Vitamin Studies Spell Confusion for Patients

ABC News ^ | October 14, 2011 | Unknown

[decimon]

If it's Monday, it must be bad news about multivitamin day -- or was that Wednesday? No, Wednesday was good news about vitamin D, not so good news about vitamin E -- if you're confused, join the club.

The alphabet soup of vitamin studies making headlines in the last few weeks has left more than one head spinning, and most clinicians scrambling for answers.

As the dust begins to settle, physicians interviewed by MedPage Today and ABC News agreed on a bit of simple wisdom -- a healthy diet is more important than a fistful of supplements.

"I had already asked my patients to stop their vitamin supplements four to five years ago, with the exception of those with a deficiency of vitamin D, ... pregnant patients [who should get] folate and prenatal multivitamins, or those with cognitive impairment, when I would recommend a vitamin B complex," Albert Levy, MD, a primary care physician in New York, said in an email to MedPage Today and ABC News.

Whether patients heed the advice is another question, as recent research has shown that more take supplements now than ever before. More than half of Americans report taking a multivitamin or other dietary supplement, up from 40% just two decades ago.

[caveat emptor]

From a scientific standpoint, it makes absolutely no sense to think that we somehow need to take large quantities of purified or synthesized vitamins, when the human race has existed for the last million years or so without them.



You're absolutely right, as long as you don't want to live long and prosper. Pauling (PDF) had it right about Vitamin C, my doctor and his advisors have it wrong about vitamin D ("everyone gets enough vitamin D from sunlight and no one needs supplements"), and almost no one gets it right about iron.

Funny thing, my doctor is 15 years younger than me and has had colon cancer, but not me. We both live at Latitude 51° N, with less sunlight than south of here, plus on the cloudy west coast of B.C., but I take 4000 IU daily of Vitamin D, and he takes none. But hey, what do I know, that's just an n=2 survey.

In addition to the Vitamin D I take 1 multi-vitamin pill per day (iron free), 8-10 grams if Vitamin C, and a bit of B₁₂.

Most animals synthesize their own Vitamin C, and don't have heart attacks. Primates including humans lost that ability somewhere along the way to now. Back in the old days before the great FR purge, some evolutionist pointed out the gene where this loss occurred. I have no idea how to find it now. As well, women develop heart disease later than men due to monthly menses (regular loss of blood, and therefore iron).

I first heard of the iron-heart connection through internet postings of someone who called himself The Watchman. He may be this Freeper.

[Conservativegreatgrandma]

I’d agree with you but I know the value of extra Vit C and D.

[Conservativegreatgrandma]

You take 8-10 grams Vit C daily? I take four but I have read a lot about it. I know what it did for rheumatoid arthritis and by accident I found out that it helped immensely with the pain of a bad shoulder injury. Now, I also believe it protects one from plantar fasciitis, and carpal tunnel.

Reading about intravenous Vit C and it's ability to control pain is extremely interesting.

[exDemMom]

But as we evolved over millions of years, life expectancy was not what we hope for today. People suffered from all sorts of diseases mediated by vitaHin deficiencies, from the obvious rickets (which often caused death in childbed in an age before Caesarean sections), visual problems, osteoporosis, cancers potentially linked to Vitamin D deficiencies, and so forth. People lived short lives full of suffering. We’d like to do a bit better now. We have a not-unrealistic expectation that we’ll be able to live long, healthy lives and remain active into our eighties.

The major contribution to our current life-expectancy is control of infectious disease. That results from sanitation measures and vaccinations, and has nothing to do with adequate nutrition. And the observation that a lack of a particular nutrient leads to pathological conditions does not mean that excesses of that same nutrient will lead to super-health. Quite the opposite, in many cases. Either you have enough of a given nutrient, or you don't. In addition to control of infectious disease, genetics plays a huge role in life span.

Unfortunately, it’s hard to do that with today’s “balanced diet.” By the time that tomato arrives at your house after its trip from Holland, or the green pepper gets here from California, or the grape is eaten after being shipped from Chile, it’s questionable whether much nutrition remains in it. A valid case can be made that people who don’t raise their own food ought to take supplements just to restore the nutrition that is supposed to be in a balanced diet.

I highly question that all the nutrients are somehow disappearing during shipment. According to this article, the half life of some of those compounds is 6-8 days, and the loss is mediated through tissue death. Which suggests to me that the nutrient loss occurs in proportion to the degradation of the veggies. I don't know about you, but I avoid buying or eating any produce that doesn't look nearly perfect. BTW, I would ignore the pink editorial note at the end of the article I linked. The article was written on the basis of scientific research; the editorial note was not.

It’s also been clearly demonstrated that the office worker who lives north of Charleston, South Carolina is not getting enough Vitamin D because he isn’t exposed to enough sunlight in the winter, especially if he’s black. This phenomenon has been linked to the increasing incidence of asthma in black children. One may reasonably assert that it’s appropriate for those who live in northern latitudes to take Vitamin D supplements.

I'm highly skeptical of many of those vitamin D claims; for instance, the blanket assertion that we cannot get enough vitamin D through normal sun exposure. It sounds like a ploy to sell more vitamins to me (as do a lot of these claims--vitamins are a HUGE business). In the one special case you mentioned, that of black people living in the north, the point is probably valid that they don't get enough sunlight. That's because the high levels of pigment in black people's skin is an adaptation to living in an area with strong sunlight, very unlike what one finds in the US. That pigment does such a great job of blocking UV light that little of it penetrates down into the living cells where it is needed for vitamin D synthesis. Those of us who have European or Asian ancestry, especially if our ancestors came from the northern parts of those continents, are far better adapted to the amount of sunlight that we are exposed to here. We have far less of that pigment, so more UV light can penetrate.

BTW, I've noticed that American blacks, in general, are lighter than African blacks. Maybe because they're adapting to the lower levels of sunlight in the US as compared to Africa?

And are you really going to be able to consume enough dairy foods to take in 1500 mg per day of calcium needed to sustain strong bones into old age? You can eat a “balanced diet,” whatever that may consist of, and still have osteopenia or osteoporosis after menopause. So calcium and Vitamin D supplements may be appropriate.

Once again, you're bringing pathological conditions into the discussion of normal nutrition. Bone diseases associated with menopause are related to genetics. A woman whose genetics predispose her to osteoporosis may not be able to consume enough extra calcium or vitamin D to counteract the bone loss, because she DOES have a genetic disease. Luckily, there are drugs developed to treat those diseases now.

There’s just too much sound science demonstrating that some supplements really do improve health and the quality of life.

No, there is no science that says that consuming excesses of trace nutrients is superior to consuming adequate amounts of them. While fostering the belief that more=better is excellent for the supplement industry, it is not based in rigorous science. In 2009, Americans spent $26.9 billion on dietary supplements, including vitamins, according to Carlotta Mast, editorial director at Nutrition Business Journal. Vitamins are Big Business.

[exDemMom]

PS....I eat healthy and have most of my life, I exercise and have most of my life....never smoked....but, menopause almost killed me. My maternal grandfather died in his sleep of either a massive cardio problem or something similar (he was thin).....I will take vitamins because I think they help, and because people are DIFFERENT! As people age their abilities to process nutrients can change for the worse...IMHO...oh, and I have a doc who is a MD and ND....who does research and teaches....I’ll listen to him.

Genetic problems are separate from the issue of taking excesses of trace nutrients. The best that you can do is try to get proper nutrition and exercise--and NOT load up on supplements, which can do more harm than good. Heart disease and other circulatory problems run in my family, on both sides. So far, my longest-lived relative died when he was 81 or 82... the next longest-lived was 72. My sister has high blood pressure. I exercise and try to eat right, and I don't have any cardio problems. I never had high blood pressure, except when I had preeclampsia when I was pregnant. My resting heart rate is below 60. Maybe I was lucky and avoided getting the nasty genes that kill off other members of my family--I don't know.

The bottom line is still, either you get enough of the trace nutrients, or you don't. It's just like oxygen--either you get enough, or you don't; consuming more than enough won't make you healthier.

[SharpRightTurn]

Research from scientists such as Bruce Ames shows pretty clearly that we can't get all needed nutrients from food. Here's from his page: Dr. Ames is a Professor of Biochemistry and Molecular Biology, University of California, Berkeley, and a Senior Scientist at Children's Hospital Oakland Research Institute (CHORI). He is a member of the National Academy of Sciences and he was on their Commission on Life Sciences. He was a member of the board of directors of the National Cancer Institute, the National Cancer Advisory Board, from 1976 to 1982. He was the recipient of the General Motors Cancer Research Foundation Prize (1983), the Tyler Environmental Prize (1985), the Gold Medal Award of the American Institute of Chemists (1991), the Glenn Foundation Award of the Gerontological Society of America (1992), the Lovelace Institutes Award for Excellence in Environmental Health Research (1995), the Honda Prize of the Honda Foundation, Japan (1996), the Japan Prize, (1997), the Kehoe Award, American College of Occup. and Environ. Med. (1997), the Medal of the City of Paris (1998), the U.S. National Medal of Science (1998), The Linus Pauling Institute Prize for Health Research (2001), and the American Society for Microbiology Lifetime Achievement Award (2001). His over 450 publications have resulted in his being among the few hundred most-cited scientists (in all fields): 23rd most-cited (1973-1984). Research Interests The research of the lab involves various aspects of tuning-up metabolism to optimize health. Mitochondrial decay with age due to oxidation of RNA/DNA, proteins, and lipids, is a major contributor to aging and the degenerative diseases of aging. In old rats (vs. young rats) mitochondrial membrane potential, cardiolipin level, respiratory control ratio, and cellular O2 uptake are lower; oxidants/02, neuron RNA oxidation, and mutagenic aldehydes from lipid peroxidation are higher (1-3). Feeding old rats the normal mitochondrial metabolites acetyl carnitine (ALC) and lipoic acid (LA) at high levels for a few weeks reverses much of this decay, the two complementing each other, in some cases synergistically, and restores the lost mitochondrial function to the level of young mitochondria (1-3). Ambulatory activity, cognition, heart, and immune function decline with age and feeding ALC and LA to the old rats also restores a good part of the lost function (1-4). Considerable progress has been made in understanding the mechanism of action of the two metabolites (1-3, 5, 6). LA is a mitochondrial coenzyme and is reduced in the mitochondria to a potent antioxidant, dihydrolipoic acid. LA is also an effective inducer of the phase-2 antioxidant enzymes, about 200 enzymes including those required for glutathione synthesis (5, 6). Inadequate intakes of vitamins and minerals from food can lead to DNA damage, mitochondrial decay, and other pathologies (7). Intakes below the EAR, i.e. 2 standard deviations

[exDemMom]

Taking excessive vitamin supplements has nothing to do with longevity. I already said this above, but I’ll say it again: the biggest factor in our current lifespan is control of infectious disease, through sanitation measures and vaccination.

The fact that your doctor got colon cancer and you didn’t is highly unlikely to be related to the fact that you consume huge quantities of a trace nutrient. I suspect that a formal study would not reveal that people who take excess doses of trace nutrients have a lower cancer rate than people who are adequately nourished but do not consume excess trace nutrients. My mother in law died of breast cancer several years ago; she was a big believer in the miracles of supplements. She had many bottles of various supplements that she took on a regular basis, and she sold them, as well. But she still died of cancer.

Estrogen seems to have a protective effect against heart disease, which is why men and post-menopausal women have higher rates of heart disease than pre-menopausal women. It has nothing to do with the monthly loss of iron. (If you cook using iron skillets, btw, you should be able to consume sufficient iron without ever popping a pill.)

So far, there have not been many studies on long-term effects of taking excessive amounts of trace nutrients. It *is* known that excessive vitamin C causes kidney damage, but that’s just one effect. Scientists are becoming more interested in these questions, which is good—but, given the amount of money in the vitamin industry, getting funding to do those studies may be problematic.

[ottbmare]

You had better address that to ExDemMom, who does not agree with you. I’m on your side. Except I’m too busy to go on debating her today.

[SharpRightTurn]

A link to a few abstracts by Dr. Ames about the importance of getting adequate nutrition:

http://mcb.berkeley.edu/index.php?option=com_mcbfaculty&name=amesb

[decimon]

Firstly, I welcome your input. This, like every topic, benefits from informed discussion.

As far as I can tell, that vitamin C causes kidney stones was an assumption not verified. Mega-doses of anything seems a bad idea to me unless targeted at some specific condition.

Near all I’ve read about vitamin D leads me to believe that few of us will get adequate amounts without supplementation.

I’m one of those people described as taking a muti-vitamin, mineral, etc. pill as ‘insurance’ against inadequacy in diet. The pill I take has no mega-doses of anything.

[decimon]

Ames has been everyone’s hero at one time or other. ;-)

“In the 1970s, Bruce Ames was a hero to environmentalists—the inventor of the Ames Test, which allows scientists to test chemicals to see whether they cause mutations in bacteria and perhaps cancer in humans. His research and testimony led to bans on such synthetic chemicals as Tris, the flame-retardant used in children’s pajamas. A world renowned cancer researcher with a calm, reasoned manner, Ames was an ideal witness in the case against man-made chemicals. As science writer John Tierney aptly described him in Hippocrates, “He has a quiet, kindly tone of authority as he patiently explains why things are the way they are....He sounds so sensible. which is one reason he made such a good witness for the environmentalists in the 1970s.”

But it’s a scientist’s imperative to change his mind when the data change— and recent data have made Ames deeply suspicious of high dosage chemical testing and especially of the notion that man-made chemicals are uniquely dangerous. We are, he has discovered, surrounded by mutagens—not only synthetic chemicals but also natural ones—and blindly banning suspicious modern substances can do more harm than good.”

http://reason.com/archives/1994/11/01/of-mice-and-men

[goodnesswins]

I think a definition of “excessive” is in order....

[aimhigh]

It would be easy to create a similar study showing that people who take prescription drugs die earlier than those who don’t.

[caveat emptor]

Taking excessive vitamin supplements has nothing to do with longevity. I already said this above, but I'll say it again:

Say it again if you like, but saying it a third time won't make it true.

“Just the place for a Snark!” the Bellman cried,...“Just the place for a Snark! I have said it twice:...Just the place for a Snark! I have said it thrice: ...What I tell you three times is true.”

Estrogen seems to have a protective effect against heart disease... It has nothing to do with monthly loss of iron.

The reverse of your claims is well established.

Scientists are becoming more interested in these questions, which is good—but, given the amount of money in the vitamin industry, getting funding to do those studies may be problematic.

Your view that the "Vitamin industry" is so powerful that it makes medical research funding "problematic", while ignoring the multibillion dollar drug business is quaint, but charming.

[caveat emptor]

You take 8-10 grams Vit C daily? I take four but I have read a lot about it. I know what it did for rheumatoid arthritis and by accident I found out that it helped immensely with the pain of a bad shoulder injury. Now, I also believe it protects one from plantar fasciitis, and carpal tunnel. Reading about intravenous Vit C and it's ability to control pain is extremely interesting.

Most days. I've become a bit nonchalant about exact doses. Approximately four ½t amounts daily in water. My 8-10 grams is based on a recommendation by Pauling. IIRC it was extrapolated to human weight from what various animals synthesize for themselves.

It makes sense for rheumatoid arthritis from what little I know about it, and for tendon or ligament repair in the shoulder injury as well.

I also believe it protects one from plantar fasciitis, and carpal tunnel

I did vigorous Scottish Country Dancing when younger. I developed a plantar fascia problem in my right foot at one point from dancing too exuberantly and without enough control. I figured out what the problem was, slowed down and modified my dancing until it healed, and never had the problem again.

Reading about intravenous Vit C and it's ability to control pain is extremely interesting.

How could one ever get that kind of therapy?

[Conservativegreatgrandma]

If you search the net you can probably find it. I know of a doctor in Omaha who does it and there is a quite famous clinic in Wichita who seems to specialize in it.

There are also been grants made to study the effect of intravenous Vit C on cancer.

It's been a long time since I spent a lot of time researching it but it's fascinating reading once you get started.

[exDemMom]

The damage caused by excessive doses of vitamin C and other water-soluble vitamins isn’t so much kidney stones, but deposits of oxalate (or other) crystals in the kidney tubules and other organs. Furthermore, the process of straining the excess vitamin C out of the blood puts needless wear-and-tear on the kidneys.

Given the huge profits of the vitamin industry, I would take anything claiming that you can’t get adequate amounts of whatever nutrient from your diet or normal activities with a huge grain of salt. It makes no sense at all to believe that we evolved to need higher doses of trace nutrients from our diet than we can get through our natural activities. Our diets are far more varied than those of our ancestors, meaning that the likelihood of missing essential nutrients (as long as we make an effort to “eat healthy”) is far lower than what our ancestors faced.

[exDemMom]

I think a definition of “excessive” is in order....

"Excessive" means more than your body needs to carry out metabolic functions. When you take in more than you need, your body either discards the excess through urination (putting strain on the kidneys proportionate to the amount of excess), or stores it in fat deposits,which can lead to other toxic effects.

To a certain extent, your body is equipped with a sophisticated system for eliminating excess trace nutrients... but stressing those systems with large excesses can have very deleterious effects.

It is impossible to put numerical values on what constitutes "adequate" or "excessive" trace nutrient intake. Like calorie intake, these are very individual.

[Osage Orange]

Are you a Doctor?

Are you a Chemist?

Are you a Scientist?

Do you have a Degree of any type? And if so..what might that be?

I'm not asking to be an ass....I just thought it might be helpful.

[Osage Orange]

but I’ll say it again: the biggest factor in our current lifespan is control of infectious disease, through sanitation measures and vaccination.

Are you saying...when you say "our", you mean American's?