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.
New studies “proving” that vitamins kill people hit front pages and news broadcasts across the country seemingly every day.
Paul A. Offit’s recent piece in The New York Times, “Don’t Take Your Vitamins,” mentioned a number of studies that suggested a correlation between supplementation and increased risk of death. Offit asserts, “It turns out … that scientists have known for years that large quantities of supplemental vitamins can be quite harmful indeed.” The flaws in the studies he quoted have been well documented. Giving large doses of a single antioxidant is known to set up a chain reaction that creates more free radicals.
But many studies do not prove anything. Science is squirrelly. You only get the answers to the questions you ask. Many of the studies that are performed are called observational studies or epidemiological studies. They are designed to look for or “observe” correlations. Studies like this 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 die 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 they fly 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, many recent studies on vitamins are 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” flies in the face of all reasonable facts from both intervention trials and outcome studies published over the past 40 years. For example, recent trials published within the last few years indicate that modest nutritional supplementation in middle age women found their telomeres didn’t shorten. Keeping your telomeres (the little end caps on your DNA) long is the hallmark of longevity and reduced risk of disease. A recent study found that B12, B6 and folate given to people with memory loss prevented brain atrophy that is associated with aging and dementia. In fact, those who didn’t take the vitamins had almost ten times loss of brain volume as those who took the vitamins.
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, vitamins C and 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. Fish oil is approved by the FDA for lowering triglycerides and reduces risk of heart attacks and more. There are many other studies ignored by Offit in his New York Times piece.
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. Many studies simply fail 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 in which all nutrients work as a team to support your biochemical processes.
Michael 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 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 over 15,000 patients and performing extensive nutritional testing on them, it is clear to me that 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% of our population is vitamin C deficient.
Scurvy in Americans in 2013? Really? But if all you eat is processed food–and many Americans do–then you, like the British sailors of the 17th century, will 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?
In short, these studies often confuse rather than clarify, and they only serve up doses of media frenzy and superficial analysis. They leave 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!
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