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TalkingNutrition

Providing perspectives on recent research into vitamins and nutritionals

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3 Reasons Multivitamin Supplement Headlines don’t Apply to You

By Michael McBurney

Should I be taking a multivitamin supplement? If the headlines are confusing you, let’s discuss the studies and what you need to know.

Have you had a heart attack recently? Are your periodically using intravenous infusions? If not, then this study isn’t relevant to you.  Lamas and colleagues wanted to know if patients who had previously had a heart attack (myocardial infarction) benefitted from taking a high-dose multivitamin supplement or intravenous infusions of a chelating agent. And the authors also fail to highlight that the controls also received an open-label, oral, low-dose vitamin regimen. In other words, these individuals should have been pretty well-nourished so it shouldn’t be surprising that there weren’t statistically significant benefits of extra vitamins. Of course, the fact that almost half (46%) dropped out of the study before its conclusion suggests that they may not have been very compliant/nourished. Bottom line. Interesting experimental hypothesis but poor execution. Probably the most important statement by the authors is “No evidence suggested harm from vitamin therapy in any category of adverse events.”

Are you a physician? Are you working in the Top 5 of the Best Jobs of 2013? The second study was a randomized, double-controlled trial (RCT) evaluating long-term multivitamin supplementation in male physicians. The Physicians Health Study (PHS) II evaluated numerous nutrients (beta-carotene, vitamin C, vitamin E, multivitamin) in different combinations on the prevention of cancer, cardiovascular disease (CVD), and age-related eye diseases in 15,000 male physicians 55y and older.  Physicians taking a multivitamin supplement had an 8% reduction in total cancer risk (Gaziano et al, 2012). Among these US male physicians, a multivitamin did not affect cardiovascular events (myocardial infarction, stroke or morality (Sesso et al., 2012). And today we learn that there was no impact of multivitamin use on 4 repeated assessments of cognitive function over 12 years. As Grodstein and colleagues wrote, the study may have been conducted in a “population (that) may have been too well-nourished to benefit from a multivitamin”. This is reasonable given that almost 14 years ago, the authors (Sesso et al., 2002) reported that these doctors were leaner, exercised more frequently, and had lower plasma total cholesterol levels  than most men of the same age.


Do you know your nutritional status? Have you had your dietary intake analyzed? Or even better, a blood analysis of your nutritional status? The third study by Fortmann and colleagues is a replay of the November, 2013 draft recommendations released by the US Preventive Services task Force (USPSTF).  The statement by the Council for Responsible Nutrition is correct in affirming the safety of multivitamins, their importance in filling nutrient gaps, and that a paucity of well-conducted RCTs should not be used to scare people from using multivitamins. The study affirms the safety of multivitamins. The authors should also be commended for recognizing that RCTs are not ideally suited to evaluate nutrients. Unlike drug RCTs, the complexities of diets and essentiality of nutrients means that a true placebo control cannot exist. Everyone has some level of nutrient intake.

Nutrition guidance can be thought of like financial advice.  Individuals with financial means have access to a broader, richer selection of investment vehicles than someone struggling to pay for essentials – food, clothing, and housing – with a fixed income. Yet, in the event of a catastrophic event, insurance is more important to the person with limited financial resources than someone with access to a diversified mix of investments.  Similarly, people who are not using multivitamin supplements are more likely to have poorer diets and could usually benefit the most from supplementation. Taking a multivitamin supplement is a safe, effective insurance policy. When making recommendations about multivitamin supplement use, it is critically important to remember the audience because the practice of nutrition is nuanced by culinary preferences, cultural habits and individuality (age, sex, size and activity). Or as Dr Gladys Block said, “none of these studies accurately represents the American population. It is pretty common that in this day and age with the lifestyle many of us lead that we don’t always take the time to have a balanced diet, and even if you do have a balanced diet, you can still have nutrient deficiencies”.

Nutrition guidance is never as simple as ‘multivitamins are bad’. Consider the words of other eminent scientists from USDA HNRCA Tufts University, Creighton University, St Louis Veterans Administration Medical Center, University of Medicine and Dentistry of New Jersey, Harvard University, University of Toronto, Purdue University and University of North Carolina Chapel Hill,Nutrients are orders of magnitude less expensive than drugs”.

Citations

Lamas GA, Boineau R, Goertz C, Mark DB, Rosenberg Y, Sylianou M, Rozema T, Nahin RL, Lindblad L, Lewis EF, Drisko J, Lee KL, and TACT Investigators. Oral high-dose multivitamins and minerals after myocardial infarction: A randomized trial. 2013 Ann Intern Med doi: 10.7326/0003-4819-159-12-201312170-0004

Grodstein F, O’Brien J, Kang JH, Dushkes R, Cook NR, Okereke O, Manson JE, Glynn RJ, Buring JE, Gaziano JM, Sesso HD. Long-term multivitamin supplementation and cognitive function in men: A randomized trial. 2013 Ann Intern Med doi: 10.7326/0003-4819-159-12-101312170-00006

Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP. Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the US Preventive Services Task Force. 2013 Ann Intern Med doi: 10.7326/0003-4819-159-12-201312170-00729

Sesso HD, Gaziano JM, VanDenburgh M, Hennekens CH, Glynn RJ, Buring JE. Comparison of baseline characteristics and mortality experience of participants and nonparticipants in a randomized clinical trial: the Physicians’ Health Study. 2002 Controlled Clin Trials doi: 10.1016/S0197-2456(02)00235-0

Gaziano JM, Sesso HD, Christen WG, Bubes V, Smith JP, MacFayden J, Schwartz M, Manson JE, Glynn RJ, Buring JE. Multivitamins in the prevention of cancer in men: The Physicians’ Health Study II randomized controlled trial. 2012 JAMA doi: 10.1001/jama.2012.13641

Sesso HD, Christen WG,  Bubes V, Smith JP, MacFayden J, Schvartz M, Manson JE, Glynn RJ, Buring JE, Gaziano M. Multivitamins in the prevention of cardiovascular disease in men. The Physicians’ Health Study II Randomized Controlled Trial. 2012 JAMA doi: 10.1001/jama.2012.14805

Guallar E, Stranges S, Mulrow C, Appel LJ, Miller ER. Enough is enough: stop wasting money on vitamin and mineral supplements. 2013 Ann Intern Med doi: 10.7326/0003-4819-159-12-201312170-00011

Blumberg J, Heaney RP, Huncharek M, Scholl T, Stampfer M, Vieth R, Weaver CM, Zeisel SH. Evidence-based criteria in the nutritional context. 2010 Nutr Rev doi: 10.1111/j.1753-4887.2010.00307.x


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