This randomized, double-blind, placebo-controlled clinical trial evaluated the efficacy of a daily multivitamin to prevent cognitive decline among 5,947 male physicians aged 65 years or older participating in the Physicians’ Health Study II. After 12 years of follow-up, there were no differences found between the multivitamin or placebo groups in overall cognitive performance or verbal memory.
Researchers noted that doses of vitamins may have been too low or the population may have been too well nourished to benefit from a multivitamin. However, Annals of Internal Medicine also published an editorial titled “Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements,” which discussed three recent studies that indicated no positive effect for vitamin and mineral supplements.
The editorial stated, in part, “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 in other countries.”
Trade Groups Respond
Trade associations, including the Council for Responsible Nutrition (CRN) and the Natural Products Association (NPA), Washington, D.C., fired back.
“The authors of this editorial base their argument against vitamins and minerals on the premise that most supplements do not prevent chronic disease or death. But the authors’ hypothesis is flawed in that multivitamins are not intended to cure chronic disease or prevent death solely on their own,” said Cara Welch, PhD, senior vice president of scientific and regulatory affairs at NPA. “They are designed to address nutrient deficiencies, and to aid in the general health and well-being of consumers. Multivitamins are not meant to serve as the answer to all of life’s ailments; they are, however, an important piece of the puzzle in leading a healthy lifestyle.
Dietary supplements are overwhelmingly safe, she added, “as even the studies the authors referenced in this editorial generally found no indication of harm from supplementation outside of some high-dose therapies. In fact, the trials the authors cited even demonstrated benefits in some instances, specifically a reduced risk of cancer in the Physicians’ Health Study II trial. Vitamin and mineral supplements are an excellent source of nutrition for those who don’t eat a complete diet, and consumers should not feel they are wasting their money.”
NPA’s CEO and Executive Director John Shaw said it’s “extremely unfortunate” that the “overblown” editorial misinformed consumers and attached the dietary supplement industry.
“It’s no secret that many consumers in this country don’t get the recommended nutrients from their diet alone, and multivitamin and mineral supplements are an affordable alternative. For the medical professionals who authored this piece to claim that the use of supplements is not justified, is, quite frankly, baffling.”
The editorial also called for a halt to future trials of vitamins for chronic disease prevention, saying such trials in well-nourished populations are likely “futile.”
“It’s flat-out irresponsible that they wouldn’t want further studies on preventive care,” said Mr. Shaw. “Consumers should in no way be deterred from continuing to take the products that contribute to their improved health on a daily basis, and we encourage all consumers to discuss their dietary supplement regimen with their healthcare professional.”
Duffy MacKay, ND, vice president, scientific and regulatory affairs at CRN, said expectations about why people take multivitamins should be managed. “Research shows that the two main reasons people take multivitamins are for overall health and wellness and to fill in nutrient gaps. Science still demonstrates the multivitamin works for those purposes, and that alone provides reason for people to take a multivitamin.”
Although this study did not find benefit in cognitive function, he noted, two other recently released arms of the Physicians’ Health Study II did find benefit in the specific study population in reducing the risk of cancer and cataracts. “While people should not expect that multivitamins in isolation can prevent disease, the fact that an affordable and convenient addition of a multivitamin to your daily health regimen may provide benefits on top of filling nutrient gaps makes it a smart choice in combination with other healthy habits.”
CRN President and CEO Steve Mister said the editorial demonstrates a “close-minded, one-sided approach” that attempts to dismiss even the proven benefits of vitamins and minerals. “We would not suggest that vitamin supplements are a panacea for preventing chronic disease, but we hope the authors would agree that there is an appropriate place for supplements. Given that government research repeatedly demonstrates that the typical consumer diet is falling short on critical nutrients, vitamin supplements are an appropriate option to meet those needs.
With regard to safety issues, Mr. Mister noted “the USPSTF draft recommendation, the basis for which comes from a study in the same issue of the Annals of Internal Medicine, did not identify safety concerns for vitamins at nutritional doses. Specifically, several scientific authorities have dismissed the concerns raised by the editorial for vitamin E, including this USPSTF report, which states ‘The USPSTF found adequate evidence that supplementation with vitamin E has little or no significant harm.’ The concerns around beta-carotene are isolated to high doses in smokers, and are not a concern for the majority of consumers taking a multivitamin; we would however recommend that smokers pay strict attention to their beta-carotene intake under the advice of their doctor. The evidence does not indicate any real health risk for multivitamin use.”
Mr. Mister agreed however, that enough is in fact enough. “Stop the reductionist approach to nutritional research. Stop insinuating there is evidence of harm. Stop ignoring the scientific evidence that demonstrates there is value to getting your essential nutrients. There is plenty of scientific evidence that recognizes that vitamin and mineral supplements have a role in good health for all Americans.”