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Providing perspectives on recent research into vitamins and nutritionals


Experts Reiterate Importance of Multivitamin Supplements to Fill Nutrient Gaps

By Michael McBurney

In the December 2013 issue of Annals of Internal Medicine, the Editor and staff orchestrated the publication of and editorial entitled ‘Enough is Enough’ along with 3 multivitamin intervention trials. Today, the journal published a series of letters with strong responses by scientists.

Drs Balz Frei (Linus Pauling Institute, Oregon State University), Bruce Ames (Children’s Hospital Oakland Research Institute), Jeffrey Blumberg (Tufts University Friedman School of Nutrition and Science Policy), and Walter Willett (Harvard School of Public Health) accuse Guallar and colleagues of ignoring decades of nutrition research and diet monitoring of the US population. They write: ‘ few persons in the United States follow the Dietary Guidelines for Americans. Consequently, most persons in the United States are not “well-nourished” and do not meet the Institute of Medicine’s recommendations for the dietary intake of all vitamins and essential minerals.

In their letter, Balz and colleagues note that >93% of adults do not get the estimated average requirements of vitamins D and E, 61% do not get enough magnesium, and 50% do not get enough vitamin A and C, from their diet alone. 98% and 71% do not meet recommended intakes of potassium and vitamin K. These scientists were not alone in their critique.

Dr Irvine Mason writes a scathing letter reminding Guallar and colleagues that they disregarded the best and most comprehensive study to date, the Physicians Health Study II (PHS II). In PHS II, an 8% reduced risk for cancer was measured in men using a multivitamin supplement. In his summary, Mason recommends it is better to be thought a fool than to put opinions in print and remove all doubt!

A registered nurse, Deborah Stepp, expressed concern that more babies may be exposed to unnecessary risk because their mothers stop using a multivitamin at a time when nutrition is particularly important, i..e pregnancy.

Dr Thomas Friberg (University of Pittsburgh) and a principal investigator of Age-Related Eye Disease Study (AREDS) and AREDS II chastised Guallar and colleagues for being oblivious of the fact that multivitamin supplementation helps prevent vision loss in age-related macular degeneration. See AREDS2, Lutein, Zeaxanthin and Age-Related Macular Degeneration for details.

Dr Frei is quoted in NutraIngredients:

It’s irresponsible to ignore decades of nutrition research and tell the people of the United States they have no need for a supplement that could be so helpful, and costs as little as $1 a month.’

Nutrients are essential for life. When nutrient intake is low, deficiency diseases occur. Excessive intakes, of anything, can be harmful. In the administration of medicines, physician’s often adhere to the words of Paracelsus, ‘the dose makes the poison’.  The same principle may be applied to nutrients. However, where  is the value in denigrating dietary supplements? Professionals shouldn’t base their guidance on emotional opinions regarding source of nutrients (food vs supplement); they need to focus on the outcome – remedying nutrient gaps to optimize nutritional status for longterm health. Dietary supplementation is a safe, effective approach to improve nutritional status.  Health is affected by nutritional status not source of nutrients.  It is naive and unscientific for health professionals  to make recommendations on the value of dietary supplementation using randomized interventions that have not assessed nutritional status.

For more information on the Editorial and 3 research papers, see TalkingNutrition blogs: Tuesday, December 17, 2013  (3 Reasons Multivitamin Supplement Headlines don’t Apply to You), Wednesday, December 18, 2013 (If Only Everyone Lived in a Perfect World, Nutrition Would be Irrelevant), and Friday, December 20, 2013 (Is Your Nutrition Tank Full? Dietary Assessment vs Biomarkers).

Main Citations

Frei B, Ames BN, Blumberg JB, Willett WC. Comments and Responses: Enough is Enough. 2014 Ann Intern Med 160 (11): 807

Mason I. Comments and Responses: Enough is Enough. 2014 Ann Intern Med 160 (11): 808

Stepp D. Comments and Responses: Enough is Enough. 2014 Ann Intern Med 160 (11): 808

Friberg TR. Comments and Responses: Enough is Enough. 2014 Ann Intern Med 160 (11):808

Other Citation

Guallar E, Stranges S, Mulrow C, Appel LJ, Miller III, ER. Enough is enough: Stop wasting money on vitamin and mineral supplements. 2013 Ann Intern Med 159 (12):850-851. doi: 10.7326/0003-4819-159-12-201312170-00011