First, this isn't any sort of a study per se.
Second, I find the statement above upsetting. They're saying that there is NO evidence that vitamins work (or don't work), and in the absence of any evidence we should all take vitamins. I would favor actually waiting for the evidence first.
I think that evidence will be difficult to collect. We aren't talking about a single substance with a single outcome measure. As you know, a multi contains many substances that we know are necessary for human function. How do you measure all of the possible factors? And over what time period? Perhaps if one's diet is really excellent, they are under no stress, they don't have any adverse environmental exposures, they have no genetic 'weaknesses', etc, that lucky person can get by with just diet alone. But lets be real here. There is plenty of data out there that suggests we don't eat anywhere near a good diet, there are endocrine disrupting chemicals everywhere in our environment, we are stressed to the max, we don't sleep enough, etc. I just don't see the harm in taking moderate doses of cofactors we know we need for our biochemical machinery to run.
There is already epigenetic evidence of the benefits of providing ample doses of methylating factors, such as folate, B12 and B6. Not crazy doses, but enough. Many Americans do not even get RDA amounts of these, and the damage done to DNA resembles that of radiation damage.
Regarding fish oil, I agree that all of the answers are not yet in. I do think, however, that there is enough known about the biological functions of omega-3s to be optimistic about their role in human health. There has been some conflicting data about fish oil and arrhythmia, but I wouldn't take that to mean that fish oil takers are dropping dead of V-fib. How about cell membrane fluidity and the impact that has on cell function, receptor function, neurotransmitters, etc? How do you measure that over one's lifetime? Again, I think we have to look beyond a single outcome measurement when we talk about potential benefits. More and more emerging data strongly suggests that we are all overly inflamed. Knowing the biochemistry of omega-3s and omega-6s, their ratio, associated eicosanoids and cytokines, etc, I think reasonable doses of fish oils will prove to do way more good than harm.
Even if we assume that the benefits seen in some studies / subgroups are true, the absolute benefit for young healthy people would be tiny, as the 10 year incidence of heart disease in otherwise healthy 30-40 year olds is less than 1%.
Again, my point is that we should think about what proper nutrition over a lifetime can do for us. Sure, the risk of heart disease is low for a 30-40 year old. But those 30-40 year olds will grow older. Is it unreasonable to think that the things they do (or fail to do) for their health while they are young will not impact their future health? This is where we drop the ball, I think. We wait until someone has the heart disease then react.
Thank you for your suggestion to review the Vit D literature. As the PD for a major univeristy IM program, attending resident journal club weekly, I actually feel quite comfortable with this subject.
You misread me here. No disrespect intended. It's just that, despite the wave of new vitamin D study, not everyone is familiar with this work.
I have no quarrel with the use of Vit D supplementation in older adults, especially those with low bone density. However, I see no evidence that Vit D supplementation in otherwise healthy young adults is valuable.
The benefits to bone are clear, so I agree with that portion. But vitamin D does more than act on bone, as you know.
NHANES 2000-2004 measured Vit D levels in the US population. In adults age 20-49, the average Vit D level was 62. I don't see a st dev for that number, so I can't predict how many people would have a level low enough that Vit D supplementation might be helpful, but it would seem low.
I think there is too much variability in risk factors for D insufficiency to look at overarching averages like these. We need to be able to predict who may be at risk, test them, then supplement as needed. Risk factors for low D include age, where you live, time of year, skin pigmentation, and obesity. National averages don't help us in picking out individuals at risk. As for the average D level being 62, I'm assuming that is 62 nmol/L, not ng/mL. 62 nmol/L is about 25 ng/mL, and the current minimum is 30 or 32 ng/mL. As such, according to this data, the average American is at least vitamin D insufficient. Studies looking specifically at this issue suggest many are insufficient/deficient, and across all age groups from newborns, kids, adults, and (especially) elderly.
If we're discussing Vit D levels in regards to CV health, then we have less data on which to base decisions. Low Vit D levels are associated with CV disease, however we have no intervention trials. Low Vit D levels could simply be a marker of other problems -- perhaps those patients with lower levels of exercise (and hence lower levels of sun exposure) have lower Vit D levels. In that case, it might be the lack of exercise that increases CV risk, not the Vit D itself. Sure, Vit D deficiency MIGHT be the causitive factor, as
this article suggests, but even this article points out that more evidence is really needed.
Of all of the supplements out there, I agree that Vit D has the most evidence suggesting it's use. Given the much higher risk of osteoporosis in women, I do suggest to my young women that they consider daily Vit D supplementation. Still, the evidence is weak overall.
I agree that there is a lot of association data out there and research should march forward. But given the volume of data already out there, the safety of vitamin D, and the cost (pennies/day), do you believe there is a real harm in recommending reasonable vitamin D supplementation to most patients?
How much do vitamins cost? Estimates suggest that americans spent upwards of $8-10 Billion dollars annually on vitamins. Although that's nothing compared to the $700 billion bailout, it seems like a lot of money to me.
Not if taking vitamins saves us money in the long run. I would agree that at least some of that 8-10 billion is spent on less-than-worthy products.
What are the risks of vitamins? A nice summary was in the
WSJ in 2006
I'll check it out. Thanks for the link.
I am all for preventing disease. I am not for giving people unproven treatments that might or might not help.
I am for giving people supplements that are safe, reasonably priced, and make good biological/biochemical sense in terms of effect. We may never have all the data we would like to have given the complexity of studying these things. I don't think that is reason enough to avoid something as benign as a multivitamin. Medicine (and by extension, most research) is geared toward identifying the pathology and matching the correct drug to it. Nutrition and wellness promotion do not function in that model.
Five years ago it was flax seed, pomegranates and wheat grass. Don't get me wrong, the ideal diet would (and should) include all of these ingredients...well, maybe not wheat grass
