In the JournalsPerspective

Trio of studies casts doubt on value of routine vitamin supplements

The value of vitamin and mineral supplements for preventing or delaying the progress of chronic diseases is called into question by three new investigations.

Published in the Annals of Internal Medicine, the research is summarized in an accompanying editorial that concludes, “Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.”

One group of researchers systematically reviewed 27 existing trials, including more than 400,000 participants, that analyzed multivitamin supplements and single or paired vitamins. The analysis reported no clear benefit from supplements on all-cause mortality, cardiovascular disease or cancer.

A second analysis concluded that long-term use of a daily multivitamin did not provide cognitive benefits in male physicians aged 65 years or older. This research included 12 years of follow-up examining cognitive performance among 5,947 men who participated in the Physicians’ Health Study II.

The third evaluation concluded that high-dose oral multivitamins and minerals did not reduce cardiovascular events in patients after myocardial infarction.

“After a median follow-up of 4.6 years, there was no significant difference in recurrent cardiovascular events with multivitamins compared with placebo,” wrote the researchers of an accompanying editorial.

The editorial also describes a contradiction between evolving evidence about vitamin and mineral supplements vs. trends in consumption.

“Sales of multivitamins and other supplements have not been affected by major studies with null results,” the editorial said. “And the U.S. supplement industry continues to grow, reaching $28 billion in annual sales in 2010.”

Only Vitamin D, according to the editorial, is “an open area of investigation, particularly in deficient persons.”

The value of vitamin and mineral supplements for preventing or delaying the progress of chronic diseases is called into question by three new investigations.

Published in the Annals of Internal Medicine, the research is summarized in an accompanying editorial that concludes, “Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.”

One group of researchers systematically reviewed 27 existing trials, including more than 400,000 participants, that analyzed multivitamin supplements and single or paired vitamins. The analysis reported no clear benefit from supplements on all-cause mortality, cardiovascular disease or cancer.

A second analysis concluded that long-term use of a daily multivitamin did not provide cognitive benefits in male physicians aged 65 years or older. This research included 12 years of follow-up examining cognitive performance among 5,947 men who participated in the Physicians’ Health Study II.

The third evaluation concluded that high-dose oral multivitamins and minerals did not reduce cardiovascular events in patients after myocardial infarction.

“After a median follow-up of 4.6 years, there was no significant difference in recurrent cardiovascular events with multivitamins compared with placebo,” wrote the researchers of an accompanying editorial.

The editorial also describes a contradiction between evolving evidence about vitamin and mineral supplements vs. trends in consumption.

“Sales of multivitamins and other supplements have not been affected by major studies with null results,” the editorial said. “And the U.S. supplement industry continues to grow, reaching $28 billion in annual sales in 2010.”

Only Vitamin D, according to the editorial, is “an open area of investigation, particularly in deficient persons.”

    Perspective

    Based on these studies, there is nothing that shows that there is any benefit from a multivitamin as part of a daily regimen. However, the studies also show that there appears to be no clinical or medical harm in taking a multivitamin on a daily basis, either. The only harm is the impact it might have on one’s pocketbook.

    I don't specifically tell my patients that they should take a multivitamin. I tell them that, based on the information that we have to date from numerous studies, a multivitamin really has not been shown to be of any benefit to them; I then let them make the decision.

    I think the problem that we have with most of the studies that have been done is that we truly don't know what would be the best multivitamin, if there is one, for a person to take. Most of these trials have been based on what we think is best for the general population. None of the studies has been designed to identify any specific subgroups of individuals who would benefit.

    Can I say that we've done the definitive study that has closed the door to the issue? Probably not. Do I think we'll ever see a definitive trial? Probably not. I think the data we have is probably the best data that we'll be able to obtain on the subject, and I would say that there's a significant amount of data that shows that there is no benefit from a daily multivitamin.

    • David J. Frid, MD
    • Staff cardiologist, preventive cardiology, Cleveland Clinic

    Disclosures: Frid reports no relevant financial disclosures.

    Perspective

    Why are pharmaceuticals not subjected to this type of scrutiny? Are any of them really proven to prevent chronic disease or death?

    By the way, this was not a “real” study, but a meta-analysis of three studies on the effect of vitamins on three specific chronic diseases. I see no definition of a “multivitamin,” which can have only two or many more ingredients. Also, I see they used placebo pills for 12 years, and I have to wonder about compliance with that regimen.

    Instead of using super food powders, whole food concentrates or food-based supplements, such studies are based on low-grade synthetic vitamins and inorganic minerals.

    In his article, “Mainstream media attacks multivitamins in yet another example of quack science catapulted into the news by pharma interests,” at NaturalNews.com, Mike Adams says, “Not coincidentally, these brands of low-grade multivitamins are actually manufactured by companies owned by pharmaceutical interests. They really do have a financial incentive to make multivitamins look bad, and so their multivitamin formulations are intentionally designed to fail.”

    One has to wonder if the original Age-Related Eye Disease Study nutrients were formulated to prove that vitamins do not work against age-related macular degeneration.

    While we hate to think that politics plays a role in human health, in reality it does. In the words of Andrew Weil, MD, “We do not have a health care system in America. We have a disease-management system – one that depends on ruinously expensive drugs and surgeries that treat health conditions after they manifest rather than giving our citizens simple diet, lifestyle and therapeutic tools to keep them healthy.”

    So, pardon any cynicism, but we’re talking about two different approaches to true health care, and the financial incentive to keep people sick is winning.

    • Jeffrey Anshel, OD, FAAO, Primary Care Optometry News Editorial Board Member

    Disclosures: Anshel has no relevant financial interests.