by Jeffrey Dach MD
This article is part one of a series,
for part two, click here.
Rather than making you healthier, you might be surprised to know that the vitamins you take every day are actually killing you. This recent story has been running in the media based on a meta-analysis by Goran Bjelakovic published in JAMA 2007. (1,1A, 10,11,13) The problem is that this JAMA article was a flawed hatchet job not worth the paper it was written on. Out of 748 vitamin studies, the researchers selected only 67 focusing on high dose synthetic vitamins, and excluded all the others showing benefit. This called selective sampling. (1B,1C,1D)(11) Left Image vitamin display courtesy of wikimedia.
Selective Sampling: How to Prove There is No Water in the Ocean
Above image: Tourists in the Ocean with Rocky Bottom Courtesy of Wikipedia
To demonstrate this selective sampling technique in the above JAMA, you can do an easy experiment that proves there is no water in the ocean. Merely go down to the beach front, wade into the water up to your ankles and collect a sample from the ocean floor for later analysis. Reach under the surface of the water, pick up a few pebbles from the ocean floor, and take them back to your laboratory for sophisticated chemical analysis with nuclear magnetic resonance. Amazingly, this print out shows no water! You have thereby proven there is no water in the ocean, and can publish your report in a prestigious journal. Sadly, this is the current state of our medical journals, and now you can understand how easy it is for the media and the public to be deceived.
Proven Health Benefits of Vitamins
Negative articles on vitamins are seen in the mass media. Usually, these are funded directly or indirectly by drug companies, and the researchers are paid to come up with negative findings in order to discredit vitamins so people will take more drugs. It is a simple matter of follow the money trail.
When the studies are done by a neutral party such as the Chinese government, the results are closer to reality. A study from Linxian province in China showed a 9 per cent reduction in mortality from only three vitamins: E, A and selenium. They also showed a 13% reduction in cancer mortality, and a 21% reduction in gastric cancer mortality.(2)
Another study showed selenium supplementation prevented esophageal cancer, heart disease, stroke, and total death: (3)
Folate supplementation in pregnant mothers prevents birth defects (Neural Tube defects) in the developing fetus.(4)
Vitamin C prevents coronary artery disease and a variety of other chronic diseases: (6)(7) Vitamin B-12 supplementation is recommended by the USDA for everyone over the age of 50. (US dept of Agriculture 2005 Food Guidelines)(14)(8) In fact there are volumes of research data showing benefits of vitamin supplementation.(9)
The Bottom Line, Be Skeptical of News Media
Bottom line is that you can’t believe the newspapers or media when it comes to vitamin, mineral or nutritional supplements, because the media depends on advertising revenue from the drug companies. The media will therefore tend to run stories which are negative for vitamins and supplements, which in comparison makes the drug ads look good. The reality is that by and large, vitamins are safe, and drugs are dangerous. Adverse effects from drugs cause 140,000 deaths and 76 billion a year in health care annually.(15)(16)
So remember to be skeptical of news media stories which have a hidden agenda. Direct-to-Consumer drug advertising is also largely deceptive and misleading, and should be banned here in the US as it has been banned in all other countries (with the exception of New Zealand).
Which Vitamins Require Caution?
The water soluble vitamins C is readily excreted in the urine and therefore can be taken at high doses with no ill effects. B vitamins are also considered relatively safe with the exception of vitamin B6, pyridoxine, which can be toxic causing sensory neuropathy above 300 mg per day. The biologically active form of pyridoxine is called P-5-P (pyridoxal-5-phosphate) which has no reported toxicity and is preferred. (17-21) Make sure your B Vitamin Complex uses the P-5-P version rather than plain old pyridoxine. We routinely measure serum P-5-P levels just to be on the safe side. Niacin in large doses can cause characteristic flushing, and skin tingling of the neck and face. Although harmless, this can be alarming to the unsuspecting patient who may seek medical assistance resulting in over-treatment for a harmless self-limiting symptom. When considering B vitamin supplementation, it’s best to consult a knowledgeable physician to measure relevant levels and make dosage recommendations.
The fat soluble vitamins A and D can accumulate and cause toxicity at high doses over prolonged periods, so these must be monitored. We routinely measure vitamin D blood levels, and supplement Vitamin D with serial monitoring of blood levels. Also, Vitamin E and fish oils have a blood thinning effect, which can cause bleeding tendencies. Most anesthesiologists will recommend avoiding Vitamin E and Fish Oil prior to elective surgery to avoid bleeding. Also, make sure to inform your surgeon or anesthesiologist about your intake of other blood thinners like aspirin, persantine or coumadin if you are thinking about having elective surgery.
Update May 2013
Antioxidants: The Real Story Biased Researchers; Parroting Press by Gert E. Schuitemaker, PhD, Orthomolecular Medicine News Service, May 14, 2013
“The Linus Pauling Institute noted that two important studies with positive results of antioxidants were completely ignored by the Bjelakovic-group.[4,5] From these and other comments, it is clear that antioxidants continue to be considered essential to health. “
This article is part one of a series, for part two, click here.
Articles with related interest:
Jeffrey Dach, M.D.
Links and References:
Vitamins ‘could shorten lifespan’ Research has produced mixed results
Taking certain vitamin supplements may adversely affect people’s lifespan, researchers have suggested. BBC News 28 February 2007,
Mortality in Randomized Trials of Antioxidant Supplements for Primary and Secondary Prevention. Systematic Review and Meta-analysis, by Goran Bjelakovic, MD, DrMedSci;Dimitrinka Nikolova, MA; Lise Lotte Gluud, MD, DrMedSci, Rosa G. Simonetti, JAMA 2007;297:842-857.
Alliance for Natural Health Critiques JAMA Study Claiming Synthetic Vitamins Can Kill You JAMA – ‘vitamins kill’ – no they don’t! Alliance for Natural Health (UK), Mar 5, 2007 Straight to the Source
(1D) Poor methodology in meta-analysis of vitamins. Dr Steve Hickeyi,ii, Dr Len Noriegai and Dr Hilary Roberts iFaculty of Computing, Engineering and Technology, Staffordshire University; iiSchool of Biology, Chemistry and Health Science, Manchester Metropolitan University. Poor methodology in meta-analysis of vitamins Dr Steve Hickeyi Dr Len Noriegai and Dr Hilary Roberts
J Natl Cancer Inst. 1993 Sep 15;85(18):1483-92.
Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population.Blot WJ, Li JY, Taylor PR, Guo W, Dawsey S, Wang GQ, Yang CS, Zheng SF, Gail M, Li GY, et al..
ORIGINAL RESEARCH COMMUNICATIONS
Prospective study of serum selenium concentrations and esophageal and gastric cardia cancer, heart disease, stroke, and total death1,2,3
Wen-Qiang Wei, Christian C Abnet, You-Lin Qiao, Sanford M Dawsey, Zhi-Wei Dong, Xiu-Di Sun, Jin-Hu Fan, Elaine W Gunter, Philip R Taylor and Steven D Mark
Results: We found significant inverse associations between baseline serum selenium and death from ESCC (RR: 0.83; 95% CI: 0.71, 0.98) and GCC (0.75; 0.59, 0.95).
FDA web site: How Folate Can Help Prevent Birth Defects by Paula Kurtzweil
Experimental Biology and Medicine 226:243-270 (2001)
Folate, Homocysteine and Neural Tube Defects: An Overview
Nathalie M.J. van der Put1,*, Henny W.M. van Straaten, Frans J.M. Trijbels* and
Linus Pauling Protocol for Reversing Heart Disease
Owen Fonorow 2005
Vitamin C Information Linus Pauling Institute Oregon State University
B12 by Richard A. Kunin, M.D. 2000
list of Clinical Studies that document the importance of micronutrients and nutrition in maintaining optimum health.
Full pdf of JAMA article, Mortality with antioxidants
Dr. John Briffa is a London-based doctor and author with an interest in nutrition and natural medicine. My opinion is this review’s weaknesses and limitations mean that it’s hard to draw any conclusions from it. The selective approach to selecting studies, the very variable protocols of the studies, and the fact that the focus was on high doses of synthetic nutrients, means that this review has little or no relevance to individuals taking, say, a multivitamin and mineral each day as nutritional insurance.
Vitamin pills can “increase rate of mortality” Reuters News Service
Scientists reviewed 67 studies on 230,000 people to see whether so-called antioxidant vitamins prolonged life expectancy.
FOXNEWS.Mom, This Study Says I Don’t Have to Take My Vitamins!
Wednesday, April 16, 2008. The Health Food Manufacturers’ Association told Sky News online that the study was “in essence, systematically flawed.” “The analysis focused on one broad category of study, then evaluated just 67 of the 748 studies that could be included in the review,” according to the Association.
Dietary Guidelines for Americans 2005, USDA
Key Recommendations for Specific Population Groups
People over age 50. Consume vitamin B12 in its crystalline form (i.e., fortified foods or supplements). Women 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 enhancer of iron absorption, such as vitamin C-rich foods. Women of childbearing age who may become pregnant and those 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. Older adults, people with dark skin, and people exposed to insufficient ultraviolet band radiation (i.e., sunlight). Consume extra vitamin D from vitamin D-fortified foods and/or supplements.
Arch Int Med Vol. 155 No. 18, October 9, 1995
Drug-related morbidity and mortality. A cost-of-illness model
J. A. Johnson and J. L. Bootman Center for Pharmaceutical Economics, College of Pharmacy, University of Arizona, Tucson, USA.
Drug-related morbidity and mortality was estimated to cost $76.6 billion in the ambulatory setting in the United States.
(16) Classen, David C. MD MS, Pestotnik, Stanley L. MS RPh, Evans R. Scott PhD, Lloyd James F., and Burke John P. MD, “Adverse Drug Events in Hospitalized Patients: Excess Length of Stay, Extra Costs, and Attributable Mortality”, JAMA, January 22, 1997, Vol. 277, Num. 0, pp. 301-306. Adverse drug events hospitalized patients excess length of stay extra costs mortality Classen Jama 1997
With 140,000 people dying each year from adverse drug events and another 88,000 dying from acquired infections makes it a total of 228,000 deaths a year from hospital related harms. This makes it the third leading cause of death in the United States, only behind heart disease and cancer according to the CDC’s statistics (National Vital Statistics Report, July 24, 2000, Vol. 48, No. 11, p. 26).
Ann Rheum Dis. 2006 December; 65(12): 1666–1667.
Pyridoxine toxicity courtesy of your local health food store C D Silva and D P D’Cruz
Med J Aust. 1987 Jun 15;146(12):640-2.
Pyridoxine neuropathy. Waterston JA, Gilligan BS.
Abstract A case of sensory neuropathy in a young woman due to long-term ingestion of pyridoxine, with subsequent recovery, is described. Pyridoxine neuropathy may occur after the long-term ingestion of doses as low as 200 mg a day. Because of its widespread use in the community, both the general public and the medical community need to be aware of this recently described complication of megavitamin therapy.
Neurology. 1985 Oct;35(10):1466-8. Sensory neuropathy with low-dose pyridoxine.Parry GJ, Bredesen DE.Abstract
We describe 16 patients with neuropathy associated with pyridoxine abuse. The clinical picture of a pure sensory central-peripheral distal axonopathy was consistent. Pyridoxine dose was 0.2 to 5 g/d, and duration of consumption before symptoms was inversely proportional to the daily intake. In all patients with adequate follow-up, improvement followed discontinuation of pyridoxine. The ready availability of up to 1-gram tablets makes it likely that this neuropathy will continue to be seen.
N Engl J Med. 1983 Aug 25;309(8):445-8.
Sensory neuropathy from pyridoxine abuse. A new megavitamin syndrome.
Schaumburg H, Kaplan J, Windebank A, Vick N, Rasmus S, Pleasure D, Brown MJ.
We describe seven adults who had ataxia and severe sensory-nervous-system dysfunction after daily high-level pyridoxine (vitamin B6) consumption. Four were severely disabled; all improved after withdrawal. Weakness was not a feature of this condition, and the central nervous system was clinically spared. Although consumption of large doses of pyridoxine has gained wide public acceptance, this report indicates that it can cause sensory neuropathy or neuronopathy syndromes and that safe guidelines should be established for the use of this widely abused vitamin.
Indices of Pyridoxine Levels on Symptoms Associated with Toxicity: A Retrospective Study
Aliya N. Chaudary;1 Adam Porter-Blake;2 Patrick Holford2
Conclusions: There appeared to be no association between symptoms associated with vitamin B6 toxicity and vitamin B6 dose (between 30mg and 230mg) during a period of 3–27 months. A suitable vitamin B6 NOAEL of 100 mg / day and a suitable LOAEL of 150 mg / day is suggested.
Jeffrey Dach, M.D.
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