11.01.11
In October, vitamins and minerals ran across some stumbling blocks when two research articles—published the same week—claimed they are worthless and might even cause harm. Both appeared in the Journal of the American Medical Association (JAMA). Ultimately, this prompted researchers to make some large, sweeping conclusions about dietary supplement use in general. And predictably, these were met with some sharp criticism.
In the first study, researchers said older women who took a daily vitamin supplement, even just a multivitamin, had an increased risk of dying of cardiovascular disease and cancer. Iron seemed to be the most problematic, while calcium actually showed some benefit.
The second study showed that men had a higher risk of developing prostate cancer when taking vitamin E. More specifically, subjects randomly assigned to take a 400-unit capsule of vitamin E every day for about five years were 17% more likely to get prostate cancer than those on placebo.
Commenting on the limitations of these studies, Cara Welch, PhD, vice president of scientific and regulatory affairs, Natural Products Association (NPA), Washington, D.C., said, “I’m always pleased to see analysis on the long-term effects of supplementation. This study, however, is quite limited in scope; the data are observational and self-reported, so contributing factors are not addressed. Subsequently, the authors cannot conclude any cause and effect and there is no reason why women should change what they’re doing based on this report.”
She continued, “There are plenty of studies published that demonstrate the benefit of supplementation and fortification. This specific study should not dissuade the general public from the benefits of addressing a vitamin or mineral deficiency with dietary supplements.”
Regarding the prostate cancer study, Dr. Welch said, “This particular study does reveal the need for additional research into the link of vitamin E and prostate cancer, specifically clarifying the mechanism of action, before anyone can draw conclusions. I look forward to seeing additional research in order to accurately evaluate the effect of vitamin E supplementation on prostate cancer incidence.”
It is important to remember, Dr. Welch added, that the results of this study, specifically looking at vitamin E in isolation, cannot be extended to taking vitamin E in a combination supplement as the authors imply. In fact, she said, “The authors want to extend their initial findings onto supplementation as a whole, urging skepticism from consumers for these products, which they falsely claim are unregulated. This goes beyond the scope of the study and exhibits an unprofessional attitude.”
The Council for Responsible Nutrition (CRN), Washington, D.C., also weighed in with its thoughts. Commenting on the dietary supplements and mortality study, Duffy MacKay, ND, CRN’s vice president of scientific and regulatory affairs said, “The authors note in their article that ‘…dietary supplements are commonly taken to prevent chronic disease…’ The statement would be more accurate with the addition of one word: dietary supplements are commonly taken to help prevent chronic disease. In other words, dietary supplements should not be expected, in and of themselves, and without the synergy of other healthy habits, to prevent chronic disease.”
“The study may make for interesting scientific water cooler discussion, but certainly does not warrant sweeping, overstated concerns for elderly women,” Dr. MacKay added. “Further, the authors show their own bias with this statement: ‘We recommend that they [dietary supplements] be used with strong medically-based cause, such as symptomatic nutrient deficiency…’ which basically means these researchers would rather wait [until] we all get scurvy before acknowledging any need for supplemental nutrients.”
Like Dr. MacKay, Steve Mister, president and CEO, CRN, also believes there’s a bias that can’t be overlooked. “The supplement industry regularly gets accused of this practice—in some cases rightly so—yet medical journals seem to be given a pass, as if somehow they held no bias whatsoever.”
“Let’s look at some of the facts in this publication,” Mr. Mister added. “First, within the article itself are a number of opinions, including this one: ‘Also, cumulative effects of widespread use, together with food fortification, have raised concern regarding exceeding upper recommended levels…’ It’s quite popular these days to talk about overnutrification, but in fact research consistently shows that most people are falling short in several key nutrients, such as potassium, calcium, vitamin D and fiber while certain subpopulations fall short in folate, vitamin B12 and iron.”
Mr. Mister went on to say that critics of dietary supplements would continue to advocate that vitamins and minerals be regulated like drugs, but even they should realize that while drugs undergo rigorous RCT (randomized clinical trial) testing, many safety issues for drugs still do exist. In addition, he said, “If nutrients were regulated like drugs, the cost and availability of supplements would make it difficult for average consumers to make these products part of their healthy lifestyle.”
“The editors add their own ‘editorial note,’ using this study as an opportunity to bemoan the fact that ‘A better investment in health would be eating more fruits and vegetables, among other activities.’ This recommendation comes despite the fact that we don’t see a lot of RCTs for fruits or vegetables either. Even without RCTs, we agree that people should be eating more fruits and vegetables; however, in a practical world, consumers are not doing that, and dietary supplements are an option—not a substitute—for getting some (not all) of the health benefits from fruits and vegetables,” Mr. Mister concluded.
Jeffrey Blumberg, PhD, vitamin researcher and professor of nutrition science and policy at Tufts University in Boston, who was interviewed by USA Today regarding both JAMA articles, shared his views regarding supplementation. “The average diet is poor when it comes to meeting recommended intakes of vitamins and minerals. Only about 3% of Americans adhere to the dietary guidelines. How many Americans do you know who eat five to nine servings of fruits and vegetables a day and consume at least 50% of their grains as whole grains?”
Dr. Blumberg said if consumers eat a perfectly healthful diet, then they don’t need supplements. “But for the 97% who aren’t there yet, for goodness sake, take a multivitamin.”
In the first study, researchers said older women who took a daily vitamin supplement, even just a multivitamin, had an increased risk of dying of cardiovascular disease and cancer. Iron seemed to be the most problematic, while calcium actually showed some benefit.
The second study showed that men had a higher risk of developing prostate cancer when taking vitamin E. More specifically, subjects randomly assigned to take a 400-unit capsule of vitamin E every day for about five years were 17% more likely to get prostate cancer than those on placebo.
Commenting on the limitations of these studies, Cara Welch, PhD, vice president of scientific and regulatory affairs, Natural Products Association (NPA), Washington, D.C., said, “I’m always pleased to see analysis on the long-term effects of supplementation. This study, however, is quite limited in scope; the data are observational and self-reported, so contributing factors are not addressed. Subsequently, the authors cannot conclude any cause and effect and there is no reason why women should change what they’re doing based on this report.”
She continued, “There are plenty of studies published that demonstrate the benefit of supplementation and fortification. This specific study should not dissuade the general public from the benefits of addressing a vitamin or mineral deficiency with dietary supplements.”
Regarding the prostate cancer study, Dr. Welch said, “This particular study does reveal the need for additional research into the link of vitamin E and prostate cancer, specifically clarifying the mechanism of action, before anyone can draw conclusions. I look forward to seeing additional research in order to accurately evaluate the effect of vitamin E supplementation on prostate cancer incidence.”
It is important to remember, Dr. Welch added, that the results of this study, specifically looking at vitamin E in isolation, cannot be extended to taking vitamin E in a combination supplement as the authors imply. In fact, she said, “The authors want to extend their initial findings onto supplementation as a whole, urging skepticism from consumers for these products, which they falsely claim are unregulated. This goes beyond the scope of the study and exhibits an unprofessional attitude.”
The Council for Responsible Nutrition (CRN), Washington, D.C., also weighed in with its thoughts. Commenting on the dietary supplements and mortality study, Duffy MacKay, ND, CRN’s vice president of scientific and regulatory affairs said, “The authors note in their article that ‘…dietary supplements are commonly taken to prevent chronic disease…’ The statement would be more accurate with the addition of one word: dietary supplements are commonly taken to help prevent chronic disease. In other words, dietary supplements should not be expected, in and of themselves, and without the synergy of other healthy habits, to prevent chronic disease.”
“The study may make for interesting scientific water cooler discussion, but certainly does not warrant sweeping, overstated concerns for elderly women,” Dr. MacKay added. “Further, the authors show their own bias with this statement: ‘We recommend that they [dietary supplements] be used with strong medically-based cause, such as symptomatic nutrient deficiency…’ which basically means these researchers would rather wait [until] we all get scurvy before acknowledging any need for supplemental nutrients.”
Like Dr. MacKay, Steve Mister, president and CEO, CRN, also believes there’s a bias that can’t be overlooked. “The supplement industry regularly gets accused of this practice—in some cases rightly so—yet medical journals seem to be given a pass, as if somehow they held no bias whatsoever.”
“Let’s look at some of the facts in this publication,” Mr. Mister added. “First, within the article itself are a number of opinions, including this one: ‘Also, cumulative effects of widespread use, together with food fortification, have raised concern regarding exceeding upper recommended levels…’ It’s quite popular these days to talk about overnutrification, but in fact research consistently shows that most people are falling short in several key nutrients, such as potassium, calcium, vitamin D and fiber while certain subpopulations fall short in folate, vitamin B12 and iron.”
Mr. Mister went on to say that critics of dietary supplements would continue to advocate that vitamins and minerals be regulated like drugs, but even they should realize that while drugs undergo rigorous RCT (randomized clinical trial) testing, many safety issues for drugs still do exist. In addition, he said, “If nutrients were regulated like drugs, the cost and availability of supplements would make it difficult for average consumers to make these products part of their healthy lifestyle.”
“The editors add their own ‘editorial note,’ using this study as an opportunity to bemoan the fact that ‘A better investment in health would be eating more fruits and vegetables, among other activities.’ This recommendation comes despite the fact that we don’t see a lot of RCTs for fruits or vegetables either. Even without RCTs, we agree that people should be eating more fruits and vegetables; however, in a practical world, consumers are not doing that, and dietary supplements are an option—not a substitute—for getting some (not all) of the health benefits from fruits and vegetables,” Mr. Mister concluded.
Jeffrey Blumberg, PhD, vitamin researcher and professor of nutrition science and policy at Tufts University in Boston, who was interviewed by USA Today regarding both JAMA articles, shared his views regarding supplementation. “The average diet is poor when it comes to meeting recommended intakes of vitamins and minerals. Only about 3% of Americans adhere to the dietary guidelines. How many Americans do you know who eat five to nine servings of fruits and vegetables a day and consume at least 50% of their grains as whole grains?”
Dr. Blumberg said if consumers eat a perfectly healthful diet, then they don’t need supplements. “But for the 97% who aren’t there yet, for goodness sake, take a multivitamin.”