

For more information on getting a metabolic tune up see www.drhyman.com.

Now I'd like to hear from you ...

What do you think about the recent media hype regarding vitamins?

Why do you think vitamins get this kind of media while pharmaceuticals, which

have a much larger impact, are often ignored?

Why do you think the decades of research showing positive effects of vitamins is

hidden?

To your good health,

Mark Hyman, MD