03.16.10
The Council for Responsible Nutrition (CRN), Washington, D.C., has issued a statement in response to a controversial article that appeared in the April 2010 issue of Readers Digest.
While taking a multivitamin does not replace a healthy diet, multivitamins can act as an insurance policy to help get essential nutrients into our bodies when our diets inevitably fall short. After all, no one is perfect all of the time and it can be difficult to get all of the nutrients we need every day from food alone, especially while watching the number of calories we consume. According to the National Health and Nutrition Examination Survey (NHANES), many Americans, including children and adolescents, fail to consume recommended amounts of vitamins E, C, D, and A, as well as calcium and magnesium. And data from the National Marine Fisheries Service shows that on average, Americans only consume about 16 pounds of fish and shellfish per year—far short of the recommended 2 servings of fatty fish per week needed to reap the heart-healthy benefits of omega-3 fatty acids found in fish.
It’s important to remember that dietary supplements, by definition, are not intended to treat, diagnose, mitigate, prevent, or cure disease. However, they can help support health or basic bodily functions. Omega-3 fatty acids are widely accepted by healthcare professionals, as well as scientific organizations, for helping reduce inflammation, lowering triglyceride levels and contributing to a healthy heart and blood vessels. The American Heart Association, in fact, in a 2002 Scientific Statement on omega-3 fatty acids and cardiovascular disease, states that ‘…for patients with coronary artery disease, the dose of omega-3 (1 g/d) may be greater than what can readily be achieved through diet alone. These individuals, in consultation with their physician, could consider supplements for CHD risk reduction.’
The very nature of science is that it is an evolutionary discipline—we learn things from one study, and then seek to confirm those results, look in a different direction, or test for even more possibilities. The latest results don’t necessarily nullify earlier findings.
Scientists are now considering the importance of looking at the habits of healthy people to determine how to achieve good health. Research shows that individuals who use vitamins and other supplements also engage in other healthy behaviors, such as trying to eat a well-balanced diet and being physically active, according to the 2008 CRN Consumer Survey on Dietary Supplements. Supplement users also tend to place an emphasis on health as a priority in their own personal lives, as reflected in their day-to-day habits when it comes to maintaining overall wellness. When asked to indicate whether or not they agree with the following statements about their personal behaviors, supplement users and non-users responded as follows:
More than 150 million Americans use dietary supplements each year. In the U.S. alone, billions of bottles of supplement products are sold in a year, and yet for the first full year (2008) that it was mandated by law that companies report serious adverse events to FDA, the agency reported only 672 serious adverse events. Compare that number to the pharmaceutical industry where hundreds of thousands of serious adverse events are received by FDA each year.
Douglas MacKay, ND, vice president, scientific and regulatory affairs, said that while the article suggests vitamins may not be worth taking, strong science demonstrates otherwise.
“The reality is that vitamins and other dietary supplements play an important role—along with other smart choices such as healthy diet and exercise—in helping promote and maintain overall health and wellness,” he said. “In addition, vitamins can be valuable for a host of other reasons, including some of the areas discussed in this article, such as filling nutrient gaps, helping prevent neural tube birth defects, supporting heart health and more.”
He went on to say that the article cherry-picked through scientific literature, and offered a counter perspective (offered below) to the Reader’s Digest opinion:
“Fact: Most Americans don’t eat as well as they should and vitamins—including a multivitamin—can safely and affordably help fill nutrient gaps.
While taking a multivitamin does not replace a healthy diet, multivitamins can act as an insurance policy to help get essential nutrients into our bodies when our diets inevitably fall short. After all, no one is perfect all of the time and it can be difficult to get all of the nutrients we need every day from food alone, especially while watching the number of calories we consume. According to the National Health and Nutrition Examination Survey (NHANES), many Americans, including children and adolescents, fail to consume recommended amounts of vitamins E, C, D, and A, as well as calcium and magnesium. And data from the National Marine Fisheries Service shows that on average, Americans only consume about 16 pounds of fish and shellfish per year—far short of the recommended 2 servings of fatty fish per week needed to reap the heart-healthy benefits of omega-3 fatty acids found in fish.
In December 2009, the American Dietetic Association, the world’s largest organization of food and nutrition professionals, issued an updated position paper on nutrient supplementation, which reaffirms the importance of obtaining nutrients from the consumption of a variety of nutrient-rich foods, but also acknowledges that ‘Additional nutrients from supplements can help some people meet their nutrition needs as specified by science-based nutrition standards such as the Dietary Reference Intakes.’ Dietary supplements—as their name implies—do not take the place of a healthy diet, but can augment the diet and help ensure that individuals get the nutrients they need.
Fact: Vitamin C and Echinacea may help cut the duration and severity of a cold.
Though the body of research is not conclusive, a meta-analysis shows that taking vitamin C may reduce the duration of a cold by 8 percent in adults and more than 13 percent in children. Additionally, another meta-analysis published in a July 2007 issue of The Lancet, suggests that taking the herbal supplement Echinacea could reduce the risk of catching a cold by 58 percent and reduce the duration of colds by an average of 1.4 days.
Though the body of research is not conclusive, a meta-analysis shows that taking vitamin C may reduce the duration of a cold by 8 percent in adults and more than 13 percent in children. Additionally, another meta-analysis published in a July 2007 issue of The Lancet, suggests that taking the herbal supplement Echinacea could reduce the risk of catching a cold by 58 percent and reduce the duration of colds by an average of 1.4 days.
Fact: Omega 3 fatty acids (DHA and EPA)—found in fish oil supplements—support heart health.
It’s important to remember that dietary supplements, by definition, are not intended to treat, diagnose, mitigate, prevent, or cure disease. However, they can help support health or basic bodily functions. Omega-3 fatty acids are widely accepted by healthcare professionals, as well as scientific organizations, for helping reduce inflammation, lowering triglyceride levels and contributing to a healthy heart and blood vessels. The American Heart Association, in fact, in a 2002 Scientific Statement on omega-3 fatty acids and cardiovascular disease, states that ‘…for patients with coronary artery disease, the dose of omega-3 (1 g/d) may be greater than what can readily be achieved through diet alone. These individuals, in consultation with their physician, could consider supplements for CHD risk reduction.’
Additionally, research from the 2008 “Life…supplemented” Healthcare Professionals Impact Study, conducted with cardiologists, shows that 73 percent of cardiologists believe this regimen—healthy diet + vitamins and other supplements + exercise—is essential for a healthy heart. The study also showed that 72 percent of the nation's cardiologists recommend dietary supplements to their patients, and more than half (57 percent) take supplements themselves, with the most popular being multivitamins, omega-3/fish oils and vitamin C.
Fact: It’s important to put science into perspective by looking at the whole body of evidence, rather than cherry-picking a study or two.
The very nature of science is that it is an evolutionary discipline—we learn things from one study, and then seek to confirm those results, look in a different direction, or test for even more possibilities. The latest results don’t necessarily nullify earlier findings.
For example, the author references the Women’s Health Initiative Study—a long-term study of more than 160,000 midlife women which looked at a variety of chronic disease outcomes, including whether or not multivitamins have an effect on cancer, heart disease and stroke. One of the results of the study was that, ‘following an eating pattern lower in total fat did not significantly reduce the incidence of breast cancer, heart disease, or stroke, and did not reduce the risk of colorectal cancer in healthy postmenopausal women.’ Does this mean that we discount the previously established evidence and recommendations that a low-fat diet may decrease the risk of heart disease and indulge in a high-fat diet? No. Does it mean that we should put this large study into context with the rest of the evidence, do further studies, and see where the science evolves? Absolutely—for both foods and vitamins.
Fact: Observational studies have shown that individuals who engage in a healthy lifestyle—including eating a healthy diet, exercising, taking supplements, not smoking, etc.—tend to have lower rates of chronic disease, including cancer.
Unfortunately, there is no certainty as to what will prevent or cure cancer. However, studies have shown that dietary supplement use has been associated with decreased risk of chronic diseases in numerous observational studies involving tens of thousands of people, and in some studies the benefit has increased with long-term use.
Unfortunately, there is no certainty as to what will prevent or cure cancer. However, studies have shown that dietary supplement use has been associated with decreased risk of chronic diseases in numerous observational studies involving tens of thousands of people, and in some studies the benefit has increased with long-term use.
For example, a study published in the February 2010 issue of Cancer Research found that leafy green vegetables, folate and multivitamin use appeared to offer protection against lung cancer. Another study found that women with higher intakes of calcium from both food and supplements—up to 1,300 milligrams (mg)/day—appear to have a lower risk of cancer overall, and both men and women with high calcium intakes have lower risks of colorectal cancer and other cancers of the digestive system. That doesn’t mean that individuals should expect a vitamin alone to protect against cancer—but it does mean that dietary supplements play an important role in many areas of health.
Fact: Consumers who take dietary supplements tend to also engage in other healthy habits.
Scientists are now considering the importance of looking at the habits of healthy people to determine how to achieve good health. Research shows that individuals who use vitamins and other supplements also engage in other healthy behaviors, such as trying to eat a well-balanced diet and being physically active, according to the 2008 CRN Consumer Survey on Dietary Supplements. Supplement users also tend to place an emphasis on health as a priority in their own personal lives, as reflected in their day-to-day habits when it comes to maintaining overall wellness. When asked to indicate whether or not they agree with the following statements about their personal behaviors, supplement users and non-users responded as follows:
84% of supplement users say they try to eat a balanced diet, compared to 68% of non-supplement users
62% of supplement users say they exercise regularly, compared to 50% of non-supplement users
73% of supplement users say they visit a doctor regularly, compared to 54% of non-supplement users
65% of supplement users say they regularly get a good night’s sleep, compared to 59% of non-supplement users
CRN maintains that vitamin supplements are one component of a total health package and should not be teased out of the overall wellness equation.
Fact: Dietary supplements have a very strong safety profile.
More than 150 million Americans use dietary supplements each year. In the U.S. alone, billions of bottles of supplement products are sold in a year, and yet for the first full year (2008) that it was mandated by law that companies report serious adverse events to FDA, the agency reported only 672 serious adverse events. Compare that number to the pharmaceutical industry where hundreds of thousands of serious adverse events are received by FDA each year.
It’s wise to engage your healthcare professionals (whether it’s your doctor, nurse practitioner, registered dietitian, pharmacist or other health expert) in dialogue about the dietary supplements you take, as it’s a good idea for the people you go to for health advice to know about everything you put into your body. In addition, it is important to always follow the directions on the label and not take more than is recommended.”