My Vitamins Are Killing Me Part Two

FE_DA_BoyChoking_Vitamins Are Killing Me

My Vitamins Are Killing Me Part Two

by Jeffrey Dach MD

For Part One Click Here.

Every year or so, we are can expect an orchestrated media blitz funded by the drug industry to convince us that vitamin supplements are bad for us.  They whisper in our ear the message that our lowly vitamin pill is not making us healthier, and instead may be killing us.  The message tells us to stop our vitamin pill, and instead take a drug, since drugs are good for us and vitamins are bad for us.  Upper left image courtesy of US News.

Editorial in the Annals of Internal Medicine

This year, the news media is mindlessly parroting an editorial from the Annals of Internal Medicine proclaiming that “nutritional supplements do not prevent chronic disease, their use is not justified and they should be avoided” In addition, “the general population of supplement users have no micronutient deficiencies“. (1):

My Vitamins Are Killing Me Here is the quote from the editorial (1):

“The large body of accumulated evidence has important public health and clinical implications. Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action. The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and other countries.”(1)

Conclusion is Not Supported by the Studies

Aside from the fact that the three vitamin studies published in the Annals do not in any way support those conclusions, and aside from the fact that all three studies are plagued with methodological flaws which have been pointed out by many others, let’s look at a few obvious facts about vitamins.

Go to the Grocery Store and Look at a Few Labels

iodized saltGo down the aisle to the Table Salt section of your supermarket.  Take a look at the label on the box of Table Salt. (left image).  The label  says “Iodized Salt” which means a natural supplement, iodine, has been added to the salt.

If we don’t need supplements in our food, then why did the government decide to add Iodine to Table salt in 1924 ?  The reason is obvious.  The American diet is deficient in Iodine, and segments of the population are iodine deficient leading to health problems, including mental retardation.  Adding Iodine to table salt boosted the IQ of Americans and made us smarter.   Health benefits of iodine supplements are discussed in my previous article on this topic.

Fortified Breakfast Cereals

Kellogs Label Cereal BoxGo further down the aisle in the supermarket to the breakfast cereal section of the grocery store.  Look at the label on the cereal box.  What do you see ?

Riboflavin, thiamine, iron, vitamin D, vitamin A, B6, B12 and folate have been added to the cereal.  (left image)

Why does the cereal need to be fortified?  This is explained by the cereal company. Here is a quote from the Kellogg Corn Flake Web Site explaining why they fortify their cereals with vitamins (9):

“Simply put, fortification is the process of adding vitamins and minerals to foods that do not contain them. By fortifying our cereal with nutrients like riboflavin, iron, thiamin and folic acid, we can better help you to meet the daily dietary recommendations of these vitamins and minerals.”(9)

Will Kellogg Corn Flakes and all the other Food Companies stop fortifying cereals with vitamins and minerals because an editorial in the Annals of Internal Medicine funded by Drug Companies says they should stop ? I don’t think so, and neither should you.

Ask the Government if We need Vitamins – B12 and Folate

USDALet’s go to another place to ask if we don’t need our vitamin supplements, ask if we should throw them into the garbage can.  Lets go ask the government.  Lets take a look at the USDA 2010 dietary guidelines which tell us:

“Because older adults may have a hard time absorbing vitamin B-12 from food, the USDA’s 2010 Dietary Guidelines for Americans recommend that people over 50 years-old incorporate B-12 fortified foods or B12 crystalline supplements in their diets. ” (6,7)

Folate Prevents Birth Defects- Supplementation with Folate Advised

The government also advises folate to prevent neural tube deformities. “If you’re a woman of childbearing age who may become pregnant or is in the first trimester of pregnancy, consume adequate synthetic folic acid daily (from fortified foods or supplements) in addition to food forms of folate from a varied diet.” (6.7)

Anti-Vitamin Editorial is More Drug Industry Sponsored  Propaganda ?

Big PharmaSo now that we know that our food industry believes our food is deficient and needs fortification with vitamin supplements, and even our own government agrees we need vitamin supplements,  what can we conclude ?

Perhaps this anti-vitamin editorial in the Annals of Internal Medicine is merely sponsored propaganda from the Drug Industry.

Remember that natural supplements represent competition to the drug industry.  Why not eliminate the competition creating a  sicker population which then requires more drugs, and more health care?  This is a simple formula for increasing drug sales and profits, but unfortunately makes for a sicker nation with higher expenditures on health care.

A Skewed Population of ill People

My most significant criticism of this Anti-Vitamin Editorial is that as  physicians, we do not see healthy people.  They have no reason to seek medical attention.

We see in our offices every day a skewed population of people who are there because of health issues.  They have, among other things, vitamin, mineral and micro nutrient deficiencies.(8)  Some of these deficiencies are caused by inadequate dietary intake, some are caused by drug interactions which prevent absorption, some are caused by auto-immune illnesses,  some are caused by genetic abnormalities in transport proteins, etc.  It is the job of the physician to identify these vitamin, mineral, micronutient deficiencies and rectify them as best as possible.  That is what I try to do.

It is not helpful to publish a rant in the medical literature about how there are no micronutient deficiencies in the population, and besides vitamins and minerals are worthless.   This is not a valid intellectual exercise, which only benefits the drug industry sponsors.  It certainly does not benefit the population.

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Jeffrey Dach MD

Links and References

1) http://annals.org/article.aspx?articleid=1789253
Eliseo Guallar, SaverioStranges, Cynthia Mulrow, Lawrence J. Appel, Edgar R. Miller, III; Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Annals of Internal Medicine. 2013 Dec;159(12):850-851.

2) http://annals.org/article.aspx?articleid=1789248
17 December 2013   Oral High-Dose Multivitamins and Minerals After Myocardial Infarction: A Randomized Trial
Gervasio A. Lamas, MD; Robin Boineau, MD, MA; Christine Goertz, DC, PhD; Daniel B. Mark, MD, MPH; Yves Rosenberg, MD; Mario Stylianou, PhD; Theodore Rozema, MD; Richard L. Nahin, PhD, MPH; Lauren Lindblad, MS; Eldrin F. Lewis, MD; Jeanne Drisko, MD; Kerry L. Lee, PhD, for the TACT (Trial to Assess Chelation Therapy) Investigators*
Conclusion: High-dose oral multivitamins and multiminerals did not statistically significantly reduce cardiovascular events in patients after MI who received standard medications. However, this conclusion is tempered by the nonadherence rate.

3) http://annals.org/article.aspx?articleid=1789250
17 December 2013  Long-Term Multivitamin Supplementation and Cognitive Function in Men: A Randomized Trial
Francine Grodstein, ScD*; Jacqueline O’Brien, ScD*; Jae Hee Kang, ScD; Rimma Dushkes, PhD; Nancy R. Cook, ScD; Olivia Okereke, MD; JoAnn E. Manson, MD, DrPH; Robert J. Glynn, PhD; Julie E. Buring, ScD; J. Michael Gaziano, MD, MPH; and Howard D. Sesso, ScD, MPH
Limitation: Doses of vitamins may be too low or the population may be too well-nourished to benefit from a multivitamin.
Conclusion: In male physicians aged 65 years or older, long-term use of a daily multivitamin did not provide cognitive benefits.

4) http://annals.org/article.aspx?articleid=1767855
17 December 2013
Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force
Stephen P. Fortmann, MD; Brittany U. Burda, MPH; Caitlyn A. Senger, MPH; Jennifer S. Lin, MD, MCR; and Evelyn P. Whitlock, MD, MPH
Limitations: The analysis included only primary prevention studies in adults without known nutritional deficiencies. Studies were conducted in older individuals and included various supplements and doses under the set upper tolerable limits. Duration of most studies was less than 10 years.
Conclusion: Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on CVD.

5) http://ajcn.nutrition.org/content/79/5/805.full
Am J Clin Nutr May 2004 vol. 79 no. 5 805-811
Breakfast cereal fortified with folic acid, vitamin B-6, and vitamin B-12 increases vitamin concentrations and reduces homocysteine concentrations: a randomized trial1,2,3
Katherine L Tucker,    Beth Olson,    Peter Bakun,    Gerard E Dallal,    Jacob Selhub, and    Irwin H Rosenberg

6) http://now.tufts.edu/news-releases/mild-b12-deficiency-cognition
Mild Vitamin B12 Deficiency Associated with Accelerated Cognitive Decline  December 5, 2012   Andrea Grossman

7)  http://www.fda.gov/forconsumers/consumerupdates/ucm118079.htm

Food Guidelines, published by the Department of Health and Human Services and the U.S. Department of Agriculture (USDA),

If you’re a woman of childbearing age who may become pregnant or is in the first trimester of pregnancy, consume adequate synthetic folic acid daily (from fortified foods or supplements) in addition to food forms of folate from a varied diet.

Special Nutrient Needs

According to the Dietary Guidelines for Americans, many people consume more calories than they need without taking in recommended amounts of a number of nutrients. The Guidelines warn that there are numerous nutrients—including vitamins—for which low dietary intake may be a cause of concern. These nutrients are:

calcium, potassium, fiber, magnesium, and vitamins A (as carotenoids), C, and E (for adults)
calcium, potassium, fiber, magnesium, and vitamin E (for children and adolescents)
vitamin B-12, iron, folic acid, and vitamins E and D (for specific population groups).

Regarding the use of vitamin supplements, the Dietary guidelines include the following:

Consume a variety of nutrient-dense foods and beverages within and among the basic food groups. At the same time, choose foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol.
Meet recommended nutrient intakes within energy needs by adopting a balanced eating pattern, such as one of those recommended in the USDA Food Guide or the National Institute of Health’s Dietary Approaches to Stop Hypertension (DASH) eating plan.
If you’re over age 50, consume vitamin B-12 in its crystalline form, which is found in fortified foods or supplements.
If you’re a woman of childbearing age who may become pregnant, eat foods high in heme-iron and/or consume iron-rich plant foods or iron-fortified foods with an iron-absorption enhancer, such as foods high in vitamin C.
If you’re a woman of childbearing age who may become pregnant or is in the first trimester of pregnancy, consume adequate synthetic folic acid daily (from fortified foods or supplements) in addition to food forms of folate from a varied diet.
If you are an older adult, have dark skin, or are exposed to insufficient ultraviolet band radiation (such as sunlight), consume extra vitamin D from vitamin D-fortified foods and/or supplements.

8) http://www.ncbi.nlm.nih.gov/pubmed/21864284

Curr Med Chem. 2011;18(30):4635-50.

Selenium and clinical trials: new therapeutic evidence for multiple diseases.  Sanmartin C, Plano D, Font M, Palop JA. Department of Organic and Pharmaceutical Chemistry, University of Navarra, Irunlarrea, Pamplona, Spain.

The understanding of the essential role of selenium (Se) in human health has increased substantially in recent decades. Micronutrient deficiencies are very common in the general population and may be even more common in patients with different pathologies due to genetic or environmental causes and prescription drug use. Selenium is used by people in the prevention and/or treatment of different disorders including cardiovascular disease, osteoarthritis, rheumatoid arthritis, hypothyroidism, stroke, atherosclerosis, cancer susceptibility and treatment, HIV, AIDS, neuronal diseases such as Alzheimer or amyotrophic lateral sclerosis, pancreatitis, depression, and diabetes amongst others. Several mechanisms have been suggested to mediate the biological effects of Se and these include antioxidant defence systems, synthesis and stability of metabolites that act as intermediates implicated in diverse selenoproteins expression pathways oxidative metabolism, immune system modulation, DNA intercalators, kinase regulation, enzymatic cofactor, and gene expression. A number of clinical trials in recent years have provided convincing evidence of the central role of this element, either alone or in combination with other micronutrients or antioxidants, in the prevention and treatment of multiple diseases. Based on these studies this review focuses on the advances made so far in the study of mechanisms and applications of selenium compounds that could be suitable for chronic diseases.

9) Kellogg Corn Flakes Fortification Page

10) Physicians’ Health Study II, Harvard University.  November 5, 2012.  http://phs.bwh.harvard.edu/index.html

http://well.blogs.nytimes.com/2013/12/16/a-challenge-to-vitamins/?_r=0
Should We Toss Our Vitamin Pills?
By RONI CARYN RABIN

http://www.forbes.com/sites/larryhusten/2013/12/16/case-closed-multivitamins-should-not-be-used/
Larry Husten, Contributor
Case Closed: Multivitamins Should Not Be Used

http://www.cnn.com/2013/12/16/health/multivitamins-studies/
Are multivitamins a waste of money? Editorial in medical journal says yes
By Nadia Kounang, CNN
updated 9:15 AM EST, Tue December 17, 2013

———————-

debunking

http://brandonturbeville.blogspot.com/
Friday, December 20, 2013
The Case Against Corporate Media and Big Pharma Science Grows Stronger
Brandon Turbeville
Activist Post  In a recent anti-supplement propaganda article by NPR entitled “The Case Against Multi-Vitamins Grows Stronger,” the notorious “news” agency lavishly reported the alleged findings of “experts” proving that “vitamin supplements don’t help most people and can actually cause diseases that people are taking them to prevent, like cancer.” Immediately, the entire mainstream media machine jumped into action promoting the statements of the “experts” and claiming that the case is now closed regarding the effectiveness and safety of nutritional supplements. Typically, Big Pharma mouthpieces such as NBC and CBS followed suit in repeating the same talking points.

The first, and most obvious, flaw in this latest anti-supplement propaganda campaign is the fact that mainstream media outlets are citing an editorial, not a study.

Second, the claim that the general population shows no evidence of micronutrient deficiencies is beyond absurd. From consumption of food products that are nutritionally deficient to even organic produce than is deficient in vital minerals due to soil mineral depletion, the fact is that this generation of Westerners is the most micronutrient deficient of all time (assuming adequate food availability).

Widespread micronutrient deficiencies have been known about since at least 1936 when a U.S. Senate Report was released addressing the depletion of the soil which it determined left 99% of Americans nutrient deficient.

http://www.lef.org/featured-articles/Flawed-Research-Used-to-Attack-Multivitamin-Supplements.htm
Flawed Research Used to Attack Multivitamin Supplements
By Blake Gossard, Kira Schmid, ND, Luke Huber, ND, MBA, Steven V. Joyal, MD
Two flawed studies and an editorial published in the December 17th issue of the Annals of Internal Medicine have attempted to discredit the value of multivitamin supplements.1-3
Both of the studies were plagued by grievous methodological flaws.

http://newhope360.com/breaking-news/beyond-media-blitz-coming-real-conclusions-recent-multivitamin-research
Beyond the media blitz: coming to real conclusions on recent multivitamin research
Dec. 20, 2013 Barry Ritz

The current issue of Annals of Internal Medicine groups together three generally well-done studies on the topic of multivitamins and chronic disease prevention with what could be described as a sensationalistic, headline-grabbing editorial.  The editorial, entitled Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements, serves as a call to action for medical professionals to actively advise against the routine use of vitamin and mineral supplements and for researchers to cease any further, futile research into the potential benefits of supplements in the general population.

http://info.achs.edu/blog/bid/329657/Nutrition-Vitamins-and-Holistic-Health
ACHS Health and Wellness Blog
Nutrition, Vitamins, and Holistic Health
Posted by Dorene Petersen on Wed, Dec 18, 2013 @ 10:27 PM
By Oleg Maksimov, Ph.D., Academic Dean. A CNN news report earlier in the week that boldly stated that vitamins and supplements are a waste of time and money caught my attention.  The article the news report referred to was written by Dr. Alice G. Walton and posted on the Forbes website. “Vitamins Lack Clear Health Benefits, May Pose Risks,” basically argues that we should stop wasting money on multivitamins, since there is little evidence to their benefit and some evidence to their detriment[1]. This really surprised me, since I just finished reading a handful of studies demonstrating a relationship between vitamin E intake and reduced risk of type 2 diabetes[2] and lower amyotrophic lateral sclerosis rates[3].

http://www.bodybuilding.com/fun/vindicating-vitamins-protecting-your-health-is-not-a-waste.html
Don’t fall for sensational headlines and slanted science about vitamin/mineral supplementation. Nothing short of your long-term health is at stake.
by Jim Stoppani, Ph.D. Dec 20, 2013
“Vitamins Are A Waste of Money!” read the headline, and its sensational nature spread through the media like a Kardashian selfie. Not only are these supplements a waste of money, the stories implored, but they also might even be harmful.

http://www.dsm.com/campaigns/talkingnutrition/en_US/talkingnutrition-dsm-com/2013/12/PHSII_USPSTF_multivitamins.html
TalkingNutrition.dsm.com

3 Reasons Multivitamin Supplement Headlines don’t Apply to You
By Michael McBurney.  .

——————-
http://ajcn.nutrition.org/content/79/5/805.full
Am J Clin Nutr May 2004 vol. 79 no. 5 805-811
Breakfast cereal fortified with folic acid, vitamin B-6, and vitamin B-12 increases vitamin concentrations and reduces homocysteine concentrations: a randomized trial1,2,3
Katherine L Tucker,    Beth Olson,    Peter Bakun,    Gerard E Dallal,    Jacob Selhub, and    Irwin H Rosenberg

http://now.tufts.edu/news-releases/mild-b12-deficiency-cognition
Mild Vitamin B12 Deficiency Associated with Accelerated Cognitive Decline  December 5, 2012   Andrea Grossman

BOSTON— Being mildly vitamin B-12 deficient could be an indication that some older adults are at a greater risk for accelerated cognitive decline, an observational study from researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging (USDA HNRCA) at Tufts University suggests.
Martha Savaria Morris, Ph.D., an epidemiologist in the Nutrition Epidemiology Program at the HNRCA at Tufts University, and colleagues examined data from 549 men and women enrolled in a cohort of the Framingham Heart Study, focusing on scores on the Mini-Mental State Examination (MMSE), a short list of questions and tasks commonly used to screen for dementia.  The subjects were divided into five groups, based on their vitamin B-12 blood levels.
“Men and women in the second lowest group did not fare any better in terms of cognitive decline than those with the worst vitamin B-12 blood levels. Over time, their MMSE scores declined just as rapidly,” Morris said. “Rapid neuropsychiatric decline is a well-known consequence of severe vitamin B-12 deficiency, but our findings suggest that adverse cognitive effects of low vitamin B-12 status may affect a much larger proportion of seniors than previously thought.”
In the August 2012 issue of the Journal of the American Geriatrics Society, Morris and colleagues write that MMSE scores dropped, on average, 0.24 points per year versus an average drop of 0.35 points annually in the two groups with the lowest vitamin B-12 blood levels. The authors observed an even steeper decline of about 1-point per year in some people in the two lowest groups who also exhibited high blood levels of folate or took supplements containing its synthetic form, folic acid, although their models indicate the additional cognitive decline is potentially related to other health problems in this particular study population.
– See more at: http://now.tufts.edu/news-releases/mild-b12-deficiency-cognition#sthash.5FBGkcLg.dpuf

Because older adults may have a hard time absorbing vitamin B-12 from food, the USDA’s 2010 Dietary Guidelines for Americans recommend that people over 50 years-old incorporate B-12 fortified foods or supplements in their diets. – See more at:

http://now.tufts.edu/news-releases/mild-b12-deficiency-cognition#sthash.5FBGkcLg.dpuf

full text
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820055/
Nutrients. 2013 Sep 30;5(10):3975-92. doi: 10.3390/nu5103975.
Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients.
Wierdsma NJ1, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA.
Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years) and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B₆, B₁₂, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin were determined (before prescribing gluten free diet). Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B₆ 14.5%, folic acid 20%, and vitamin B₁₂ 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) < 18.5), and 29% of the patients were overweight (BMI > 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B₁₂. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly “early diagnosed” CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.

 

Jeffrey Dach MD
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My Vitamins Are Killing Me Part Two
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Your Vitamins are Killing You ? Why You Need Your Vitamins.
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