Most adults in the West regularly take a vitamin supplement, such as a multivitamin-but doctors believe they are not only wasting their money, but also endangering their health, and even shortening their lives.
Instead, modern medicine maintains that the average, healthy person can get all the nutrients he or she needs by eating a balanced diet.
It’s a view taught to doctors at medical schools-which often devote just a day out of a five-year training programme to nutrition-and one supported by drugs regulators such as America’s Food and Drug Administration (FDA). As the UK’s National Health Service (NHS) states categorically on its website: “Most people can get all the vitamins and minerals they need by eating a balanced, varied diet.”
Vitamin and mineral supplements are, according to this view, a waste of money. Worse, they can kill you, as headline-grabbing studies occasionally tell us. The latest-the Iowa Women’s Health Study-con-cludes that older women who supplement their diet increase their risk of dying at a younger age than those who don’t take supplements. Iron supplements appear to pose the greatest risk (Arch Intern Med, 2011; 171: 1625-33).
In 2008, the influential Cochrane Collaboration came to a similar conclusion that also dominated the news agenda for days afterwards. The Cochrane researchers discovered, in a meta-analysis of 67 medical trials, that people who took a high-dose antioxidant, such as vitamin A, beta-carotene (converted by the body into vitamin A) or E, were more likely to die than those who didn’t take a supplement (Cochrane Database Syst Rev, 2008, 2: CD007176).
With these studies as a backdrop, the European Union is currently deliberating on the potency of vitamin and mineral supplements that can be sold in stores throughout Europe. The Alliance for Natural Health (ANH), a lobby group, fears the ‘maximum permitted levels’ (MPLs) of supplements will be set very low, and will have no therapeutic value.
The FDA is putting forward proposals to restrict the sale of nutritional products available in stores in the US, and even blocking those that have been introduced within the past 20 years until they pass prohibitively expensive trials.
So, can we stay healthy only by eating a balanced diet or do we need to supplement? And if we do take vitamin and mineral supplements, are we raising our chances of dying prematurely?
The average person
The baseline for adequate levels of nutrition needed to maintain a healthy body is the ‘Reference Daily Intake’ (RDI), which replaced the ‘Recom-mended Daily Allowance’ (RDA). These levels (see Factfile B) are considered to be sufficient to meet the needs of up to 98 per cent of healthy individuals, and can be obtained by eating a healthy diet, say health officials. Exceptions include pregnant and breast-feeding women, children aged from six months to five years, the over-65s and people with darker skin, all of whom should supplement with vitamin D tablets. Children should also supplement with vitamins A and C until the age of five years, according to the NHS.
However, the first problem with the one-size-fits-all approach is that few of us are either average or healthy, or both. Each of us is biochemically unique. According to nutritionist Dr Damien Downing, a research study of guinea pigs discovered that individual requirements for vitamin C differed 20-fold among the animals, and “the range of human individual requirements can be assumed to be at least as great”, he said.
Our nutritional needs also vary according to our age and gender, our stress levels and our genetic profile. Some of us have an inherently higher requirement for folic acid, and vitamins B6, B12 and B2, for example, and low levels in women with this predisposition increase their risk of breast cancer (Carcinogenesis, 2001; 22: 1661-5), while those with a particular enzyme variant need far more B6 than the standard RDI suggests.
RDI levels are designed to maintain health, but are inadequate when we are ill or suffering from a chronic problem. Autistic children, for example, need far higher levels of B6 than the standard recommendation; an autistic child weighing 135 lb (60 kg) needs 1000 mg/day, one study has discovered (Autism Res Rev Intl, 1997; 11: 3)-whereas the RDI suggests just 2 mg/day for the average, healthy person.
The balanced diet
A balanced diet consists of eating sensible, and varied, amounts from the following five food groups:
Many of us suffer from chronic health problems because we do not follow a balanced diet properly and, instead, over-indulge in fats and sugars, while eating insufficient amounts of fruits and vegetables in particular, says the NHS.
But the balanced-diet approach is overly simplistic. It does not differentiate between processed and unprocessed foods, organic and mass-produced foods, individual health profiles, our age and gender, and whether we have a chronic illness. Overall, it over-looks a range of problems about the food we eat that throws into question the whole theory of a balanced diet.
Fresh food
The unspoken assumption of the balanced diet is that the food we eat is nutritious-it must be providing us with the vitamins and minerals our body needs to function. All food starts to lose its nutritional value from the moment it is slaughtered, picked, baked or produced, and so the fresher the food, the greater its goodness.
However, a survey of a typical supermarket, reported by Alex Renton on MailOnline (26 March 2011), revealed that:
If you want to have the health benefits of a balanced diet, you need to buy locally, ideally from a farm shop if possible, or grow your own. However, there is another problem even if you can buy direct from the farmer or have your own vege
table patch.
Depleted soil
Intensive farming and pesticides have stripped the soil of its minerals, and this has affected the goodness of the food we eat. In 1900, wheat was 90-per-cent protein, but today, it is closer to 9 per cent; in 1948, 100 g of spinach contained around 158 mg of iron, but today, that has plummeted to just 1 mg (Gemmer E. Who Stole America’s Health? Lecture, 1995).
As a result, we are lacking in essential minerals, such as magnesium, chromium and vanadium, and many people are deficient in one or all three. Indeed, such deficiencies may lie behind the growing diabetes ‘epidemic’, as suggested by a number of studies (Am J Clin Nutr, 1992; 55: 1161-7; Diabetes, 1980; 29: 919-25).
One study of 1995 adults found that more than 90 per cent were consuming inadequate amounts of folate, while vitamin C and magnesium intakes were low in more than 50 per cent of the group, and iron and calcium consumption was inadequate across all groups (Can J Diet Pract Res, 2007; 68: 23-9).
In a study of 433 men and 876 women in low-income groups in the UK, 25 per cent of men and 16 per cent of women were deficient in vitamin C, and were at high risk of developing scurvy (J Public Health [Oxf], 2008; 30: 456-60).
A study of vegans discovered that the food they ate contained just 46 per cent of the RDI requirement for selenium (www.rawfoodlife.com/Articles ___Research/Perfect_Food/perfect
_food.html). In fact, most of us are deficient in selenium, and this lack can trigger a range of age-related diseases such as cancer, heart disease and loss of brain function, say researchers from the Children’s Hospital Oakland Research Institute in California (FASEB J, 2011; 25: 1793-814).
In an accompanying editorial, the editor of The FASEB Journal, Dr Gerald Weissman, commented: “This paper should settle any debate about the importance of taking a good, complete multivitamin every day. As this report shows, taking a multivitamin that contains selenium is a good way to prevent deficiencies that, over time, can cause harm in ways that we are just beginning to understand.”
To supplement or not?
If we are malnourished by the food we eat, should we be taking vitamin and mineral supplements to ensure that we maintain health? And if we do so, are we causing more harm than good and even hastening our own death?
The studies that suggest supplements can be killers have been strongly criticized by pro-vitamin groups who dismiss them as ‘bad science’, yet their findings-while flawed-highlight the subject’s complexities.
According to Dr Robert Verkerk, director of the ANH, the following needs to be taken into consideration when supplementing:
Researchers from Purdue University have also discovered that the manufacturing process used for some vitamins degrades them quickly-thereby making them nutritionally worthless-and may even be causing harm.
Anti-caking agents-used in powdered forms of vitamins and especially vitamin C-are failing to protect the nutrient from moisture damage, even at relatively low temperatures and levels of humidity. As a result, many people may be getting little or no nutritional value from such supplements. Worse, once the process of degradation has started, the product changes rapidly from a solid to a liquid state and becomes unstable, possibly causing health problems (J Food Sci, 2011; 76: C1062-74).
Not many dead
When these issues are taken into account, the so-called ‘killer effects’ of supplements identified by a small handful of studies become questionable. The Iowa Women’s Health Study relied on information collated from questionnaires completed by 38,772 women, but failed to ask the women the dosages and types of vitamin supplements they were taking. The ‘dangerous’ vitamin supplements included B6 and folic acid, and the minerals iron and copper, the researchers said.
As well as failing to note the type of supplements being taken, they also did not ask the women if they were also taking pharmaceutical drugs, or about their nutritional status and whether they already had subclinical signs of a chronic disease that supplements would not have helped to reverse.
The Cochrane review, published three years earlier, discovered that 13.1 per cent of the 232,550 participants taking an antioxidant supplement-whether vitamin A, C or E-died compared to 10.5 per cent of deaths in the non-supplement group. However, before arriving at the trials included in the review, the Cochrane researchers dismissed 405 other studies of vitamin supplements that did not have any deaths, thereby weighting the results before-hand. The 67 trials selected for the meta-analysis included only those that tracked people who were already chronically sick-and so more likely to die-and who were taking high-dose supplements. This, as the ANH pointed out, was not a fair reflection of the average supple-ment use.
The bottom line
In their concluding remarks, the Cochrane researchers say their findings support the drive to have vitamin use more carefully controlled and restricted.
A sceptic may argue that their recommendation reveals their true hand, and it’s an accusation that has been laid at the door of other researchers who have concluded that vitamin supplements are killers.
Their findings certainly provide ‘evidence’ to feed the drive-throughout Europe and, more recently, in the US-to restrict supplement availability, but this handful of studies stands out starkly against the thousands that have demonstrated genuine, and therapeutic, benefit from supple-ments (see box, page 13). Their other findings are also out of step, which is another clue that there is something wrong in their analysis and/or interpretation.
Bryan Hubbard
Factfile A: House rules for good health
For the consumer, maintaining health is relatively straight-forward, provided you follow some simple house rules:
Factfile B: Your daily lack
The following are the Reference Daily Intakes (RDIs) for the main vitamin and mineral groups. These are the minimum requirement to avoid deficiencies, and are not the levels required for maintaining good health. Amounts for those marked with an asterisk (*) need to be increased dramatically beyond the RDI.
Vitamin/Mineral | RDI |
Vitamin A | 5000 IU |
*Vitamin C | 60 mg |
Calcium | 1000 mg |
Iron | 18 mg |
*Vitamin D | 400 IU |
Vitamin E | 30 IU |
*Vitamin K | 80 mcg |
*Vitamin B6 | 2 mg |
*Vitamin B12 | 6 mcg |
*Magnesium | 400 mg |
*Zinc | 15 mg |
Factfile C: Supplements help, not kill
The handful of studies that suggest supplements shorten life fly in the face of the thousands that, over the years, have demonstrated that supplements prevent-and even help to reverse-serious health problems.
WDDTY ISSUE 22 NO.9, NOV. 2011